Consumer's Guide To Health Insurance In Florida

The Guide to Health Insurance for Individuals and Families in Florida

My life long ambition is to do good in this world.

These amalgamation of paragraphs are designed to help you choose the right health insurance plan in Florida. The right company, the right deductibles, options, etc.

The end result is that you are health insurance wise, saving thousands of dollars, while preserving your health, mental and physical well being.

I am not joking about saving thousands of dollars on health insurance but I was joking about using such a big word like "amalgamation." I am not sure what got into me.

Deductibles are funny When a potential client calls and desires to have the same health coverage that his neighbor has who works for the city of Orlando, forget about it. Keep in mind that the city of Orlando is paying for at least half the cost of insurance. The deductibles and co payments in group insurance plans are much lower than in individual insurance plans. What is available for State of Florida workers, city workers, IBM employees are not going to available to regular people. The way for you to get lower cost insurance premium is simply by having a high deductible. That is it. Insurance companies offer different deductibles to the client. The insurance company will have deductibles ranging from $500 to $5,000. The $500 deductible is very attractive to "hypochondriacs", people who love going to the doctor. The smart insurance company really does want "hypochondriacs" as policyholders. The company will pay the claims of the policyholder but if enough unhealthy people are part of the company's "block of business" then the health insurance company simply goes to the Florida Department of Insurance and gets a rate increase for all the existing and new policyholders. Of course, the goal of a Florida health insurance company is to grow and prosper. Eventually when a company has high premiums then the health insurance company will not get any more new customers. The health insurance company will get smaller and smaller till they eventually say "adios" to the insurance industry. We know that "hypochondriacs" cause an excess amount of health care expenses over and above what they pay in premiums. The smart insurance companies try to dissuade these folks from knowing that their company even exists. You may ask what do "hypochondriacs" have to do with deductibles? A person who loves going to the doctor will want a very low deductible. The smart company will be charging an unreasonably high premium for the lowest deductible. End of story.

Let's look at the numbers

We'll compare the difference in premium of the $500 versus the $5,000 deductible. I am just punching the numbers; here is a health insurance company that charges an extra $300 per month for the $500 deductible for a certain age, gender, zip code and tobacco status in the state of Florida.

To pass the deductible, whether it is a $500 or $5,000 one has to get sick. In order to get accepted to the policy you have to be healthy. Even if the new policy holder does get sick, which is not likely for someone who is healthy now, what is the likelihood that the policyholder will have a major illness (hospitalization) each and every 15 months? The $300 monthly saving versus the $4,500 deductible difference would be 15 months. .

Unless you end up in the hospital an average of once every 15 months during your time insured with the health insurance company in Florida, you end up with a raw deal.

Keep in mind that to be accepted to the insurance company you have to be relatively healthy so what is really the chance that you will end up in the hospital each and every 15 months? We are just playing the law of averages, just like the insurance company.

Eventually, at the time of your application to the insurance company in Florida, you will be looking at a piece of paper with the various deductible and premiums side by side. From a numbers perspective, look real hard and good. The extra benefits that come with the low deductible will almost never (really never) be economically worth your while unless, of course, you enjoy going to the doctor. The New England Journal of Medicine reports that "hypochondria" affects 5% of the population. I have to mention that the average individual health insurance policy sold is held on average for 18 months. That is it. People get jobs that pay for health insurance, get Medicare, get married, get divorced, move to Alaska, Canada, etc. Every so often the cost of paying the health insurance gets to be too much of a financial burden for the policyholder and they will just stop paying the insurance premium. I really do not want to be the responsible for a person not having health insurance. With no insurance, tragedy can strike. If illness should occur then the person probably will not get top-quality care and may be wiped out financially. Of course, after an illness occurs then the person becomes uninsurable. Please do me a favor, get the least expensive basket of benefits so that you end up keeping your health insurance. If you have a lot of money it is not a big deal to dig into your wallet to pay the deductible charge if an illness should occur. On the other hand, if you are financially struggling then it is really important to keep paying the insurance premiums to prevent really bad stuff from happening.

Why health insurance is really good.

The big companies will have a huge PPO (Preferred Provider Organization) network with tens of thousands of medical professionals across the state. The Florida health insurance company will negotiate for you a relatively low fee for doctor charges. These are not rock bottom fees that a self respecting doctor will turn down. $50-$60 dollars for an office visit. If the doctor sees you for 10-20 minutes and works a full day the doctor will not be starving even after paying rent and office staff.

Have you ever wondered how a doctor can charge $200 for the office visit? Let's say that the doctor sees 24 patients per day, which is a patient every 20 minutes over 8 hours of work. At the end of every day of work the doctor brings in $4,800. The doctor will bring in $103,200 per month working 5 days a week and $1,238,400 at the end of the year. Even after paying for a fancy office and a glamorous staff the doctor just bought the biggest house in the county after just one year of working 8 hours a day, 5 days a week.

When the patient requests to pay $60 per visit, the cardiologist now knows that you have no insurance and it would be problematic to collect fees on that super costly surgery and hospitalization.

Hospitals, blood labs, expensive medical procedures all work the same way. The Florida health insurance company will be reworking the bill to lower the charges for you. So that $800 of blood work just became $240. Even if you have lots of medical tests you may still not hit even a $2,500 deductible. An overnight hospital stay and a surgery is what will cause that $5,000 deductible to be an issue. Who runs the show?

You may say that it is the big insurance companies who control insurance premiums and the health insurance industry. Wrong. In my opinion, the only player is the Florida Department of Insurance. The folks that work and run the companies in Florida are really conservative, nerdy type of guys

In fact, the big insurance companies are public companies traded on the stock exchange. These folks that run the company, set up a health plan, get the plan approved in the state and start selling.

The premiums that the insurance company charge is based on medical expenses of the policy holders. Every time the company wants a rate increase the accountants simply bring the numbers to the Florida Department of Insurance and they approve the rate increase based on a specific formula.

Every player in this process is a nerdy guy. There is no such thing as bargaining, opinions or feelings. It just so happens that any insurance agent that is new to the market with a particular health insurance line has a competitive advantage. If the company can successfully dissuade "sick" people from taking their health insurance their competitive advantage can last for a few years.

The fact is that most people who apply and get accepted for an individual insurance policy don't go to the doctor much in the first few years. If an illness occurs then you will be definitely keeping the Florida health insurance policy and costing the company a fortune, possibly even millions of dollars. The new insurance company needs to pick up new customers, so, of course, they need affordable insurance rates initially. The formula is relatively simple. By offering low cost health insurance, you build up a big client base until the rates get more and more expensive because of those few folks who got sick and actually used the insurance. But that does not usually happen for a few years from the time that the insurance company had entered the market. I have seen this phenomena happen time after time with various health insurance companies. That is the system. After a few years if the premiums get too expensive, there may be a better deal. There is a catch; new applicants have to be medically qualified for the new insurance company. As well, pre-existing conditions will come into play again. Insurance agents throughout Florida will be selling a specific plan for the same price. This is how the Florida Department of Insurance helps you during your search for an affordable health insurance plan. Very simple. Prices are regulated. The insurance agent in Miami will offer the same price as an insurance agent in Orlando for a particular plan. Shopping will not help lower the price. You can shop till you drop and the price stays the same. What is important is that you are actually informed as to what the best deal in the health industry for your particular situation. It would feel really silly when you are sitting at the bar and you find out that your best friend is paying less money simply because your "buddy" got lucky and was told of the best deal in town. Well, I have to believe that you, the reader, my friend, will be getting the best deal simply because that is what you deserve. This is not a complicated job. I keep track of the insurance industry and you end up with the most affordable policy out there. This is not complicated.

Paramedical Exam for new applicants.

New applicants for health insurance must qualify medically. There are companies that will send a paramedic to your home or work to give you a blood test. Once in a while, they forget to tell you that you should be fasting for blood test. No eating. So, when you wake up you have a delicious breakfast and scrumptious chocolate muffin before the paramedic shows up. You can imagine what will happen. The health insurance company sees your cholesterol readings and is sure that you are diabetic. Moral of the story, miss a meal and get the Florida health insurance plan.

Pre-Existing Health Conditions

They are not covered. Pre-ex are not covered. It is that simple. Let's say five different companies just spend a lot of time and money setting up their insurance plans in Florida, all five companies have this dream of one day being rich. These insurance providers may be big publicly traded companies but the successful publicly traded company is set up just like the local dry cleaner who wants to make money, provide a good service and go home at night with a clean conscience.

When a potential customer, just like you, is shopping for a new health plan; price is the thing that sticks out. Money talks and everything else walks. There is a lot of small complicated print in the contract but we all can figure out that $300 per month is less than $500 per month. According to the law; an insurance company does not have to accept all applicants.

After the applicant is accepted then pre-existing conditions are the big issue. Let's say that the applicant has high blood pressure, gets accepted by the company, and then has a stroke shortly afterwards. Chances are that the Florida health insurance company will not pay the bill. Years ago, I had special information that one insurer, XYZ Company, was, in fact, paying the bills. My neighbor, Joe, came to me with high blood pressure so I sent Joe to XYZ Company. Before you know it, XYZ, keeps raising and raising the rates. Joe's condition got a bit worse as the years went by.

Every time I see clients they are crying to me about the really expensive monthly premiums. What other option was there, I don't have a crystal ball but I do know that if a company will pay for pre-existing conditions and is more likely to accept relatively unhealthy people then that company in Florida is just more likely to raise rates in the future. Since the consumer is looking for affordable care insurance today as well as in the future, these are things that we should know.

A Third Degree Felony: Lying on a Florida health insurance application is a third degree felony. There is a guaranteed health insurance for those who can not get accepted to a standard Florida health insurance plan. This is a very favorable program for the tens of thousands of folks who cannot get accepted to a standard Florida health insurance plan. But let's face facts; a person who has medical problems really wants to save money when they go to the doctor. The insurance company first has to accept you, and then there is a one or two year pre-existing waiting period. If the company cannot prove that you lied on the initial application then you are home free. The insurance company always has the option to nullify the policy if the applicant lied on the application. This is just like a contract with the building contractor. Except that Florida health insurance is regulated by the State of Florida and the company is scared stiff of making anybody upset, of making waves. he State of Florida wants to help insure an even playing field by putting some teeth into the law to keep everyone honest. Therefore, lying on an insurance application is a third degree felony. My little brother is a warden of a prison near Orlando and he has never told me of a new inmate serving time because he forgot about high blood pressure on an application. Maybe there is a whole bunch of guys sitting in jail right now because of misstatements on a applications. Folks, if you hear any interesting news, please tell me.

Some Common Terms for a Florida Health Insurance Plan

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