October 2015

Information on Open Enrollment for Major Medical Insurance

By Mitchell Gordon

Health Insurance QuestionsIt is that time of year again, open enrollment for major medical health insurance. The Affordable Care Act, affectionately known as “Obamacare” as I shall refer to it for the remainder of this message. Also, I will only address the health care and insurance issues, not the rest of the law. First and most important, OBAMACARE IS NOT INSURANCE!!!! It is the law that dictates what the insurance companies must give you (include in their policies). When you hear someone tell you they do not want Obamacare, just the regular insurance, they are wrong in their assumptions. EVERYONE who has major medical has Obamacare. All insurance companies that have major medical that conforms to the law is in compliance to Obamacare, If not, and there are plenty of coverages and policies that do not conform and are not illegal to offer and have, but these people will be subjected to the fines imposed, regardless of what they think they have. First of all, if anyone who is selling you a policy and asks ANY questions about pre-existing conditions, it does not conform to the law and is liable for penalties. If someone offers you a policy that pays certain amount per day for separate incidents and has limits, this is an indemnity plan and does NOT conform to the law and also will incur penalties.

Now, for some information on how this all works. I, as an agent can take you directly to the insurance company, and I represent almost all companies in the state of Florida, and sign you up for a policy. This is the MOST expensive way to buy insurance. The next choice is going on the Marketplace Exchange. Here you will get the EXACT SAME POLICY for less money. Yes, some doctors do not accept on exchange policies, but many do. If you are eligible for a subsidy (tax credit), you will get the lowest price available in the system. Keep in mind, all these policies, no matter which way you get them are the same. You do not get less coverage because you are getting a subsidy.

There are five levels of coverage. I will not include the lowest, Catastrophic level in this conversation, so we will key in on Bronze, Silver, Gold, and Platinum. Whether you get the lowest level of Bronze, or the highest of Platinum, the coverage is the same. I will repeat, THE COVERAGE IS THE SAME!! The difference will only be the premium, the deductible, the maximum out of pocket, and the copays. If you are getting a subsidy, you can apply it to the cost of the premium in ANY level you choose. But very important, ONLY THE SILVER LEVEL will give you SHARE OF COST which will lower your deductible and your maximum out of pocket.

When you deal directly with the Health Care.gov website and/or call in to the navigators, keep in mind, when they were hired, they were not allowed to have any insurance experience. That’s like going to your mechanic to fix your car and finding out he was not allowed to know anything about auto repair before he was hired. I will say they are very polite but they do not know the nuances of purchasing insurance.

When you want a health insurance policy, there are a few points to consider before you decide which is best for you. Your immediate health needs, your future health needs and what you are looking for in a policy. The cheapest premium is not always best if it gives you the highest deductible or the highest maximum out of pocket.

There are other considerations, but I do not want to write a 20 page thesis. Most of the insurance companies pay the same commission so agents should not have an agenda on where to place you. YOU are the client and the ONLY concern we should have, not the physician or the insurance company. Of course, one of the first and most important questions to ask is who is your primary care doctor and which doctors do you want to make sure you keep. This is why it is important to work with an independent agent that has access to all, or most of the major companies. Also, there is NO FEE for our service to you. Having an agent gives you another advocate to help you with problems and understanding your coverage. This is imperative, to UNDERSTAND what you have, how it works and how to use it.

At Gordon Insurance Group, “Education before Enrollment” is not just a motto, but our ONLY way of doing business. Whether you choose us or any other agent (there are plenty of us out there and there is plenty of business for all of us). Take advantage of our expertise. We are members of MOROF and can be reached through their website or contact at 407-963-6105, (email: mg@gmi-invent.com). There is never any obligation to sign up for anything. We love to teach everyone how to have the best coverage available.

GIG  Gordon Insurance Group


“Education before Enrollment”