Health Insurance Tips and FAQ

Pharmacy

Good Rx – https://www.goodrx.com/

Use the FREE website and app for Good Rx whenever possible at the pharmacy if you do not plan to reach your deductible.  This will not go towards a deductible, but it will save a lot of money in many cases.

Why is it important to have Prescription Drug coverage?

A recent survey showed that prescription drugs make up 35% of all private healthcare plans (Laszewski, Jan 2019).  It is increasingly important to make sure you have this coverage in this area, and too often people think since they are not on a drug today they will have no need in the future.  This would be a big problem should someone have a diagnosis such as cancer.  Drugs in this category can easily cost over $100,000/year.

What is the difference between HMO, PPO and Epo

It is important to note that these will differ depending upon plan and state and the broad classifications can be misleading.  For instance,  in 2020 in Collier County, Florida we now have the following:

  • Florida BlueCare (HMO):  No gatekeeper or referrals necessary, Florida only, no out of network benefits.
  • Florida Blue Options (EPO): No gatekeeper or referrals necessary, wide nationwide network of providers, out of network benefits.  Acts much like a PPO.
  • Cigna Connect (EPO): Gatekeeper AND referrals necessary, Florida only, no out of network benefits.  Acts much like a restrictive HMO.
Do I need to have a Primary Care Provider if I am on a PPO?

From an insurance point of view, we recommend you always have a primary care provider, even if  your not required to have one.  In an Urgent Care, often times you will get a different doctor each time you visit and you lose your continuity of care.  Also, in Florida, providers often get too busy during “season” and should you not have one already, you may be unable to find one that suits your needs.

 

Are Short Term Plans as Good As ACA Plans?

Short term plans have been around since before the Affordable Care Act and are basically the same as they have always been.  If you are considering a short term plan, read the fine print.  For example, even if you are on blood pressure or cholesterol medicine and have issues controlled, you will likely NOT be covered in the event of a circulatory issue.   The fact is that many things are not covered.  Insurance companies will tell you:  these plans are still meant only as “band-aids”.

 

Will Things Change in 2020 for Health Insurance?  How Can I Save Money?

At this time, there is so much gridlock in congress, we are sorry to say that nothing significant appears to be coming down the pipeline.  So at this point, the Affordable Care Act plans are still the most reliable, but are also the most expensive option if you are not subsidized.     However, more and more of our clients have found that they can be subsidized, and that is a great relief.  We are working hard to find individualized solutions to as many people as possible.

 

Shop Shop Shop

Unfortunately, with any plan it’s becoming more and more important to shop around to find the services you need for the lowest prices since deductibles are so high.  As a rule, the hospitals will always charge the most so if you are paying out of pocket for MRIs or Physical Therapy, you will probably be best off picking a private practice.