Buying Ohio Individual Health Insurance

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Your Top Ten Checklist

• Buying Individual Health Insurance Ohio
• Tracy McManamon
• One Source Benefits
• 877-549-1212

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1. Cost is More Than Premiums
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Premiums based on many different factors
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1. Cost is More Than Premiums

• Type of coverage
• Deductible and other cost-sharing features
• Network
• Health status
• Age
• Gender (where permissible)
• Geographic location

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1. Cost is More Than Premiums
Deductibles Amount you pay out of your pocket
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How much are you comfortable paying?
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1. Cost is More Than Premiums

• Lower deductible higher premium

Higher premium lower deductible
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Coinsurance
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2. How Coinsurance and Copays Work

• Health insurance plan payspercentage, you pay
  percentage
• Coinsurance may apply only to certain items like
  hospitalization
• Use of in-network provider services reduces
  your coinsurance costs
• Look at your maximum out-of-pocket expenses

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2. How Coinsurance and Copays Work
Copays You pay fixed dollar amount for doctor
visit or prescription
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3. Hospital Coverage
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Review limits
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3. Hospital Coverage

• Length of hospital stays
• Outpatient treatments
• Tests
• Doctor or specialist visits, medication while in
  hospital, and any inpatient hospital deductible

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Provider Networks
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4. Importance of Networks

• Contracted doctors, hospitals, pharmacies, etc.
• Health insurance plans distinguish benefits and
  costs by networks
• In network often less expensivethan out of
  network

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5. Preventive Care

• Look for
• Preventive care
• Blood pressure
• Certain cancer screenings,
• Type 2 diabetes screenings
• Vaccinations
• Annual physicals
• Routine GYN exams
• 100 coverage
• No copay, no dollar maximum
• No deductible, no waiting period

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5. Preventive Care
Eyewear Hearing aidsand services Acupuncture,
massage therapy, vitamins Gym memberships
Look for Discounts and savings
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At some clubs, participation in this program
may be restricted to new club members.
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6. Prescription Medication

• Work with a pharmacy that is in your health
  insurers network
• Generics usually cost less than name brands
• Look for difference in pricefrom generic to name
  brand
• Lower copay for generics
• Check formulary for specific medications

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6. Prescription Medication

• Mail order Rx convenience
• Specialty drugs like insulin delivered to your
  door

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7. Types of Health Insurance Plans

• Broader-based health insurance plans have most
  coverage
• Available in lower and higher deductibles
• Higher deductible lower premium
• Health Savings Account (HSA)-compatible high
  deductible plans
• Out-of-pocket can go up to 5,950 for individuals

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Health Savings Accounts (HSAs)
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7. Types of Health Insurance Plans

• Deposit money into special account at bank
• In 2010 up to 3,050 for single and 6,150
  family
• Pay no tax on amount deposited, grows tax-free
• No tax on earnings for qualified health care
  expenses
• Must use money for health care expenses to
  qualify for tax breaks

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Health Savings Accounts (HSAs)
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7. Types of Health Insurance Plans

• Can roll over year after year
• Must have annual deductible of at least 1,200
  single, 2,400 family

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Limited benefit plans
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7. Types of Health Insurance Plans

• Also referred to as hospital plans
• Less expensive than broader-based coverage
• Might be right for people who
• Want to save money
• Consider themselves relatively healthy
• Want to protect themselves from hospital stays

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Limited benefit plans
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7. Types of Health Insurance Plans

• Do not usually cover doctor visits or
  medications
• May cover generics
• Know what youre buying

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What to consider
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7. Types of Health Insurance Plans

• Overall health
• Need for doctor visits, tests, hospitalization
• Medication now, in future

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8. Applying for Health Insurance Plans

• Youll be asked for medical history
• May deny you or charge higher premium based on
  history
• Agent should pre-qualify before applying
• Consider your situation job transition, early
  retirement, own business

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Most changes not until 2014
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9. Health Care Reform

• 2010 changes include
• Temporary government program for those denied
  due to pre-existing condition
• Lifetime limits to be lifted
• Companies cannot cancel or discontinue your
  coverage retroactively except for non-payment,
  fraud, or intentional misrepresentation of
  material fact.
• No pre-existing coverage exclusions for
  enrollees under the age of 19

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Most changes not until 2014
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9. Health Care Reform

• 2010 changes include
• No out-of-pocket max for calendar year
• Will not have to share cost of in-network
  recommended preventive care
• Eligible dependent childrenokay to stay on plan
  until 26th birthday

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10. Who to Work With

• Professionals
• Registered, licensed agent
• Reputable, stable company
• Will help you
• Get the right health insurance plan for what you
  need
• Analyze your situation

Time and advice, no extra charge
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Your Top Ten Checklist
www.onesourcebenefits.com
1. Cost Is More Than Premiums 2. How
Coinsurance, Copays Work 3. Hospital
Coverage 4. Importance of Networks 5.
Preventive Care
6. Prescription Medication 7. Types of Health
Insurance Plans Available 8. Applying for
Health Insurance Plans 9. Health Care
Reform 10. Who to Work With
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www.onesourcebenefits.com
Aetna Advantage Plans for Individuals, Families
and the Self-Employed are underwritten by Aetna
Life Insurance Company (Aetna) directly and/or
through an out-of-state blanket trust or Aetna
Health Inc. In some states, individuals may
qualify as a business group of one and may be
eligible for guaranteed issue, small group health
plans. To the extent permitted by law, these
plans are medically underwritten and you may be
declined coverage in accordance with your health
condition. This material is for information
only. Plans may be subject to medical
underwriting or other restrictions. Rates and
benefits vary by location. Plans not available in
all states. Health insurance plans contain
exclusions and limitations. Investment services
are independently offered by the HSA
Administrator. Health information programs
provide general health information and are not a
substitute for diagnosis or treatment by a
physician or other health care professional.
Providers are independent contractors and are not
agents of Aetna. Provider participation may
change without notice. Aetna does not provide
care or guarantee access to health services. Not
all health services are covered. See plan
documents for a complete description of benefits,
exclusions, limitations and conditions of
coverage. Plan features and availability may vary
by location and are subject to change. Aetna Rx
Home Delivery and Aetna Specialty Pharmacy refer
to Aetna Rx Home Delivery, LLC and Aetna
Specialty Pharmacy, LLC, respectively. Aetna Rx
Home Delivery and Aetna Specialty Pharmacy are
licensed pharmacy subsidiaries of Aetna Inc. that
operate through mail order. Discount programs
provide access to discounted prices and are NOT
insured benefits. The member is responsible for
the full cost of the discounted
services. Information is believed to be accurate
as of the production date however, it is subject
to change.
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Thank You. Visit Us At
www.onesourcebenefits.com
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