What is Health Insurance?
Health insurance is coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment.
1305 S. Key Ave
Lampasas, TX 76550
Health Insurance Types
Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the services provided.
HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.
Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.
If you have a POS plan, you can visit any in-network provider without a referral, but you’ll need one to visit a provider out-of-network.
High Deductible Health Plan (HDHP)
High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans.
If you have an HDHP, you can use a health savings account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. This can lower the amount of federal tax you owe.
Catastrophic Health Insurance Plan
A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness.
Catastrophic plans usually do not provide coverage for services like prescription drugs or shots.
Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher.
Contact us to learn more about the right health insurance for you.
What is Critical Illness Insurance?
Critical illness insurance or critical illness coverage is an insurance product, where the insurer is contracted to typically make a lump sum cash payment if the policyholder is diagnosed with one of the critical illnesses listed in the insurance policy.
The policy may also be structured to pay out regular income and the payout may also be on the policyholder undergoing a surgical procedure, for example, having a heart bypass operation.
Conditions That May be Covered:
- Alzheimer's disease
- kidney failure
- A major organ transplant
- multiple sclerosis
- HIV/AIDS contracted by blood transfusion or during an operation
- Parkinson's disease
- paralysis of limb
- terminal illness
Contact us to learn more about the right critical illness coverage for you.
What is Dental Insurance?
Dental insurance is designed to pay a portion of the costs associated with dental care. Generally, dental offices have a fee schedule, or a list of prices for the dental services or procedures they offer.
Typical Types of Dental Insurance
Indemnity Dental Insurance Plan:
This plan may be helpful when you want to stay with your dentist and he/she does not participate in a dental network. By the very nature of this plan the insurance company generally pays the dentist a percentage of your services according to the policy you purchased. In addition, you will want to review the co-payment requirements, waiting periods, stated deductible, annual limitations, graduated percentage scales based on the type of procedure and/or length of time you have owned the policy prior to starting your dental work.
Dental Health Managed Organization (DHMO):
When a dentist signs a contract with a dental insurance company the provider agrees to accept an insurance fee schedule and give their customers a reduced cost for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods, no annual maximum benefit limitations, while covering major dental work near the start of the policy period. This plan is sometimes purchased to help defray the high cost of dental procedures. Some dental insurance plans offer free semi-annual preventative treatment. Fillings, crowns, implants and dentures may have various limitations.
Participating Provider Network (PPO):
Depending on your specific plan, the PPO works similarly to a DHMO while using an In-Network facility. However, it allows you to use an Out-of-Network or Non-Participating Provider. Any difference of fees will become the financial responsibility of the patient unless otherwise specified in your dental policy. As noted, some dental insurance plans may have an annual maximum benefit limit. Thus, once the annual maximum benefit is exhausted any additional treatments may become the patient's responsibility. Each year that annual maximum is reissued. The reissued date may vary as a calendar year, company fiscal year, or date of enrollment based on your specific plan.
Contact us to learn more about the right dental insurance for you.
What is Long Term Care Insurance?
Long-term care insurance (LTC or LTCI), an insurance product that helps provide for the cost of long term care beyond a predetermined period. Long-term care insurance covers care generally not covered by health insurance, Medicare, or Medicaid.
Individuals who require long-term care are generally not sick in the traditional sense, but instead, are unable to perform the basic activities of daily living (ADLs) such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and walking.
The Benefits of Long Term Care Insurance
Long-term care insurance generally covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer's facilities. If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day, it is needed. It will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse up to seven days a week, 24 hours a day (up to the policy benefit maximum).
Other benefits of long-term care insurance:
- Many individuals may feel uncomfortable relying on their children or family members for support, and find that long-term care insurance could help cover out-of-pocket expenses. Without long-term care insurance, the cost of providing these services may quickly deplete the savings of the individual and/or their family.
- Premiums paid on a long-term care insurance product may be eligible for an income tax deduction. The amount of the deduction depends on the age of the covered person. Benefits paid from a long-term care contract are generally excluded from income.
- Business deductions of premiums are determined by the type of business. Generally, corporations paying premiums for an employee are 100% deductible if not included in the employee's taxable income
Medicaid provides some of the benefits of long-term care insurance. A welfare program, Medicaid does provide medically necessary services for people with limited resources who need nursing home care but can stay at home with special community care services. However, Medicaid generally does not cover long-term care provided in a home setting or for assisted living. People who need long-term care often prefer care in the home or in a private room in an assisted living facility.
Contact us to learn more about the right long term care insurance for you.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.
If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare.
Most Medicare Advantage Plans also offer prescription drug coverage.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.
Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.
You can also ask the plan for a written advance coverage decision to make sure a service is medically necessary and will be covered. If the plan won't pay for a service you think you need, you'll have to pay all of the costs if you didn't ask for an advance coverage decision.
Contact us to learn more about the right Medicare Advantage plan for you.
What is Medicare Supplement Insurance?
Medicare supplement (Medigap) insurance can help pay some of the health care costs that original Medicare does not cover, like copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medicare supplement insurance policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
Important Things to Know About Medicare Supplement Coverage
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
- You pay the private insurance carrier a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy covers one person. If you and your spouse both want Medigap coverage, we'll work with you to setup two separate policies.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
Contact us to learn more about the right Medicare Supplement Insurance coverage for you.
What is Vision Insurance?
Vision insurance is a form of insurance that provides coverage for the services rendered by eye care professionals such as ophthalmologists and optometrists.
The typical vision insurance plan provides yearly coverage for eye examinations and partial or full coverage eyeglasses, sunglasses, and contact lenses, with or without copays, depending on the plan chosen.
If you see the big picture, you know how important eye health is to overall well-being. A little attention to those baby blues, browns, greens, or hazels can make all the difference.
We can help you obtain affordable vision coverage including an annual routine eye exam for a low copayment. Plus you get coverage for contact lenses or eyeglass lenses and frames - including designer names.