1. THE 3 MOST IMPORTANT THINGS TO LOOK FOR WHEN SHOPPING FOR HEALTH
INSURANCE
By Lisa Carrillo Romeo
For those of you that do not know, November 1st through January 31st is open enrollment
for ACA/Obamacare. As per (healthcare.gov), the law requires that everyone must have health
insurance. For those that do not enroll in any form of health insurance, there will be a penalty of
over $600 for individuals and over $2,000 for families in 2016. As of November 1st we are
taking applications to be effective starting January 1st, 2016. In order to have a plan effective
January 1st, 2016, the application must be submitted and processed with the first premium paid
for by December 15th, 2015. Some people and families may qualify for government assistance in
paying their premiums. Small businesses would benefit from reviewing what they are paying for
their employees health insurance compared to what the Affordable Care Act (ACA)/Obamacare
could offer their employees and their families. The employees may be eligible for government
subsidies in 2016.
When shopping for a plan, the first thing most people look for is the lowest possible
premium. Yes we do need to stay within our reach of affordability. But, is the lowest possible
premium really the best choice in the long run? Absolutely not! I will tell you why.
There are many people that never go to the doctors. In general, they are healthy. With
that in mind they most likely look for a plan with the lowest possible monthly premium. Then
out of the blue they catch a cold with fever or the flu. That leads them to the doctor’s office
paying out of pocket expenses for the doctor’s visit. Then the doctor orders a blood test and chest
x-ray which then leads to an MRI. And guess what, those tests are also out of pocket expenses.
Then they wonder why they had to pay thousands of dollars out of pocket in one year when they
had been paying monthly premiums for health insurance. Sometimes just and extra $10 - $40 per
month in paying more for premium costs could make a big difference in actual savings.
This is what they did not look for or ask the right questions:
1. DEDUCTIBLE – their deductible was $10,000 for the year for hospital stay prior to
the insurance company paying 100% or any percentage of needed medical services.
2. CO-PAYS – the plan they chose with the lowest available premium did not offer
doctor’s visits, imaging services nor pharmaceutical meds with a copay. Many plans
offer $10, $25 or less in co-pays costs for doctor’s visits and $75, $50 or less co-pay
for specialists. Imaging services could have a $150 co-pay. Pharmaceuticals could
have a copay from “0” and up for generic brands. Well-known brands are more
expensive. The plans vary.
3. MAXIMUM OUT OF POCKET EXPENSES – their maximum out of pocket
expenses was also $10,000 before the insurance company would pay for anything.
That means that any medical services on top of their lowest possible premium would
need to reach the amount of $10,000 for the year before the insurance plan would

2. even benefit them. Now think about it. Is that a realistic number to pay for out of
pocket in one year in order to have the insurance company pay for anything?
REMEMBER: THE CHEAPEST PREMIUMS COULD ALWAYS END UP
HAVING US PAY A LOT MORE OUT OF POCKET. The health insurance plans
change every year. That means when the year is up, all the money we laid out for
medical services starts back at “0” starting all over to build up to the deductible and
maximum out of pocket expenses prior to the insurance company paying for
anything. Then the same cycle begins the next year.
I URGE EVERYONE TO DO THEIR RESEARCH OR ASK THE RIGHT
QUESTIONS.
If you have any questions, I’d be glad to help you. Just PM me, email me:
lis4rom@msn.com or call me at 954-295-2514. I am ACA/CMS certified and a
licensed independent agent in the state of Florida.