The Benefits of a PPO Plan

Exploring healthcare options can be overwhelming, but a Preferred Provider Organization (PPO) plan could be ideal if you value flexibility and a wide range of choices. Unlike more restrictive plans, a PPO allows individuals the autonomy to select healthcare providers without the prerequisite of a designated primary care physician. From the freedom to choose specialists directly to the broader network of healthcare providers, let’s look at the distinctive advantages that a PPO plan has. As you explore your options, it could be compelling to pursue balanced and accessible healthcare.

Tips for First Time Insurance Buyers

Navigating the world of health insurance can be daunting, especially for first-time buyers. The myriad of plans, coverage options, premiums, and unfamiliar jargon can make the process overwhelming. However, securing the right health insurance is crucial in safeguarding your well-being and financial stability.

We have some guidance and essential tips to help first-time health insurance buyers make informed decisions, ensuring you choose a plan that aligns with your needs, lifestyle, and budget. From understanding key terminology to evaluating coverage options, we have some questions to ask on your journey to securing the best health insurance plan for your circumstances.

What does care look like when I am well?

Most people, especially first-time health insurance buyers, expect to use their health insurance plan sparingly. You probably plan to go to the doctor for a yearly check-up and maybe an urgent care visit or two. Pay close attention to recurring costs, such as the monthly premiums and copays, and make sure they fit your budget.

Secondly, learn what free services the plan might offer to keep you healthy. One common benefit of insurance plans is free annual check-ups and immunizations.

Is this health insurance plan affordable if I get sick?

While you never want to imagine the worst, planning for emergencies, extended hospital stays and injuries is crucial. Ensure your plan offers affordable care options when these issues arise. Strive for a good balance between predictable expenses such as monthly premiums, deductibles, and out-of-pocket maximums and those that arise unexpectedly, like copays or coinsurance only applicable when you seek medical attention.

Can I see my current doctors under this plan?

Choosing healthcare professionals or facilities covered by your plan results in cost savings. Conversely, seeking care outside of these approved options may lead to reduced coverage from your health plan, potentially resulting in higher bills. Therefore, verifying that the doctors and clinics you intend to visit are within the network of the health insurance plan you’re evaluating is crucial.

What is the prescription drug coverage under this plan?

Drug costs can add up quickly, so review the plan’s list to determine how much your prescriptions cost. Additionally, look at the cost of drugs you or your family might need for illness, like antibiotics.

Are alternative therapies covered?

Health insurance plans have varying approaches to covering alternative therapies such as chiropractic and acupuncture. Some programs provide coverage for these therapies like conventional care, while others offer limited or no coverage. If the inclusion of alternative therapies is important to you, carefully examine the benefits outlined in your plan.

How is customer support with this plan?

Health insurance can be challenging to navigate, and you will inevitably have questions and need support from the plan provider. Find out how to get support and answers to your questions if needed. In the end, health plans aren’t one-size-fits-all. Talk to someone who can help match your unique needs with the plan that suits you best.

Contact Tom Miroballi today!

Tom Miroballi, Independent BCBS Agent, will help you evaluate and select the right insurance package to make your healthcare work for you. Before signing up, Tom will explain the terms, rules, or whether the plan will cover something.

Affordable health insurance is just one call away! Give Tom a call at 630-863-3477 or email him today!


Navigating Open Enrollment

As the open enrollment period approaches, it marks a critical time for individuals and families to make vital decisions about their healthcare coverage. This annual opportunity allows us to review and change our health insurance, dental plans, vision coverage, retirement contributions, and more. With various options and information to consider, navigating the open enrollment period can seem overwhelming. In this guide, we will break down the complexities of the open enrollment period for you.

Health Insurance

  • Changes in Plan Provisions: Check for any modifications to your plan’s provisions or options that might have occurred during the year. Review the plan costs, including premiums, deductibles, out-of-pocket expenses, and copays.
  • Anticipated Medical Needs: Assess how frequently you and your family might need to visit a doctor or face significant medical expenses in the coming year.
  • Family Additions: If there are any new family members, such as a baby or spouse, ensure that your plan accommodates their needs.
  • In-Network Providers: Confirm if your preferred doctors and hospitals are still in-network providers for your plan to avoid unexpected costs.
  • Prescription Coverage: Determine whether you require prescription coverage and if your current plan adequately addresses this need.
  • Health Changes: Reflect on any changes in your health during the year or anticipate any upcoming health-related events, such as new chronic conditions, pregnancies, or surgeries.

Dental Insurance

Consider your dental needs and habits. A basic plan may suffice if you regularly visit the dentist for preventative care. However, if complex procedures like root canals or oral surgeries are on the horizon, opting for more comprehensive coverage is wise.

Vision Insurance

Be aware of the two primary types of vision plans available:

  1. Vision Discount Plans: These plans typically come with lower premiums but provide only a percentage discount on services from eligible providers.
  2. Vision Benefit Plans: Operating like traditional health insurance, you pay a premium for coverage. Some plans also offer allowances to help cover the costs of eyeglasses.

Flexible Savings Accounts (FSAs)

In 2023, participants can contribute up to $3,050 to an FSA, providing coverage for individual and dependent medical expenses. You’ll elect your FSA contribution during the open enrollment period, which remains fixed throughout the year unless a qualifying life event occurs.

Remember that any remaining balance in the FSA at year-end is typically forfeited, though employers may allow up to $610 to roll over to the next plan year or offer a two-and-a-half-month grace period.

Health Savings Accounts (HSAs)

For 2023, the HSA contribution limit is $3,850 for individuals and $7,750 for families. If you are 55 or older, you are eligible for an additional $1,000 catch-up contribution. Some employers may also contribute to your HSA, assisting with medical expenses.

A key benefit of HSAs is that contributions can roll over yearly, empowering you to accumulate funds over time. This accumulated balance can even be utilized to cover medical expenses during retirement. However, an important caveat is that you must be enrolled in a high-deductible health insurance plan to qualify for an HSA.

Retirement Plan

Evaluate your current contribution levels to determine if you’re on track to receive the full employer match. If not, it’s time to consider a boost. Even if you are already eligible for the maximum employer match, consider increasing your contributions by 1% to 2%. You’ll hardly notice the impact on your take-home pay, yet these seemingly minor adjustments can wield significant benefits, fostering substantial growth in your retirement savings over time.

Other Types of Insurance

Take a moment to review other insurance options provided by your employer, such as life, disability, and accidental death and dismemberment policies. Ensuring adequate coverage can grant your loved ones financial security and peace of mind should the unexpected arise.


Reassess and modify your beneficiary designations. This step becomes particularly crucial if you’ve recently encountered a significant life event, such as the birth of a child, marriage, or divorce.

Tom Miroballi, Independent BCBS Agent, will help you evaluate and select the right insurance package to make your healthcare work for you. Before signing up, Tom will explain the terms, rules, or whether the plan will cover something.

Affordable health insurance is just one call away! Give Tom a call at 630-863-3477 or email him today!


Pre-Existing Condition Rules

Some health conditions require the patient to access more medical care. If you have specific health needs and are searching for health insurance, you might wonder how your pre-existing condition can impact your coverage. What exactly is a pre-existing condition, and how does it work when searching for health insurance coverage?

According to a 2019 study, approximately 25% of adults under 65 have pre-existing conditions. A pre-existing condition is a health condition, illness, or injury you are aware of before applying for health insurance coverage. The majority of these issues are considered long-term or chronic. Here are some examples of pre-existing conditions: 

  • Epilepsy 
  • Asthma 
  • Sleep apnea 
  • Cancer 
  • Diabetes 

Before the 2010 passing of the Affordable Care Act (also known as Obamacare and ACA), pre-existing conditions could result in health insurance companies denying coverage for individuals or charging significantly higher premiums. This is because your insurance company expects that your pre-existing conditions will eventually cost them more money in treatments and procedures.

Your health insurance policy will specifically list pre-existing conditions and coverage on your paperwork. Make sure to read the details of any plan you are considering and how the plan covers your current medical conditions or health problems. Not all health plans offer coverage for pre-existing conditions; however, plans through the Marketplace will.

Other factors can affect your health care costs besides pre-existing conditions. These include your plan, whether you use tobacco, family size, and age.

In sum, current law states you cannot be charged more or denied for your pre-existing health condition. However, there may be health plans that are a better fit for you than others for your pre-existing medical condition. For example, if you get regular medical care or treatments, a plan with a higher monthly premium and a lower deductible might best meet your needs.

When choosing a health plan, it is essential that you consider your own healthcare needs. For example, if you require more frequent care due to ongoing medical conditions, those specific needs could impact your chosen plan, but you cannot be denied coverage due to them.

Tom Miroballi, Independent BCBS Agent, will help you evaluate and select the right insurance package to make your healthcare work for you. Before signing up, Tom will explain the terms, rules, or whether the plan will cover something.

Affordable health insurance is just one call away! Give Tom a call at 630-863-3477 or email him today!


Finding Small Business Health Insurance

Finding health insurance for your small business can be a huge and daunting responsibility as a business owner. You may not feel equipped to make the best decisions for yourself and your employees’ families. There is a lot of information out there about small business health insurance, so let us break down the most important things to consider when choosing your plan.

There are many reasons to offer your employees health insurance, but some may wonder if health insurance offerings for small businesses are required. The Affordable Care Act requires all employers with over 50 full-time employees to offer health insurance. However, for retention and recruitment, you might want to provide health insurance even if you do not have 50 employees.

You have three options for health care for your small business.

Small Business Group Health Insurance 

As the name suggests, these plans are for coverage for a group of people. They offer insurance at a reduced cost because the insurer’s risk is spread across a group of policyholders. In most states, you need one employee to qualify for a group health insurance plan, the employer must contribute to employee premiums, and there are no open enrollment periods. Often the group health plans require 70% participation. While the plans offer many benefits, some small business owners find them expensive and unpredictable, with premium changes each year and participation requirements.

Self-Funded Plans 

Often seen as a more customizable option, self-funded plans are plans where the employers pay for claims out of pocket when they arise rather than paying a predetermined amount to a carrier as in group plans. These plans can be more affordable per enrolled employee than traditional plans, and you are not subject to state health insurance premium taxes. Additionally, you might have money previously set aside for health insurance costs left over at the end of the year. The employer can use this money for other business needs. However, self-funded plans can be a riskier choice, as the company handles paying out the claims, which can be a massive hardship for small companies if there is a catastrophic event.

Health Reimbursement Arrangements (HRAs)  

HRAs offer the option for employers to reimburse their employees for individual insurance premiums on a pre-tax basis. In short, employees pay for their health services, then submit a claim for reimbursement. This model allows employees to choose a health insurance plan that works for them. The small business contributes a specific amount monthly. A huge benefit of these HRAs is that the employees can avoid income taxes on the money used for health expenses, and the company can use the reimbursements as a tax deduction.

If you are planning to foster your business’ growth over the next few years, you want to be sure to attract and retain outstanding talent. Compensation is a substantial part of the decision for your candidates. Choosing the best insurance plan for your small business is an investment in your growth.

You don’t have to find health insurance for your small business alone. Tom Miroballi, Independent BCBS Agent, will help you decide and select the right insurance package to make your healthcare work for you. Before signing up, he will explain the terms, rules, or whether the plan will cover something.

Affordable health insurance is just one call away. Give Tom a call at 630-863-3477 or email him today!



Why You Should Evaluate Your Health Care Coverage

Once you choose your health care coverage, it is tempting to file the papers away and move on. However, there are many reasons why regularly reevaluating your healthcare coverage benefits you and your family. Here are some things to consider when evaluating your insurance coverage regularly.


Insurance costs are fluid, so your healthcare coverage costs can change from one plan year to another. Make sure you know your health care coverage’s fee structure for deductibles, copayments, and coinsurance. Depending on your situation, you might prefer a plan with a high premium and low copays and deductibles. Conversely, it might be more appropriate to research insurance plans with low monthly premiums and higher copayments and deductibles for your situation.

Life Change 

Life changes may lend themselves to changes in your coverage needs. Review and update your insurance coverage based on your and your dependents’ ages and current medical conditions. In any case, be informed about your health insurance plan. Find out the plan’s specific coverage for medical, vision, and dental situations.

Plan Changes  

Additionally, even if you have had the same plan for many years, insurance companies will change the coverage levels. Sometimes these changes occur in a plan year. By law, you will receive written notice of any changes to your insurance coverage.

Network Changes  

One of your primary concerns when evaluating your insurance plan is likely being able to continue to see the same medical professionals whom you have a relationship with. Consider your policy’s services in and out of the network when evaluating your coverage.

 “In-Network” means that your doctor joined your insurance company’s network of healthcare providers and charges less. “Out-of-Network” refers to a doctor that has not partnered with your insurance company to lower the costs. As a result, you may have to pay part or all of the bill yourself.

Claim Process 

Insurance claims can be confusing and take up a considerable amount of time. Some insurance companies allow you to file your claims online. The ease with which you can file your claim is an essential consideration for many families.

Company Reputation  

Your health insurance package is essential for your peace of mind and financial future. When evaluating plans, investigate the reputation of your current insurance company or the one you are considering. Here are some questions you can ask: 

  • Is the company financially solvent?
  • Does it provide quality care?
  • Does the insurance company offer excellent customer service?
  • What do the reviews online say about the insurance company?

Tom Miroballi, Independent BCBS Agent, will help you evaluate and select the right insurance package to make your healthcare work for you. Tom will explain the terms, rules, or whether the plan will cover something before signing up. Affordable health insurance is just one call away! Give Tom a call at 630-863-3477 or email him today!



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