For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Do 100% health plans offer the policy holder greater peace of mind? In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Wouldn't the 80/20 plan still offer you adequate coverage? Isn't it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?
In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or "ripped-off" by their insurance company and/or insurance agent. So what do you think happens almost 100% of the time when I ask these individuals "BASIC" questions about their health insurance policy? The following is a list of 10 questions that I frequently ask a prospective health insurance client. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any "per illness" maximums or caps? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? This fee is in addition to your plan deductible. Access fees are additional fees that you pay per treatment. It may just mean that you dealt with a "bad" insurance agent. So how could you tell if you dealt with a "bad" insurance agent? Because a "great" insurance agent would have taken the time to help you really understand your insurance benefits. A "great" agent spends time asking YOU questions so s/he can understand your insurance needs. A "great" agent recommends health plans based on all four variables; wants, needs, risk and price. Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a "great" agent. Insurance agents are no different than any other professional. Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So ask yourself, "Is this a company that I would trust to pay my health insurance claims?
Additionally, find out if your agent is a "captive" agent or an insurance "broker." "Captive" agents can only offer ONE insurance company's products." Independent" agents or insurance "brokers" can offer you a variety of different insurance plans from many different insurance companies. A "captive" agent may recommend a health plan that doesn't exactly meet your needs because that is the only plan s/he can sell. An "independent" agent or insurance "broker" can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.
I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. Lastly, if you have any concerns about an insurance company, contact your state's Department of Insurance BEFORE you buy your policy. Your state's Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders.
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