Captain Health USA

Making Health Insurance Great Again!

Leave a comment

9 Things You Didn’t Know About Short-Term Health Insurance

Before you sign on the dotted line, know what you are in for when it comes to short-term health insurance. It may be a seductive option when you begin to explore it, but when you begin to dig in and get a flavor for what it will taste like, you may be a little surprised. Number 5 may shock you!

1. NO Guarantees…
Did you know? When applying for short-term health insurance, acceptance is not guaranteed. That means, there is a possibility that you could be turned down.

2. Got pre-existing conditions? Know this…
Short-term health insurance does NOT cover pre-existing conditions. That means if you have already been diagnosed with something like cancer, multiple sclerosis, diabetes, or, you are pregnant before you sign up for short-term medical insurance, your condition will not be covered.

3. Caps on procedures
Congrats! You signed up for short-term health insurance and it’s just in time for your routine colonoscopy. Imagine going to the hospital for the colonoscopy and when you are discharged you are slapped with a bill that you didn’t expect. How could that be? You were covered, weren’t you? Not necessarily. If the procedure cost above and beyond the cap put in place, you could be footing the bill.

4. Caps on tests and lab work
Just as with the procedure scenario mentioned above, the same thing can happen with tests and lab work. If you are participating in short-term health insurance, know what will be covered when it comes to tests and lab work.

5. Annual cap of policy payout
Read the fine print of any policy before you sign. Understand what the policy caps are. You may be surprised just how much or little your policy will payout each year.

6. Not guaranteed renewable
Did you know? Come the end of the year and when it is time to renew, it is not guaranteed that the short-term health insurance provider you selected will renew your policy.

7. Limits on Doctor visits
Another fine print detail to search out when considering short-term health insurance is how many times will you have a co-pay to see the doctor? There are limits or caps put in place when it comes to co-pays for doctor visits.

8. Per day limits on hospitalization
Another surprise you may not be expecting with a short-term health insurance is the amount of days they cover for a hospital stay. Should you need hospitalization while covered under the plan, you may want to investigate if there are any limits on how many overnight stays you can have when in the care of a hospital or how much they pay per day.

9. Can have high deductibles
Another area to consider before electing for short-term health insurance is the deductible cost. Short-term health insurance can have higher than average deductibles.

When considering short-term health insurance, take the time to really understand what the plan is saying, what it is covering, how much it is covering and what payment responsibilities you will have or could potentially have should you need medical care and treatment.

Do you need help making an informed decision? I am happy to help! Schedule a FREE consultation with me by calling: (813) 391-3448


Leave a comment

When Should You Go to the ER? And, If You Do, Will You Be Stuck With the Bill?

You are experiencing excruciating pain in your abdomen.  You know there is something really wrong. Your first instinct is to rush to the hospital, it could be appendicitis but you are not sure.  It’s best to let the experts tend to you, right?  After all, they are doctors and you aren’t.  

The above scenario seems logical right?  

But it may not seem like the best course of action according to your insurance company.  

In the article titled: “An ER visit, a $12,000 bill — and a health insurer that wouldn’t pay” (link) describes a similar story and the insurance company didn’t agree that the symptoms, the pain and the final diagnosis weren’t severe enough to warrant an emergency room visit.  In fact, the insurance company deemed the ER visit in appropriate and denied the claim which caused the hospital to demand payment for treatment and tests.  In some cases, insurance companies have begun charging their clients with “penalty fees” for inappropriate ER visits. While some of the more draconian rules have not come to Florida yet, they are in other states and the number of states is growing.  The article suggests: “All of these policies suggest a new and controversial strategy for reining in health care costs: asking patients to play a larger role in assessing their own medical condition — or pay a steep price.”  It is unreasonable to expect patients to self-diagnose and do it accurately.  

What is being done about insurance companies denying emergency room claims?  Congress is getting involved and asking questions.  Specifically, the articles sites that Claire McCaskill (D-MO) sent Anthem a letter stating, her concerns that Anthem is requiring its patients to act as medical professionals when they are experiencing urgent medical events.  Emergency room physicians are also taking a stand.  They are exploring options that allow them to push back to insurance companies like Anthem who have ER policies in place like the one explained here. It doesn’t stop there.  Hospitals are engaging with patient advocacy groups, asking pertinent questions, pressuring legislators to take notice of what is happening in the system and demanding better solutions.

Review your policy to make sure you understand what your policies emergency room coverage is.  If you are unsure what your policy states, get in touch with the insurance company so they can go over it with you.   If you have any questions on it please reach out to me anytime.

To read the entire article referenced in this blog post from Vox, click here.

Leave a comment

You Have Health Insurance, Now What?

Now that open enrollment is over, you have picked a plan, what is your next step?  Your next step is to use the plan you selected! Make sure you take full advantage of your health care coverage.  

Getting A Checkup…

Getting a checkup is something you must schedule on your calendar every year!  A checkup helps to create a baseline or a range of normal that is specific to you and your overall health.  Our healthcare system is designed to offer preventive care.  Preventive care is a proactive approach to healthcare where you and your doctor work together to identify potential issues before they become major problems.  

Below is a list of preventative care that is covered for adults.  When you visit your doctor, it is a good idea to ask them to address these screenings during your visit.

  1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
  2. Alcohol misuse screening and counseling
  3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
  4. Blood pressure screening
  5. Cholesterol screening for adults of certain ages or at higher risk
  6. Colorectal cancer screening for adults over 50
  7. Depression screening
  8. Diabetes (Type 2) screening for adults with high blood pressure
  9. Diet counseling for adults at higher risk for chronic disease
  10. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
  11. Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
  12. HIV screening for everyone ages 15 to 65, and other ages at increased risk
  13. Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:
  14. Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  15. Obesity screening and counseling
  16. Sexually transmitted infection (STI) prevention counseling for adults at higher risk
  17. Syphilis screening for adults at higher risk
  18. Tobacco Use screening for all adults and cessation interventions for tobacco users

Please note that these services are free only when delivered by a doctor or other provider in your plan’s network.

Planning regular checkups and working together with your doctor is the best way to take proactive action when it comes to your health.

Do you have questions about your health plan and what it covers?  Schedule a FREE consultation with me by calling:  (813) 391-3448

Leave a comment

What is a Catastrophic Plan and are you Eligible?

When selecting health insurance during open enrollment, you may decide to select a “Catastrophic Plan.”  To do so, you must meet certain criteria in order to be eligible for this type of plan.

Defining a Catastrophic Plan

Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case health scenarios, like getting seriously sick or injured.

Most routine medical expenses are paid by you if you elect this type of plan.

You are only eligible for this plan if:

You are under 30 OR you are of any age and you have a hardship exemption or affordability exemption. These exemptions are based on Marketplace or job-based insurance is unaffordable.

What’s Covered?

  • Catastrophic plans cover the same essential health benefits as other Marketplace plans.
  • Catastrophic plans cover certain preventive services at no cost.
  • Catastrophic plans cover at least 3 primary care visits per year before you’ve met your deductible.

How much do they cost?

  • Monthly premiums for this type of plan are usually low,
  • Deductibles:  Deductibles are the amount you have to pay on your own for most services before the plan starts to pay anything.  These can be very high for this type of plan.  For example, the deductible for this plan during 2017, for all Catastrophic plans is $7,150. After you spend that amount, your insurance company pays for all covered services, with no copayment or coinsurance.

This can be very confusing and it may be difficult to make the best choice for you and your family.  The good news is, I am here to help!  Let me help guide you through the open enrollment process this year so that you can make an informed decision.

Schedule your FREE consultation by calling:  (813) 391-3448

Leave a comment

Is It True? An End to Subsidies?

What a crazy time we live in where things move so fast but in reality not much actually changes.

This morning the President “said” he ended subsidies to the insurance companies (not to individuals) for cost sharing.

So what’s this really mean to us?…..Actually, nothing and here’s why….

First…very important….

The subsidies that were ended were payments to the insurance companies to lower among other things, the deductible on a policy. They were not the payments to individuals to help them pay for insurance. AND the reduced deductibles will still be in the policies.


The insurance companies have already priced in an increase of about 20% as they expected the payments to stop.


The subsidies an individual gets are based on a few things. Income, location, and the 2nd lowest cost silver plan in the market. So if the cost of the 2nd lowest cost silver plan goes up so does your subsidy to offset some or all of the increase.

Now you see how what the President did really means very little to us. Your subsidy should go up as the plan cost goes up.

So whats the fight about?……….

The president wants to do something to Obamacare…anything at this point. Also……

The President wants to put pressure on Congress so he “says” stop the subsidies to the insurance companies. I’m not sure he will actually get away with that as multiple states will sue to reinstate them.


So in most cases, instead of the gov’t giving money directly to the insurance companies to reduce your cost of insurance they will end up giving it to you in the form of increased individual subsidies…..which will go to the insurance companies to reduce your cost of insurance. Seems like the same end result to me.

I hope this helps explain a few things.

I can’t wait to see what tomorrow brings 🙂


Leave a comment

Making Open Enrollment An Easy Process

Open enrollment for 2018 health insurance coverage is right around the corner.  The enrollment dates are November 1, 2017, through to December 15, 2017.  All health insurance coverage, decisions, and selections you make during the open enrollment period will be valid beginning January 1, 2018.

Before open enrollment begins on November 1, 2017, there are some things you will want to gather before you speak with a qualified agent.  Your agent will need to know who will be covered under your plan and the type of insurance required.  

Below is a comprehensive list of the items you will need in order to make a sound and educated decision on your health care coverage.  

If you already are covered then it’s very easy. You just need to advise your agent if any of the items below have changed over the past year.

Pre-Open Enrollment Checklist:

  • Household size:  Make a list of the people in your household that will be needing health insurance during 2018
  • Current mailing address for everyone who is applying for coverage
  • Birth dates for all household members
  • Social security numbers for everyone who will be getting coverage
  • Information about how you file your taxes
  • Estimate of what your household income will be for 2018
  • A list of any major life changes for each member of your household getting coverage such as  Marriage, Income, Moving, Births, Divorce, etc.

After you have gathered all of the information listed above, call a health insurance agent who is well versed in the Affordable Care Act and understands the laws that surround it. If you do not have an agent and need help in making the best healthcare coverage decisions for you and your family, I am here to help!  Schedule your FREE consultation by calling:  (813) 391-3448

Leave a comment

Why It Is More Important Than Ever To Have A Knowledgeable and Reputable Health Insurance Agent

In an article I recently read, entitled “ObamaCare Advocates:  Hole Too Deep to Make Up Outreach Cuts” it states that the Trump Administration has cut 90% of the funding set aside for educating the population on their options for health care coverage.  What does this mean for you?  In short, you may be losing out on critical information you need to make an informed decision about health care coverage for you and your family.

It is speculated that this cut could result in fewer people getting the health care coverage needed due to not knowing or being aware of the open enrollment periods and deadlines, what types of coverage is available, how health care coverage works and how to navigate the system.  A recipe for disaster for the average American.

With this new cut, it is more important than ever to have a knowledgeable and reputable health insurance agent represent you to ensure you are getting the health care coverage you need and deserve, on time!  Not all agents are created equal!  When selecting an agent, select someone who is:

  • Professional and who is responsive and available to take your phone
  • Well educated when it comes to the Affordable Care Act
  • Informed and stays on top of Affordable Care Act current events
  • Understands the law
  • Will listen to your needs and will consult with you about your best options

If you are concerned about the upcoming open enrollment period, how much health care coverage you need for you and your family and how to avoid potential fines, I can help!  Visit my website for FREE valuable tools like “Dave’s Doctor Search” and a list of resource links.  Follow me on Facebook to learn about your healthcare options, breaking news and to get connected!

Do you have questions or need help navigating the health insurance system?  I am happy to help! Schedule your FREE consultation: (813) 391-3448

Doing my part in Making Healthcare Great Again!