Health insurance  

What is major medical insurance?

Health Insurance that covers most serious medical expenses usually after a deductible and co-insurance have been met.

Health insurance in the United States of America is a difficult concept to understand at times. With over 300-million residents in the country, 15.3% remain uninsured completely, while the other 84.7% have health care plans via employers' private pools, private companies, the Veterans Health Administration, the Children's Health Insurance Program and Medicare/Medicaid/TRICARE.

Health insurance in general is an easy concept to understand, however. Paying a rate-usually monthly-to an entity of some sorts providing coverage will mean that, should you fall ill and need medical assistance, your insurance package should cover a percentage or all of the costs.

A problem the American public faces, besides the millions uninsured, is the "underinsured" crisis. Roughly 35% of all Americans with existing health care plans find that their particular packages do not cover the full costs of medicines, procedures, and more private plans fail to cover preexisting conditions.

Since most of the health care in the U.S. is provided by the private sector, individuals are paying out of pocket for health packages instead of paying into a single-pay subsidies pool, as with Canadian and UK health systems. There is much heated debate whether single pay plans can adequately meet our needs…most research shows the quality of single pay care health care is diminished.

Changes have recently been made to America's health care industry, via legislation passed by Congress. With 2,000 pages of legislation that even the lawmakers failed to read, America's health care bill, dubbed "Obamacare," has become one of the most difficult things to understand in recent history. At this time the legislation has passed Congress, March 2010, but is being tested by the courts as to its “constitutionality;” so we don’t really know if this baby can stand, walk or talk, on its own.
Health care in America does need reforming; question is who will legislate…the bureaucrats in DC or the free market system.

Some recent changes that have been enacted from this bill:
NEW: preventative care 100% covered on all products without any copay or deductible: i.e. pap, pelvic, prostate, bone density, colonoscopy
NEW: No life time “limits” on policies, no caps on Rx nor organ transplant or hospice
When approaching major medical coverage I personally believe to find “value” focus on higher deductibles and protect oneself from “catastrophic” (financial) loss. Basically you bear the costs of the “small stuff” and use the insurance for the major diseases/accidents etc. In this way you’ll have monthly “premiums” that are better aligned.

A good major medical health insurance will have out of pocket limits to protect your finances. After the deductible is met and the coinsurance is achieved the plan covers 100%. If your plan doesn’t have an out of pocket limit you have unlimited risk…imagine paying 20-30% for chemo or radiation therapy!

Most plans offer a co-pay for the doctor’s visit plus prescription drug coverage. To stream line your costs some remove the doctor’s copay. A big caveat of insurance is
“repricing.” In having major medical even before the deductible is met your claims are “repriced;”meaning they are reduced from the “retail” to a “wholesale”…this can save significantly on those doctor’s ordered “tests.”

Call or email me and let me run a variety of quotes for you and your family.



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Insurance Agent for Seniors

Mitchell Jerome

3235 Glade Springs Dr
Kingwood, TX 77339

Phone: 713.639.5097
Cell: 832.287.1122
Fax: 832.644.6423
Toll Free: 877.402.7236

Specializing in:

Located in Kingwood Texas and serving the Greater Houston area and the state of Texas, Florida and Tennessee.