Matloff Insurance / Health

HEALTH INSURANCE

Protect your family against the financial burden

of rising healthcare costs

Almost everyone knows that health insurance is probably the most important insurance we own. We never want to be ill or injured, but we know that sooner or later we may have a significant medical bill at the ER, doctor’s office or surgical center. A lengthy hospital stay could run up a bill of over a million dollars.

The Affordable Care Act (ACA), signed on March 23, 2010 and implemented on January 1, 2014, has made health insurance simpler in some ways and more complicated in other ways.

What's simpler?

The ACA allows any U.S. citizen or legal resident, regardless of health, to qualify for health insurance. There are no medical questions asked anymore. Health insurance is guaranteed issue. There are no waiting periods for pre-existing conditions.

What's more complicated?

The rates for most policies have gone up, not down. The network of doctors and hospitals have changed, so that the insurance policy you have may or may not cover your doctors, hospitals, or medications.

We help individuals and employers find health insurance policies that are affordable. We review all of our client’s doctors and preferred hospitals and determine which insurance company and plan will be best for them.

For employers, group health insurance requires periodic reviews. We work three months in advance of your renewal looking for better and more affordable plans.

For some people, Washington has made a mess of health insurance. For others, it has been an opportunity to correct problems of the past. Time will tell. But for now, we are here to help you or your firm to make the right decisions.

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Medicare RX Plan and Medicare Advantage
Third-Party Marketing Organization (TPMO) Disclaimer:

"We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options."

Open Enrollment

Open enrollment for individual health plans is from typically from November 1st through January 31st. You must have a Qualifying Life Event in order to purchase a policy outside of the open enrollment. The effective date will vary depending on the qualifying event and application submission date. Please contact us for more detailed info.

Open enrollment for group or employer-sponsored health plans varies from company to company, though most happen in December or January. You must have a Qualifying Life Event in order to join the policy outside of the open enrollment. The effective date will usually be the date of the qualifying event. Please contact us or your HR administrator for more info.

Important Checklist

Before purchasing or joining a plan, it's always a wise idea to check at least the following items:

-Are your doctors in-network? If not, how does the plan work with out-of-network doctors? What is the reimbursement rate and how is it calculated?

-Will your medications covered? Do any require prior authorization (PA) or have any quantity or dosage limits?

-How will your pre-existing conditions and ongoing treatments be covered?

-Will your pending procedures be covered? If so, how much will they cost you?

-Based on your expected needs, which plans will provide the best financial value or lowest overall cost (premium + expected healthcare costs)?

-Do you qualify for financial assistance for individual plans or what is the employer subsidy on your group's plans?

-What is your are your options if a procedure, medication or claim is denied?

-For HR directors or business owners, is there a better carrier offering a better deal with similar or upgraded benefits? Do you have Kaiser on the side of your existing group health plan? Is the company compliant with the ACA? Do you have an IRS Section 125 (aka Cafeteria Plan) and Wrap Summary Plan Description (SPD)?

-Etc.

As a value added service to our group clients, we cover the cost of the Cafeteria Plan, Wrap SPD, and Federal COBRA upon request.

DESCRIPTION

HEALTH QUOTE REQUEST