Many people wonder what they should know before meeting insurance agents and brokers to purchase health plans. Determining your demographic profile, risk factors, preferable healthcare plan, and price range would help you get ready for the most-often-asked question.
Though health insurance companies are not allowed to reject to cover or charge anyone with pre-existing conditions high premium under the current laws, they have designed different types of health insurance plans in order to accommodate your health conditions better. Health insurance agents and brokers often ask you these questions in order to determine the most suitable healthcare plans for you and your family:
(1) Your demographic profile: age, gender, education, and ethnicity (note: understanding your ethnicity will help you learn the types of genetic diseases that would potentially occur in your life).
(2) Any risk factors(e.g. do you smoke?).
(3) Types of healthcare plans you prefer:
HMO: Health Maintenance Organization, if you are ok to let your family doctor refer all specialists (e.g. orthopedic surgeon) for you.
PPO: Preferred Provider Organization, if you still prefer to choose certain specialists yourself.
EPO: Exclusive Provider Organization, which you can choose specialists and medical care from a limited network of doctors and hospitals.
POS: Point-of-Service, if you are ok to let your family doctor refer all specialists for you and yet reserve the rights to see specialists outside of the network the insurance companies are affiliated with. You will be responsible for covering most of the medical costs when you see medical staff not inside your network.
“Determining your demographic profile, risk factors, preferable healthcare plan, and price range would help you get ready for the most-often-asked question.”
(4) Price you are willing to pay for your insurance premium. Factors to consider include:
Deductible: the $ you have to pay before the insurance plans start to cover.
Co-pay: the $ you will have to pay for every medical appointment, after you have paid your deductible.
Co-insurance: The percentage of the medical cost (e.g. healthcare services and drug prescription) you will have to pay after both deductible and co-pay.
Before you talk to your insurance broker, think about what chronic diseases (e.g. diabetes, genetic conditions) and the potential life-changing events (e.g. the arrival of new child, marriage) you have within the fiscal year after the enrollment. Though you don’t have to share this information with the broker, it will help you determine the type of health insurance you should purchase.
Unfortunately, most private health insurance plans do not cover much of the long-term-care (LTC), including senior nursing home, at-home health aides, and assisted living facility. We #ElRobleHomeCare is working on becoming a Medi-Cal HCBS provider to ease your financial burden when you use our services. Nevertheless, it is strongly recommended to purchase life insurance that will cover your long-term care in the future.