Important Health Insurance Questions – Asked & Answered by Decent Insurance

Buying health insurance is one of the biggest investments you can make for yourself or your family. Not only are you investing in services, but you are investing in your health and wellbeing. Whether you’re searching for the perfect plan solo or working with a broker, we’ve compiled key questions you’ll want to keep top-of-mind as you browse options.

Which plan makes sense for me?

Health plans are organized by tier, with bronze plans typically having the lowest premiums and platinum plans having the highest. Be sure to look beyond the premiums.

Individuals have different needs, so it’s important to understand and anticipate your needs when buying health insurance. Some prefer to purchase just enough coverage in case of an emergency. Others may have medical issues that require surgery or routine checkups. It makes sense to map your individual situation and anticipate your needs.

Are you shopping all of your options?

In general, health insurance companies rank alongside cable companies as the least liked companies in America. Yet, we often accept it and don’t bother shopping around for a plan each year to find something better. Or, we don’t look outside the government-run health insurance exchanges, even though we earn too much to qualify for subsidies. “Off-exchange” websites like Kind offer more choice for families and individuals shopping for health insurance and choice allows you to pick a plan that is more customized to your needs.

What does health insurance cost?

Great question! It’s also a complicated question. While it’s impossible to be an oracle regarding health needs, you can make educated guesses about what to expect. Consider three important factors to help you estimate your health care costs: deductible, out-of-pocket max, and premium. Each will impact the total amount you spend on health care costs annually.

Premium

This one is the easiest to calculate. Take the monthly premium, multiply it by 12 and that is your annual premium cost. 

Deductible

This is what you pay before the insurance kicks in to cover additional care. If your deductible is $2,000, that is the amount you’re responsible to pay before health insurance begins to pay out. (Remember: having insurance means you pay negotiated rates for healthcare services, which often are much lower than you would pay without insurance.)

Important to note is that some plans offer FREE services — whether that’s primary care visits or telemedicine visits — these are services included in your premium and do NOT go toward your deductible.

Out-of-Pocket Max

This can be confusing, so we’ll illustrate with an example. Let’s say you require surgery, and it costs $25,000. Let’s also assume that your plan looks like this:

• Deductible: $5,000
• Coinsurance: 20%
• Out-of-pocket max: $8,000

You will not be responsible to pay the entire $25,000. Instead, your responsibility will look like this:

• Deductible: You pay the first $5,000 of covered medical expenses.
• Coinsurance: You pay 20% coinsurance on the remaining costs ($20,000), which amounts to $4,000.

At this point, it looks like your total costs would be $9,000 (the total of your deductible and coinsurance: $5,000 + $4,000).

But wait! Your out-of-pocket maximum is $8,000, so your insurance company will pay all covered costs that exceed that amount. That includes surgery as well as any other covered care you need for the rest of the plan year.

What is direct primary care (DPC) and why might it matter to me?

DPC means primary care providers now give individuals and families unlimited access to a doctor. It centers on the doctor-patient relationship meaning you won’t get shooed out of your doctor’s office after 15 minutes AND you can contact your doctor however many times you want.  This “free primary care model” eliminates the need for doctors to deal with mounting paperwork (like health insurance claims info) and focus on what they love to do — take care of people. It’s the kind of health care people want, and the kind of care that doctors want to provide.

What is Decent and why should I pay attention?

Health insurance can and should be affordable. The founders of Decent were just like you, successful entrepreneurs and self-employed professionals who constantly struggled to find affordable healthcare coverage.

By partnering with the Texas Freelance Association, Decent is able to offer ACA-compliant health insurance to self-employed professionals and sole proprietors at up to 50% less than plans listed on healthcare.gov.

These plans place no restrictions on pre-existing conditions (or charge extra) and you don’t need to undergo a medical screening to qualify. All of the plans also offer free primary care, so you don’t have to worry about any copays for doctor office visits. 

No copays, no mystery bills showing up in your mailbox weeks later. Free.

Self-employed WCA members, including Freelance Austin members qualify for a special discount. Click here to learn more.