Rav: Hello, everyone, and welcome to the official podcast of the BNI success link. Today we are going to talk about the top 3 things everyone should remember before picking their health insurance plan. The official podcast of BNI successfully, we are linked to success.
Hello again, everyone. I’m your host, Rav Mendiratta, from socio squares and landing leads is where my business leads. Today we are going to talk about a subject that often confuses me, which is the top three things everyone should remember or know before they pick their health insurance plan. And of course, I have an expert on this subject with me, John basket. John, thank you so much for doing this.
John:Yes, thank you. Thank you. I really look forward to it.
Rav: John, I know you’ve been in the insurance, the health insurance industry for over 30 years. But why don’t you tell our audience a little bit about your business, what you do and how you help people?
John: Yes, absolutely. Well, I started in the health insurance world in 1978. And I worked for major insurance companies, processed claims, became an account manager, and managed large accounts and Wells Fargo, Hewlett Packard, Kaiser aerospace, to name a few at DHL. And so I have a lot of experience in a variety of positions in the health insurance world. And most of them most of my years, we’re with insurance companies from Cigna to equitable Blue Cross. So I have a lot of experience with large clients, individuals, and small businesses.
Rav: A lot of fun, please. So you’ve seen the nitty gritty of working at large insurance companies to helping individuals as well as small business owners. And you know, essentially how each company operates. You know, the ins and outs on both sides. That’s awesome.
John: Yeah, I know how the insurance companies think, or they don’t think I know how to communicate with them to get the best response.
Rav: That’s amazing. I’m sure our audience would love this session. So let’s talk about the basics. First, HMO, PPO, EPO these terms can be very confusing at times, even if I understand what they stand for, but how do you decide which plan is good for you? Then how do you come up with a recommendation? What? What do you suggest about how people should think about this?
John: Yeah, often, I think it’s best to if I’m helping somebody if they have a physician or a network that they like, it is very difficult for some people to change doctors. So I’ll have them work backward, ask that doctor’s office whom they contract with, and then expand from that and see what the best fit for them to still access those doctors is. But an HMO is a health maintenance organization. And the way those work is that the insurance companies pay a lump payment to that group, and they act as a corporation; they act as one. Like Kaiser is an HMO, they’re a staff model. But other companies will set up arrangements that act like Kaiser, but the doctors are not in one location yet. They don’t have to be. They can be throughout the area. So they act as one. And they get paid.
The insurance companies pay those medical groups, such as HMOs to represent their population. They have so many men, women, and age groups, and they pay them a lump payment, then that medical group takes that money and they try to give care based on that payment they get. So if they can do it profitably, if they’re profitable, they get to keep the difference, right?
So it’s a different method, and it’s more of a stricter network. So you it’s difficult to go outside of that network. You’ll HMO is a group of doctors, and it’s not easy to go outside. You need to have a life-threatening emergency to go outside of that network.
A PPO is a list of doctors that have agreed to the terms, and you’re on a PPO plan. If you enroll in a PPO, you can go see any doctor as long as they’re licensed to practice. If you stay in the network, you get a discount. You can go outside of the network, but you’ll end up paying more because there’s the incentive for benefits is to stay in the network of doctors who have signed that agreement.
Rav: Got it. And EPO, is that a combination of both or?
John: An EPO is taken. Can that PPO network and you need and there’s no going outside of it? You can’t go outside of a network you it’s exclusive. So it’s a larger network than an HMO would be. But you need to stay in. There’s no network availability.
Rav: Interesting.
John: And Usually, at this point, people start to yawn. But it’s okay. This is why my wife won’t take me to parties anymore, because I know too much about this stuff. But there’s Yeah, so HMO is the most restrictive. PPO is the most open because you can go anywhere. And EPO is right in between those two. It’s a big network, but you can’t go outside the network.
Rav: Got it. That’s, and that’s a good framework. Thank you for sharing that. Yeah. Now, let’s talk about some mistakes you’ve seen people make when picking their health insurance plans,
What would you say are the top three mistakes you have seen people making?
John: Well, the first mistake is to stay healthy and stop getting sick. You know, if everybody stayed healthy, we wouldn’t need doctors. You know, don’t run with scissors and stay inside. And I’m sorry to be silly.
1)Not finding an appropriate person to help:
The biggest mistake is to find someone like me. There’s no expense to finding a broker. You’re paying for a broker, whether you use one or not. I would say find someone that you enjoy working with who can help you and because you’re paying for him.
2)Don’t wait until the last minute:
What I see a lot of people do because health insurance isn’t that exciting. And I’ll do it later. We procrastinate. And we put off the health insurance until it’s last minute. And insurance companies don’t like moving fast. They are there. It’s like trying to parallel park. If you eat too, you can’t make the insurance companies move faster than they do. They just have that it takes 10 working days for everything that they do. And so it’s really hard to make them quick. You can’t. So don’t try to, you know, do it before the deadline.
I think those are the two biggest mistakes I would see often.
Rav: All right. And yeah, I’m sure this would be enlightening for many that there is no additional cost to use someone like you. So we should all work with a broker like him.
John: Yeah. Because they’re, you’re paying for anyway.
Rav: Right. Let’s, let’s thank you for sharing that. Let’s come to the title of this podcast, right, the top three things. Maybe you’ve shared some of this already. But what would you say are the top three that everyone should know? And ask or Remember before they pick their health insurance plan.
John: What I advise people when they’re trying to decide what plan to pick because there are so many plans out there, but they don’t. They’re not really that different from each other. So I would suggest people look back to last year or the prior years. And how much did you use your plan, because it’s all a gamble. We’re gambling, that we’re not going to use it, but just in case we want to have insurance for this because you don’t want to, it is a catastrophic method. I think it is one of the best ones to think of is that you don’t want to lose everything on your own. Right?
So you want to have insurance to cover the big things. And you look back to see how much you interact with your insurance? Did you how often did you use it to kind help you make a decision on what you’re going to use going forward? And then, if you have someone like me, an agent to show I’m a broker to show the differences.
I think the biggest number that people overlook when they compare health insurance plans is the out-of-pocket maximum, the OOP you will see on a list of comparisons. And that out-of-pocket maximum is the dollar amount that you’re exposed to. That’s what you’re on the hook for every calendar year is the out-of-pocket max. And you’ll sometimes see the plans will have the exact same amount, but one costs a lot more than the other one. So if you understand that with that frame of mind, it will help you to make a decision on what plan fits you the best.
Rav: Interesting. Yeah, I never paid attention to the out-of-pocket max.
John: Yeah, let’s be like, for example, silver to gold plan if you’re on an in looking at individual plans will have the exact same amount but one cost the silver of the gold a lot more than the silver plan because it has richer benefits for out of for office visits, an prescriptions and all the deductibles are smaller. But when you look at it on a catastrophic basis, they’re exactly the same. So it doesn’t always make sense to pay more premium for a richer plan if your ultimate exposure is the same. And that’s what drives me crazy. Anyway,
Rav: Those are some very, very interesting insights. And I never thought about this. So thank you so much for sharing this. I have one more question before we let you go. And I got to ask this because I’m in digital marketing.
So what is the best digital marketing strategy that has worked for you?
John: Well, you know, it’s just what I found is that people on social networks, I pop up there, people will type in the top agents of top brokers in the area. And I’ve been popping up on these various platforms like, oh, wow, I guess I am doing a good job. Because people are calling me, but that’s generally what I’ve been exposed to is just popping up on these other social programs.
Rav: That’s awesome. It’s great to hear that social media works well for your business. And I think both Facebook and next door do a wonderful job in recommending great local providers like you. So I’m really happy to hear that social media is working for your business. Thank you, John. This was a great session. Thank you so much for sharing.
John: Thank you, Rav
Rav: I’m sure our audience will take away a lot of things from this.
John: Wonderful, thank you.
