Julie’s Got You Covered

Your Doctor, Your Meds, Your Money: How to Choose a Health Plan That Actually Works for You

• Julie Sears • Episode 14

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What Should I Consider When Choosing A Health Insurance Plan?

Feeling overwhelmed by health insurance options? You're not alone. Julie Sears cuts through the confusion with practical wisdom that transforms how you'll approach your healthcare decisions.

The magic starts with one simple question: "What do you actually use your coverage for?" This perspective shift immediately clarifies whether you need a plan with higher monthly premiums and lower out-of-pocket costs, or if you can save money with a higher-deductible option. Julie expertly breaks down how to match your real-life medical needs with the right coverage structure instead of getting caught in the premium-deductible trade-off trap.

Network coverage emerges as a critical factor many people overlook. When your doctor doesn't accept your insurance, you might face paying full price with nothing coming off that bottom line. But Julie's prescription advice might surprise you most – she reveals how paying cash through discount programs like GoodRx can save you significant money compared to using insurance for many medications. 

Family coverage presents unique opportunities, too. Julie explains how splitting family members onto different plans based on their individual health needs can optimize your coverage while minimizing total costs. 

Ready to transform your approach to health insurance? Schedule your free 30-minute consultation by calling 469-348-4066 or visiting integrityhealthinsuranceadvisors.com. 

To learn more about Integrity Health Insurance Advisors visit:
https://www.IntegrityHealthInsuranceAdvisors.com/
Integrity Health Insurance Advisors
469-348-4066

Speaker 1:

Welcome to Julie's Got you Covered, the podcast where Julie Sears, founder of Integrity Health Insurance Advisors, takes the fear out of finding the right health insurance. With seven plus years of experience, she's here to make finding the perfect coverage a breeze. Stay tuned for details on how you can snag a free 30-minute consultation. Tuned for details on how you can snag a free 30-minute consultation.

Speaker 2:

Choosing a health insurance plan can feel overwhelming, but it doesn't have to be. In this episode, julie breaks down what really matters when making your decision so you can move forward with confidence. Welcome back everyone. I'm Sophia Yvette, co-host, slash producer, back in the studio with Julie Sears. Julie, how's it going today? Great. How are you? I'm also doing great. So, julie, everyone wants to know what should I consider when choosing a health insurance plan?

Speaker 3:

The first question I ask most families is what do you use your coverage for? In a typical year, a lot of people don't use it for much, so it stumps them because they don't really go for anything other than their annual exams and occasional sickness, and that's great. We can shop, starting with that, and obviously we would be mindful of that out of pocket. But for someone who does have some medical conditions or some maintenance medications, then we want to take that into account to make sure that you don't have a high deductible that has to be met prior to that coverage kicking in, because you may be a more frequent user and we don't want you experiencing that high out of pocket. If we can just shift a few things around, maybe pay a little bit more monthly and get that upfront coverage that you're going to need, where a family that doesn't use it may be able to go the other way and have a little bit more out of pocket in the event something big happens, but they don't have that usual month-to-month type usage that someone else might have.

Speaker 2:

So, julie, what's the biggest difference between a deductible and a premium?

Speaker 3:

Your premium will go up as that deductible comes down. Things have shifted since the Affordable Care Act took over, so it's a little less forgiving. So you might not get as much savings as you would have experienced 15 years ago in that deductible going down and then increasing your premiums. In that deductible going down and then increasing your premiums, typically the premiums are just high and don't have a lot of give, even when we are increasing or decreasing that deductible. So we're just trying to find that perfect fit and make it as least painful as possible.

Speaker 2:

So, speaking of a perfect fit, why is it important to check if your doctor's in network?

Speaker 3:

So, speaking of a perfect fit, why is it important to check if your doctor's in network Out of network can cause a lot of out of pocket? So if your doctor does not accept the insurance that you are currently covered on, then it could go to your full out of pocket, or they just may not accept it at all and you'll just be required to pay cash and have that full out of pocket experience with nothing coming off of that bottom line.

Speaker 2:

How can I estimate my out-of-pocket costs for the year?

Speaker 3:

Typically we're going to look at what that normal usage looks like and kind of estimate how many visits you anticipate having. If you have any procedures that you're looking to have done, we can look at what portion of that is paid for by the insurance once you hit that deductible and we can come up with a rough estimate. Of course we can't guarantee what the future looks like and we don't know what tomorrow brings, but we can at least get a good estimate of what your normal out-of-pocket expenses should look like.

Speaker 2:

What should I look for in a prescription drug plan?

Speaker 3:

Prescriptions are now tricky. A lot of plans now have a deductible that has to be met prior to your prescriptions being covered, and so for a lot of the maintenance meds it doesn't make sense because you'll never hit that deductible. So typically I will recommend using one of the discount plans and paying cash. So GoodRx is a great resource. Cost Plus Drugs is also another great resource, and those will ship right directly to your house. Saves you a little time and gas for having to get out and get those. So it just depends on what medications you're using and it typically takes a little bit more digging. So someone who has those basic maintenance meds like blood pressure, cholesterol, those types of medications those are typically pretty cheap, even when paying cash. Someone with more of a chronic condition like diabetes those medications typically are a little bit more expensive and require a little bit more shopping than some of the others do. So we definitely take a little more time digging into that to make sure you're properly protected.

Speaker 2:

So, when it comes to these medications, how cheap is cheap and how expensive is expensive?

Speaker 3:

As far as cheap. Walmart offers cash breaks as low as $4 for generics, so a lot of pharmacies are doing that now. Obviously, paying cash is the best way to go, especially if your insurance requires a deductible or a high copay for generic medications. There's no sense paying that $25 copay if you can get it for $4. There's a savings of $21 a month. I'm sure plenty of people can find things to do with that. There are medications out there that are over $1,000 a month. There are some that are $5,000 a month. We'd look at manufacturer assistance that will help with copay cards based on your income. They've got a lot of different programs and we'd want to look at one of those to keep that on them and not you to help save some of that money.

Speaker 2:

What a price range. It's a big price range. So, julie, how do family plans handle deductible differently than individual plans?

Speaker 3:

so a family plan is typically a combination of two or more of the individuals on the plan hitting that deductible. So with a family of six, if it's wanting two or three people to hit that deductible, obviously on an individual plan you're fully responsible for that out-of-pocket and that or that deductible and out-of-pocket where, like I said, most family plans it's going to be either two or three of those individuals hitting that deductible and out-of-pocket before absolutely everything is covered.

Speaker 2:

Why is it helpful to talk with an advisor before enrolling?

Speaker 3:

Because every family situation can be so different and with kids going off to college being diagnosed with something a little more chronic, then that changes the whole situation and the dynamic and it could make sense to split the family to get someone who needs more care on a lower deductible plan without everyone having to pay a higher premium, or just making sure that the required doctors are in network along with your medications being properly covered. So it's a very convoluted system nowadays and it's a little more than just kind of plug and play. So you can't just go by the standard like Blue Cross is great, because there are varieties of Blue Cross and your doctor may not be in network with one of them.

Speaker 2:

Well, love it. Julie. Thank you for the insight into this. We'll catch you in the next episode and have a fantastic rest of your day you too thanks for tuning in to.

Speaker 1:

julie's got you covered. Ready to say goodbye to insurance stress, head to integrityhealthinsuranceadvisorscom or call 469-348-4066. That's 469-348-4066 to book your free 30-minute consultation With Julie. Health insurance doesn't have to be scary, she's got you covered.