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Solutions & Tools

Our Resources help guide and navigate you through the best solutions and tools for your insurance needs.

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ARS- Associates

For those over 65 or with disabilities:

Costs that will not be paid or refunded by insurance. Healthcare.gov says Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

Resource: https://www.healthcare.gov/glossary/out-of-pocket-costs/#:~:text=Your%20expenses%20for%20medical%20care,services%20that%20aren't%20covered.

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. (Healthcare.gov)

Resource: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/#:~:text=The%20most%20you%20have%20to,the%20costs%20of%20covered%20benefits.

The deductible is the amount paid out of pocket by the policyholder before an insurance provider will pay any expenses. (From Wikipedia)

Resource:
https://www.healthcare.gov/glossary/deductible/

A fixed amount you will pay for your plan after the deductible.
Resource: https://www.healthcare.gov/glossary/co-payment/

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

Resource: https://www.medicare.gov/what-medicare-covers/what-part-b-covers

Medicare, often known as original medicare, is a federal program that provides individuals 65 years or older healthcare coverage or to those with disabilities. Original Medicare coverage is broken into two parts—Part A and Part B—and is accepted by most doctors and hospitals in the country. The federal program is funded from payroll taxes that pay for Part A (generally at no charge) and an adjusted monthly amount for Part B.

Medicare Part A covers in-patient hospital stays, nursing facility, hospice, lab tests, surgery and home health care while Part B helps cover medically necessary services like doctor services and tests, outpatient care, home health services, medical equipment and other medical services. Part B covers some medical services as well.

Pays only partially for healthcare costs including deductibles for hospital stay and leaving you exposed for 20% of Part B expenses.
Note: Chemotherapy is a Part B expense.

Resource: https://quote.unitedmedicareadvisors.com/umaadw?gclid=Cj0KCQjw16KFBhCgARIsALB0g8JwOFj5TQc3pWSGyBpiYAXCIsplMCS2C-rqokdl9_WHdkjrAfZB_WcaAr6BEALw_wcB

https://www.medicare.gov/what-medicare-covers/what-part-b-covers

When you turn 65 you have an initial, 7 month (3 months before, month of, and three after birth month) enrollment period to sign up for part A and/or part B. If you fail to sign up for Medicare on time, you'll risk a 10 percent surcharge on your Medicare Part B premiums for each year-long period you go without coverage upon being eligible. (Since Medicare Part A is usually free, a late enrollment penalty doesn't apply for most people.)

Resource: https://quote.unitedmedicareadvisors.com/umaadw?gclid=Cj0KCQjw16KFBhCgARIsALB0g8JwOFj5TQc3pWSGyBpiYAXCIsplMCS2C-rqokdl9_WHdkjrAfZB_WcaAr6BEALw_wcB https://www.medicare.gov/what-medicare-covers/what-part-b-covers

Health blog: nutrition https://www.healthline.com/nutrition

Mental health:
https://www.dailyom.com/cgi-bin/display/inspirations.cgi

senior:

Covers basics of healthcare. It wasn’t designed to cover everything that one can experience. It doesn't even cover pharmacy medications; those are an add-on product. For those who do not purchase that product there is a penalty that is applied when a drug plan is ultimately chosen. The biggest risk is that the medical expenses of the original A and B Plan have no financial cap. Meaning that you can have a health event whos maximum amount you would not know. It would be undetermined. Putting you at great financial risk. Prescription drugs are not covered. For seniors the biggest risks for financial bankruptcy is related to health expenses. For example chemotherapy is a Part B expense of original medicare. So the charges would be 20% of whatever that amount would ultimately be for treatment.

Is the risk of an investment that you lose. In the context of original medicare there is no cap so there can be high risk.

Medicare Supplement Plans, also known as Medigap, helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles.

Resource: https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap

Medicare Part C is a type of insurance option that offers Original Medicare benefits plus more. It's also known as Medicare Advantage. Some Medicare Part C plans offer health coverage benefits such as gym memberships, vision, hearing, and transportation services. It may include drug coverage which Original Medicare does not include.

Resource: https://www.healthline.com/health/medicare/what-does-medicare-part-c-cover

Medicare Advantage Plans may offer extra coverage from that of Original Medicare, such as vision, hearing, dental, and health and wellness programs as well as other preventative services and alternative healthcare. Most include Medicare prescription drug coverage (Part D). Many of these plans are offered at zero or low cost premiums.

Medicare advantage plans have copays, some have deductibles, and all have maximum out-of-pocket costs that a patient can be exposed to in any one year. Typically, chemotherapy is charged at 20%, with the copay capped at the maximum out-of-pocket cost.

Most med adv have embedded drug plans with many of the common generic drugs offered at zero or low cost.

Medicare Advantage plans are provided in several different types. The most common being an HMO (Health Maintenance Organization) with a defined provider network and are typically a requirement for a primary care doctor to refer the patient to a specialist. A PPO (Preferred Provider Organization) that allows patients to typically access care in and out of networks without being referred to from their primary care doctor.

Medicare Advantage plans are attractive to many people because of their low premium and low co-pays, but catastrophic illness can reach plan max out of pocket costs. There are other options from various companies to mitigate some of these out-of-pocket costs such as those related to cancer, heart attack and stroke.

For those under 65:

What is ACA

The affordable care act is affordable health insurance made available to more people.

How do you qualify for the subsidies? If income is too high for subsidy what other options are there?

  1. In states that have expanded Medicaid coverage, your household income must be below 138% of the federal poverty level (FPL) to qualify.
  2. In all states, your household income must be between 100% and 400% FPL to qualify for a premium tax credit that can lower your insurance costs.
  3. If your income is above 400% FPL, you may still qualify for savings on a 2021 Marketplace health insurance plan.

Other Options:

Opt 1. Healthcare ministry programs - non profits

Opt 2. Supplemental plans - how can they work?

Supplemental health insurance is an insurance plan that covers costs above and beyond standard health insurance policies. It may provide additional insurance coverage or pay for costs not covered by a traditional health insurance plan, including coinsurance, copays, and deductibles

Resource: https://www.thebalance.com/the-basics-of-a-supplemental-health-insurance-plan-2645664

Opt 3. Short term policies how they work?

As the name implies, short-term policies offer health coverage for less than one year. Typically these policies offer fewer covered benefits and consumer protections compared to plans that meet all Affordable Care Act (ACA) standards. As a result, short-term policies generally have lower premiums.

Resource: https://www.kff.org/health-reform/fact-sheet/aca-open-enrollment-for-consumers-considering-short-term-policies/#:~:text=As%20the%20name%20implies%2C%20short,policies%20generally%20have%20lower%20premiums.

Resource: https://www.healthcare.gov/glossary/subsidized-coverage/

Group health policies

a group plan spreads risk across a pool of insured individuals. This benefits the group members by keeping premiums low, and insurers can better manage risk when they have a clearer idea of who they are covering.

-minimum requirments?

In most states, you must have at least two employees and a 70 percent participation rate to offer a group health insurance policy.

-structure “sensus” age demographics.

Alternatives include primary care membership plans, medical cost-sharing programs, health savings accounts (HSAs), medical services discount cards, and high-deductible policies. Primary care membership plans allow participants to receive care from a primary care physician for a flat fee, usually paid monthly.

Resource: https://www.investopedia.com/articles/personal-finance/021016/5-alternatives-traditional-health-insurance.asp