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Group Health Insurance Coverage Vs. Individual Health Insurance Coverage


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You are correct. I don't know if I would say “spoiled, " but it is true that when people come out of a group plan, it is different. NOW you are paying for your own insurance. Before, most of it was paid for by your ex employer and then through cobra you started to pay for all the insurance. Sure, when an employer is paying the premium (or most of it) each month, let's have the doctor visit co - pay and immediate drug co - pays. They are nice conveniences. When you are paying for the insurance then we have to be a little more selective and focus in on what needs to be covered. We have to weigh convenience against actual cost per month / year. It becomes a question of insurance not so much convenience. You do get immediate help in the form of a 25 - 40 % in network discount, but you will have a little out of pocket. You have to weigh this against the amount of money you will save annually in terms of premium.

This United plan is the easiest plan to understand possible. You have a calendar year deductible (for all potential medical expenses) then there is an 80 / 20 split after the deductible. Your 20% can never be more than $3000 dollars maximum in any one calendar year. Again, the word in insurance. We are talking about security. You may be dealing with this until age 65 unless you get a job w/ benefits or win the lottery, so we have to start thinking long term not just about the first time we have to shell out 70 - 80 dollars for a doctor visit instead of a 10 - $20 co - pay.

Drugs will come under your deductible in the plans we are comparing. We can add a drug card which will give you a $20 co - pay for generic drugs and after a $250 drug deductible a 50 co - pay for brand name drugs. The drug card of course is extra money again. 9.54 extra per month on the 1000 deductible plan, 11.10 extra per month with the 2500 deductible. It's about the expensive brand name drugs. Also, when you get into this type of insurance, there is no getting ahead of a company in terms of pre existing conditions, or more directly, pre-existing medical expenses. It is money already going out each month to treat something so what an insurance company will do is one of 2 things. They 1) cover the condition and charge you extra money (rate) for the already existing cost to treat each month or 2) they waiver (don't cover) the condition but they won't charge extra premium. Golden rule typically uses the later approach whereas Humana will employ the former.

* Cobra information:

Cobra was started by the federal an attempt to help citizens avoid an unnecessary lapse in health insurance when they leave an employer provided GROUP insurance plan.
It was never intended for people to use any longer than necessary much less than for the 18-month maximum period.
It is important to understand that cobra, as an extension of a Group plan is much more expensive than an individual plan of equal coverage. Why? Because, like all group plans, it is a guaranteed issue insurance product. Therefore, more risky to an insurance company. An Individual plan, fortunately, is medically underwritten which removes risk and is therefore less expensive. Most leading companies offer both types of insurance. Diabetics, for instance, must be insured under a more expensive group plan because they can not medically qualify for a lower priced individual plan.
Whenever someone is looking into acquiring their own insurance coverage, they owe it to themselves to get the best Individual plan possible for the money WHILE THEY ARE HEALTHY ENOUGH TO MEDICALLY QUALIFY. A person can ALWAYS go out and get themselves a group plan (at 2 - 400 %) more premium per month. Why would anyone ever do this unless they had to? The second and most important thing to be aware of is that if a person uses of the full 18 mos. of their cobra plan and meanwhile has a change in their health"status, " they will be unable to qualify at the end of said 18 mos. unless they, yes, use the 63 day hippa law and yes PAY 200% ON THEIR PREMIUM.

For more information on health insurance and the service we offer please visit our websites, , . Or contact Joe Jessome directly at 800-828-2950.


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