When was the last time you reviewed what your healthcare plan really offers? Most people focus on the basics—doctor visits, prescriptions, and emergency care—but many plans come with additional perks that are often underutilized or completely overlooked.

Here are a few valuable benefits that might be included in your health plan, just waiting to be used:

Health Coaching

Whether you’re working on lowering your cholesterol, managing a chronic condition like asthma or diabetes, or simply trying to lose weight, health coaching can be a game-changer. These one-on-one sessions with wellness professionals provide personalized support to help you stay on track and reach your goals.

24/7 Nurse Hotline

Health concerns don’t follow a 9-to-5 schedule. That’s why many providers offer around-the-clock access to licensed nurses and medical professionals. Whether you’re wondering if your symptoms warrant a trip to urgent care or need advice on managing a minor illness, help is just a phone call away.

Cost Estimator Tools

Healthcare costs can vary widely, even within the same city. Many insurers provide online cost calculators to help you compare prices for procedures, tests, and visits. This tool empowers you to budget more effectively and avoid surprises when the bill arrives.

Diet & Weight Management Programs

Healthy living isn’t just about cutting calories. Many plans offer access to nutritionists, guided meal planning, and long-term lifestyle programs to support your overall well-being. These programs can make it easier to adopt habits that stick, without having to figure it all out on your own.

Take Advantage of What You’re Already Paying For

If any of these services sound like something you’d benefit from, now is a great time to contact your healthcare provider and ask what’s included in your current plan. You might be surprised by what’s available to you at little or no extra cost.

Whether you’re evaluating plans for the first time or considering switching providers, Health Plans of America is here to help you navigate your options and make the most of your coverage. Don’t leave valuable benefits on the table—get informed, get covered, and get the care you deserve.

If you’re currently enrolled in Medicare or considering signing up, it’s essential to understand exactly what’s covered under your plan—and just as importantly, what isn’t. While Medicare provides comprehensive coverage for many healthcare needs, there are some health-related services that it doesn’t cover. Being aware of these exclusions can help you make more informed decisions about your care and ensure you’re not caught off guard when the bills come.

Here are some of the most common services that Medicare does not cover:

1. Routine Foot Care

Medicare typically does not cover routine foot care, such as the treatment of corns, calluses, or toenail care. While this may come as a surprise to some, it’s important to note that treatment for foot injuries or certain medical conditions related to the feet, such as diabetes, is covered. If you have specific foot health concerns, you may want to explore other insurance options or consult with your doctor about additional coverage for preventative care.

2. Cosmetic Surgery

Unless cosmetic surgery is medically necessary to repair or improve the function of a malformed body part or following an injury, Medicare will not cover elective cosmetic procedures. This means surgeries like facelifts, breast augmentations, or tummy tucks—intended purely for aesthetic purposes—will not be covered by your Medicare plan. However, if the surgery is needed for reconstructive purposes after an accident or illness, Medicare may cover part of the costs.

3. Orthopedic Shoes

While orthopedic shoes can be beneficial for individuals with specific medical conditions, Medicare coverage is limited. Medicare only covers orthopedic shoes if they are part of a leg brace. This means that unless your shoes are prescribed as part of a necessary medical device or treatment plan, you’ll likely need to pay out of pocket for these types of shoes or inserts.

4. Dental and Vision Care

Medicare generally doesn’t cover routine dental care, including cleanings, fillings, dentures, or tooth extractions. Additionally, most vision care services, such as eye exams for glasses or contact lenses, are not covered under Original Medicare. However, Medicare Part B may cover some vision-related services if you have certain medical conditions, such as cataracts or glaucoma.

5. Hearing Aids and Exams

Similarly, routine hearing exams and hearing aids are not covered by Medicare. If you need hearing aids, you will likely have to cover the cost yourself, or look into additional insurance options that may offer coverage for hearing-related services.

The Silver Lining: What Medicare Does Cover

While Medicare doesn’t cover every health service, it provides extensive coverage for a wide range of medical needs, especially those related to acute illnesses, hospital stays, doctor visits, and some preventive services. From routine screenings and vaccinations to prescription drugs (under Part D), Medicare ensures that a variety of your health needs are met.

Make Informed Decisions for Your Health Coverage

Before you choose a Medicare plan, it’s crucial to assess your unique health needs and consider any conditions or services you might require that aren’t covered under standard Medicare. Some additional coverage options, such as Medigap or Medicare Advantage, may help fill in the gaps left by Original Medicare.

If you’re still uncertain about which plan is best for you, don’t hesitate to seek professional guidance. At Health Plans of America, we make the process easier by offering you expert information, resources, and access to licensed Medicare specialists who can help guide you through the decision-making process.

Have more questions or need help understanding your options? Connect with a licensed Medicare specialist today and take the first step toward securing the right coverage for your needs.

Navigating the world of health insurance can feel like learning a new language. With all the jargon and unfamiliar terms, it’s easy to get lost in the details. However, understanding a few key terms can make managing your health insurance plan much simpler and help you make better, more informed decisions. Here are five essential health insurance terms that you need to know:

1. Premium

Your premium is the amount you pay monthly to maintain your health insurance coverage. Think of it as your “membership fee” to have access to the insurance plan. However, it’s important to note that paying your premium doesn’t necessarily cover the full cost of your medical services. In fact, it’s just the baseline for having coverage. Depending on your plan, your premium could be a small part of the total amount you pay for healthcare each year.

2. Deductible

The deductible is the amount you must pay out-of-pocket for healthcare services before your insurance starts to share the costs. For example, if your deductible is $1,000, you’ll need to pay that amount in full before your insurer kicks in to cover a larger portion of your healthcare costs. But keep in mind, even after you’ve met your deductible, you may still need to pay copayments or coinsurance until you reach your out-of-pocket maximum.

3. Copayment (Copay)

A copayment, often called a copay, is a fixed amount you pay for a specific service or prescription. For instance, you might pay $20 for a doctor’s visit or $10 for a prescription medication. Your insurer typically covers the rest of the cost. Copays often come into play after you’ve met your deductible, and they are one of the ways health insurance companies share costs with you. Copays can vary depending on the service, and some plans have different copays for different types of care (e.g., primary care visits vs. specialist visits).

4. Coinsurance

Coinsurance works similarly to copayments, but instead of a fixed amount, it’s a percentage of the cost. Once you’ve met your deductible, you will be responsible for a percentage of the covered services. For example, if your coinsurance is 20%, and you receive a medical bill for $100, you’ll pay $20, while your insurance covers the remaining $80. Coinsurance continues until you reach your out-of-pocket maximum.

5. Maximum Out-of-Pocket

The maximum out-of-pocket (often called the out-of-pocket limit) is the most you’ll ever have to pay in a year for covered healthcare services. This includes your deductible, copayments, and coinsurance costs. Once you hit this limit, your insurance will cover 100% of your remaining covered medical expenses for the rest of the year. However, remember that your monthly premium doesn’t count toward this limit, so you’ll still need to pay that regularly, regardless of how much you’ve spent on healthcare.

Why These Terms Matter

Understanding these terms is more than just navigating the fine print on your health insurance plan—it’s about making smarter, more informed decisions regarding your healthcare. When you know how these elements work together, you can plan better, budget for expenses, and avoid surprises when it’s time to pay your bills. Whether you’re selecting a new plan or managing your current one, these terms will be critical to understanding your costs and coverage.

Simplify Your Health Insurance Search

At Health Plans of America, we make finding the right health insurance plan hassle-free. Our licensed insurance agents are here to help you navigate through the complex world of health coverage, ensuring you get a plan that works for both your health needs and your budget. Don’t let confusing insurance terminology hold you back—get in touch with us today and take the next step toward securing the coverage you deserve.

HMO, PPO, EPO: Breaking Down Health Insurance Plans Without the Headache

Navigating health insurance can feel like learning a whole new language—HMO, PPO, EPO, copay, deductible… it’s enough to make your head spin.

But don’t worry—we’re here to simplify the jargon and help you understand the most important details so you can choose the best health insurance plan for your needs (and your budget).

Let’s break it down:

HMO: Health Maintenance Organization

Looking for a budget-friendly plan with predictable costs? An HMO might be for you.

• Lower premiums and fixed copays
• Requires you to choose a Primary Care Physician (PCP)
• Referrals needed to see specialists
• Only covers in-network providers

This plan works best if you’re comfortable sticking with one doctor and staying within a defined provider network. Just make sure you choose a PCP you trust—they’ll be your go-to for all things healthcare-related.

PPO: Preferred Provider Organization

If flexibility matters more to you, a PPO plan offers more freedom—at a higher price.

• Higher premiums than an HMO
• No referrals needed to see specialists
• Coverage for both in-network and out-of-network care
• Lower out-of-pocket costs when you stay in-network

A PPO is a solid choice if you regularly visit healthcare providers or want the ability to see specialists without jumping through hoops.

EPO: Exclusive Provider Organization

EPOs are something of a middle ground between HMOs and PPOs.

• Only covers in-network care
• Typically no referrals required
• Larger network than an HMO
• Premiums vary depending on the plan

This plan is great if you’re okay staying in-network but want a wider range of doctors to choose from—and fewer restrictions when seeing specialists.

Final Thoughts

Understanding the differences between HMO, PPO, and EPO plans can make choosing the right health insurance much easier. It all comes down to your healthcare needs, preferences, and budget.

At Health Plan Market, we make it simple to explore your options. Our licensed insurance agents are here to help you find a plan that fits your life—and your wallet.

Ready to get started? Let us guide you to the coverage that works for you.

What is Medigap and Do I Need It?

Have you heard of Medigap and wondered how it differs from a Medicare Advantage plan? It can be confusing to navigate the world of Medicare options, but we’re here to break down the key differences to help you make an informed decision.

Medigap vs. Medicare Advantage: Key Differences

• Premium Costs: Medigap typically has higher premiums compared to Medicare Advantage, which often offers lower monthly costs.
  
• Out-of-Pocket Expenses: With Medigap, you’ll generally pay fewer out-of-pocket costs for medical care. On the other hand, Medicare Advantage tends to have higher out-of-pocket expenses.
  
• Where You Can Receive Care: Medigap is accepted nationwide, so you can receive care anywhere in the U.S. Medicare Advantage, however, is typically limited to specific regions and states.
  
• Provider Network: Medigap doesn’t require you to stay within a specific network of providers, while Medicare Advantage plans do, meaning you’ll need to use in-network doctors and hospitals for the best coverage.
  
• Prescription Drug Coverage: Medigap doesn’t include prescription drug coverage (Part D), so you’d need to enroll separately for that. Medicare Advantage, however, usually includes prescription drug coverage as part of the plan.

Navigating Medicare options can be overwhelming, but you don’t have to do it alone. If you have more questions or need guidance, Health Plans of America is here to help. Their team of licensed insurance professionals is ready to provide you with personalized information and resources, making the decision process easier. Connect with a licensed Medicare specialist near you today!

Traveling This Summer? Here’s What You Need to Know About Medicare Coverage

Are you planning to travel within the U.S. this summer? The good news is that most doctors and hospitals accept Original Medicare. If you experience a sudden illness or injury, Medicare Part B typically covers emergency medical care while you’re away.

However, if you’re heading abroad, there are a few important details to consider. Medicare does not cover medical expenses incurred outside the U.S. This includes not reimbursing for prescription medications you purchase while overseas. That said, Medicare may cover certain services abroad, such as inpatient hospital care, ambulance services, or dialysis in foreign hospitals, but coverage is often limited.

For additional protection when traveling internationally, Medigap (Medicare Supplement insurance) can be a lifesaver. Medigap is designed to work alongside Original Medicare, helping to cover costs that Medicare doesn’t pay, such as copayments, coinsurance, and deductibles. Importantly, some Medigap plans offer emergency medical coverage for situations that occur outside of the United States. This is a huge benefit for anyone who plans to travel abroad and wants peace of mind knowing they’re covered if an unexpected health issue arises.

Not all Medigap plans offer this benefit, so it’s essential to choose the right plan based on your travel needs. Medigap Plan C and Plan F, for example, offer foreign travel emergency health coverage, but you’ll need to check with your provider to ensure it’s included in your specific plan.

In addition to offering overseas protection, Medigap helps cover costs not included in Original Medicare, such as:

• Deductibles: Medigap can help you pay for the out-of-pocket costs associated with Medicare Part A and Part B deductibles.
  
• Coinsurance and Copayments: Medigap covers some or all of the coinsurance and copayments that Original Medicare doesn’t cover.
  
• Extended Hospital Stays: If you require additional hospital days beyond what Medicare covers, Medigap can pick up the cost.

If you’re concerned about medical expenses while traveling or want to reduce your out-of-pocket costs at home, Medigap can provide extra peace of mind.

Still unsure which plan is right for you? Reach out to a live insurance expert at Health Plans of America to discuss your options and get the coverage you need today!