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Anyone Handle/Know Health Ins. in Florida?

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Anyone Handle/Know Health Ins. in Florida?

Old 05-14-2013, 08:22 AM
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Default Anyone Handle/Know Health Ins. in Florida?

Do some recent career changes, I find myself with no health insurance other than COBRA (which is currently in force) but it is very expensive. Anyone have any options/ideas for family coverage in FL?
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Old 05-14-2013, 08:25 AM
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Hey Steve. I believe THT member Runabout is licensed for health. It is going to be tough the rest of the year, but new options should open up next year. Hope everything is going OK for you.
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Old 05-14-2013, 08:40 AM
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Having come from NJ to FL and shopping myself into a fever. For us, at least, Humana was the cheapest and pay claims reasonably well (I had one battle with them over diagnostic/wellness lab work... took about a year to resolve, but in the end, they saw the light and paid the claim). Aetna was terrific when we were in NJ and had the kids, but more expensive here - they paid everything without issue.

2 Adults and 2 Kids, I'm at $362 a month. Very very high deductible, but I get all "wellness visits" and that crap included (Obamacare LOL). In NJ that same exact policy, with the same deductible is up to around $1200 a month. Doh.

I would avoid Blue Cross (or whatever it's called here) -- at least in NJ they were bastards about paying claims.

That's about all in know when it comes to Health down here...
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Old 05-14-2013, 10:17 AM
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Originally Posted by Sprockets View Post
Hey Steve. I believe THT member Runabout is licensed for health. It is going to be tough the rest of the year, but new options should open up next year. Hope everything is going OK for you.
its just getting to next year that is rough. currently COBRA is running 1600/month! and we only have my wife's income at the moment. I lost my job in January - it was sudden and not expected and the circumstances are simply mind boggling, but I can't get into it here, The problem is in my field, in this area, everyone knows everyone else and I had a management job - not too many around, and no one seems to be willing to consider me for a non-management position
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Old 05-14-2013, 10:19 AM
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Originally Posted by OldPete View Post
Having come from NJ to FL and shopping myself into a fever. For us, at least, Humana was the cheapest and pay claims reasonably well (I had one battle with them over diagnostic/wellness lab work... took about a year to resolve, but in the end, they saw the light and paid the claim). Aetna was terrific when we were in NJ and had the kids, but more expensive here - they paid everything without issue.

2 Adults and 2 Kids, I'm at $362 a month. Very very high deductible, but I get all "wellness visits" and that crap included (Obamacare LOL). In NJ that same exact policy, with the same deductible is up to around $1200 a month. Doh.

I would avoid Blue Cross (or whatever it's called here) -- at least in NJ they were bastards about paying claims.

That's about all in know when it comes to Health down here...
Pete, Did you go though a broker or agent? if so, have a number?

By the way, its a few days a way, but so far, the weather looks good for Friday...
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Old 05-14-2013, 11:10 AM
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I hate to say it but $1,600/month isn't ridiculous in FL for group coverage. We are paying about $1,300 for just my wife and I. She is not insurable under an individual policy, so our coverage is through a small business policy. Our hope is that next year individual coverage, while it may be more expensive than it is now, may actually save us money.
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Old 05-14-2013, 11:42 AM
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Originally Posted by makosteve66 View Post
Pete, Did you go though a broker or agent? if so, have a number?

By the way, its a few days a way, but so far, the weather looks good for Friday...
What I did was use eHealthinsurance.com to get all the different plans and rates, etc. I then called around to agents that handled the line I was interested in (Humana). I made a list of the time I called them and when they called me back. I had a few "test scenarios" to see if they knew their crap (most don't) (I'm not a pro, but I've learned a lot -- handling both a small business group plan, individual plan, and a family plan). The one that called me the back the fastest and knew what he/she was talking about got the business.

eHealthinsurance.com absolutely SUCKS when it comes to helping you with the "tricks of the trade" -- but they are a GREAT (VERY GREAT) resource for comparing things across many different lines.

Last weekend was mother's day and this weekend I have my wife's mom in from NJ... but you never know.
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Old 05-14-2013, 11:45 AM
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Originally Posted by Sprockets View Post
I hate to say it but $1,600/month isn't ridiculous in FL for group coverage. We are paying about $1,300 for just my wife and I. She is not insurable under an individual policy, so our coverage is through a small business policy. Our hope is that next year individual coverage, while it may be more expensive than it is now, may actually save us money.
1600/month is lot when I have no income! I am looking for Rx coverage and then major medical - it can have a big deductible, but I don't want to be without it if something major happens - catastrophic care, if you want to call it that

My problem is that I am on some much expensive medication!
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Old 05-14-2013, 11:45 AM
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Pete. As we discussed, my schedule is wide open. if you have a half day anytime, let me know
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Old 05-14-2013, 11:58 AM
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Originally Posted by makosteve66 View Post
Pete. As we discussed, my schedule is wide open. if you have a half day anytime, let me know
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Old 05-14-2013, 03:19 PM
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We have used an agent in south florida for the last 10 years for our health insurance. I have never met him, but he is just a phone call away when we need him. We also have a large deductible to keep our premiums low. Give him a call, he won't steer you wrong.




John O. Micalizio
InsurancePROSdirect founder
Dedicated Agent
Office - 561-737-4110
Cell - 954-829-4058
Fax - 561-364-3829
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Old 05-14-2013, 03:23 PM
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Sprockets, thanks for the acknowledgement. I am licensed in health, but it is not the focus of my business, but I'll see what I can do to help. Steve, what I'm getting ready to write is generic information and should be questions that will be asked of you, your wife and your family to determine the right coverage for you.

The Cobra is no more expensive than it was when you were employed with the company...only difference is you're paying 100% of the premium yourself now. Before, the company paid a very large portion of the premium, anywhere from 50 - 100%....the percentage is determined by the company and the same percentage is paid for all employees and their beneficiaries.

There are two basic types of individual policies and you will need to determine which is best for your needs. The first is a copay type plan in which you will have coverage from day one, but will have to pay a copay for any services, the copay will be either a set dollar amount or a percentage. For example, you go to your primary care doctor and you have a $25 copay and insurance pays the rest of the bill. You go to the emergency room and you pay a $200 copay and the insurance company pays the rest of the bill. Copay plans are typically more expensive and work well for families with chronic health issues or children that are prone to injury.

The other type of a plan is going to be a high deductible plan, the amount of the deductible will be a determining factor of the monthly premium. Naturally, the higher the deductible, the lower the premium. With this type of plan, you will get one free "well visit" per year in which age appropriate test will be performed at no charge. After that, you have no coverage until you have met your deductible....then they pay a all or a percentage of your medical bills. For example, you pick a 100% plan with a $2500 deductible and you twist your knee and have to go see a ortho specialist. You would be responsible for 100% of the bill because you have not met your deductible, let's say the bill is $150 for this example. You now have a $2,350 deductible left. The ortho tells you that you need surgery and you have the surgery. The bill for the surgery comes to $18,000.....you pay $2,350 and insurance pays the rest. Once your deductible is met, they will pay for 100% of your health care for the rest of the policy year. These policies are generally less expensive than copay type plans and are good for people that generally don't go to the doctor unless it's an emergency.

Both types of plans have prescription plans available....or they can be issued without.

General questions that should be answered to determine the correct type of policy for you.
1) Do you have children.
2) Does anyone in your family have any health issues? (diabetes, heart condition, MS, etc)
3) How many times a year does each member of your family go to the doctor?
4) Is anyone in your family on an anti depressant or other psych medication?
5) Smokers or non smokers?
6) Ages?

These are generic questions that need to be asked/answered and are between yourself and the insurance professional. Depending upon where you live, one carrier may have a stronger network over another and therefore be a better fit for you. For example If I can answer any questions for you, please don't hesitate to contact me.
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Old 05-14-2013, 03:48 PM
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Originally Posted by runabout View Post
Sprockets, thanks for the acknowledgement. I am licensed in health, but it is not the focus of my business, but I'll see what I can do to help. Steve, what I'm getting ready to write is generic information and should be questions that will be asked of you, your wife and your family to determine the right coverage for you.

The Cobra is no more expensive than it was when you were employed with the company...only difference is you're paying 100% of the premium yourself now. Before, the company paid a very large portion of the premium, anywhere from 50 - 100%....the percentage is determined by the company and the same percentage is paid for all employees and their beneficiaries.

There are two basic types of individual policies and you will need to determine which is best for your needs. The first is a copay type plan in which you will have coverage from day one, but will have to pay a copay for any services, the copay will be either a set dollar amount or a percentage. For example, you go to your primary care doctor and you have a $25 copay and insurance pays the rest of the bill. You go to the emergency room and you pay a $200 copay and the insurance company pays the rest of the bill. Copay plans are typically more expensive and work well for families with chronic health issues or children that are prone to injury.

The other type of a plan is going to be a high deductible plan, the amount of the deductible will be a determining factor of the monthly premium. Naturally, the higher the deductible, the lower the premium. With this type of plan, you will get one free "well visit" per year in which age appropriate test will be performed at no charge. After that, you have no coverage until you have met your deductible....then they pay a all or a percentage of your medical bills. For example, you pick a 100% plan with a $2500 deductible and you twist your knee and have to go see a ortho specialist. You would be responsible for 100% of the bill because you have not met your deductible, let's say the bill is $150 for this example. You now have a $2,350 deductible left. The ortho tells you that you need surgery and you have the surgery. The bill for the surgery comes to $18,000.....you pay $2,350 and insurance pays the rest. Once your deductible is met, they will pay for 100% of your health care for the rest of the policy year. These policies are generally less expensive than copay type plans and are good for people that generally don't go to the doctor unless it's an emergency.

Both types of plans have prescription plans available....or they can be issued without.

General questions that should be answered to determine the correct type of policy for you.
1) Do you have children.
2) Does anyone in your family have any health issues? (diabetes, heart condition, MS, etc)
3) How many times a year does each member of your family go to the doctor?
4) Is anyone in your family on an anti depressant or other psych medication?
5) Smokers or non smokers?
6) Ages?

These are generic questions that need to be asked/answered and are between yourself and the insurance professional. Depending upon where you live, one carrier may have a stronger network over another and therefore be a better fit for you. For example If I can answer any questions for you, please don't hesitate to contact me.

Good explanation. This is type i have with medicare because i don't go to the doc's other then my yearly physical
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Old 05-14-2013, 05:08 PM
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If nothing else get your kids into the Healthy kids, Florida kid care. We saved a lot of money. It is based on how much you make. Even if you find a group rate, this will be cheaper for the kids, it is run by the State of Florida.
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Old 05-14-2013, 05:34 PM
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Depending on your age, there are several "wellness" visits that you would get for zero out of pocket. Not just one. Again, this depends on your age and history. For example -- you could get your annual physical, a colonoscopy, and a couple of other specific tests... all under the guise of "wellness" -- the key is to makes sure it is NOT coded as diagnostic!

Additionally, COBRA rates are a riddle. The rate that you are paying is often *not* the same as what your employer was paying. Not that it really matters -- since I have never understood COBRA rates or why anyone would ever take the bait when there are plans that you could keep the difference in the bank and get a lower cost high ded. policy. I was in a plan where they offered COBRA @ $560 a month. I got the same coverage, same plan, and same coverage as an individual for $230 a month. So, again, COBRA is a scam, IMHO.

The only real riddle you have to solve is how much risk you want to take on. Add to the mix the new rules regarding preexisting conditions, and I can't see any reason to have a Rolls Royce policy anymore. Bad for the country in the long haul -- good for the short term.

Sounds like the OP wants catastrophic insurance (I'm the same way). You can get a decent plan in Broward for around $170 a month. There are cheaper, but they have no max out of pocket on the co-payment which I don't like. OTOH -- and I don't know the answer -- why not take out a plan with no max out of pocket, and if needed roll into a better plan with a max out of pocket limit?

Additionally -- there are several plans that WILL pay for office visits (minus a copay) and waive the deductible if the provider is in network.

JUST an FYI.

Trust me, get familiar with eHealthInsurance.com -- and then find a smart agent that knows the line(s) you like!
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Old 05-14-2013, 05:40 PM
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One reason everyone should have health insurance, even one with a high deductible, is procedures can be up to 80% cheaper if you have insurance vs. paying cash.(what a messed up system!) I have an $8000 deductible, but a few years ago I was trimming a palm tree with huge spikes on it. One of the spikes went into my knuckle and broke off. I needed to have surgery, The total of the bills for the surgery facility, the surgeon, the anesthesiologist, etc, were $6500. After being repriced for my insurance company, the bills came in at $1800, which I had to pay because I hadn't met my deductible. In this case I saved nearly 5k without meeting my deductible on a plan that a healthy young male could purchase for under $100/month.

Last edited by kylesdad; 05-14-2013 at 05:41 PM. Reason: spelling
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Old 05-14-2013, 06:32 PM
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A related question about Cobra:

I was let go a while back from a company. I was told that Cobra would work retroactively. I couldn't believe it, but our HR department and insurance company made it perfectly clear.

They claimed that if I didn't pay for Cobra for x amounts of months then had a major Dr. or Hospital bill that I could then pay for Cobra and Cobra would then pay my bills.

It didn't seem logical to me, but after extensively questioning it that's what I kept getting told.

I never needed it so never used it, but still question whether it would have worked.

Anyone know?
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Old 05-14-2013, 08:06 PM
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Originally Posted by ndb8fxe View Post
A related question about Cobra:

I was let go a while back from a company. I was told that Cobra would work retroactively. I couldn't believe it, but our HR department and insurance company made it perfectly clear.

They claimed that if I didn't pay for Cobra for x amounts of months then had a major Dr. or Hospital bill that I could then pay for Cobra and Cobra would then pay my bills.

It didn't seem logical to me, but after extensively questioning it that's what I kept getting told.

I never needed it so never used it, but still question whether it would have worked.

Anyone know?
Yes, you have up to 90 days to select Cobra. If you didn't initially select Cobra, but in the 85th day, you had an incident and needed medical attention, you could activate your Cobra and be covered, but you would have to pay the back premium from day one.
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