We are an agency dedicated and focused on helping our community make informed decisions about their health insurance, both Medicare and Obamacare. If you have health insurance and have questions about your coverage, or if you don't yet have health insurance and would like to get free or low-cost health insurance, contact us for help.
You may have wondered what exactly health insurance is and what it means to have one. Health insurance is an agreement between the insurance company or “carrier” and an individual or company. This type of insurance helps people protect themselves financially against high medical costs, such as in the event of an accident, while also having a better quality of life with better medical care.
In the world of insurance, it is very common to hear the term "deductible" which is a bit confusing. The deductible is the amount of money that you, as the insured/client, agree to pay before the insurance begins to pay your medical expenses. For example, if you have a deductible of $3,500 and unfortunately you have a car accident whose medical expenses are $57,000, the average in the United States, it means that you as the insured have to pay that $3,500 before the insurance covers the rest. In this case, the insurance will potentially protect you from paying more than $53,000 unless your policy has other limitations.
The copay is the amount of money that you, as a patient, must pay each time you request medical services. The average cost of a visit to the family doctor in the United States in 2016 was $265. This means that if you visit your family doctor for a cold or other illness, you'll be asked to pay that $35 for the visit, and your insurance will potentially pay the rest. Normally, insurance companies have a predetermined maximum per medical service to avoid overpaying. For example, if your insurance has defaulted that the maximum cost for a visit to the family doctor is $200. And the doctor bills your insurance for $500. This means that you may be responsible for $300 less your $35 copay or $265. This is a slightly exaggerated case with the consultation of a family doctor but it may be possible in case of an emergency hospitalization due to an accident or medical emergency.
According to a study by The American Journal of Medicine, 67% of bankruptcies are due to medical expenses. An unexpected visit to the emergency room, due to an accident, illness such as bronchitis, or unexpected situations such as abdominal pain, costs an average of 3 thousand dollars. Having health insurance protects you, not only you as a client, but also your family member from being part of the bankruptcy statistics and having peace of mind in the event of an unexpected situation. This is without counting the costs of more severe or recurring diseases such as cancer, diabetes, kidney failure, etc. These are just a few of the many reasons why having health insurance makes a lot of sense. The best part is that most people qualify for a government subsidy, making health insurance free or very low cost depending on your personal situation.
Obamacare or The Affordable Care Act (ACA) is a set of laws for access to health insurance until before the age of 64. Among many other things, Obamacare specifies a subsidy or discount from the federal government to make health insurance more accessible to the general public. Medicare, on the other hand, is insurance provided by the federal government, through private companies, for the elderly. at age 65 or who have been receiving social security disability benefits for more than 2 years.
It is the federal health insurance program for people 65 years of age or older, people who have been receiving disability benefits through social security for more than 2 years, and people with end-stage renal disease.
The beneficiary usually receives his Medicare card 3 months in advance of the effective date. It is a white cardboard card with a red and blue stripe that commonly includes part A and part B. The beneficiary is responsible for seeking additional or supplemental coverage.
Part A is access to hospital coverage and Part B to doctors, Part D helps cover the cost of prescription drugs and the famous Part C, which are the Medicare Advantage Plans that combine hospital, doctors, medication, and other benefits such as Dentist, Glasses, Hearing Aids, Transportation, Non-Prescription Medications, among other benefits.
The Affordable Care Act or popularly known as Obamacare. It is a set of laws that were a primary part of President Obama's agenda. This health reform, whose objective was to make medical insurance accessible and affordable for everyone, is still in force, although it has changed a little over the years and the different administrations. These laws grant the benefit of having health insurance until the age of 65. Among the benefits of Obamacare are emergency room services, hospital, maternity, doctor and laboratory services, mental health and substance abuse services, rehabilitation, preventive services, and pediatric services, among others. According to statistics, more than 23 million have access to health insurance through Obamacare and 10 million get it for free.
The cost of health insurance depends on many things, such as the amount you want to pay in copay, deductible, and your personal and family financial situation. However, most people qualify for health insurance at no monthly cost. For example, at Texas Medical Care Plans, most of the people we help are in plans with no monthly cost. To find out how much insurance would cost for you or your family, contact us so we can give you a quote.
Obamacare is the same as private insurance. The difference is that in Obamacare the government offers a subsidy to pay the monthly premium, and in private insurance, you are covering the total monthly premium of your insurance.
All plans and companies are good, but there will always be an option that best suits your health and financial needs. The best way to find out if your current insurance company is the best for you is to send us a message to review your coverage without obligation.
The vast majority of people qualify for $0 per month plans. 4 out of 5 people can get a plan for $10 or less per month. But this depends on 5 factors: income, family size, age, city, and type of coverage you are looking for.
This number will connect you with a licensed insurance agent. Texas Medical Care Plans is not affiliated with any government agency. Texas Medical Care Plans is a licensed insurance agency that works with people enrolled in Medicare to explain their options for Medicare Advantage Plans, Medicare Supplements, and prescription drug plans. We do not offer all plans available in your area. Any information we provide is limited to the plans we offer in your area. Please contact Medicare.gov or 1-800-MEDICARE for information on all of your options.
You can still get the health insurance that you deserve