Wellness | Five Items to Consider Before Applying for Health Care [Dedicated]

By: Jamie Durante

Having options is not always such a good thing, especially when it comes to determining which health care plan is going to best serve you and your family. Thankfully, you no longer have to worry. We are sharing with you the five items you need to consider before applying for health insurance, courtesy our friends at Robin’s Signature Health, Financial & Insurance Services.



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1. Determine Which Plan is Right For You

Consider this first step your starting point. There are many different types of plans to choose from for your health coverage, however don’t be overwhelmed by the availability of options. We have simplified what you need to know about each potential health care plan in order to make this process as painless as possible.

Health Maintenance Organization Plan (HMO) - A HMO plan requires for you to choose a Primary Care Physician who is responsible for coordinating and overseeing your care. If you need to see a specialist under your HMO, you must see someone in the same Medical Group as your Primary Care Physician by obtaining a referral from your Primary Care Physician. If you see a specialist without a referral or one that is not in your network, your insurance will not cover the cost.

Preferred Provider Organization Plan (PPO) – PPO plans provide more flexibility when picking a doctor of hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance may pay if you see a non-network provider, although it may be at a lower rate. Premiums tend to be higher and its common for there to be a deductible for many services.

Covered California (Affordable Care Act/Obamacare) Plans – Covered CA offers both HMO and PPO plans that are broken down into four tier levels: Bronze, Silver, Gold and Platinum. Each tier offers plans that have the same level of coverage, however medication costs, network of doctors and hospitals and monthly premiums will be different.

Those who are over 65 years old, or are younger than 65 but have been deemed eligible due to disabilities by the Social Security Administration, are eligible for Medicare and have several health plan choices:

Original Medicare – People who have paid into the Social Security system for Medicare through past employment will be eligible for Part A of Medicare, which covers hospitalization. There is no extra charge for Part A. They will also be eligible for Part B, which covers medically necessary doctor’s services. The monthly charge for Part B depends on your income, but the majority of people currently pay $104.90. This cost is subject to change annually and the cost is determined and set by Social Security.

Medicare does not cover all medical costs. Therefore, one may opt to obtain Supplemental Insurance plans, such as an Advantage Plan or a Medi-Gap plan to help cover the costs that original Medicare does not. Also, Medicare does not cover prescription drug costs, and you must purchase a drug plan (which is also known as Part D) or you may be subject to life-long fines!

Medicare Advantage plans typically have very little or no monthly premiums to pay. This HMO-type plan still considers you to have Medicare, but a private health insurance company manages your care. Some Advantage plans also include drug coverage so you do not have to purchase a separate drug plan. You may even receive vision, dental and gym memberships as part of this plan.

Medi-Gap Plans are PPO-type plans that allow you to visit any doctor or hospital that accepts Medicare. While you have all the benefits of Medicare, a private health insurance company covers some additional costs not covered by Medicare. These plans do have a monthly charge, and you are required to purchase a drug plan since drug plans are not included. With a Medi-Gap plan, you are essentially paying for the freedom to visit any doctor who accepts Medicare.



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2. Evaluate Which Plan Meets Your Needs for Doctors

Do you have a current doctor that you love? Find out if your doctor is contracted under the health plan you are considering. This is especially important when you’re applying for coverage under Covered California!

You also want to find out which medical groups are contracted with your considered health plan. This is because larger networks mean you’ll have more options for specialists within your network.



3. Make Sure Your Medications Will Be Covered

Just to keep things interesting, prescription medications will cost you different amounts depending upon your health insurance provider, and costs can change every year. Medications are categorized into different tier levels, and each health insurance company can classify drugs differently. Beware that tier levels and costs can change every year.



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 4. Determine Which Hospitals Best Serve Your Needs

Do you want to have your second baby where you had your first? Is there an emergency room close to your house that you’d like to have on call if needed? If so, you want to make sure that your preferred hospitals will be covered with the health plan you are considering.   It’s also important to make sure the doctor and health group you’re choosing under your plan is affiliated with your hospital.



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5. Choose A Stable Health Insurance Company

Reputation means everything these days, especially since there have been mergers of many health insurance companies recently. If you would like to depend on consistent premiums and plans for years to come, it is recommended to stick with a larger, more stable health insurance company.  Although it is possible to change your health plan in the future, it’s best to plan for the long-term and ensure your health insurance will deliver you and your family lifesaving benefits for years to come.


Open enrollment for Medicare runs from October 15, 2015 through Dec 7, 2015. The open enrollment for Covered California for 2015 runs from November 1, 2015 through January 31, 2016. It’s your responsibility to take charge of you and your family’s health. Don’t let the seemingly complicated world of health care intimidate you. Our friends at Robin’s Signature Health, Financial & Insurance Services are here, and they’re more than happy to help.

Stay healthy, Inland Empire!


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Robin’s Signature Health, Financial & Insurance Services offers practically every type of insurance for you, your family and your business. They represent many of the best-known and highly-rated insurance companies in the country. Some of their most important areas of coverage include Health Insurance, Life Insurance, Business/Group Insurance, Accidental Insurance, Disability Insurance, Medicare, Retirement Planning and Long Term Care. 

For more information, please call (909) 919-6049 or visit their website at www.signaturehfs.com.


Full Disclosure: This article was sponsored by Robin’s Signature Health, Financial & Insurance Services, and is not all-inclusive.  All opinions expressed are 100% our own.