Our Purpose at The Shoppe

At The Health Insurance Shoppe our goal is to educate the consumer on their current or future health insurance benefits to make sure they are receiving the best possible benefit at the lowest possible price.

What do we mean?

We want to address consumers that currently do not have a HSA (Health Savings Account) qualifying plan.The Health Insurance Shoppe is a large advocate of HSA compatible health insurance plans and believes that these are the best available plans to Americans and cost the least in monthly premium.  Before we are to et into HSAs lets go over a traditional plan of health insurance.

Right now in the current private health insurance market it is very difficult to find a low deductible health plan such as a $500 deductible.  There are two carriers that offer one, Blue Cross and Assurant.  All remaining carriers begin at $1,000 and up.  The deductible is the amount of money that you must pay first before your insurance company is to begin paying a percentage of future bills.

The percentage the insurance carrier will pay is referred to as Co-insurance.  This is usually presented as 100%, 80%, 70% and 50%.  This # represents how much the insurance carrier will begin to pay after your deductible.  Your share is the remaining amount out of 100%.  The percent that you pay goes towards what is  referred to as your out-of-pocket (OOP) expense limit.  Once your OOP is met, the insurance carrier will then begin to pay 100% of further calendar year expenditures.

When you add the plan deductible and OOP together, you will get your true exposure in risk on  a large claim.  If there is more than one person on the plan, than you must multiply the plans deductible and OOP x 2.  Each member will have their own separate deductible and OOP to meet before the plan will begin to pay 100%.

Some plans might include pre-paid benefits such as office visit copay's and prescription drug copay's and a possible ER benefit.  Blue Cross and Blue Shield of Illinois is the only carrier that offers an ER benefit that will either cover 100% of the charges or waive the deductible and require you to pay your co-insurance of the bill towards your OOP.  All other carriers are going to slap a copay of $100 and require you to pay the whole bill as a deductible than OOP expense.

As far as office visit copay's, these will cover the cost if the initial office visit, not any additional lab work, x-rays or diagnostic tests that may be requested at time of visit. Please note that copay's do not apply to the plans deductible or OOP.  When you select a copay, you are automatically asking the insurance company to begin paying on claims.  The typical cost of an office visit for an Internist is usually $75-$125.  This cost is established for patients w/o health insurance.  If the provider accepts your insurance than you will receive a discount on the base cost.  Typically 30-40%.  So...if we discounted $125 x 40%, we would be looking at a true cost of $75.  With a copay, you would be paying anywhere from $20-$35 for this cost, and at the same time, you are paying 30-40% more in premium for this benefit.


Now, with prescription drugs, majority of carriers other than Blue Cross and Blue Shield of Illinois (must select $500 or lower deductible) will provide an upfront generic Rx copay than require you to meet a separate $500 or $1,000 deductible for Brand Name or Preferred Brand Name drugs, before you would begin to pay a copay.  Please note that Rx copay's do not apply towards the plans deductible or OOP.
If there is not a copay for prescription drugs on your plan, but with a benefit, the end cost (discounted rate) will be applied towards your plans deductible then OOP.

That pretty much sums up traditional plans of health insurance.

Now...when we talk about HSA qualifying plans, they are referred to as High Deductible Health Plans (HDHP) .  These are the only plans are regulated by the U.S. Government, and for 2010, the lowest qualifying deductible is $1,200 for an individual and $2,400 for a family.  The government also regulates how much risk you can be exposed to in a calendar year.  For 2010 an individual can not be responsible for more than $5,800 in exposure and $11,600 for a family.

HSA plans are usually presented with 100% coverage or 80% coverage.  At 80%, it might be more beneficial to look at a plan with copay's that will provide less risk than the deductible and OOP combined when looking at 80% coverage.

When their is more than one member on the plan, the deductible is a family deductible, and all expenditures are applied towards the one deductible, not separate, like traditional plans.

When looking at 100% coverage after the deductible, the premium rates are significantly lower than non-HSA
plans with the same deductible, and are providing 100% coverage after the deductible, rather than 80%.

HSA plans do not include copays for office visits or prescription drugs.  You will be responsible to pay for these expenses at the negotiated (discounted) rate towards your plans deductible.

However, HSA plans will cover your Preventative Care at either a copay or 100%.  So...their might not be a copay if you are sick and need to see the doctor, but there is one for your annual physical and OB/GYN for females.

Even while saving you money in premium rates and risk exposure, having an HSA qualifying plan, allows you to open up an actual Health Savings Account (HSA) at your local bank (some offer free-checking).  With this account, the money that you contribute into it can be used to pay for your deductible expenses and any IRS qualifying expense tax-free.  This method will only put more of your hard earned money back into your pocket.  The total amount of money that enters the account for the year, becomes an above-the-line tax deduction.

An individual has the opportunity to contribute up to $3,050 into the account, and a family can contribute $6,150 for 2010.  Any unused funds, roll over to the next year for additional contributions.

Please call the shoppe today to learn how you can benefit from HSA plans, and begin to start saving $ today!

You can learn more information by visiting my website, www.thehealthinsuranceshoppe.com

thanks,

-The Shoppe