Medicare Supplement Insurance

To purchase Medicare Supplement Insurance you must be enrolled in Medicare Part A and Part B. Medicare Supplement Insurance (also known as Medigap) fills in the gaps that you would have to pay for only having traditional Medicare, which can be quite costly. There are twelve standardized plans known as A-L plans that offer various benefits to help offset your healthcare cost, all of which can be reviewed from different insurance companies by selecting Medicare Supplements from the home page drop down menu.

Medicare Advantage

Medicare Advantage is sometimes called Part C, and is another option to traditional Medicare Part A and Part B.  Medicare Advantage Plans are approved by Medicare, but run by private insurance companies that include different plans like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).  The types of plans available depend on your geographic location so give us a call at the number listed above to go over which plans are available to you.

Medicare Part D (Prescription Drug Coverage)

Medicare Part D is a voluntary prescription drug program for Medicare beneficiaries.  Here at Yourhealthquotes.com we offer many Prescription Drug plans, all of which are approved by Medicare. Different plans cover different Brand Name and Generic drugs, so you should ensure the plan you are considering covers any brand name drugs you are currently taking and wish to continue.

Long-Term Care Insurance (LTC)

Seniors who have to stay in a nursing home or Long-Term Care facility can rack up large bills quick.  It can average $3,200 to stay in a Long-Term Care facility.  This is why we recommend having Long-Term Care Insurance, which is designed to pay or reimburse covered long-term care costs if you need assistance or supervision because you are not able to do some of the basic “activities of daily living” (ADLs) such as bathing, dressing, or moving from a bed to a chair. It might also cover individuals who have mental disabilities caused by Alzheimer’s disease, or other mental illness or brain disorders. Long-term care costs may include services rendered in your home, a nursing home, assisted living facility or adult day care.

An annuity can be a valuable way to invest money that you have saved, or that is in an old 401k or IRA plan.  The types of annuities we work with at Yourhealthquotes.com offer protection of your principle investment, with a chance to grow your money significantly over time.  These are called Fixed Annuities, and are basically CD-like investments that pay guaranteed rates of interest, which in most cases are higher than you would receive in a CD from a bank.  In a CD (Certificate of Deposit) you typically have to pay taxes on your gain at the end of each year, whereas most annuities defer taxation until you start making withdrawals, which over multiple years can add up to a large amount of money.  A Fixed Annuity can be deferred or immediate.  Since Fixed Annuities pay guaranteed interest rates, we highly recommend them for people who don’t want to worry about the ups and downs of the stock market.  The types of Fixed Annuities we deal with at Yourhealthquotes.com can be started with investments starting as low as $1,000, though the more you invest initially the higher your bonus will be.  A bonus is a percentage the insurance company will give you for investing in one of their Annuities, which in some companies can be as great as 10% of your initial investment.

There are many types of health insurance and medical insurance plans offered by Health Net. They have a large variety of Medicare Plans, from Medicare Supplements to Part D prescription drug plans, as well as a very affordable selection of group plans for small businesses, medium businesses, and large businesses. One of their newest and most popular group plans is called the SmartCare HMO, due to its affordability. Individuals and families also have a great selection of plans to choose from with Health Net, from HMO’s to PPO’s, you can find whatever you need by clicking on the Individual Health tab above. Health Net individual plans have a unique feature called Decision Power, which is a program that brings together resources and personal support in a single location. Decision Power, offers support to members like talking to a health coach, information about health improvement plans, and tracking of personal health information in a safe, central location. In California Health Net has both vision and dental plans available.

The health group plans available in California in Health Net’s Enhanced Choice Portfolio include the Standard EOA, Value EOA, Advantage EOA, Options EOA, SmartCare HMO, Standard HMO, Value HMO, Advantage HMO, Options HMO, and the Salud HMO y Mas, which has an option of coverage in Mexico.

HMOs in California are regulated by the DMHC. HMOs are required to have an internal complaint/grievance process in place.

Important Things to Remember Regarding Health Maintenance Organizations:

• If you are a member, you are required to obtain health care services from HMO providers, except in certain emergency situations.
• You choose your doctor, so this is a key decision because that physician directs your care. That doctor will often coordinate referrals to specialists within the HMO.
• Your options may be limited by the geographic restrictions of the HMO network.
• Depending on the plan you choose at enrollment, you may have a co-payment each time you utilize an HMO covered service.
• You can seek assistance from the DMHC on all HMO and managed care questions, and you have any additional coverage questions please contact us at Yourhealthquotes.com by clicking on the Contact tab at the top of the screen.

Grace Period – Certain period that follows the premium due date during which a payment can be made to continue a policy without it lapsing or canceling due to non-payment. Life and Health policies are only where this is applicable. To be certain, you should check your policy to see how long the grace period is.

Guaranteed Issue – Is a health insurance policy that will be approved or issued regardless of any preexisting conditions. Underwriting is not determined by the applicants past and current physical condition or past medical procedures. The insurance company will not require a physical examination and cannot decline an applicant coverage due to past medical history on guaranteed issue policies.

Independent Medical Review – A process in which independent expert medical professionals with no ties to your health insurance company or health plan review specific medical decisions made by an insurance company. Independent Medical Review Program is required by California state law, which is administered by the CDI and the DMHC depending upon what type of coverage you have (indemnity or HMO).

Medically Necessary – It can be a device, procedure, therapy, treatment plan, or a drug that your insurance policy will cover. Your physician or hospital will have decided it as necessary for your medical well-being, or health condition.

Policy – A contract that binds an individual or group policyholder to an insurance company or vise-versa. The policy will explain which duties, obligations, and responsibilities the insured and the insurance company have. Included in a policy usually is an application, certificate, endorsement, or any other document that might describe, limit, or exclude coverage benefits under the contract.

Preexisting Condition – A medical condition in which you may have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare policies of 3 or more persons cover preexisting conditions after you have been insured for 6 months, and individual policies cover preexisting conditions after you have been insured for 1 year. Creditable coverage, which has been described above, will be counted towards any preexisting condition exclusion in either an individual or group policy.

Usual, Reasonable, and Customary – It is determined by an insurance company, and gives a normal payment range for a specific medical procedure performed within a given geographic area. The price for medical procedures varies throughout the state. Sometimes the charges submitted to an insurance company will be higher than what the insurance company determines as normal for certain medical care services, in which case they may not allow the full amount charged to you.

Business Day – Typically Monday through Friday, in which a health insurance company is open for business. They tend to be closed on Saturday’s, Sunday’s, and most state recognized holidays.

Calendar Day – Includes any day that is on the calendar each month, including Saturday, Sunday, and state and federal holidays. That being said, if any action tied to a time frame in an insurance policy or CDI regulation or code falls on a Saturday, Sunday, or state or federal holiday; then that particular act is postponed to the next calendar day that does not fall on a Saturday, Sunday, or state or federal holiday.

Certificate of Coverage – This is a document issued to a member of a group health insurance plan, which indicates evidence of that member participating in the groups insurance plan.

Certificate of Creditable Coverage – A written statement from your previous insurance carrier showing the length of time you were covered.

Creditable Coverage or Prior Qualifying Coverage – How long in months you had health coverage in place before your existing or new policy went into effect. Creditable coverage must be counted towards any preexisting condition exclusion in either an individual or group policy.

Claim – When you need to use your insurance a notification to your insurance company shows that payment is due under the policy provisions.
Co-payment – Typically a percentage or specified dollar amount that you pay to your provider for covered health care services in addition to any deductible.

Coverage – The benefits in an insurance policy which includes the entire scope of protection in an insurance contract.

Denial – When you apply for insurance but get rejected. Several factors can contribute to an individual being Denied for coverage. Also in terms of claims, a insurance company may decide to withhold a claim payment or pre-authorization. This can happen for may reasons as well, possibly because the medical service is not covered, not medically necessary, or experimental or investigational.

Deductible – The amount which is usually fixed, a member must pay before benefits from the insurance company are payable.

ERISA – Stands for the Employee Retirement Income Security Act (1974). Administered by the U.S. Department of Labor, Employee Benefits Security Administration. ERISA regulates employer-sponsored pension and insurance plans (self-insured plans) for employees.

Group coverage can be a good choice for those in particular that may have preexisting conditions because the waiting period is only six months instead of one year as with individual health insurance policies. They are also guaranteed issue so you would not have to worry about the possibility of getting declined as with individual medical insurance. If you have been insured previously under group coverage without a break in your insurance of 180 days, credible coverage will be applied to the six month waiting period.

You have to be a member of an association, whether its in industry, professional, trade, of something else in order to have an MEWA. It is a trust fund used to offer health care benefits to the employees in these particular industries. They are very heavily regulated now a days due to the fact that in the 80’s and 90’s there was widespread abuse of claims by MEWAs. The legislation that was drafted to curtail this abuse of claims, forced all MEWAs to file applications for certificates of compliance by November 30, 1995. If they failed to do this they risked loosing their ability to operate all together in California. Strict requirements must have been met in order to be granted this all important “certificate of compliance” for MEWAs. Its no longer legal for new MEWAs to form and to offer health care benefits. Less than 10 MEWAs have been issued certificates of compliance by the California Department of Insurance, permitting legal operation here.

As an employee your workplace may present a MEWA health plan if they are an employer member of a trade, industry, professional, or other association.

• As stated in the previous paragraph, currently less than ten MEWAs operate in California with certificates of compliance.
• After November 30, 1995, no new MEWAs can form, operate, or apply for CDI certificates of compliance.

Medi-Cal

Medi-Cal is looked after by The California Department of Health Services (DHS), and is funded by both state tax revenue and federal tax revenue. It is California’s version of the low income health program know as Medicaid. It pays for different healthcare services for people with minimal income or disabled people and does not require you to be healthy in order to qualify for coverage. There are different eligibility criteria that you have to meet in order to receive Medi-Cal, and you can continuously receive those benefits if you remain eligible. Medi-Cal is managed through your local county welfare/social services department.

All HMO Plus Plans, Dental and Vision benefits are provided by Health Net of California, Inc. Dental benefits are administered by Dental Benefit Providers of California, Inc (DBP), a California licensed specialized dental plan. Health Net contracts with EyeMed Vision Care, LLC, a vision services provider panel, to provide and administer vision benefits. (DBP) and EyeMed Vision Care, LLC are not affiliated with Health Net of California, Inc.

All PPO Plus Insurance Plans, Dental and Vision benefits are underwritten by Health Net Life Insurance Company. Dental benefits are administered by Dental Benefit Administrative Services. Vision benefits are administered by EyeMed Vision Care, LLC. Dental Benefit Administrative Services and EyeMed Vision Care, LLC are not affiliated with Health Net Life Insurance Company.

Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net® is a registered trademark of Health Net, Inc.

As with all individual health insurance plans, your health history and underwriting will determine your final rate or premium amount. As well as when you wish your effective date to start, your age, the plan you choose, and the geographic location in which you may live. For instance Phoenix Arizona health insurance rates tend to be lower than many other states.  Premium changes due to legislative or regulatory requirements will become effective on the effective date of such changes.

Children younger than the age of 19 may by charged not exceeding double the standard level 1 premium rate due to health status during an open enrollment or late enrollment period. If the child has not maintained coverage for the full 90-day period prior to the application date, an additional 20% surcharge will apply for the first 12 months of coverage (does not apply to late enrollees). Health Net or Yourhealthquotes.com will contact you if a rate other than the standard rate is offered.

• Health Net HMO 40
• Health Net HMO Value 50
• PPO Advantage 3500
• PPO Advantage 6500
• PPO Value 4500
• PPO Value 7500

Health Net of California Farm Bureau:

• CFB HSA 4500
• CFB HSA 6000
• CFB PPO Standard 4000
• CFB PPO Standard 6000
• CFB PPO Standard 7500

Instead of paying for healthcare expenses completely out of pocket, insurance will cover a portion for both diagnosis and treatment of a medical expense that is covered by your particular plan. California gives you a wide variety of health insurance, which is why you need an agent like us at YourHealthQuotes.com to decipher the differences. Below is a list of the different types of health insurance plans available to you in California and Arizona.

• Indemnity Policies (Traditional Fee-for-Service Insurance)
• Preferred Provider Organizations (PPO)
• Health Maintenance Organizations (HMO or Managed Care)
• Self-Insured Health Plans (Single Employer Self-Insured Plans)
• Multiple Employer Welfare Arrangements (MEWA)

The California Department of Insurance (CDI) regulates indemnity policies. Indemnity policies typically allow you to pick any doctor and hospital that you wish when seeking health care services. The staple and meaning of traditional fee-for-service insurance is choice. You choose what provider to visit when seeking covered medical services with few geographic limitations. A deductible may be required to be paid for the healthcare services provided if you have purchased an indemnity policy. That means you pay a specific amount before benefits are paid. Here at YourHealthQuotes.com we offer plans from numerous insurance companies with many deductible options, give us a call if you need help deciding at 602-752-6327.