In the world of California health insurance the average Californian will generally have many health care options available to them. The more health conditions one may have will of course limit these options but it is still important that you speak with a licensed health care professional who can keep you informed. Occasionally I will speak with a client who thinks they are uninsurable only to find that, after submitting their application they get approved at a slightly higher premium. Those people who do get turned down have the option of the MR MIP plan. MR MIP (Major risk medical insurance plan) is a government run health insurance policy that is funded through tobacco taxes. You can expect an inflated premium for the MR MIP plan due to it being a guaranteed issue plan that covers you regardless of health status. Uninsurable people may find they can work this plan into their budget with a little planning. It never hurts to ask for the details! My services are always free of charge and you will always get the most up to date accurate information.Many Californians will shop around on the internet in order to find the cheapest monthly premium available. While I commend these people for taking the initiative to do their own health insurance research; many never thoroughly examine the health insurance plan at the time they purchase it. A simple glance at the health plan benefits is not enough! Try to imagine yourself in a few different emergency situations, and then ask a customer service representative (with the insurance company) or your insurance agent to explain how specific catastrophic situations will be covered.
California health insurance plans that you see marketed as though they are gold usually have some serious pitfalls to them. The paragraphs below are examples of current plans that are highly marketed because of cheap premiums. I am going to take a few moments and analyze these plans to show you their pitfalls. I’ll make up a few accident scenarios so you can see exactly what kind of coverage you will get on these highly marketed plans. For privacy reasons I cannot disclose the name of insurance carriers or the plan title but I asure you the following story is based off of a real insurance plan that is currently being marketed today!
Andrew and his wife decided to go skiing in Lake Tahoe for a weekend. A few months before their weekend get away Andrew put his wife and himself on Health Plan Plus 900 deductible (name must be changed due to law...but this plan is real and currently being sold in 2009). On the way down the mountain Andrew falls off his skis breaking a leg and fracturing a wrist. The ambulance ride, x-ray, lab and hospital stay rack up a bill of $4000. With the $900 deductible already satisfied Andrew is left with $3100 which the Health Plan Plus 900 will cover at 60% leaving him with a total out of pocket cost of $2140.
But wait…
Andrew was administered Vicodin and Oxycontin medication due to the pain. While the Health Plan Plus 900 covered the Vicodin at a $10 co pay the Oxycontin was a brand named prescription; brand named prescriptions are not covered and Andrew ended up paying the full price at $100. A month later he had to refill the Oxycontin Rx racking up a total cost of $210 in prescription medications!
There is more…
There is a limit of 2 office visit check ups on the Health Plan Plus 900. The first 2 follow up office visits for his wrist and leg were covered at a $40 co pay. Andrew ended up being in a cast for 6 weeks, he needed roughly 3 more follow up check ups for physical therapy sessions once his cast came off. Since Andrew already exhausted his 2 office visit maximum for the year he ended up paying the full amount for each therapy session at $200 each. All five office visits combined totaled $680, none of this amount applied to the co-insurance maximum for the year. This means Andrew only satisfied $2140 of a $4900 out of pocket max for the year (the office visits and Rx co-pays on the Health Plan Plus 900 do not count towards the deductible and out of pocket max). If Andrew has another accident this year he must satisfy another $2760 in out of pocket cost to reach the maximum of $4900. An accident means he must be admitted to the hospital for the $2760 to be satisfied, Rx co-pays and office visits won’t count.
I hope this example will show you the dangers of a plan like the Health Plan Plus 900. Of course, it is better to have this insurance plan than nothing at all but with a quick assessment of your options J.C. Lewis Insurance Services can help find you the right coverage at the right price!
