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​Health Benefits Now Blog
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Health Insurance 101: Can I Go From Substandard to Standard Risk?

4/18/2019

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A Smoker, A Diabetic, And An Asthmatic Walk Into A Bar…

When it comes to health insurance, there are certain factors we can control--and certain ones we can’t.

What can we do about our genetics and our lifestyle choices that will insure we get the best health insurance for our buck?

How Pre-Existing Conditions Affect Health Insurance

A pre-existing condition is a medical condition that existed before a health plan was in place. These conditions can include diabetes, asthma, cancer, and the like. Whether or not these diseases are congenital does not affect how the pre-existing condition is treated in the underwriting world.

Underwriting is the process of analyzing and taking on risk. In insurance, your application and medical records are examined by an individual underwriter, who compares you to a large pool of applicants. This helps them to determine how much your risk is “balanced” by the circumstances of others in the pool. Age, health conditions, weight, and even gender affect the balance. For example, a female is generally reviewed as a preferred risk over a male-- because statistically females live longer.  

Within health insurance, anything besides Obamacare will typically make you wait 1-2 years before receiving any type of coverage regarding that pre-existing condition--IF they accept the pre-existing condition in the first place.

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Lifestyle Changes And When They’ll Take Affect

Unlike pre-existing conditions,  the factors you can control--for example, any nicotine habits or how much you weigh--can work out in your favor.

But how much change is needed to affect your risk level, and when will any changes in lifestyle take effect?

Say you want to kick nicotine and you’re already covered. On average, you’re paying $50-$60 more per month for your coverage than would a non-smoker. You can submit a change in your status, but only after you’ve been off of nicotine products for one full year.

Or, say weight is a factor. For all its flaws, underwriters still use the BMI to determine whether someone is overweight. Taking a look at the BMI index will help you determine what category you fall into. Keep in mind that the BMI is largely unisex and does not take into account the difference between fat, muscle, and bone. While some underwriters take this in strides, it’s not guaranteed.

So, let’s say you’d like to lose some weight and bring down your premium. Your first 10 pounds account for the largest change in premium, and anything more than 10 pounds will only be credited by half--unless you’ve kept off that weight for more than a year.

Take a look at it this way:

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Peter weighed 300 lbs when he first had his health insurance plan. In the past six months, he’s lost 80 lbs.

​But what the insurer takes into account is this:


300 - 10 lbs - 35 lbs (or half of 70, the amount of weight lost after 10 lbs) = 255

So, even though Peter technically weighs 220 lbs, the insurer will treat him like he weighs 255 lbs.

Happily, Peter is able to keep off this weight for a full year, and is then credited as 220 lbs and his premium is adjusted accordingly. The insurer, again, makes this decision based on statistics. Many people who lose weight gain it back within a short period of time, so the insurer will mitigate risk by making sure any new habits have at least a one-year shelf life.

Need A Quote?

One of the things you can control today is whether or not you request a free health insurance quote.

We’ll find out where you’re at right now and where you can be, premium-wise. And yes, we have options for you outside of Open Enrollment.

What are you waiting for?

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Get A Quote!
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Health Insurance 101: What If I Missed Open Enrollment?

4/12/2019

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You missed open enrollment for 2018--can you still get health insurance for 2019?

For traditional health insurance, you’ll have to wait till November 1st of this year. But thankfully, there are still a host of options available to you!

Short-Term Medical

Short-term medical is a traditional insurance route designed to fill in all sorts of gaps. Whether you missed open enrollment or are simply waiting for your job’s benefits to kick in, you don’t have go a single month without healthcare coverage.

Available for installments of 1-12 months, short-term medical plans offer the same benefits as long-term plans, such as:

  • ER and ambulance coverage
  • Urgent care benefits
  • Certain types of preventive care
  • Often, access to telemedicine networks

These plans aren’t designed to cover, necessarily, for niggling costs like doctor’s visits, but are there for true emergencies: hospital visits, urgent care, and the like. You’ll know you’re covered for the greater of risks, and all without going through Open Enrollment’s loopholes.

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Get A Short Term Med Quote!
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Ministry Health Plans

Also known as healthcare sharing ministries, these plans have existed as an alternative to health insurance for several decades but are just now experiencing a surge in popularity.

Ministry health plans are NOT insurance. Therefore they are NOT subject to the open enrollment regulations. They still operate on the same principles of insurance (pooling together resources to mitigate risk) and offer competitive healthcare packages.

The key things to note are:

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Get A Ministry Healthshare Quote!
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Supplemental Insurance

Anything that covers above and beyond minimum essential coverage counts as supplemental insurance, or ancillary products.

Ancillary products like vision and dental insurance are free from the open enrollment deadline. Other products could include critical illness, long term care, and disability insurance.

These narrowly focused products offer cheaper premiums and, in the case of critical illness insurance especially, can deliver the most bang for your buck should the worst come to pass.

Our main concern with insurance is always the emergencies that fall into the “expensive and unexpected” category, and if you’re waiting for your minimum essential coverage, they can cover for some for the more extreme cases.

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Get A Supplemental Insurance Quote!
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Patient Advocacy

Our last suggestion is different from both traditional health insurance and healthcare sharing ministries. Whether you’re covered or not, patient advocacy programs can provide you their services for a simple monthly fee.

What are these services? Healthcare advocates focus on reducing your out-of-pocket costs when it comes to medical bills. They want you to receive the most reasonable charges (if any). They work with insurance carriers, doctors, and administrators to fight on your behalf and get you a UCR (usual, customary, and reasonable) charge that is UCR.

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Health Insurance 101: I'm In Transition--What Should I Do About My Health Insurance?

4/4/2019

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A Game of Zeroes: Why You Shouldn’t Go Periods of Time Without Health Insurance

You’re in transition. Whether voluntary or not, whether you lost your job or chose a new one, whether you’re going freelance or waiting for Medicare, the bottom line is: you need health coverage.

Your first option might be to just ignore your other options. You’ll just wait it out. What’s a few months without health coverage, especially if you’re not prone to vertigo-inducing hobbies or any clutch of deadly diseases?

The answer is simple, and we’ll illustrate it with what we like to call the “game of zeroes.”

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Say you have a $100 medical emergency. Not the end of the world. You might have preferred pocketing that Benjamin but a bill like that isn’t about to break the bank.

Let’s add a 0 to that sum. Now you’ve got a $1,000 emergency. A set-back? Yes. But again, not enough to bankrupt you. Even if you don’t have that kind of money ready in the bank, paying off $1,000 is not unheard of.

Time to add another zero. Now you’ve got a $10,000 medical bill--equivalent of a few days in the hospital. This hurts. This can turn into a long-term credit nightmare. Still smaller than the average college debt but at least it’s not bigger than your yearly income.

Well, another zero then. Let’s contemplate a cool $100,000. Not a reasonable sum by any stretch of the term, but you know the price of catastrophes can be high. It’s prices like these that health insurance was designed for. And exactly the kind of unexpected sums that can bankrupt the uninsured.

The odds of such catastrophic cases are always low, but it’s their possibility that created the necessity for insurance in the first place. Insurance is the analysis and mitigation of risk, and we all enter into insurance contracts because we know life comes as a bit of a bet. Accidents, allergies, asthmatic attacks--and these are just what’s listed under the letter ‘A.’

If you don’t believe us, just read Steve’s story here.

If you’re ready to look at what options you have besides waiting, we’ll guide you through our short-term solutions (for those who simply are in a transition), long-term solutions (for those who want a bit more control over their health coverage), and alternative solutions (for those who want to supplement or replace traditional health care coverage).

Current Trends in Healthcare Coverage

Let’s take the broad view first: presidential mandates. Obamacare is in effect for the next foreseeable future, but the penalty fee for non-insured has currently been waived by President Trump. While that decision has not yet made its way out of the courts, the fee is not currently a slap-on-the-wrist that the average consumer needs to worry about.

Now, the average person will probably receive health coverage through their place of work. Group policies typically create more affordable premiums, which is why this model became so popular in the first place. However, this may not always be the case.

Before the 1980s, health insurance worked a lot like car insurance--you paid out-of-pocket for smaller expenses like doctor’s visits, but you were covered for hospitalization and the like (similar to how you pay out-of-pocket for oil changes but your auto insurance is there for you in the case of an accident). However, health insurance morphed into what it is today: a full package deal that covers for doctor’s visits, specialists, prescription assistance, hospitalization, telemedicine, and the like. And the more services a company provides, the more they’ll charge. Premiums have continued to rise since the 80s--but will this be the model for the future?

While IRAs, 401(k)s, and other retirement plans are still a large factor in employee benefits, it’s important to think about the needs of the next generation and technological breakthroughs like telemedicine will affect the cost and demand of healthcare coverage. It won't always be one-size-fits all; with demand for personal customization in everything from frozen yogurt to health policies, do you have a good idea of what you want/need going into the next 10 years?

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Get A Health Quote Now!
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Short-Term Solutions

You don’t expect to be out of health coverage for more than a few months. You’re simply waiting. Waiting for your next job’s benefits to kick in, waiting for your retirement check.

Waiting can be a dangerous game--did you know that three-fifths of Americans don’t have enough money saved up for a minor medical emergency (averaging $1,000)?

Thankfully, there are options outside of locking into another long-term health coverage plan. The most straightforward of these is the concept of short-term medical.

Short-term medical plans allow members to choose coverage from anywhere between 1-12 months. Members pay a monthly fee to have access to the same types of services available to them in their traditional health care coverage plans, including:

  • Doctor’s Visits
  • ER and ambulance compensation
  • Urgent care benefits
  • Certain types of preventive care
  • Telemedicine, etc.

And what’s a temporary monthly fee compared to a $10,000 medical bill?

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Get A Short Term Med Quote Now!
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Long-Term Solutions

In this scenario, you need a long-term solution. The strategies we list here are for those who A) want to keep their current health plan but add to it, or B) want to replace their current health plan (or lack thereof) entirely.

Where do you find yourself?


  • Supplementing Current Health Insurance:
    • Ask this critical question, “What does my policy NOT cover?”
    • This list is shorter than what IS covered, for one
    • With this in mind, you can take control of your insurance and evaluate what gaps of coverage you want to fill in
  • Replacing Current Health Insurance:
    • Do you want a traditional plan that covers doctor’s visits and emergencies, or do you want to cover for specific emergencies only?
    • Does your max benefit make sense for the amount of people being covered in your plan? (A family of six with a $25,000 max benefit is a lot different from a couple with a $25,000 max benefit)
    • Does it make more sense to continue with your current group or individual plan and simply supplement it (see above)?
    • Can you switch to your spouse’s group policy and then add one of our plans listed below?
  • No Current Health Insurance:
    • If health issues or financial restraints has kept you from applying so far, please consider our Alternative Solutions as well, so that you’ve got some amount of healthcare cushion while looking into your options.

Let’s return to the game of zeroes. Can you afford a $75 doctor’s visit? Can you afford a $100 gaff or a $1000 accident? Yes--you may not want to, but these aren’t unreasonable emergencies. What we want to avoid--what insurance was really designed for--are these large, unreasonable sums, like $10,000 or even $100,000 medical bills.

There are plans that cover specifically for these types of emergencies. And yes, you can apply for these policies without having to give up your current health plan. Typically broken up by types of medical calamities, the four most popular types of coverage plans are:

Accident insurance: Designed to help pay for out-of-pocket and medical costs that may incur due to an accidental injury. It can even cover for transportation and lodging needs in addition to hospitalization, exams, and the like.

Critical illness insurance: Otherwise known as a dread disease policy, it was initially designed to help elders afford the privilege of growing older--even at the risk of such catastrophes as stroke, heart attacks, organ transplants, coronary bypasses, etc. In addition, critical illness insurance can cover for costs not typically included in traditional health insurance coverage.

Cancer insurance: Sometimes cancer is not included in a critical illness policy (see above) and may be listed under a separate coverage plan.

Disability insurance: Provides income during transitional periods when you might be missing work or making less money because of a narrow set of circumstances.

Because these policies are designed for very specific circumstances, and not as a catch-all where everything but the doctor’s sink is thrown in, they can be very affordable. Not only that, but they account for the emergencies that can truly lead to bankruptcy. They make for great supplements or even affordable replacements for traditional health coverage.

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Get An Accident or Critical Illness Quote Now!
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Bonus Solution: Patient Advocacy

A patient advocacy program is available for the uninsured, underinsured, and just plain old insured alike. For a monthly fee, you have access to a network of professionals who will work with carriers and hospitals alike to reduce your out-of-pocket costs incurred due to hospitalization or other patient services. Find out more here!

And don’t forget, every Health Benefits Now quote is quick, free, and painless!

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Life Insurance 101: What They Don't Tell You In the Pamphlet

3/29/2019

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When's The Best Time To Apply For Life Insurance?
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The best time to apply for life insurance is in your twenties, bar-none. Why? Whether you opt for whole life insurance or 30-year term, if you apply in your twenties you’ll:

  • Pay less premium over time
  • Be covered during your “Full House” years
  • Likely have less expenses and/or health issues to wrangle over in the initial application process 

This is regardless if you’re married and have children, whether you’re twenty or twenty-nine.

Now, we’ll go easy on you and admit that if you’re still covered under your parents’ insurance (up to age 26 in most states), then waiting to sort out your health and life insurance around age 25 isn’t a bad bet. And if college debt, car payments, a minimum wage job, or what-have-you has got you second-guessing additional monthly payments, we’ll level with you:

While we can’t technically hand out what your premium would be if you started paying in your twenties vs. if you decide to pay later on in life (there’s regulations about these things), we can tell you that a ballpark average for a twentysomething applying for good life insurance usually lands between $35-$50 a month. Do you know what that looks like? Two nights eating out + a Netflix or Spotify account.

The idea of possibly cutting back making you antsy? While everyone’s situation is different, we tend to err on the side of “don’t sweat the small stuff.” We’re going to drop the name of a guy who doesn’t even know our insurance company exists (Ramit Sethi) and let you chew on this principle:

It’s called the Big Wins Manifesto, and we love it for so much more than the fact it basically says, “Hey! Why give up the $5 lattes [and the much-needed life insurance] when you can focus on the big investments that will actually get you ahead?” While the focus of this article isn’t career-based financial planning (and we’ll just link Sethi’s manifesto so you can learn from and support his ideas yourself!), it’s worth looking into as you start making financial decisions for you--and not as a shoulda-woulda-coulda from a random financial expert.

What If I’m Not In My Twenties?

No, you don’t start dying on the inside once you reach thirty. Where that depressing idea of looking at life came from, we don’t want to know. And we’re not about to make you feel guilty because you’re still deciding on life insurance in your thirties and up.

Yes, life insurance rates tend to rise depending on the age of the applicant. And yes, there’s a bigger difference between thirty and thirty-nine than there is between twenty and twenty-nine (at least in the underwriting world).

But we often know more of what we want and what we need by the time we’re in our thirties: our careers have schooled us on personal and financial investments, families and mortgages are (on average) in the picture, and thoughts of the future are a bit more immediate.

Besides, there’s always term insurance; no one says you’re married to life insurance (unless they’re selling you whole or universal life, that is).  A ten-year term
life policy may be just up your alley!


​How Do Tax Brackets Affect My Death Benefit?
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On the topic of costs (oh, joy!), let’s take the long view on the hidden costs of life insurance. This is going to vary over time and by state, but let’s get comfortable with the overall idea so it doesn’t sneak up on us later, shall we?

When death benefits are issued, they are taxed on that year’s tax bracket--not the year the policy was first issued. That could mean that your $200,000 death benefit could be cut down by say, a 28% tax bracket. Okay, now your beneficiary receives $144,000.

While there’s no way of knowing what the given tax bracket might be should your policy ever be issued (if you have term) or exactly when it is issued (if you have whole), it’s not a bad rule of thumb to estimate a 30% tax bracket and decide if that means you want to insure a higher death benefit or look into additional financial investments to help provide for your loved ones.  

And that’s something important to remember: life insurance is an investment.

Can I Pick A "Wrong" Beneficiary?
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Here’s a quick tip: if it can be helped, don’t declare your estate as your beneficiary.  

Those tax brackets we just mentioned? Well, when you apply your death benefit to your estate, your heirs now have a wealthier estate to manage. And a more expensive estate = a more taxable estate. Oftentimes your heirs will be saddled with more taxes, less death benefit, and the beginning of a headache. But be sure to talk with your personal agent about what possible scenarios would look given your unique circumstances.

Most people will be content leaving their primary beneficiary as their spouse, and may name their children as contingent beneficiaries. In fact, it's almost always a good idea to name a contingent beneficiary, and the reasoning is the same as the estate example above. Say you and your spouse both pass away in a car accident and you have no contingent beneficiaries declared. Your death benefit is now inherited by your estate--which again creates that over-taxed scenario that we're not the biggest fans of.

But there can be dozens of ways and reasons for your life insurance policy--like those illustrated in
this article.


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We want to make your policy shopping quick, comfortable, and painless. These are just a few of our insights on life insurance, but feel free to contact us today with any of your burning life insurance questions!

Until then--be happy, healthy, and insurance-savvy!

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Life Insurance 101: A Quick Overview

3/22/2019

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Perhaps you know next-to-nothing about life insurance--the terms, the angles, the advantages and disadvantages. And you wouldn’t be alone.

Today we’re bringing you three quick life insurance tips: we’ll break down the basic terms you need to know, look at how much insurance you need, and explain the differences between the two main types of life insurance.

Let’s get started!

Life Insurance In A Nutshell

Though different forms of life insurance have been around since the days when the Roman Empire was still kicking, insurance as we know it really began in the mid-1800s. It’s a formal contract between the insured and the insurer that states a lump sum of money will be paid out at the insured’s death, or after a set period of time--given that the insured pays their premium, that is.

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​Most people choose between $100k to $250k for their death benefit. How can insurance companies afford to promise all of these extravagant sums? Well, it turns out that your high school statistics class was good for something.

Underwriters use the law of large numbers to determine the probability that they’ll be paying out these grand death benefits. Obviously, they bet that the majority of people will not need to cash out before the end of their term (if they have term insurance) or within the first, say, ten years of their whole term insurance policy.

If this was more likely (say, the member in question had pre-existing conditions, poor health, or was considerably aged), then they would adjust for this likelihood either by increasing premiums across the board (which naturally occurs over time) or by denying the potential member.

How Much Life Insurance You Should Buy

Most people purchase between $100k and $250k of life insurance. Typically, the age and amount of children, the salary a spouse does or doesn’t make, and the cost for daily living will determine the appropriate amount.

  • How much do you have in savings?
  • How many kids do you have?
  • How many years would you like your family to be covered?
  • And what would the monthly living costs look like?

It’s a good idea to keep in mind funeral costs, charitable donations, and educational funds, amongst other costs and concerns that go beyond the typical lump sum payout.

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*Keep in mind that the example chart above does not account  interest rates or tax brackets.

Whole vs. Term Life Insurance

Life insurance is a financial tool, but it’s not the only one.

If you’re not yet familiar with what whole life or term life are, the basic split comes down to this:


You pay for whole life until you die. As long as premiums are met, you’re covered. As you continue to pay premiums, you accumulate cash value. It’s similar to how some credit cards will reward you with a small kickback for continually paying your bills. With whole life, you are guaranteed a payout at death and the death benefit is dispersed to your chosen beneficiary (whether that be your heir, estate, foundation, etc). They will also receive that accumulated cash value. It sounds a bit like a handy savings account is tacked onto your insurance contract--and what’s more, the payout is guaranteed. Sounds nifty, right?

On the other hand, term life is only guaranteed for the term chosen. Say you want to make sure your family is covered if something should happen to you within the next 10 years. You pay your premiums for those 10 years, but if something happened to you, say, 11 years after the policy, your family would receive zero coverage. However, term insurance tends to be cheaper in the long run and statistics are in your favor if you’re covered from the years 35-45, if such is the case.

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What Does Your Perfect Life Insurance Policy Look Like?

This blog is just getting started--but if you have any more questions on today’s article, feel free to reach out to our friendly staff and to stay tuned for future posts!

Ready to get a free, quick quote today? We’d be happy to help you find your perfect life insurance policy. At Health Benefits Now, we believe in helping people come to their best decisions regarding healthcare coverage.

We can’t wait to get started!

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Life Insurance 101: Using Life Insurance as a Financial Tool

3/15/2019

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​What’s Your Goal?

Life insurance is a personal finance tool, plain and simple.

It’s a way to hedge your bets. It was created to pay money after somebody passes away. The who, the what, and the why almost seems painfully obvious: those with families buy insurance to provide protection should the odds not come up in their favor.
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Take a look at the chart above. Do you know where you fall?

Common Circumstances

Income Replacement: You want to protect your family against the premature death of either yourself, your spouse, or another guardian and to use your life insurance to offset the loss of income. 

Final Expenses: Part of the reason you are looking into life insurance is to help cover for funeral and other administrative expenses incurred due to loss.

Business Insurance: One of the most common uses of life insurance is actually related to businesses and business partners. The policies usually come in these 4 flavors:

  • Key Person: The premature loss of a key employee or business partner can spell loss for all those who work for said company. Key Person insurance was created to compensate for this problem. The payoff typically covers for what money that employee would have brought in and the cost it takes to hire and train a successor, or whatever has been deemed appropriate in the insurance payoff. In this case, the company would be the beneficiary.
  • Executive Bonus: Essentially, your employer pays the premium on your life insurance policy. Sometimes called 162 plans, after Section 162 of the Internal Revenue Code, it’s a way to deduct certain expenses, like a compensation related to an employee’s salary.
  • Split Dollar: Another way you might get an employer to pay your premium is through a Split Dollar plan. In exchange for an interest in the death benefit and policy cash value, the employer pays most or all of the premiums and therefore own the policy, but the employee may name the beneficiary.
  • Deferred Compensation: This is another kind of deal made between employer and employee, wherein a portion of wages earned is deferred for a later date--in this case, should the employee suffer a premature death.

Emergency Fund: Life never runs smoothly after a loss, especially a premature one. Life insurance policies can be tailored to include an emergency fund, meant to account for time taken off work, medical expenses, and counseling.

Estate Taxes: Don’t make the mistake of writing “payable to my estate” as your beneficiary! One way to hike up taxes is to add value to your estate; which really means you could end up leaving a highly-taxable estate to your loved ones. Instead, make your life insurance policy even smarter by having it help you curb estate taxes. See our recommended reading below and talk to one of our agents today to get started!

Special Circumstances

Charitable Giving: With some clever allocation, you can use your life insurance proceeds leave a gift to an organization without making too much of a dent in the overall size of your estate. Just use the death benefit to replace the value of the property gifted to heirs.  

Special Needs Child: We want to give all that we can to our children, and life insurance policies can be tailored to provide funds for those with special needs.

Education Fund: Should the unthinkable happen, a life insurance policy can be used to make sure your children still receive the caliber of education you always planned for them.


Start Planning Your Future Today

As you can see, there are a host of ways to look at life insurance. The basic reasoning behind any policy isn’t complicated, however: you want the peace of mind that comes with knowing what you value is being taken care of.

All insurance is about peace of mind.


Thankfully, our quotes are quick, painless, and free. Request information today and we’ll be back to you within 1-2 business days (and we’re always trying to beat our own record)!
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Bonus: Other Great Reads

Questions and Answers on Life Insurance - Tony Steuer
“The Why and How of an Executive Bonus Plan”
“How To Avoid Taxation on Life Insurance Leads”

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How Healthcare Advocates Help You Save On Medical Bills

3/7/2019

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The usual story that people get told about healthcare is this:

  1. If you make a certain amount of money, you have to get insured.
  2. If you’re employed at a big company, take their health insurance--no questions.
  3. If you’re self-employed, good luck navigating the internet avalanche of offers!

But we all know it’s more nuanced than that. Here at Health Benefits Now, we’re demystifying healthcare one article at a time. And today we’d like to shed light on something they don’t normally tell you about healthcare and insurance:

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What’s A Healthcare Advocate?

Healthcare advocates (sometimes referred to as patient advocates) focus on reducing a member’s out-of-pockets costs when it comes to medical bills. Depending on the advocacy program, they can assist self-paying patients as well as those with insurance. In short, they help patients navigate the healthcare system so they receive the most reasonable bill (if any) at the end of the day.

How do they do this? Advocates are trained in the in and outs of the healthcare system and use their direct contacts at hospitals and carriers to represent their clients’ cases. They collect paperwork about how much the member makes and how much coverage (if any) they already have. As you’ll see below, there’s plenty of loose interpretation in insurance policies--and advocates work to make that interpretation come out in their clients’ favor.

It’s important to note that healthcare advocacy programs are NOT insurance. Yes, you pay a monthly fee, and yes, you can receive discounts on hospitalization. However, healthcare advocates work with those who have little, no, or lapsed insurance--and they don’t “share risks” like an insurance company is designed to do.

You might be asking at this point: Ok, then what’s the point? Why pay extra, especially if I already pay for insurance?

To answer that question, we’re going to take a brief pit-stop and talk about insurance contracts. Even if you are currently uncovered, it’s good to know how to interpret the fine print:

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Medical Emergencies: The Usual, Customary, and Reasonable Charge

Ask yourself this: What constitutes a medical emergency? For you, that might be anything that leads to an unforecasted visit to the doctor or ER. It could be a broken arm or the swine flu or a sudden deadly allergy. Either way, it was unexpected and it wasn’t from any type of negligence on your part, and now you’re stuck with the co-pay (or worse) on your medical bill. Surely, this is a medical emergency.

But neither you nor your doctor are the ones interpreting what constitutes a medical emergency. That responsibility belongs to somebody you’ve never met who happens to work in your insurance carrier’s office. And they’re looking at your insurance contract, which is talking less about “emergencies” or more about what those “emergencies” cost.

Because it’s also neither you nor your doctor that get to interpret what a “usual, customary, and reasonable (UCR) charge” amounts to. You racked up four days and three nights at a hospital (like our pal Steve below)? And it costs $12,000? Your insurance carrier could very well state that this is not usual, not customary, and not reasonable. Because who else has a say?

So, their UCR charge? Say they pick $7,000. Know what that means? You’ve got a cool five grand to come up with. Sure, this was an emergency, but in their book it wasn’t  that kind of emergency!

Good News: We aren’t about to tell you that insurance companies are never there for you (we wouldn’t be in this business if we thought that), and, to reiterate, you do have an advocate on your side.

Just take a look at Steve’s story down below to see how healthcare advocacies have worked miracles:

Steve’s Story

Back in 2012, Steve was self-employed and working a non-salaried position at a Fortune 500 company. The position was seasonal, eight months out of the year, to coincide with football’s pre-, mid-, and post-season. At the time, the job did not offer year-round benefits.

Steve was going on his third year with his company. He was married, didn’t have any dependents to worry about, and was used to weathering his lapse in coverage in the off-season between January and May. After all, so far, so good.

It happened in February 2012--a whole four months before Steve was set to be covered with Fortune 500  premium benefits. A sudden bout of pancreatitis landed Steve in the hospital for a total of 4 days/3 nights, which created just over $12,000 in medical bills.

What was Steve going to do? He wasn’t covered through his entrepreneurial business, and he’d just been clocked off his seasonal benefits at work.

There was one teeny change that Steve had made in his healthcare. It just so happened that 2012 was the year that he picked up a healthcare advocacy program.

One week and a bit of paperwork later, and his particular healthcare advocate was able to verify that he had a source of income but was financially unable to pay for his medical bill--and that same advocate was then able to knock off everything.

Now, this is NOT a guarantee that this happens every time. But if you look up “miracle worker” in the dictionary, we wouldn’t be surprised if a patient advocate’s portrait showed up. 
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So, how can an insurance agency help you find out more about healthcare advocacy?

For that, you just request a free quote.

Already covered by an insurance carrier? No problem--we can still look into adding an advocacy program to your custom healthcare plan.

It takes five minutes to get a quote, and all the information you get is free.

What are you waiting for? ​
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A Love Letter to Short Term Medical (3 Reasons To Consider)

2/27/2019

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The Who and What of Short-Term Medical

Short-term medical insurance is exactly what is sounds like. It’s a temporary solution to fill in gaps in insurance. So, it’s great for those waiting on Medicare, in-between jobs, or who just missed open enrollment. It can provide the same benefits as a typical health insurance policy (i.e. Major Medical), simply on shorter terms: typically between 1-12 months.

What types of benefits? Again, the only difference between short-term and major medical is the duration. So, you’ll be offered financial protection, up to the following possibilities (depending on the particular provider):

  • Doctor’s visits and certain types of preventive care
  • ER and ambulance coverage
  • Urgent care benefits, etc.


Why Should I Consider Short Term Medical?

Unfortunately, healthcare is expensive. And we have a saying around here: in the insurance world, it’s all Murphy’s Law. Anything that can go wrong, will. Why stress the vulnerability of not being covered? Even if you’re 1-3 months in-between jobs, kidneys have been known to act up and the previously undiagnosed can rear its ugly head, amongst other things.

But here’s an upside: take a look at the word temporary. Remember, even the expenses are temporary. You may or may not be paying more for your medical coverage than you were previously--but we’re talking about less than a year here. And our quotes are a whole lot better than a $15,000 hospital bill.

How Do I Sign Up for Short Term Medical?

If you submit a quote today, we will get back to you in one business day or less. Take 5 minutes today, receive a free quote, and we will find the best offer for your needs. We don’t pad things around here, nor do we want to. So, the only thing you have to lose is five minutes. Pour yourself a cup of coffee, but don’t expect it to be cool by the time you’re done. Got more questions? Call our number (888-437-8628) or head on over to our Contact Form.

We look forward to hearing from you!

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Foresight is 20/20: Your Guide to Vision Insurance

2/19/2019

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Last week we discussed dental insurance, but a good look at supplementals wouldn’t be complete without taking a peak at how to get your eyeballs covered. Want discounts on contacts, lenses, and exams? Stick around.

How Vision Insurance Works

Let’s get one thing clear: vision insurance is worth it--if you need corrective vision materials like contacts or glasses. If neither you nor a member of your family needs corrective vision, then paying out-of-pocket for your yearly exam may be the best economic decision. However, vision insurance, like dental insurance, is also there for you when the unexpected (and expensive) happens. It’s all Murphy’s Law in the insurance world, and we’re here to help you navigate through it.

Vision Insurance vs. Health Insurance

An important distinction to make before we move on is what exactly is covered by vision insurance vs. what is covered by health insurance.

Health insurance will cover eye exams IF you need them for an underlying medical condition, such as cataracts and complications from diabetes/high blood pressure, etc. (1) Health insurance will also typically cover you for eye injuries and eye diseases. Eye specialists such as ophthalmologists (specialists in eye surgery) are normally covered by health insurance.


Vision insurance covers for your yearly eye exams and can provide lenses and contacts at a significantly reduced price. Eye specialists such as optometrists (vision testing specialists) and opticians (technicians that verify vision correction) can be covered through health or vision insurance, depending on the contract terms.

Regardless, a staggering 66% of Americans 18 and over report using glasses, contacts, or both--so the odds are good that if you don’t have some type of vision correction yet, you or somebody in your household have a pretty high chance of needing them in the future (2).

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The Average Cost of Glasses and Contact Lenses

The average cost for vision insurance is modest: anywhere between $10 a month for basic coverage to $30 or $40 a month for larger families and/or premium benefits. Typical savings on contact lenses runs the gamut of around $150 for elective contacts, and sometimes up to 100% covered if they are considered “medically necessary.” Glasses “can cost just $8 or up to $600 for those without insurance. For name brands, prices can range between $50 and $1,000 or more. At an eye doctor's clinic, prices for eyeglasses will vary depending upon the frames, lenses and region of the country. The price for eyeglasses nationally is $196.” (4).

The important things to keep an eye out for are:

1. Is your preferred eye doctor in-network?
  • If not, you’ll be paying more out-of-pocket than may be worth it.
​​​2.  How much will you save on glasses or contacts?
  • Get your agent involved in calculating the ballpark average.
3.  Are there any age restrictions?
  • We know of vision plans with guaranteed acceptance!

What About LASIK Surgery?  

This question gets its own brief overview because it can be a little tricky.

LASIK surgery is the most common type of refractive surgery, used to fix near- and farsightedness and myopia. Effectively, it reshapes the cornea to enable light to enter in such as way as to allow for vision that can be 20/20 (or better).

As far as if it's covered by insurance...long story short, LASIK surgery usually ends up being classified as a cosmetic choice made by a customer. Since it isn’t medically necessary, it typically will not be covered by insurance--health, vision, or otherwise.

But during the quoting process, it’s always worth it to ask!

No Time Like the Present!

Well, quotes are free and time is short. If you’re interested in discounts on your corrective vision care (and want extra incentive to get your yearly eye exam), inquire today!

Works Cited:
  1. https://www.visionarynd.com/updates/health-insurance-vs-vision-insurance/
  2. https://www.nerdwallet.com/blog/health/vision-insurance/
  3. https://www.ehealthinsurance.com/resources/vision-insurance/common-eye-diseases-vision-insurance
  4. https://health.costhelper.com/eyeglasses.html
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Don't Bite Off More Than You Can Chew:                                  Your Guide to Dental Insurance

2/15/2019

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Dental insurance is one of those things that most people don’t think about until they really need it. Like a twenty-eight-year-old with pearly whites and perfect gums who, one day, gets his jaw broken and two front teeth chipped thanks to an ATV ride gone horribly wrong. In the insurance world, it’s all Murphy’s Law. Anything that can go wrong most probably definitely will.

So here’s a guide to help you navigate through the dental insurance system, whether you need it, and what the best options are.

How Dental Insurance Works

Dental insurance is what we call supplemental insurance--but you probably already knew that. Basically it’s just important to note that your basic health insurance won’t cover for preventive care, and worker’s comp won’t always cover for tooth damage that occurs at your place of work.(1)
Most people only enter a dentist’s office for their bi-yearly cleanings and X-rays, sliding their group plan’s card across the desk as they go. The average cost for these group policies can range from $168-$366 a year for individuals and $325-$680 a year for families. When you think about how much it actually costs to check in for two cleanings per person, and maybe an X-ray or two, the costs usually average around $400 for an individual and up to $600 plus for a family(2).

You can guess that these averages can be higher when shopping the individual market. And at this point you might be asking yourself, OK, what’s the point then? Can I just take whatever my company offers (given that you’re not self-employed) and call it a day?

In some instances, yes. If your entire family is covered at a $2,000 maximum benefit per person, and you’re paying under $50 a month for it, by all means throw up your hands in praise. But look at the fine print of your work’s health insurance offerings. If you’re paying a pretty chunk of change per month for only a $1000 maximum benefit, you might want to start considering your options. Ask yourself these questions:

  • Is my dentist in-network?
    • Yes: Great! Shop for whichever tier works best for you. While most dental insurance caps off at $1-2k maximum benefit, we know of plans with tiers that go up to $5k! Inquire today.
    • No: This doesn’t bar you from insurance, but if you want to continue seeing an out-of-network dentist you will have to pay more. It’s a good idea to ask your agent how much more so you know if you’re coming out ahead. Thankfully we have plans that come under the DenteMaxPlus, currently the largest dental PPO in America.
    • Don’t Have A Dentist: Well, now you have your pick from the provider network! When putting together quotes, our agents can even locate the closest dental offices in your zip.
  • Will my savings cover a major accident that could result in oral surgery?
    • Did you know that ⅗ of Americans don’t have enough money to cover for unexpected medical emergencies (averaging $1000)? What would you do if you needed a root canal (average $900), wisdom teeth removal (with a whopping range of $75-$800, depending on the anesthesia, number of teeth, and overall complexity), or if any of the following situations were to occur: a skiing accident leaves you face-first in a tree, a rowdy fan at a football stadium suckers you in the mouth, a car accident results in a cracked jaw, or you slip and fall on some ice and end up with a killer toothache? Some of these scenarios have been known to result in orthodox sums of up to $15,000 in damages(3)! Of course, many of the latter scenarios are unlikely--but insurance is all about insuring for the expensive and not-entirely-impossible.
  • How often will I actually go to the dentist?
    • We know, we know. People like to skip out on the dentist. Twice a year? How about once every two years? Regardless, when you’re insured for dental insurance you are typically covered for 2 cleanings per person in the plan per year and other preventive care, such as bitewing x-rays and fluoride cleanings. Fillings, full mouth x-rays, restorative amalgams & composites, simple extractions, and sealants may also fall under coverage, while major services such as oral surgery, dentures, crowns and the like usually require a waiting period. It’s always worth it to ask!

Insuring for the Worst-Case Scenarios

So the Big Bad in this scenario is oral surgery and orthodontia, right? Everybody knows somebody who’s had braces, or their wisdom teeth removed, or even a root canal. So what we want to know is, how expensive (on average) do these scenarios get, and how does dental insurance cover for them?

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Wisdom Teeth: Wisdom teeth have a whopping range of anywhere between $75-$800. This depends on the number of teeth being removed (anywhere between 1-4 teeth may need to be removed), anesthesia, and overall complexity.(2)

Root Canal: Root canals, “a procedure that replaces infected pulp in a root canal with an inert material,” cost an average of $900.(2)

Orthodontia: Braces--and it’s not just kiddos that need them either! It’s important to note that not every dental insurance plan and network will cover for orthodontia, as it is usually seen as a voluntary cosmetic surgery. Sometimes state law dictates that children must be insured for braces, but even then it usually occurs because the child in question may have problems chewing otherwise. We hereby give you permission to drill us (and any agent you talk to) about what fine print comes with orthodontia and your dental plan. The average cost for braces can vary, but we’ve never seen it go below a bare minimum of $2.5k.(5)

Alright: Sign Me Up, Scotty

If you’ve made it this far, we’d like to thank you. We know even the thought of a toothache is liable to make one suddenly appear. But you’ve answered our questions and considered your options, and you’d like us to take it from here. You’re thinking, yeah, why not get a free quote while I’m at it?
So, here’s all you’ve got to do:

  1. Inquire for a free quote--we’ll get back to you within 1 business day (but we’re always trying to beat our record!)
  2. You can save your questions for when we reach back out to you, or you can use our Contact Form to inquire about plans that may cover above-average maximum benefits or special cases like braces; or any other questions you may have.
  3. Peruse the articles from our Works Cited (see below) to get some different angles on the dental insurance business--the more you know, right?
  4. Kick back, relax, and don’t run into any trees or fisticuff brawls any time soon!



Works Cited:
  1. https://www.dentistryiq.com/articles/2016/09/managing-the-workers-compensation-dental-claim.html
  2. https://www.creditdonkey.com/average-cost-dental-insurance.html
  3. https://www.nerdwallet.com/blog/health/considering-dental-insurance-may-not-worth/
  4. https://www.investopedia.com/articles/pf/07/dental-insurance.asp
  5. https://www.angieslist.com/articles/how-much-do-adult-braces-cost.htm

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