Your Guide to Health Insurance

Navigating the world of health insurance can feel complex. Our guides are designed to simplify the concepts, clarify your options, and empower you to choose a plan with confidence and peace of mind.

Understanding the Basics

Grasp these fundamental terms to better understand how your health plan works and what your costs might be.

Deductible

The amount you pay for covered health care services before your insurance plan starts to pay.

Copayment

A fixed amount you pay for a covered health care service, usually when you receive the service.

Coinsurance

The percentage of costs of a covered health care service you pay after you've met your deductible.

Out-of-Pocket Max

The most you have to pay for covered services in a plan year. After you spend this amount, your plan pays 100%.

Comparing Plan Types

Different plans offer different levels of flexibility in how you receive care. Explore the main types to see which fits your lifestyle.

HMO (Health Maintenance Organization)

HMO plans typically require you to use doctors, hospitals, and specialists within their network. You'll also need a referral from your Primary Care Physician (PCP) to see a specialist. These plans often have lower premiums.

PPO (Preferred Provider Organization)

PPO plans offer more flexibility. You can see both in-network and out-of-network providers without a referral. Your out-of-pocket costs are usually lower when you use providers within the network.

EPO (Exclusive Provider Organization)

An EPO plan is a hybrid of an HMO and PPO. You must use doctors and hospitals in the network, but you usually don't need a referral to see a specialist. It offers a balance between cost and flexibility.

A smiling couple reviews documents at a table with an insurance agent.

How to Choose the Right Plan For You

Selecting a health plan is a personal decision. Consider these steps to find the coverage that best matches your health needs and financial situation.

1 Assess Your Health Needs: Consider how often you visit a doctor, any chronic conditions, and prescription medications you take.
2 Check the Provider Network: If you have preferred doctors or hospitals, make sure they are included in the plan's network to keep costs down.
3 Compare Total Costs: Look beyond the monthly premium. Factor in the deductible, copayments, and out-of-pocket maximum to understand your potential total annual cost.

Frequently Asked Questions

Here are answers to some common questions we receive about our health plans and services.

You can typically enroll during the annual Open Enrollment Period. You may also qualify for a Special Enrollment Period following certain life events, such as getting married, having a baby, or losing other health coverage.

In-network providers have a contract with your insurance company to provide services at a discounted rate. Out-of-network providers do not have this contract, so your out-of-pocket costs will be higher if you see them. Some plans, like HMOs, may not cover out-of-network care at all except in emergencies.

Each plan has a list of covered prescription drugs, known as a formulary. You should review the formulary for any plan you're considering to ensure your necessary medications are included and to understand your potential costs.

Ready to Find Your Plan?

Let our dedicated team help you navigate your options and find the perfect coverage for your needs. Get in touch today for a personalized consultation.

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