Is a Texas Health Savings Account Right For Your Health Insurance Policy

Did the Health Savings Account (HSA) revolution take hold, or has it been a failure? The introduction of the HSA plan back in 2004 recived about as much fanfare and publicity as our newly elected President. Everyone from President Bush and congress to every local newspaper were touting their virtues. Have the HSA plans delivered? Have they lived up to expectations? Well, the answer is both yes and no, however they had a very rocky start. First, lets explain what is an HSA exactly.

To keep matters short I won’t  get into deep detail regarding the tax advantages HSA’s can offer to the Texas health insurance consumer. Bottom line regarding the tax advantages you are allowed to contribute up to a set amount into an IRA fund and withdraw monies for medical expenses. If you wish to know more about the tax advantages there are thousands of websites explaining the matter in more detail.

HSA plans are very simple plans, you have one deductible to meet for all insured family members, unlike your traditional PPO doctor co-pay plans which generally have two or three deductible per family. Most times the deductibles hover around $6000 per family. After the deductible has been met the plans that I write generally pay 100% after the deductible. Most PPO doctor co-pay plans then pay at the traditional eighty-twenty co-insurance. So HSA plans DO offer potentially lower out of pockets in the event a family has a major sickness or injury. There are some agents in the Texas health insurance market that do write HSA plans with higher deductibles and out of pockets but for the most part I see the Texas HSA plans with about the before mentioned six grand out of pocket.

So far so good, right? Well unfortunately wrong. Here is where they start to differ from their major medical sisters. HSA plans apply all medical expenses to the deductible. A Texas health insurance consumer can not have doctor visits and drug prescriptions covered until the deductible has been met, otherwise they fall out of compliance with federal IRS guidelines. The new trend with HSA plans is to cover a limited amount of preventive care before the deductible has been met, however the numbers that don’t cover preventive still out number the ones that do at this point. So simply put a client that goes to the doctor for the common cold or flu will pay all expenses out of pocket up until a point the family deductible has been met.

Texas health insurance consumers should understand that they are buying a straight high deductible plan with no additional benefits when they purchase an HSA plan from a Texas health insurance agent. Period. Clients that rank having doctor visits covered and drug prescription coverage with a co-pay are not ideal clients for these plans. The family will be very unhappy if they allow a Texas health insurance agent to convince them these plans are the right fit for them.

I find that Texas HSA plans work well for those families that have no children or the kids in the family are teenagers. I have also found the HSA plans work well for families that are over fifty-five, as they rarely go to the doctor. Texas consumers that buy the HSA and have a couple of kids under six could be very disappointed in the performance of their Texas health insurance policy.

One interesting note about HSA plans, they are the easiest plans to understand out of all the plans in the Texas health insurance marketplace. It’s simple, meet the deductible, plan kicks in.

In most cases HSA plans offer much lower monthly premiums than your traditional doctor co-pay plans. In some cases the monthly price drop can be a couple hundred dollars a month. That’s a substantial savings for consumers that are experiencing the financial hardships that our present economy is causing.

So to summarize, the HSA plan is great for families that do not go to the doctor often and they also provide some semblance of a cost certain on out of pocket expenses, however if you are someone that needs the doctor co-pay for the times you take your children to the doctor, and need the drug prescription co-pay the HSA will not work for you.

I think the HSA plans have not taken off in popularity as much as congress and some very single minded Texas health insurance agents thought they would. Who knows, maybe they someday will, I just dont think you can ever replace the mindset of having a doctor co-pay, so I think the plans will only be a marginal player in the Texas health insurance marketplace.

I do feel if you rarely use your coverage and are getting pinched by the extremely high premiums of today’s Texas health plans, get a quote today. They might well work for you, but if your expecting something that more resembles group coverage stay with your PPO doctor co-pay plan, otherwise unhappiness is just around the corner.

United HealthCare changes gears in the Texas Health Insurance Market

Golden Rule Insurance Company, which is owned by industry giant United HealthCare, changed directions slightly last week by introducing new products for consumers of the individual health insurance market in Texas. These new products can be viewed as both great news or harmfull to the Texas Health Insurance consumer, it all depends on who your health insurance agent is. Sound confusing? Well, it is. You can discuss United HealthCare with one agent and not two seconds later talk to another and get an entirely different price. Why? New product offerings are allowing the agent to decide which portfolio of products the wish to offer.

Let’s try an digest this confusion. United HealthCare, which offers it’s individual Texas health insurance policies through Golden Rule Insurance Company has been one of the most expensive plans on the Texas health insurance playing field. I quote them every day but their rates just don’t match up with the Aetna’s, and Blue Cross type of full doctor co-pay PPO policies that are being offered in Texas. Although the coverage offered by Golden Rule was solid, it was just to difficult to present to consumers when on average it was over one hundred dollars a month more.

Apparently Golden Rule recognized that they were not the large player their name comands and slightly revamped their portfolio for the new year. Here is the problem, they are offering the Texas health insurance broker the choice of selling one of two plans. One plan is similar to the current plan with solid coverage. The rates on this “standard” plan have decreased slightly. The second option that is being offered to brokers is a policy called the “Platinum Series”, this plan cost on average about ten percent more than the standard plan for similar benefits. The new Platinum Series plans also require a non-refundable thirty-five dollar application fee. Also a very strong note need to be played regarding how this Texas health insurance plan can be marketed. The Platinum Series plans offer the broker selling the Texas health insurance policy the ability to chop the number of doctor visits down to only four visits a year. When a Texas health insurance broker reduces the number of doctor visits on the Golden Rule policy the monthly premium the clients pays is now about the same price as the standard plan. In short, the Texas health insurance consumer would get lower benefits for the same monthly premium by selecting a broker that only offers the Platinum Series. it doesn’t make any sense to me either.

Now here is the big question. Why would any Texas health insurance broker agree to market this plan? It has a non-refundable thirty five dollar application fee, it has a wait of six months for any preventive care/wellness benefits, and brokers will be forced to sell the limit on doctor visits set at four a year to be competitive. The answer is actually quiet simple. It’s all about commission. The Platinum Series products offer higher commissions to the brokers presenting it.

We as agents and brokers in the Texas Health Insurance market had decisions to make when this offering took place. Do we wish to market the standard or the Platinum Series plans, we had to choose one or the other. We were not allowed to market both. The decision I made at peelerinsurance.com was to ONLY market the standard plans. I will continue to stand firm on my position of only offering the highest quality Texas health insurance products to the Texas consumer regardless of commission. It just goes against everything i believe in and everything I have worked so hard to accomplish in the Texas health insurance market to offer a product that I know is overpriced just for my own gain. It’s called morals and to me this lacks them as well as lacking fairness.

Some days I wonder if I will ever figure out what goes through the minds of insurance companies and agents by the actions they take, but greed is a nasty animal.

Now that you know the facts how can you the Texas Health Insurance consumer avoid this greed trap? After getting a quote from your chosen broker ask them if the plan is the Platinum Series product. Although I would like to think that they will tell you the truth you may wish to question further and ask if there is a limit on doctor visits or the six month wait on preventive care. Of course the application fee should also clue the consumer in as to what policy the broker is offering. If the answer is yes to any of those questions move on to someone else, or, call me. I will be more than happy to provide you quotes on the standard major medical doctor co-pay plans from Golden Rule.

Avoid the Texas Health Insurance PPO Network Trap

Most all Texas health insurance consumers on the individual market are using plans that in some form utilize a Preferred Provider network knows as PPO’S. These networks allow the client of a Texas health insurance plan to visit a doctor and be considered as in network therefore just paying a co-pay or deductible and allowing the negotiated billing to take over. What happens if your doctor withdraws from the network, in some cases even with pending major surgery just days away?

First for a little explanation of how PPO networks work. A Texas health insurance company enters into a contract with doctors and hospitals, also known as providers. The agreement states that the providers will charge a certain price for a certain medical procedure. These discounts can amount to as much as fifty or sixty percent. The advantage to the provider is they have some semblance of a guarantee of getting their services paid from the Texas health insurance company. The advantage to the insurance company is in cost containment and control. As long as your provider is in network you have a simple co-pay or deductible to meet and the provider then bills the Texas health insurance company. Before there were PPO plans consumers were forced to pay the bill up front and file the claim on their own without much help from the provider. Clients would wait weeks before the Texas health insurance company would release payment to the client for the bill.

OK, this exact case I’m going to explain happened just a few days ago. The consumer had been visiting a doctor that at the time WAS in network. Thousands of dollars in testing had already been done and it was determined the client needed brain surgery. The doctor scheduled her brain surgery for a few weeks out. During the pre-op meetings my client was informed that her doctor no longer was a member of her PPO network, as the provider had decided to stop taking all insurance plans. Brain surgery is less than two weeks away and her provider just dropped the biggest bomb of her life. The client is now left scrambling to figure out what to do. The doctor didn’t seem to care that his client would now have to pay thousands upon thousands of additional dollars in order to have the surgery. After speaking with the insurance company it was determined that she could attempt to convince the provider to sign a continuity of care agreement, this is an agreement that for just her surgical procedure he would bill all charges as in network. He still would not budge, he held firm on his new business practice of NO INSURANCE. Cash only.

The reason I feel this story is so important is this. Most Texas health insurance agents or brokers do take the time to inquire about who your present doctors and providers are but things can change. Any time a consumer needs to have a medical procedure please ask questions, inquire about PPO network status. Before a surgery is preformed request to know who will be the anesthesiologist and confirm he is in network. Confirm that the facility or hospital is in network. So many times consumers of Texas health insurance policies just assume that if my surgeon is in network all the providers will be in network. That assumption is wrong up to fifty percent of the time in my opinion. 

When a doctor is considered out of network on a Texas health insurance PPO plan, out of network deductibles and charges apply. These amounts can add up to thousands and thousands of dollars that are unexpected. Always protect yourself, ask questions call the facility and confirm your status. Just because the providers show up in an outdated network book or on the Internet as in network means nothing. Things change and these type of changes can only do harm to the consumers of Texas health insurance policies.

Hidden truths about Co-Pay Health Insurance Plans in Texas

In Texas there are basicially three types of health insurance plans, the health savings account high deductibles plans, the P.P.O. doctor co-pay plans and the limited benefit plans. Today I will just talk about the PPO doctor co-pay plans and how so many Texas families find confusion or become dissatisfied after a claim is processed after a doctor visit.

OK, lets set this up. You take your young son to the doctor because of an apparant cold he has. While at the visit the doctor decides to run a few test to get a better idea of what he is dealing with. Lets say some blood test and a throat culture are done. He determines all is fine your son just has a cold, gives you a few sample drugs and your on your way with only the twenty dollar co-pay. It’s all over, right? Well, unfortunately WRONG!!

Two weeks later you open the mail and you have received this strange bill from the doctors office for lets say three hundred dollars, this bill says something about all the testing that was preformed the day of your sons visit as not covered by your insurance company. Whats the first thing most Texas families do? Call the agent or Texas health insurance company asking why was it not covered. I have taken countless of calls related to this very issue.

Most times the lab work preformed on your son was not denied for coverage, is was applied to your yearly deductible. This is so very frustrating to both the agent and you the client. For years most individual health insurance companies in Texas would have a co-pay for the doctor visit ONLY and all other charges applied to a deductible that was so extremely high the consumer would never meet it. Almost 100% of policies operated in this fashion for years up until just a year or so ago. Now I am finding more and more Texas health insurance policies allowing lab and x-rays to be covered in the co-pay eliminating the hassle and stress of figuring out a claim.

In my view it all started with Aetna, about three years ago when they introduced their individual health insurance policy in Texas they paid lab and x-rays within the small co-pay, provided the charges were incurred at the time of the doctor visit and done in his office. This health insurance policy eliminated clients calling and discussing claim problems with their agent instantly. It was amazing. But most all the other Texas health insurance policies all still applied charges outside the normal doctor visit consultation to the base deductible.

Moving the clock forward to today I find that more and more Texas health insurance companies are starting to pay lab charges within the co-pay and the Texas health insurance consumer is the winner. Texas health insurance companies like Unicare, Golden Rule/Unitedhealth Care, and Humana have to a certain degree  all followed Aetna on this practice and more and more of my business seems to be moving toward these companies. Unicare made the biggest change by also allowing more preventive coverage for children under eighteen and a simple co-pay for emergency room treatment. They made drastic changes with their benefit configuring and just comparing apples to apples Unicare offers the best policy on paper than any company in the Texas health insurance market.

When you decide it’s time to start looking at a new Texas health insurance plan keep in mind the pitfalls of the doctor co-pay and get assurances from your Texas health insurance agent or broker than the new plan you are getting is what’s called an all inclusive co-pay so you don’t have any hidden surprises awaiting you in the mail. Your wallet will thank you!

Individual Texas Health Insurance VS. Group Coverage

Well, it’s that time of year again, open enrollment periods for many families on group policies at work. The details are overwhelming and the prices keep climbing. The solution? Why not look into moving your dependants over to a Texas individual health policy and you, the employee, stay on your group coverage. Most consumers find that a monthly price savings of several hundred dollars will be the reward in this practice. Group coverage at work is required by law to pay a percentage of the employee coverage and in most cases the coverage cost next to nothing, where the expense lies is in the dependants coverage. Look into securing private insurance, but in doing so proceed with caution, deal with experience and do it quick!

Before deciding to jump ship on those hefty cost being deducted form your hard earned paycheck there are several things that MUST be considered before making the move to a health insurance policy in Texas. First, are your dependants healthy? If so by all means get a Texas health insurance quote. I find that families paying seven or eight hundred a month for group coverage can save about three hundred dollars a month. Consumers looking into a Texas health insurance policy must understand that unlike group policies, individual policies can and will underwrite every health insurance application. Families with health conditions that are requiring medication MAY find it impossible to secure a policy without exclusions and limitations. Not to totally deflate your thoughts on making the move to individual health coverage in Texas but with health conditions it does make it more difficult to secure health coverage in the time frame you have to notify your group coverage of your benefit selection for the new year.

Next, deal with an experienced broker or agent that can walk you through what to expect when getting individual health insurance in Texas. Most times there are slight differences between group coverage and individual health insurance in Texas. An experienced agent understands these and will advise accordingly. Without knowing these differences the consumer can be in for a major shock at claim time.

Also, give your agent or broker enough time to assist in finding you a Texas health insurance policy. Just because you submit the application to a Texas health insurance company does NOT mean you are covered. The general process takes about three weeks to complete, sometimes even longer.. and of course lots of times even less but we are dealing with your families health care we need ample time for you to make a decision based on fact, not desperation. So many times in my sixteen years in the Texas health insurance business I have had consumers call are inform me they would like to get off their group coverage but they have to do something by “the end of the week”.. and today is Wednesday. We just can’t get that done. We generaly need a month but in extreme cases I can do it in two weeks.

A few safety nets are that during the next year open enrollment for heath insurance you can migrate back to your group policy.

So if you find yourself getting close to your open enrollment period and are tired of seeing all that hard earned money being deducted from your paycheck every week, call an experienced Texas health insurance agent, allow them to assist in get you several quotes, talk about them and proceed in saving thousands of dollars next year in health premiums. Your bank account will thank you for it!!

The Texas Health Insurance Underwriting Jungle

OK, you find the right agent or broker, he shows you the best health insurance plan in Texas to fit your needs, the price fits in perfectly with your budget… all is great, right? WRONG!! Now the hard part. How on earth, in this economy when insurance companies are tightening their belts, are you going to fit your health history through the eye of that needle called Underwriting? Well, it’s tough. Health insurance in Texas has becomea game that insurance companies play with both agents and consumers. Every single health insurance company in Texas has a different set of standards they require clients to meet in order to get approved. What one company will accept as preferred issue the next will decline or place some ridiculous exclusion on the policy that any ethical agent or broker can’t recommend. How do you the client, who buys a policy once ever 3 years, manage this jungle? Easy. Deal with experience!

Most licenced insurance agents that have at least 10 years experience in this business and ONLY focus on individual health insurance in Texas should know the heartbeat of every insurance company. Experienced agents are writing and dealing with on most days the underwriting departments of every major carrier. Generally a day does not go by that I have not had long discussions over health conditions with at least 4 different companies. in any one week I will have spoke with underwriters twenty or thirty times. What does all this talking with insurance companies have to do with getting your policy approved and issued? I know where we should apply for coverage in the first place, eliminating hours upon hours of frustration for both you and me. Talking daily with the underwriting departments allows me to know with almost precision what health conditions companies will or will not take. It will also allow me to know just how that recent bout with say strep throat will be addressed by the companies.

Another factor that the underwriting jungle presents is ratings, almost every company has both preferred rates and standard rates, also in these standard rates are percentage loads above standard rate. What good is it if you get quoted a rate and then after the underwriting process it come back fifty percent higher. In this event you are not only frustrated but feel misled by someone. An experienced agent generally know how the underwriters will view a particular health condition and will apply the rating upon quoting the policy.

Health insurance companies in Texas are also allowed by law to place condition exclusions on policies. All but about two of the major health insurance companies in Texas do place these exclusions on a policy. If I speak with a consumer regarding a new policy I will only quote a company AFTER I have done a very brief questioning of a clients health history. My thoughts are which health insurance company in Texas will most likely approve without exclusions your policy. Why on earth would I quote you a company if I know from experience that company will only decline you from coverage? i would rather get it right the first time.

The jungle known as underwriting we as agents fight every day should never be your worry. Use an experienced agent that can be referred to as the “Indiana Jones” so to speak of underwriting!

Texas Health Insurance Minefield

When I started in the insurance industry in 1993 insurance policies were mostly cut and dry. Doctor co-pay plans were just becoming popular, away from the traditional deductible first old 80/20 policies. Back then deductibles hovered around 500 dollars. Today companies have raised premiums to the point that in order to secure adequate coverage at an affordable monthly premium, families have been forced to raise deductibles.  I don’t like this any more than you do, as my only goal is to provide you with the highest level of coverage at the lowest price.  After speaking with a potential client I will “shop” your business with all the “major players” in the individual health market here in Texas. I promise that when we are done you will be provided the highest benefits at the lowest cost. No agent or agency can beat what I quote you on price.

One problem that is running wild in the Texas health insurance market is the relaxed standards of benefits that can be offered. Recent law changes allow insurance companies to offer much more limited policies and I am finding that these products are being marketed by agents just looking out for THEIR bottom line. Although these policies are cheaper than your more traditional PPO plans, they expose the client to substantial out of pocket expenses in the event of an illness. Things like no drug prescription coverage, limited doctor co-pays, facility fees, and is some cases limited coverage in the event of a major illness or accident. I will never quote these types of limited benefit policies; I will only quote the products that reside in the MAJOR MEDICAL family of policies. Anyone that quotes lower prices than Peeler Insurance you need to closely review the benefits before moving forward with the policy.

I realized at an early stage of my insurance practice that in order to be successful I had to be able to offer my clients virtually every insurance company on the market. This practice ensures that when I quote a family a price I will not be undersold by some agent, possibly new to the industry that doesn’t have your best interest at heart. I need your business not only for today, but need to retain you as a client for years and years. As an insurance agent, you only do that by building trust and offering your clients top-notch service. I think you will be not only impressed but shocked that you don’t feel the need to shop agents and policies every year.

Today we have hundreds of excellent options available in the individual health market, to some degree more than ever. I work with the companies that know their way around the health insurance mine field, names like Blue Cross, Aetna, Humana, United Health Care and Unicare to name a few. When I provide a quote I will be looking over almost 1000 different plan types. So if you’re looking for straight answers, a blunt assessment of your present coverage and the most inexpensive insurance available in the Texas market, call or email me and lets discuss your needs!