Can I buy health insurance for less if I deal directly with an insurance company?

No. Health Insurance rates are strictly regulated by the state.  Your health insurance plan will cost the same whether you use the services of Benefit Studio Health Insurance or deal directly with an insurance company.


Why should I use Benefit Studio Health Insurance?

Benefit Studio Health Insurance is not owned by any insurance company, therefore we provide objective information to consumers and small business owners, helping them make informed decisions about their insurance needs.  We offer a broad selection of health insurance plans from many of the nation's leading health insurance companies.


What's a health plan network?

A health plan network consists of all the doctors, physicians, hospitals, clinics, and specialists that agree with an insurance company to charge discounted prices for their services in exchange for patient referrals.


What is the difference between in-network and out-of-network providers?

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates.  If you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider.  Though there are some exceptions, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.


What is a Preferred Provider Organization (PPO)?

A Preferred Provider Organization (PPO) is the form of managed care which typically allows you to see any doctor at any time.  A PPO negotiates discounts with doctors, hospitals and other providers, who then become part of the PPO network.  These in-network healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate.  When you see a physician out-of-network, you usually still receive coverage but at a higher cost to you.

One of the things many people like about PPOs is the ability to make self-referrals.  That means you can see any doctor you want, including specialists inside and outside the PPO network, without a referral.  However, you usually pay less when you see an in-network provider because of the negotiated provider discounts.


What is a Health Maintenance Organization (HMO)?

A Health Maintenance Organization (HMO) is a type of managed healthcare system.  HMOs and their close cousins PPOs share the goal of reducing healthcare costs by focusing on preventive care and implementing utilization management controls.

When you join an HMO, you choose a primary care physician who is your first contact for all of your medical care needs.  The primary care physician provides you with general medical care and must be consulted before you can see a specialist.  With a few exceptions, HMO members must receive their medical treatment from physicians and facilities within the HMO network.  The size of the network varies depending on the plan you choose.


Can the insurance company charge me more than the original quoted price for a plan due to my health history?

Yes, rather than decline an applicant the carriers, at times, will offer you a policy at a higher price based on risk factors such as smoking, pre-existing health conditions or medical history.


What is a premium?

The amount charged, often in installments, for an insurance policy.


What is a deductible?

A fixed yearly dollar amount you pay for most covered services before your plan begins to pay.  Depending on the plan, some services may not have a deductible or may cover certain services before the deductible is met.


What is a co-payment (or co-pay)?

A fixed dollar amount an insured individual must pay toward the cost of a particular benefit.  For example, a plan might require a $10 co-pay for each doctor's office visit.


What is coinsurance?

Coinsurance is the amount that you are required to pay for a medical claim, apart from any co-payments or deductible.


What is an out-of-pocket maximum?

This is the maximum amount of money per year you'll have to pay out of your own pocket for covered medical services.  Once you reach the out-of-pocket maximum, most insurance plans will pay for any additional covered services.  Some plans calculate the out-of-pocket maximum in addition to the deductible.


What is managed care?

Managed care health plans create "networks" of doctors, hospitals, and other health care providers.  Plan members have the most insurance coverage if they receive care from providers in the network.  The most common managed care plans are: Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs).


What is a drug formulary?

This is the list of all the prescription drugs that are covered under an insurance plan.


Can I get health insurance if I smoke?

You can find health insurance if you smoke, but your plan will most likely be more expensive than non-smokers.  Consider kicking the habit to save money.  Many plans require you to be smoke-free for a year to get non-smoker rates.


I am pregnant. Can I obtain health insurance?

Unfortunately, you cannot obtain individual or family health coverage while you are pregnant.  However, group health insurance plans may accept new enrollees who are pregnant.  So, if you have an opportunity to enroll in a group health insurance plan, that may be your best option.


What is a pre-existing condition?

Any health condition or illness that you had before your insurance coverage begins can be considered a pre-existing condition. Most health insurance plans have a pre-existing condition clause detailing under what conditions medical expenses related to a pre-existing condition are covered.


Are Medical Discount Plans the same thing as insurance?

No.  They provide discounts for medical services, but they do not offer the same type of protection as insurance.  Everyone is accepted to enroll in a medical discount plan regardless of health history or pre-existing conditions.


What is the best health plan for me?

The best match for you and your family may be different than the best match for someone else.  In order to help you answer this question, here are a few things to consider:

Are you going to need long-term coverage or just something for the short-term?

If you’re between jobs for 1-6 months, you may want to look into our short-term coverage options.  You should also consider individual or family health insurance so that your insurance remains with you and not your employer.

Are you looking for basic coverage or more comprehensive coverage?

Some insurance plans offer basic coverage to cover you in case of a major accident or illness.  These basic insurance plans typically have a lower monthly premium than plans with more comprehensive coverage.

Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which may include benefits such as: preventative care, physician services, prescription drug benefits, and routine office visits.  These comprehensive insurance plans typically have a higher monthly premium.

How important is the cost of the monthly premium to you?

If you choose a plan with a higher annual deductible, you will generally pay a lower monthly premium.  If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.

How important to you is easy access to specialists?

Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist.  If you prefer easier access to specialists, you should consider a plan that provides that flexibility.

Do you have a specific doctor or hospital that you would like to visit for healthcare?

If you would like to continue seeing a specific doctor, please check with the appropriate carrier to confirm that the doctor is included in their network.  Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.

What is the most you could pay out in case of serious illness of injury?

Health insurance plans typically place limits on how much a member is required to pay out per year.  This limit is often referred to as an out-of-pocket maximum.  Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year.