Do I need Health Insurance?

Health insurance provides you and your family affordable access to high-quality health care. Accidents, illness and injuries can happen without any warning, and medical treatments can be very expensive. Having health insurance means knowing many of your health expenses will be covered. Without it, you and your family may suffer from the financial burden.  Health insurance plans very from one to another.  Whether you are interested in a comprehensive plan or one that provides the security from having to pay major medical costs, Michigan Health and Life Group can offer you options.

Is there a “one size fits all” plan?

Because individuals vary in their health history as well as their interest in the amount of coverage they are seeking, there isn’t one plan that fits all.

Is health insurance expensive?

Health insurance is not cheap. However, it is a bargain compared to the cost of medical expenses today.  There are multiple plans available today that make it easier to find one that will fit your budget.

What is an insurance "Carrier"?
An insurance carrier is the actual insurance company that covers you. The carrier process and pay claims submitted by you or your health care provider.

What is a "Provider"?
A provider can be your physician, your hospital or other health care facility that provides your medical, dental and/or vision services.

What is a "Deductible"?
A deductible is the amount of money you must spend each year before your health insurance policy begins covering expenses. For example, if you have a $500 deductible, you must pay the first $500 in expenses. After you meet the first $500, your policy will begin to pay your medical bills based on your coinsurance or policy terms.

What is "Coinsurance"?
Coinsurance refers to the percentage of expenses that your policy will cover after the deductible has been paid. If your policy has an 80/20-coinsurance clause, your policy will pay for 80% of claims while you would pay for 20%. Once the amount paid has reached the "coinsurance maximum", your policy will then begin paying for 100% of the covered claims. So for example, if your 80/20-coinsurance policy had a $4,000 coinsurance maximum, you would pay 20% of claims up to the first $4,000 in claims. As a result, your maximum out-of-pocket expense for the coinsurance would be 20% of $4000, or $800. After you have met this $800 maximum, the policy will then begin paying 100% of covered expenses.

What is a "Copay"?
A copay is a fixed dollar amount that some plans may require you to pay for specific medical services or supplies. For example, a plan may require you to pay a $25 copay for physician office visits.  This $25 covers the initial doctor’s visit.

What is a "Provider Network"?
A provider network is a list of hospitals and physicians that will accept your insurance plan. These providers usually sign an agreement to accept payment based on a schedule of discounted fees arranged by the network. Your insurance carrier will then pay the providers based on the schedule of discounted fees. This network arrangement works for services that are covered under your policy. Your provider can still charge you the full amount for a service that is not a covered benefit under your policy.  PPO, the Preferred Provider Network, is the largest network of doctors and hospitals in Michigan.  PPO is changing its name to Cofinity.

What is a "PPO Plan"? (Cofinity)
A PPO refers to a "Preferred Provider Organization". This has a provider network, sometimes called a PPO network. You are typically allowed to also see a provider outside of the network; however, you will pay a higher deductible and a higher coinsurance.  

What is a "Health Savings Account"?
A Health Savings Account (HSA), is a tax-sheltered account you can set-up in conjunction with an HSA-qualifying health policy. You may contribute money into an HSA account, and then use that money to pay for deductibles, prescriptions, dental services, vision services or nursing home expenses. The big advantage to HSA's are that contributions, investment growth and withdrawals for health-related expenses are all free from taxation. Any money not spent in your HSA account continues to accumulate as you contribute to it every year. This money rolls over from year to year. The annual limit on how much you can contribute to an HSA changes periodically and is determined by the federal government. See “who can have an HSA” for more information.

How can I save money on health insurance?

There are plenty of ways to save money on health insurance.  By not smoking and eating right, you can obtain a lower premium.  You can also obtain a lower premium by selecting a high deductible plan or an HSA.    Another way is to select the right plan for your budget.  Paying for some of your medical expenses will reduce your premiums.   The money you save every month by selecting the right plan can be used for medical expenses at a future date if needed.  Remember, the money always looks better in your pocket than someone else's.

How do I know what is covered under my plan?

All health insurance policies list in detail what is covered, as well as what is excluded or not covered.  You also have the right to a “ten day free look”.  This means after you receive your policy, you have ten additional days to examine and cancel the policy and have your premium returned.  Some companies charge a nominal application fee, generally less than $25.00, which is typically not refundable.