Florida Health Insurance Scams With Coinsurance
Florida health insurance is a little like it is in the rest of the country only with many more shenanigans. This is why we offer the guide to shopping for health insurance in Florida. The singularly most important thing to watch for is your out of pocket annual maximum. In many cases this is the most prime area for companies and health agents to pull a fast one. The agents will typically show you a deductible which is somewhat low and then they stop there and will not even discuss coinsurance which comes after the deductible and is really a continuation of the deductible.
Coinsurance defined is the percentage after the deductible that the insured is responsible for. So if the coinsurance is 80/20 the insured would first meet the deductible and then continue to be responsible for 20% of the bills. With most reputable health insurance companies in Florida like Blue Cross or Aetna the coinsurance would stop at a defined amount, with Aetna the average is two thousand dollars. Hence, when calculating your annual exposure, it is important to add the deductible and the coinsurance maximum.
For example, if you were to purchase the Aetna Open Access 2500 health plan in Florida your deductible obviously would be 2500 and the coinsurance is 80/20 to 2500. This means that in the case of this particular health plan your out of pocket maximum is your deductible $2500 plus your coinsurance maximum $2500 for a total annual out of pocket maximum of $5000.
This is where the health insurance companies that are less than reputable where pull their tricks. They have either no coinsurance maximum or an extremely high coinsurance maximum so in many cases your out of pocket maximum is infinite, as you would be responsible for 20% of your medical bills in perpetuity. Many of these companies including many that are being sued by Attorney Generals across the country are owned by one parent company.
Another common health insurance company trick is to put lifetime maximums very low, or put caps on specific illnesses. Many companies will even offer one deductible per illness and hide the fine print. This is why it is so critical to read the contract for your health insurance policy when it is delivered and the one place to check of course if the area where they start showing all the numbers. If you see individual caps or no annual maximum out of pocket, slowly put down the policy and take your telephone and immediately cancel it.
In Florida there is a 10 day free look period where you can review your health insurance policy for these types of concerns. Additionally, even if you believe that your policy is suitable knowing of these limitations, I would instead warn that you many of the free government plans in Florida like Medicaid, will only accept you if you have been totally without health insurance for six months. However, if your policy is older than a month I would recommend not terminating it until you obtain new coverage.
Questions and Answers
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