March Insurance Group LLC

Health Insurance

Frequently asked questions about Health Insurance:

What types of Health Insurance Products do you offer?

  • Individual and Family Health Insurance. Singles and families should take a look at our individual and family health insurance plans. If you don't get your health insurance coverage through an employer, an individual and family health insurance plan is your option.
  • Small Business Health Insurance. We offer group health insurance plans for small businesses and organizations (2-50 employees).
  • Short-Term Health Insurance. If you're in need of temporary coverage, you'll want to take a look at our short-term health insurance plans. Obtaining short-term coverage is quick and easy and though it's not a long-term solution, short-term coverage can protect you while you're between jobs or after you graduate from college.
  • Dental Insurance. We provide dental insurance options priced to fit most budgets.
  • Medicare Advantage Plans. MedAdvantage Insurance, covers all or part of your Medicare part A and Part B, replacing with a private insurance company. Usually available with Part D coverage.
  • MedSupplement Insurance. Supplements your standard Medicare program, cannot be sold with Part D.
  • Part D Insurance. Medicare drug coverage plan.

Choosing the right Health Insurance Plan

Choosing the right health insurance plan can be confusing. When open enrollment rolls around at your office, you can easily get lost in alphabet soup of acronyms and a dizzying array of coverage options. Fortunately, most options can be boiled down to three basic types of managed health care plans – health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point-of-service (POS) plans.

Health maintenance organization (HMO) plans

A health maintenance organization (HMO) contracts with health care professionals and facilities to create a "provider network." If you choose HMO insurance, you'll typically pay just a small co-payment if you visit a physician or hospital within the plan network. HMO insurance often features lower premiums and co-pays than other plans. However, HMO insurance is also among the least flexible types of health insurance plans. When you sign up for one of these plans, you must choose a primary care provider (PCP). If your current physician is not in the plan, you will have to find another doctor, or pay to see your current physician. Typically, HMOs will not pay for non-emergency care if it's performed by an out-of-network physician or facility. You'll also need a referral from your PCP to see a specialist.

In general, HMOs offer you the lowest out-of-pocket costs for your care. The tradeoff is that your access to care outside the network is extremely limited.

Preferred provider organization (PPO) plans

A preferred provider organization (PPO) also enters into contractual agreements with health care providers and creates a "provider network." But unlike HMOs, PPO health insurance will cover some – but not all – of the cost of care administered by out-of-network providers.

If you select a PPO, you will have low co-payments as long as you see in-network physicians. Another advantage of PPO insurance is that unlike an HMO, you do not need a primary care physician's permission to see a specialist (as long as the specialist is in network).

However, PPOs also have a few disadvantages. Going out of network for your medical care is likely to cost you – either you'll have to pay a deductible or the difference between what the out-of-network physician and an in-network physician charges. However, unlike many HMO plans, a PPO health insurance plan generally will pick up at least some of the cost of out-of-network care.

In addition, you may have to pay higher co-payments if your doctor charges more than is "reasonable and customary" (according to the insurer) for a service.

In summary, PPO health insurance offers a wider range of access than HMO insurance, but your out-of-pocket costs tend to be higher.

Point-of-service (POS) plans

A third type of health plan, known as a point-of-service (POS) plan – offers a combination of PPO health insurance and HMO insurance services. In fact, the "point of service" in the name reflects the fact that you make your choice of whether to use HMO or PPO services each time you see a provider.

Generally, a POS has rules similar to HMO insurance, but a POS will allow you to see an out-of-network physician for a higher fee. Some HMOs actually include a POS plan so you can see out-of-network physicians.

Understanding the differences among HMO, PPO and POS plans can help you make the right health insurance plan choice during your next health insurance open enrollment period.

What is individual insurance?

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. Given the option, most people would prefer to have their employer provide group health insurance coverage. But, if this is not an option for you, it is still important for you to seek coverage. You may be pleasantly surprised with the variety and affordability of the individual and family health insurance options available.

What is Dental Insurance?

Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or "premium"), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.

What is Short Term Health Insurance?

Short-term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. If you think you'll need coverage for a longer period of time, you may want to look at a standard, longer-term health insurance option like our individual and family health insurance plans.

 The application process for short-term health insurance is usually simpler than standard, longer-term health insurance. Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care.

 Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise. If you wish to maintain your eligibility for HIPAA plans, you should not purchase a short-term plan. Please consult your benefits advisor to discuss your rights under the Health Insurance Portability and Accountability Act (HIPAA) and other rights under state law.

 Short-term health insurance plans typically do not cover pre-existing medical conditions. The definition of a pre-existing condition varies by state, but, in general, short-term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 3 to 5 years. If you have an existing medical condition, you may want to research whether you can extend your current insurance. Employer-sponsored insurance can be extended under a government-regulated option commonly referred to as COBRA, which you should seriously consider if you have an existing medical condition.

What is a co-payment?

A "co-payment" or "co-pay" is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

What is a deductible?

A "deductible" is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.

What is coinsurance?

Coinsurance is the term used by health insurance companies to refer to the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional co-payment or deductible requirements), then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80.

What is the difference between "in-network" and "out of network"?

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers. As a general rule, PPO, POS, and HMO plans make use of provider networks.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (hospital)and Part B(doctor) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Some include Part D, prescription drug coverage.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

What do Part D plans cover?

Each plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.

For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber (your doctor or other health care provider who is legally allowed to write prescriptions) thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

The March Insurance Group would be happy to discuss the options available to you. Please contact us for immediate assistance.

March Insurance Group LLC
"We Protect Your Assets"

Iron Eagle Financial Center
1036 E Iron Eagle Dr #120
Eagle Idaho 83616

208-287-3087 Telephone
208-297-5727  Facsimile
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