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From 1/1/2014 on, all individual and family health insurance plans will have these “Metallic” names whether you purchase health insurance “On Exchange” or “Off Exchange”. It gives you an easy-to-understand overview of how the plans will share the payment of your medical bills.
Health insurance companies that sell plans on the Health Insurance Marketplace can offer four types of qualified health insurance plans, including Bronze, Silver, Gold, and Platinum. The plan you choose determines not only the premium you pay but also what portion of your health costs you pay.
To make it easier to shop for coverage, health insurance plans have standardized “metals”. The “metal” plan depends on its actuarial value, or the average percentage of health care costs the plan pays vs what the member pays. The more coverage a plan provides, the higher the monthly premium and the fancier the metal level. Gold is better than Silver. Silver is better than Bronze.
This percentage will not go on forever, there is always an “Out of Pocket Maximum” (this is your pocket, not the insurance company), so you’ll only pay your portion of the expenses until you’ve reached your out-of-pocket maximum.
You’ll want to review your “Summary of Benefits and Coverage” to find out what your deductible is, your co-insurance, your out-of-pocket maximum, along with all of the important details of what your plan covers.
Regardless of the plan you choose, it will provide all 10 essential health care benefits guaranteed to policyholders under the Affordable Care Act. The difference among the plans has to do with how much overall out-of-pocket costs you’ll pay up to your out-of-pocket maximum.
Choosing the right metal tier requires evaluating your budget and assessing current and expected health care needs. Our agents guide you in reviewing the options available across the tiers and help you determine which plan best fits your health needs and budget. We can also help you determine whether you qualify for subsidies to lower your premium.
While MRIs are generally covered by health insurance, it is left to the discretion of your health insurance company to decide whether the test is medically necessary. If your provider determines that it is not, then you may pay for the procedure out-of-pocket.
If you are experiencing hair loss due to an underlying medical condition, then there is a good chance that your health insurance will cover treatment for the condition, either completely or at least a portion of the cost. To be sure, you’ll want to check your “Agreement of Coverage” document.
Gardening has been shown to positively impact our moods, reduce stress and alleviate symptoms of anxiety and depression. However, studies have shown that the benefits of this hobby may extend even beyond promoting a sense of contentment and well-being.
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Trying to determine what insurance you or your family need or qualify for can be a struggle. Do you need employer group insurance, private insurance, or Obamacare insurance?
Having two health insurance plans is legal and, in some cases, very beneficial. There are several scenarios in which you may have two health insurance plans. While it would be nice if you got double reimbursements for all your medical bills, that is not what happens when you have more than one health insurance policy.
If you have been fortunate enough to find a primary or specialty care doctor you love, it can be disappointing to say the least, when your doctor will no longer accept your health insurance plan.
Critical illness insurance, which may also be called critical care insurance or critical illness coverage, pays out a lump-sum, tax-free cash benefit, that can help you take care of any expenses that are associated with a qualifying illness.