eFLHealthinsurance Identifies the 3 Biggest Mistakes to Avoid when Buying Florida Health Insurance

Jan. 10, 2012 - PRLog -- The most expensive mistakes made by those searching for Florida health insurance are avoidable when shoppers know what to look for and understand insurance terminology. As the leading provider of online health insurance for Florida individuals and families, eFLHealthinsurance specializes in showing Floridians how to get coverage that’s adequate when major medical care is required. Out-of-pocket costs that insurance doesn’t cover can leave people financially vulnerable and even reduce their access to health care, so eFLHealthinsurance has released guidelines on how to avoid the three most costly miscalculations people make when buying health insurance.

1.   The number one error is applying for a low-premium plan without investigating potential out-of-pocket expenses. Policies state an out-of-pocket maximum, but the definition written in the policy may exclude certain health care from coverage.

For example, the annual out-of-pocket maximum may not include deductibles that have to be met before coverage begins, as well as co-payments and pharmacy charges. The deductible is a predetermined amount that policyholders must spend on health care in order to trigger the plan covering expenses.  If a policy requires that a deductible for the whole family be met before individual members can receive coverage, out-of-pocket costs escalate.

Co-payments are typically applied when a policyholder sees a doctor or fills a prescription. Common co-pays run $25 or $35 to see a doctor, while co-pay amounts vary for prescriptions. The lowest co-pays are generally for generic drugs, and brand-name drugs receive higher co-pays while certain “non-preferred” brand-name drugs have the highest co-pays.  

In addition, policies frequently define two different levels of out-of-pocket costs: one for services from in-network providers and a higher one for services delivered by providers from outside the plan’s network.

2.   Misinterpreting the actual deductible amount is the second most common mistake. A plan can have a $5,000 deductible, for example, and require that every covered member meet that deductible. For a family of four, that means that $20,000 – rather than $5,000 - would have to be spent on health care before the policy would pay for medical expenses.

Plans typically set lower deductibles for services from providers in the plan’s network than for services from external providers. The lower deductible results because certain doctors, hospitals and other providers have agreed to negotiated rates so the insurance company pays less when services are delivered by in-network providers.  Floridians who need an out-of-network specialist usually have to meet a higher deductible.


Policies can also include conditional deductibles designed to discourage the use of high-cost treatment, such as going to the E.R.  A plan may impose an extra $100 deductible for an E.R. trip that does not result in hospital admission, for instance.  

3.   A third common oversight involves overlooking limits on certain coverage. Policies may no longer be permitted to limit the coverage people receive over their lifetime, which could have resulted in literally running out of coverage when chronic health problems increase with age.

Policies may limit the amount of coverage they provide in other ways, though. For example, they may cap the number of mental health, rehabilitation or substance abuse therapy sessions they will cover in a calendar year.  If additional sessions are required, the policyholder will bear the cost.

By looking for instances where a policy defines expenses it will not cover, including deductibles, co-pays and maximums, Floridians can be sure they get the coverage they expect. Using these guidelines to avoid the three most expensive mistakes people make when buying health insurance can result in thousands of dollars of additional coverage to increase access to health care. eFLHealthinsurance also provides online educational resources to help Floridians spend less on items that may not be covered, such as prescriptions and lab work, at http://www.eFLHealthinsurance.com/additional-benefits.htm.

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About eFLHealthinsurance:
eFLHealthinsurance has become a leader in providing educational resources that enable Florida families, individuals and small businesses to keep their health care costs low. Online information explaining how to find coverage to fit individual needs is available at http://www.eFLHealthinsurance.com/how-to-guide.htm and http://www.eFLHealthinsurance.com/health-savings-accounts....

Florida residents seeking health insurance options in the individual market may use eFLHealthinsurance’s online resources or schedule consultations with professionals to compare coverage options to personal health care needs by calling 1-866-585-7661 between 9 AM and 11 PM Eastern.

eFLHealthinsurance also provides extensive resources that can lower health care costs that are not covered by insurance at http://www.eFLHealthinsurance.com/additional-benefits.htm.