Frequently Asked Questions (FAQ) 2018-10-30T14:14:05+00:00

If you’re healthy, you probably wonder if you really need health insurance. You can pay for your medical needs as they come up, and not pay a monthly premium to do it, right? While, technically, that is true, the biggest benefit to having health insurance is to protect you from emergencies that can happen anytime. A tumble down the ski slope, a broken leg, slipping on ice, appendicitis, pneumonia that lands you in the hospital…all of these will cost you a lot of money if you don’t have insurance and could cripple you with medical debt for years. The average cost in Colorado for a hospital stay is over $2,400 per day, which does not include procedures, provider fees, x-rays, or other charges (based on a 2015 study). An emergency surgery could land you with tens of thousands of dollars in medical bills. Your health insurance has an out of pocket maximum. That means your $40,000 surgery would at maximum cost you $7,150 (out of pocket max in 2017). Even though $7,150 is still a big pill to swallow, it affords you more protection than having nothing!

Put simply, an HSA is a type of health insurance policy that allows you to open and deposit money in to a savings account at the bank of your choice. You can then use the money you’ve saved on a tax-free basis for medical bills. Learn more about HSA plans here.

This depends on several factors. If your income falls within a certain range, you may qualify. We have a team of experts in our office ready to answer your questions about Tax Credits/subsidies and how they work into your health insurance plan. Learn more about subsidies here.

With most carriers, the insurance companies pay us a commission for each health policy we sell, which is already built into the premiums. However, Kaiser does not pay us for new individual policies written so we will have a separate charge directly to the insured member for our services.

Have you ever sat on hold with a company for hours, simply to ask why your payment didn’t pull out of your account? How about a 1 hour phone call just to change your address? Let’s not forget the frustrating feeling of hopelessness when you get transferred from department to department for the answer to a simple question! How many times have you used up your whole lunch break talking to an insurance company but not gotten anywhere? That’s where we can help! A broker (or agent) is your go-to when you have questions or concerns about your health insurance policy.  We can find out the answer to your questions, and since we are local, you don’t have to wait on hold for hours to talk to us!

When you receive your renewal notice in the mail, you’re not necessarily stuck with that premium. We will help you shop for the best rate and best value so you know what options are out there. If you already have a policy in place, we would be happy to become your agent for the future! Contact us to find out how easy it is.

Contact us right away! You may have a special enrollment period. If you have another job already lined up and group insurance benefits starting with the new job, you might want to consider a Short Term gap insurance plan.

Yes! Your eligibility for COBRA doesn’t mean you have to take it. Often, you can get a better rate on the individual market than you can with COBRA. Before you elect COBRA, call us! Let us know your situation and we would be happy to run you a free quote and help analyze what’s best for you and your family.

Every year, there’s an Annual Open Enrollment period. You can definitely shop then. If it’s not Open Enrollment, you may be able to shop for a qualified plan if you have a Qualified Life Changing Event.

Open Enrollment happens at the end of each year. It is the only time of year that you can shop for new insurance or change your existing coverage without having a special Life Changing Event. If you don’t have insurance and you don’t have a Qualified Life Changing Event, then you’ll have to wait for the next open enrollment to get onto a plan. You can contact us anytime to determine whether or not you can get coverage now.

Outside of the annual Open Enrollment period, the only way to get qualifying insurance is to have a Qualifying Life Change Event (LCE). If you have one such event, you can get a Special Enrollment Period to shop for insurance. These SEPs only last for 60 days from the date of your event, so if you know you have a life change coming up, let us know so we can help you get ready for your enrollment period.

Some examples of SEPs:

  • Getting Married
  • Having a baby or adopting a child
  • Losing your health benefits through your job (some limitations apply)
  • Aging off your parents’ plan
  • Moving to Colorado (some limitations apply)
  • Others: Contact us to see if your event is a Qualified Life Change

Prescription costs:

Being a smart consumer can save you money. Prescriptions can be a really big part of your annual medical bills, especially if you’re taking a monthly medication. Your insurance may not be the best deal to get your prescriptions filled. If your plan has copays for prescriptions, those will often (but not always!) be a pretty good deal. But if you have an HSA plan or a plan without copays for prescriptions, the costs of medicines can be astounding! There’s a few resources out there for you, the consumer, to shop for the best deals for your particular prescription.

  • goodrx.com – search for the cash price for your prescription online. They often have coupons available that you can print out and use. Most of the time, if you use the coupon, you will not be able to credit that prescription cost towards your deductible.
  • For high cost, brand name prescriptions (such as medications for MS), try going to the manufacturer’s website directly. Sometimes, they will have a copay assistance program available if you have regular health insurance. Sometimes, the assistance will even go towards your deductible!

Medical procedures:

  • Did you know that the price of a specific procedure can vary greatly depending on which facility you visit? Before you schedule your MRI or blood tests, you may want to price the facilities within your insurance network to find out the best deal. Being a consumer will take some time and effort on your part, but could save you money in the long run.
    • Health Care Blue Book – search for a procedure, test, or service based on your zip code. This tool can help you know what a fair price is in the area. The fair price is the amount that you should reasonably expect to pay in-network. It’s based on the local mix of prices, not the lowest price. That means some providers will be lower than the fair price. Once you get a fair price, you can call your doctor or facility and see where they fall on the price scale.
    • Did you know that a standalone emergency room can cost much more than a traditional emergency room? Urgent care centers can save you money as well, if you aren’t having a life-threatening emergency.

In contrast, however, a standalone facility for procedures like lab work, imaging, or testing can cost you significantly less than that same procedure at a hospital. We’ve put together a few comparisons for you for common procedures at two different facilities:

Colonoscopy with Biopsy Estimated Cost*
Stand alone imaging facility $1,400-$1,700
Hospital $3,700-$4,200

*Estimates only – your costs may vary. May not include physician or facility fees, etc

X Ray of Ankle Estimated Cost*
Stand alone imaging facility $50
Hospital $330

*Estimates only – your costs may vary. May not include physician or facility fees, etc

Different hospitals can vary significantly for the same that they provide. There are many reasons for this, but it may be worth your time to call the hospitals in your area to find out an estimated cost for your planned procedure, such as childbirth:

Normal Vaginal Childbirth Estimated Cost*
Hospital A $10,700
Hospital B $15,200

*Estimates only – your costs may vary. May not include physician or facility fees, etc

Normal C Section Childbirth Estimated Cost*
Hospital A $15,000
Hospital B $22,800

*Estimates only – your costs may vary. May not include physician or facility fees, etc