1. CONSUMER DRIVEN HEALTH CARE
Are You Up to Speed?
Presented By:
John V. Stewart, MSM, CDHC
Stewart’s Insurance Depot
S.E. Georgia 912.434.2090
N.E. Florida 904.729.4025
Metro Indianapolis, IN 317.570.1271
Metro Cincinnati, OH 513.868.0040
Nationwide 866.203.5097
3. Stewart's Insurance Depot
Consumer Awareness
Some myths and facts:
Health insurance companies make lots of money on us!
Fact: Health Insurance Companies make 3 cents on
every dollar.
Fact: The insurance industry is the only industry
required by law to make a profit.
So where does our insurance dollars go?
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4. Stewart's Insurance Depot
So where does our insurance dollars go?
If 87 cents of every major medical insurance dollar goes to covering us, what can I
do to help control my costs and keep my insurance premiums as low as possible?
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5. Stewart's Insurance Depot
Your personal Survey on Major Medical Insurance
Cost savings start with what kind of major medical plan I am looking to purchase.
The plan will cover with ages of:
I would like a ( local, regional or national ) insurance carrier
What amount do I want to pay as a deductible?
Do I want a coinsurance amount (what % 90/10, 80/20,
70/30, 50/50)?
How many times a year do I go to the doctor?
Do I want a plan that has doctor copays?
How many prescriptions do I purchase a year?
Do I want a plan that has prescription drug coverage?
Do I want a tax advantage plan with qualifying high
deductible insurance? Y or N
How much am I willing to put into an HSA account/year?
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6. Stewart's Insurance Depot
How much do you want to spend on Major Medical Insurance?
George Ready (Age 30) 32034
Single
Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year
Saver $2,500.00 $3,000.00 $5,500.00 N/A $70.80 Base of % Base No Copay
80% Plan $2,500.00 $3,000.00 $5,500.00 N/A $106.68 33.63%
Copay Plan $2,500.00 $3,000.00 $5,500.00 $35.00 $110.57 35.97% $477.24
100% Plan $2,500.00 $0.00 $2,500.00 N/A $127.09 44.29%
Single HSA * $2,500.00 $0.00 $2,500.00 N/A $128.02 44.70%
Nancy Ready (Age 30) 32034
Single
Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year
Saver $2,500.00 $3,000.00 $5,500.00 N/A $91.94 Base of % Base No Copay
80% Plan $2,500.00 $3,000.00 $5,500.00 N/A $140.08 34.37%
Copay Plan $2,500.00 $3,000.00 $5,500.00 $35.00 $166.98 44.94% $900.48
100% Plan $2,500.00 $0.00 $2,500.00 N/A $165.13 44.32%
Single HSA * $2,500.00 $0.00 $2,500.00 N/A $167.91 45.24%
George Ready & Family (Parents Age 30) 32034
Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year
Saver (2) $5,000.00 $6,000.00 $11,000.00 N/A $268.83 Base of % Base No Copay
80% Plan (2) $5,000.00 $6,000.00 $11,000.00 N/A $270.68 0.68%
Copay Plan (2) $5,000.00 $6,000.00 $11,000.00 $35.00 $506.15 46.89% $2,847.84
Plan 100 (2) $5,000.00 $0.00 $5,000.00 N/A $481.89 44.21%
Family HSA (1)* $5,000.00 $0.00 $5,000.00 N/A $451.67 40.48%
Gearge Ready & Wife (Age 60)
32034
Plan Type Deductible Coinsurance Total Out of Pocket Copay Premium % Cost Difference Cost of Copay/year
Saver (2) $10,000.00 $6,000.00 $26,000.00 N/A $285.72 Base of % Base No Copay
80% Plan (2) (2) $10,000.00 $6,000.00 $26,000.00 N/A $374.78 23.76%
Copay Plan (2) $10,000.00 $6,000.00 $26,000.00 $35.00 $445.28 35.83% $1,914.72
Plan 100 (2) $10,000.00 $0.00 $20,000.00 N/A $443.43 35.57%
Family HSA (1)* $10,000.00 $0.00 $10,000.00 N/A $521.38 45.20%
() Indicates number of persons needed to meet deductible requirement
* HSAs have benefit of a health savings account and tax deduction of income and 0 tax when used for IRS acceptable major medical procedures and Rxs
Note: the plans outside the HSAs and 0 coinsurance plans have larger out-of-pockets
Look what it costs to have an office visit copay and other bells and whistles.
Note: rich benefit plan 6
8. Stewart's Insurance Depot
Why HSA Qualified Plans?
• You are in control of how you use your health care dollars.
• Become more involved in managing your cost of care.
• Learn how to shop for the best prices for your care.
• Your tax-advantage contributions to your HSA account grow over
time.
• It is your money to use tax-free for qualified medical expenses.
• There is no “use it or lose it” philosophy. If you don’t use it, save it
for next year. Or better yet, for retirement.
• After age 65, HSA funds can be used for non-qualified expenses and
only income tax is assessed.
From HSABank website 8
9. Stewart's Insurance Depot
An HSA Growth Illustration
Income tax reduction anyone? The Happy family with George age 30 and Susan age
30 have changed from a conventional major medical
Contribution 2011 Limits Single Family plan to a High deductible HSA qualified family plan.
Minimum Deductible $1,200 $2,400 No kids yet, but who knows…. Remember
HSA/HDHP family plans; all insured members have
Maximum Out-of-Pocket $5,950 $11,900
access to these funds for medical expenses as
Contribution Limit $3,050 $6,150
allowable by the IRS. When George and Susan
Catch-up Contribution (55 or older) $1,000 $1,000 convert to Medicare at age 65, here is what they
have.
Estimates Below for this illustration:
Enter your average contribution per year: $ 4,000.00
Enter your average medical expenses per year: $ 850.00
How many years will your account accumulate? 35
Enter your federal tax bracket: 28%
Enter your state tax: Florida no state income tax
Enter your bank interest rate: 3%
Results of the Happy family having a HDHP/HSA:
Future Value Calculator
Net Contributions: $110,250.00
Net Contributions Per Year: $3,150.00
Tax Savings on Contributions: $30,870.00
Tax Savings on tax-deferred growth: $22,457.56
Future Value: $190,455.56 From HSABank website
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10. Stewart's Insurance Depot
Investigate Make
Ask Cost of Informed
Questions Care Decisions
ALL RIGHT: I’M READY TO TAKE CONTROL!
How do I do it?
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11. Stewart's Insurance Depot
Are we shopping for major medical care services
like we shop for other things?
Are we a savvy shopper for major medical care services?
Do we just wave our major medical insurance card and say ….. “just fix me?”
OR
Check if you do: • Do we check out where we are going
to buy
• Do we ask what the costs will be? our medications?
• Do we check to find the least • Do we investigate second opinions
costs for the and
services needed? alternate treatment regimens?
• Do we use our network provider • Do we investigate the treatment we
directory? need to
be informed? 11
13. Stewart's Insurance Depot
What to do at the doctor visit:
• Inform your doctor of any changes you are experiencing.
• Be honest about how you are feeling.
• If you are taking medication(s) prescribed by another
doctor(s), inform your doctor of these and why you are
taking them.
• Give your doctor your family medical history regarding
major illness issues and cause of death. Go back to at
least your grandparents.
Remember the 6th highest cause of death
in the US is
from taking Also be sure to:
the wrong
prescription! Take your notebook and pen….
Take notes on what to do.
Ask questions……
Write down answers.
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14. Stewart's Insurance Depot
Some Helpful Resources:
Your doctor says you need to have a Carpal Tunnel condition evaluated
and you need to have it verified by an MRA and then possible surgery.
You are now a savvy health care shopper what do you do?
Here are some suggested internet resources:
The HSA Insider hsafinder.com
CDHC Solutions CDHC Solutions
“Ask the Experts”
Consumer Driven Patient2Patient”
Market Report
MCOL’s Consumer
Driven Care
Or any other resource you choose. Here is what we found…
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15. MRI- Musculoskeletal
Always check our your
provider directory and the cost first
Source:
http://www.pearldiverinc.com/cct/content/index.jsp
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16. Carpal Tunnel Surgery
How much do you want to spend?
Source:
http://www.pearldiverinc.com/cct/content/index.jsp
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17. Stewart's Insurance Depot
Are you receiving the best value for your dollar?
Have you ever thought about paying cash instead of using your insurance? If you
have a health savings account/ high deductible major medical plan, you have the
best of both worlds.
or ?
Next time you visit your doctor and have to have an out-patient surgery and you have an
HSA Account ask what it would cost if you paid using your plan or cash for it all?
Using my insurance plan. $
Not using a hospital. $
Using a stand alone facility. $
From the above ask the Big Question…What if I pay cash for the whole procedure
using this facility?
$
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19. Stewart's Insurance Depot
What is in your eye?
Your eyes can tell you many things about the condition of your body.
Examination of your eyes can forewarn you of subtle changes taking place in
various parts of your body such as:
Glaucoma
Cataracts
Diabetes
High Blood Pressure
Night Blindness
Detached Retina
Macro Degeneration
Depth Perception
Wear good quality sunglass, avoid glares and use eye protection when
working. Never ever look directly at the sun or other high intense light!!!!!
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21. Stewart's Insurance Depot
Anyone for Hearing?
Hearing is very important and subtle changes in hearing
can cause long-term results:
• Get your hearing checked by competent
professionals
• Early detection results in less chances of
major loss.
• Never listen to very loud music or expose
yourself to loud noises.
• Wear ear protection.
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23. Stewart's Insurance Depot
Get Your Dental Check-Up & Cleaning
WHY?
• Prevents tooth decay
• Check for oral cancers
• Detection of Periodontal Diseases
• Helps keep you healthy from other diseases.
Periodontitis (http://www.nlm.nih.gov/medlineplus/ency/art)
Periodontitis occurs when inflammation or infection of the gums gingivitis is
untreated or treatment is delayed. Infection and inflammation spreads from the
gums (gingiva) to the ligaments and bone that support the teeth. Loss of support
causes the teeth to become loose and eventually fall out. Periodontitis is the
primary cause of tooth loss in adults. This disorder is uncommon in childhood but
increases during adolescence.
Causes
Periodontitis occurs when inflammation or infection of the gums gingivitis is
untreated or treatment is delayed. Infection and inflammation spreads plaque and
tartar accumulate at the base of the teeth. Inflammation causes a pocket to
develop between the gums and the teeth, which fills with plaque and tartar. Soft
tissue swelling traps the plaque in the pocket. Continued inflammation eventually
causes destruction of the tissues and bone surrounding the tooth. Because plaque
contains bacteria, infection is likely and a tooth abscesses may also develop,
which increases the rate of bone destruction.
Updated by: Jack D. Rosenberg, DDS, Advanced Dental Care, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network.
Also reviewed by David Zieve, M.D., MHA, Medical Director, A.D.A.M., Inc. 23
24. Stewart's Insurance Depot
Where do you keep a copy of your
Health Care Power of Attorney?
Bank File Drawer Shoe Box Attached to Oh, it is somewhere
something around
One of the most important places to keep a copy of your POA Health Care is in:
The glove box
Mary Stewart
I never thought of that…..
912.434.2090
And carry a card like this in your wallet.
You never know what may happen.
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