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Hints and Tips
Select the Right Plan
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Don't fall into the trap of looking only at the
lowest premium plans - while they may be good plans
for some people, they may not be for others. Consider
what is important to you and evaluate the plans based
on those criteria. Some things you may want to consider:
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- Catastrophic only versus comprehensive care -
for many people, it makes sense to insure with a
lower premium, high deductible plan, essentially
"self-insuring" for the smaller, more routine types
of care or the occasional large bill. Others need
the security of knowing they will have a relatively
steady, predictable outlay with no large bills to
pay other than premium.
- Deductible versus co-pay
- in the vein of the
above, determine whether you are most comfortable
with a plan that offers first dollar coverage via
co-pays with no deductible, or rather a more
traditional major medical plan with deductibles.
Generally (but not always) co-pay plans will have
higher premiums and/or less choice of providers.
There are some traditional major medical and PPO
plans that combine deductibles with co-pays for
office visits (with no deductible). Use the
selection criteria on the
Premium Finder page
to focus on the plans appropriate for you. In
addition, you may want to browse though some of the
plans on the
Plan Details
pages to get a better idea
of the plans that appeal to you.
- Freedom of choice of providers -
the plans that
give the highest level of freedom of choice are
typically also the highest premium, while some of
the plans that give you the lowest out of pocket
claims costs (typically HMOs) have the most restrictions
on the providers you can use. You may want to look
at the Provider list for each carrier before making
a final choice (go to our
Links page for direct
links to each carrier's provider panels), especially
if you have current doctors you want to retain.
- Types of care covered
- most plans will cover the
same spectrum of medical care but there may be subtle
differences in the extent to which some things are
covered - look at the
Plan Details
carefully. In addition, if non-traditional types
of care are important, refer to our
Alternative Care
section.
- Total costs - a common pitfall is to focus only
on premiums or only on out of pocket medical costs
when making a buying decision. Perhaps a better
approach is to look at total out of pocket costs -
deductibles and/or co-pays plus premiums - when
making your choice. Use your last several year's
experience with respect to accessing medical care to
estimate how much your deductible and/or co-pay costs
would be under the plans you are considering.
Then add in annual premium costs to compare what
total costs would be for the various choices you are
considering.
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General Hints and Tips For Using This Site
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Here are a few thoughts that may help you in your search
for appropriate and affordable health insurance:
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- If you are not that familiar with health insurance
and its terms, you may want to spend a few minutes
going through the Definitions
below.
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- In most cases, the full list of available plans
and their premiums can seem overwhelming when trying
to make a choice. You may want to generate the full
list (by requesting all options - the default
choice) to get an idea of the breadth of plans
and range of premiums. Then go back and generate
a new, shorter list by selecting those plan
designs and companies that best fit your needs.
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Alternative Care |
Chiropractic Care
Naturopath
Acupuncture
If coverage for these types of treatment
is important for you, you may want to look
at PacificSource, LifeWise and Health Net
as they have
coverage for these types of care, whereas
the other companies don't. Generally there will
be a dollar limit on the annual benefit,
but there is at least some coverage. In
addition, ODS does have some
chiropractic coverage.
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- We have another insurance company (Fortis)
that does not lend itself to online quotes at this
time, however their premiums have been very
competitive - if you are interested in seeing their
premiums, please
contact us by phone, fax, or
email.
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- We are available for assistance, including by
phone, from 8AM to 4:30PM (PDT) Monday through
Friday.
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- When filling out an application after making your
choice, please take great care in completely and
accurately filling out all questions, especially
with regard to any medical treatment history.
You are encouraged to
contact us for assistance
in filling out the application.
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Coinsurance:
The portion of a medical
claim paid by the insurance company,
generally after a deductible has been met.
For example, an 80% coinsurance rate
means the insurance company will pay
80% of the bill, while the insured is
responsible for the remaining 20%.
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Co-pay:
A payment by the insured for
a medical procedure, often paid at the
time the treatment is received. For
example, a $15 office co-pay is the
insured's responsibility toward the office
visit charge, with the rest paid by the
insurance company. Normally, no deductible
has to be met.
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Deductible:
An annual (usually) amount that must be paid
by the insured before the insurance
company pays any benefits. Usually the
amount is an "all cause", cumulative sum;
some carriers will carry over to the next year's
deductible any expenses that are applied toward a
deductible in the last quarter of the year if
the deductible is not met for that year.
Deductibles are normally on a "per person" basis,
although most carriers will also have a family
deductible that can either be a dollar amount
(usually two or three times the individual
deductible) or can be stated as the number of
people who have to meet their individual
deductibles before the family deductible is
considered to have been met. Once the family
deductible has been met, no additional
deductibles will be applied for the family for
the balance of the year.
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HMO (Health Maintenance
Organization):
A health plan that requires the use of selected providers
and that care go through or be coordinated by a Primary
Care Provider (PCP). If treatment is received from a
non-HMO provider, there is no reimbursement (except in
the case of true emergency care). Normally, there are
no deductibles applied and all services are reimbursed
at 100% after the co-pay (which is either a dollar amount or a
percentage). Increasingly, some HMOs are allowing care
to be received from non-HMO providers; however,
the reimbursement rate for such providers
is substantially lower. Such
plans are known as Point of Service (POS) plans.
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MM (Major Medical):
Traditional medical expense reimbursement plans. Generally there
is an annual deductible that must be met before the insurance
company pays any benefits. After the deductible is met, eligible
expenses are reimbursed at a "coinsurance" rate, traditionally
80% but increasingly you will see other rates. Usually there
is a dollar limit to the amount of expenses the coinsurance is
applied to (the "stop loss"); above that limit expenses are
reimbursed at 100% for the balance of the year.
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OOP (Out of Pocket limit):
A maximum dollar amount of expense you must pay
out of pocket before 100% of expenses are paid by the
insurance company. For HMOs, this is a stated total dollar amount
of co-pays; for other plans it is the deductible plus your share
of the coinsurance up to the stop loss amount.
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PCP (Primary Care Provider):
A doctor you select from the list of HMO Primary Care Providers.
All care must be received from that provider or referred by
that provider (except in the case of Point of Service Plans
or in a true medical emergency).
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POS (Point of Service):
An HMO plan that allows you to receive care from non-HMO
providers (generally at a significantly lower reimbursement rate).
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Preferred Provider Organization (PPO):
A major medical plan that has two different reimbursement levels -
one at a higher rate for providers on the insurance company's
preferred provider list, and a second, lower rate for providers
not on the list. You do not have to pick a doctor ahead of time
as you do in an HMO. Sometimes Preferred Providers are referred
to as "Participating Providers."
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Pre-existing Condition:
A medical condition that exists and has caused treatment to be
received or sought prior to the effective date of a policy.
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Provider:
A medical professional, business, or organization you receive
care from, including doctors, hospitals, pharmacies, etc.
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Stop Loss:
For Major Medical and PPOs, the dollar amount of incurred and
eligible medical expenses above which the insurance company
will reimburse 100% for the balance of the year.
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Underwriting & Existing Medical Conditions
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In the state of Oregon, individual medical insurance is
not guaranteed issue. The insurance company will review
your application after you have submitted it and will
either accept or decline; they cannot put exclusions or
waivers on the policy. If you are declined, you are
eligible for the Oregon Medical Insurance Pool (OMIP),
which is guaranteed issue, however usually at somewhat
higher rates. If this is likely to be your situation
please
contact us for additional information. It is
important that you answer all questions on the application
completely and accurately; if you omit important prior medical
treatment and the policy is issued, you may have claims for
that condition declined on the basis of an undisclosed
pre-existing condition. It is even possible that the policy
will be rescinded.
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Short Term Need For Insurance?
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| If you have a need for medical insurance for only
a limited period of time, such as while waiting to become
eligible for group coverage at work, you should look at
Short Term Medical Insurance rather than the individual
plans shown on this site.
Contact Us for details and
premiums. Generally such plans cost less, and the
underwriting is both faster and simpler.
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Coverage Outside of Oregon
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If you anticipate spending significant time outside of
Oregon (i.e. attending school out of state, wintering in
Arizona, etc.) you may want to focus on plans that
reimburse all providers at the same rate (subject to
usual and customary restrictions). Such plans do not
involve the use of HMO or preferred panels of doctors.
The plans that fall in this category are:
- LifeWise - Choice and 2000 Plans
- ODS - Individual Option
- Regence BlueCross BlueShield - CHEC Plan
A second alternative is to choose a carrier that has
some sort of national preferred panel relationship.
The following carriers have such relationships, though
not necessarily in all parts of the US:
- Regence BlueCross BlueShield's Blue Card program
allows you to receive benefits as if you are
in Oregon if you go to a provider who is a
member of their local BlueCross BlueShield
organization.
- PacificSource
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HSAs
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Health Savings Accounts are tax deductible savings accounts coupled
with low cost high deductible medical insurance. Money contributed to
such accounts not only is currently deductible, but grows tax-free. If
the money is used to pay for qualified medical expenses, disbursements
are tax-free; if used before retirement age for other purposes, disbursements
are taxable plus a 10% penalty tax. Money left in the account can be used
after age 65 for retirement income (taxable but no tax penalty). Read more about HSAs
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Age 65 or Older?
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If you are age 65 or older, you are not eligible for many of the individual policies presented
on this site due to Medicare coverage. Medicare Supplements or Medicare HMOs
are available starting on your 65th birthday. You are guaranteed to be issued coverage
if you apply before you turn 65 1/2 years old. You cannot apply for coverage until you
are 64 1/2 years old.
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Who Should Be the Primary Insured?
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Most carriers base the family rate on the age of the oldest
adult to be insured - it does not make a difference with those
carriers. However, two carriers are exceptions to the rule
and this opens up the opportunity to pay a lower premium than
you otherwise would, especially if there is a great disparity
in ages.
- ODS bases their rates on the age of the primary
insured adult, therefore in most cases you would be
wise to list the younger spouse as the primary insured.
- Kaiser Permanente bases their rates on the youngest
adult insured regardless of who is listed as the
primary insured.
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Disparity In Age In An Adult Couple
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When the two adults in a couple or family are in different
age brackets - the break points are generally 25, 30, 35, etc.
- it may be possible to save money by insuring family members
under separate policies. For example, a family with adults
ages 32 and 28 and with children would have the following
monthly premiums (Regence BlueCross BlueShield Blue
Selections $500 Deductible):
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Family under one policy (age 30-34 bracket) |
$344 |
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Or |
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32 year old - single insured |
$115 |
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28 year old spouse with children |
$148 |
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Total: |
$263 |
In this case the savings would be $81 per month for exactly
the same coverage. The savings won't always be this
dramatic and for some companies and some age brackets
the rate may actually be higher as a result of splitting,
but it is worth exploring, especially if the age
disparity is substantial. Use the filter capabilities
of the Premium Finder to find out your options. |
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Children Only
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| It is possible to insure children only on
an individual plan. Often under group insurance
the employer pays for the employee's portion of
the premium but not for the dependent's portion.
Very often it is less expensive to insure the
children under an individual policy than to
pay the group premium (especially if there
is only one child). Simply list the child
as the primary (and only) insured.
The parent should sign the application
as in the following example: "Joshua
Doe by Mary Doe, mother". Note, if
more than one child is to be insured,
each must be insured on a separate
policy - there cannot be multiple
insureds on a juvenile policy.
For this reason, if there are
several children, it may be
cheaper to go ahead and insure
under the employer-provided
group plan and pay that premium.
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