Buying Individual Health Insurance - Aetna

Your Top Ten Checklist:

Your Top Ten Checklist Buying Individual Health Insurance Tracy McManamon One Source Benefits 877-549-1212

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2 2 1. Cost is More Than Premiums

Premiums based on many different factors :

Premiums based on many different factors Type of coverage Deductible and other cost- sharing features Network Health status Age Gender (where permissible) Geographic location 3 1. Cost is More Than Premiums

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1. Cost is More Than Premiums Deductibles Amount you pay out of your pocket 4

How much are you comfortable paying? :

5 5 How much are you comfortable paying? Lower deductible = higher premium Higher Deductible Lower Premium Lower Deductible Higher Premium Higher premium = lower deductible 1. Cost is More Than Premiums

Coinsurance :

Coinsurance Health insurance plan pays percentage, you pay percentage Coinsurance may apply only to certain items like hospitalization Use of “in-network provider” services reduces your coinsurance costs Look at your maximum out-of-pocket expenses 6 2. How Coinsurance and Copays Work

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7 7 Copays You pay fixed dollar amount for doctor visit or prescription 2. How Coinsurance and Copays Work

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8 8 3. Hospital Coverage

Review limits :

Review limits Length of hospital stays Outpatient treatments Tests Doctor or specialist visits, medication while in hospital, and any inpatient hospital deductible 3. Hospital Coverage 9

Provider Networks :

Provider Networks Contracted doctors, hospitals, pharmacies, etc. Health insurance plans distinguish benefits and costs by networks “In network ” often less expensive than “out of network ” 4. Importance of Networks 10

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Look for: Preventive care Blood pressure Certain cancer screenings, Type 2 diabetes screenings Vaccinations Annual physicals Routine GYN exams 100% coverage No copay, no dollar maximum No deductible, no waiting period 5. Preventive Care 11

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12 12 * At some clubs, participation in this program may be restricted to new club members. Look for: Discounts and savings 5. Preventive Care Eyewear Hearing aids and services Acupuncture, massage therapy, vitamins Gym memberships *

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13 13 Work with a pharmacy that is in your health insurer’s network Generics usually cost less than name brands Look for difference in price from generic to name brand Lower copay for generics Check formulary for specific medications 6. Prescription Medication

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Mail order Rx convenience Specialty drugs like insulin delivered to your door 6. Prescription Medication 14

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Broader-based health insurance plans have most coverage Available in lower and higher deductibles Higher deductible = lower premium Health Savings Account (HSA)-compatible high deductible plans Out-of-pocket can go up to $5,950 for individuals 15 7. Types of Health Insurance Plans

Health Savings Accounts (HSAs) :

Health Savings Accounts (HSAs) Deposit money into special account at bank In 2010 up to $3,050 for single and $6,150 family Pay no tax on amount deposited, grows tax-free No tax on earnings for qualified health care expenses Must use money for health care expenses to qualify for tax breaks 7. Types of Health Insurance Plans 16

Health Savings Accounts (HSAs) :

17 17 Health Savings Accounts (HSAs) Can roll over year after year Must have annual deductible of at least $1,200 single, $2,400 family 7. Types of Health Insurance Plans

Limited benefit plans :

Limited benefit plans Also referred to as “hospital plans” Less expensive than broader-based coverage Might be right for people who: Want to save money Consider themselves relatively healthy Want to protect themselves from hospital stays 18 7. Types of Health Insurance Plans

Limited benefit plans :

Limited benefit plans 19 7. Types of Health Insurance Plans Do not usually cover doctor visits or medications May cover generics Know what you’re buying

What to consider:

What to consider Overall health Need for doctor visits, tests, hospitalization Medication now, in future 20 7. Types of Health Insurance Plans

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You’ll be asked for medical history May deny you or charge higher premium based on history Agent should pre-qualify before applying Consider your situation: job transition, early retirement, own business 21 8. Applying for Health Insurance Plans

Most changes not until 2014 :

22 22 2010 changes include: Temporary government program for those denied due to pre-existing condition Lifetime limits to be lifted Companies cannot cancel or discontinue your coverage retroactively except for non-payment, fraud, or intentional misrepresentation of material fact. No pre-existing coverage exclusions for enrollees under the age of 19 9. Health Care Reform Most changes not until 2014

Most changes not until 2014 :

23 23 2010 changes include: No out-of-pocket max for calendar year Will not have to share cost of in-network “recommended” preventive care Eligible dependent children okay to stay on plan until 26 th birthday 9. Health Care Reform Most changes not until 2014

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24 24 10. Who to Work With Professionals Registered, licensed agent Reputable, stable company Will help you Get the right health insurance plan for what you need Analyze your situation Time and advice, no extra charge

Your Top Ten Checklist :

25 25 1. Cost Is More Than Premiums 2. How Coinsurance, Copays Work 3. Hospital Coverage 4. Importance of Networks 5. Preventive Care Your Top Ten Checklist 6. Prescription Medication 7. Types of Health Insurance Plans Available 8. Applying for Health Insurance Plans 9. Health Care Reform 10. Who to Work With

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26 26 Aetna Advantage Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company (Aetna) directly and/or through an out-of-state blanket trust or Aetna Health Inc. In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans. To the extent permitted by law, these plans are medically underwritten and you may be declined coverage in accordance with your health condition. This material is for information only. Plans may be subject to medical underwriting or other restrictions. Rates and benefits vary by location. Plans not available in all states. Health insurance plans contain exclusions and limitations. Investment services are independently offered by the HSA Administrator. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc. that operate through mail order. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Information is believed to be accurate as of the production date; however, it is subject to change.

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Thank You. 27 13.25.300.1 (10/10)