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HEALTH INSURANCE

  • Health Insurance has several options available to people of all ages. We are not going to go into great detail on this but at least give you an understanding of what each does so you can see what health plan would be right for you and or your family.​

  • Medicare is the type of insurance mainly offered to individuals age 65 or older but can also apply to a person of any age meeting certain guidelines. Medicare is divided into 4 categories; Part A-Hospital Insurance, Part B-Medical Insurance, Part C-Medicare Advantage and Part D-Prescription Drugs. Medicare can be very complicated and our agency would like a chance to discuss this with you so we can make sure that you are getting the right coverage. Please call our office or book a virtual appointment so we can help you. Be advised that this coverage goes by enrollment periods, please call our office to discuss this.

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  • Medicare Part D will cover prescription drugs prescribed by your doctor and is provided through private drug plans that have a medi-care contract. To enroll in this coverage, PA mandates that you be enrolled in Part A or Part A and B medi-care plan.​

  • Dental Insurance is similar to your health insurance plans work and are often categorized as either indemnity or a managed-care plan. An indemnity plan usually offers a broader selection of providers than your managed-care plans. The plan is usually based on a reimbursement schedule for your covered provided services, meaning that you pay the bill out of pocket, turn the paid receipt into your insurance company and get your cost reimbursed. A managed-care plan typically allows you to go to in-network dentists, meaning the insurance company has of list of providers for you to choose from. The provider will submit the bill directly to the insurance company and not have to have you pay for cost up front unless that service is not covered or you pay a copay. 

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  • Vision is very similar to dental insurance except that this plan will help cover the expenses of routine eye care and is usually supplemental to your other types of medical insurance. A typical vision insurance policy will help cover the cost for routine checkups and the vision correction wear that your provider prescribed to you. 

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  • Long Term Care is an insurance policy that will help you cover the cost of assisted living or nursing home care in the future and allow you to plan early. Most companies will allow you to increase your coverage at a later time to help suit your needs. Some of the common factors that determine the premium for this type of policy is your current age, the amount your policy will pay per day and number of days.

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  • Health Insurance coverage is what allows individuals and families to receive medical care at base monthly rate. Some examples of what this may cover are medicine, doctor visits, emergency room visits, hospital stays, etc. Many variations go into health insurance plans including but not limited to deductibles, co-payments, coverage limits, and type of coverage.

Enrollment Periods:

  • You are going to hear that you can only enroll is certain plans during enrollment periods.

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  • Enrollments periods vary for Medicare, Medicare Part D, health insurance, etc. Please call our office to see if you qualify for one of these enrollment periods.

  

  • Like Life Insurance, Health insurance also gives you a free look period, also known as right to examine, to review your policy and make sure that the plan you chose is right for you. In PA the free look period is 10 days and if you decide in that time frame that you are not happy with your plan you can return your policy and receive a full refund. 

 

  • You will also hear a lot about HMOs, PPOs and POS. HMO’s are health maintenance organizations where the doctor bills the insurance company directly to avoid you having to pay out of pocket for covered expenses. A list of covered doctors will be provided to you but you will have to choose a primary care physician (PCP) when you first enroll. You also may have to pay a copayment depending on your type of coverage. In this plan type specialty doctors will need a referral from your primary care physician (PCP). PPOs are almost the opposite of how an HMO plan works. In this type of plan you do not have to chose a primary care physician (PCP), you can choose your preferred medical providers even though they are out of the preferred provider list. As long as the services received are covered by your plan you will still retain coverage, but if the  doctor is off the preferred list you may have a higher out of pocket cost. You will not need a referral to see a specialist in this type of plan. A POS, Point-Of-Service plan or Open-Ended HMOs, are the same as a PPO, with the following exception; If you choose to see an out-of-network provider, your copays, coinsurance and/or deductibles may be substantially higher or have a reduction in coverage and also applies to specialist that were not referred by your primary care physician.