Newbie Question

[axeman462]

I am just begining to break into the individual health insurance market. An old college just me an email saying she would like a quote for health insurance. Says she has "Hospitalization/Major Medical" with Florida Blue. she pays $79/mo

I looked up a quote for her with Aetna and their "Health Network OptionSM High Deductible 3500 (HSA Compatible)" plan and it was $281/mo

Can someone explain to me the basic differences between these type of plans? How could the premiums be so drastically different? Is the Aetna HNO plan considered a Major Medical? Is it safe to assume that the Aetna HNO is a more comprehensive policy?

 

[Yagents]

I am just begining to break into the individual health insurance market. An old college just me an email saying she would like a quote for health insurance. Says she has "Hospitalization/Major Medical" with Florida Blue. she pays $79/mo

I looked up a quote for her with Aetna and their "Health Network OptionSM High Deductible 3500 (HSA Compatible)" plan and it was $281/mo

Can someone explain to me the basic differences between these type of plans? How could the premiums be so drastically different? Is the Aetna HNO plan considered a Major Medical? Is it safe to assume that the Aetna HNO is a more comprehensive policy?

That FL blue plan has definite limitations. Basically covers hospital/surgical and preventative care only, and reimburses like $50 for a few doctor visits, and generic drugs only.

I sell that Aetna HSA all day long in FL. It's a great plan, and the best priced HSA in most FL zips. BUT, I sell the $5500 then 100% plan, as the $3500 HSA has 10% coinsurance with the out of pocket maximum to be the same $5500, but the premium is typically $75-100 more a month. So, if something major happens, your paying $5500 in both plans, why pay more premium for the same protection.

Yes, that Aetna plan will cover everything the FL blue plan covers and more. More is defined as doctor visits, specialists, outpatient surgery, other outpatient items, and all branded drugs will go towards the deductible, and all of those items are covered 100% after the deductible. Too many conditions happen outside the hospital, too many expensive cancer drugs out there that don't have generics, and too many accidents require a lot of physical therapy appts, etc......to name just a few things that the FL blue won't protect against.

Hope that helps. If you tell me the age and zip code, I can verify that HSA plan is best priced.

 

[axeman462]

She was born 3/17/67
Zip 34471

Something else came up in convo too. Would her hospitalization insurance be considered "credible coverage" under obamacare next year? Or would she have to buy a more comprehensive plan?

 

[Yagents]

She was born 3/17/67
Zip 34471

Something else came up in convo too. Would her hospitalization insurance be considered "credible coverage" under obamacare next year? Or would she have to buy a more comprehensive plan?

If her plan is "grandfathered", meaning effective before 3/23/10, she can keep her plan and avoid paying the penalty. If after, then from what we understand, her plan may be required to upgrade to a more comprehensive policy like the HSA plans I discussed. Whether to keep her GF policy, depends on her income level.

I ran quotes, figures her birthday is 3/17. You're dealing with age change, and new quarterly rates. If you go for 4/1 eff dates, rates are little higher than these. Best priced in order:

Humana Enhanced HSA $5950 100% = $192
Humana Enhanced HSA $5000 100% = $205
Aetna HSA $5500 100% = $218

United Health One is $204 and $217, but I don't recommend female clients purchase them because of a 6 mo exclusion on reproductive organs.

Depending on health conditions and meds, Aetna doesn't do any riders and will rate up, and Humana can rider and rate up. Both have pretty quick underwriting. I don't sell BCBS.

You may also want to check the networks in Ocala, Humana has an EPO in the tri county area, and PPO in Ocala

 

[GilsInsurance]

I work for Florida Blue and what she has is a hospitalization plan. Either 700, 704, 706, or 710. Those are hospitalization only but do have a doctors office visit benefit. If not then she has a 570-573 with a GoBlue plan.

 

[bluediamond]

The rate for a 572 hospital is $79 a month just ran quote.
The 700 series has more outside the hospital than previously indicated. Why don't she wait until Oct for the open enrollment in exchange's? Seems if she can't afford a decent plan then she may qualify for a subsidy. She'll want to change then anyway, word has it those hospital plans are going to have quite the increase later this year.

 

[Yagents]

If it is plan 572, the only hole I see is no RX coverage, and no habilitation/home health care/skilled nursing coverage.

Otherwise, looks more than decent, especially for the price.

If a 700 series plan, maybe revisit the exact bene's.

 

[bluediamond]

Should have clarified that all hospital & surgical plans even the 700 series will have these rate increases and there is no guarantee they will be there 1 Jan 2014.