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Frequently Asked Questions

Residents of Santa Monica, West LA, and all of Los Angeles often have questions about health care insurance that are not discussed fully on the Health Care Insurance Overview section of our website. We have posted some of the most frequently asked questions and answers below. If you do not find the information you are seeking, we invite you to submit your question to us. This helps the professionals at Wilshire Health Insurance stay in touch with the concerns of our clients and the community. In addition, the answers we provide can offer guidance to countless others trying to make sense of the bewildering world of health care insurance.

And the answer is...

Many people under 30 are tempted to forgo health care insurance to save money, knowing that they are in prime health and unlikely to develop a serious disease. Many younger adults would rather pay out of pocket for occasional visits to the doctor, such as an annual physical, rather than to take on a monthly health insurance premium. Such thinking is about half right: There is no need for healthy young adults to have a comprehensive health insurance package that loads up on benefits and has a hefty monthly premium. Paying for routine visits out of pocket makes sense, and it fits beautifully with a high deductible health insurance policy. A health care insurance policy with a high deductible amount is relatively inexpensive, however, such a policy will pay for major medical costs that you might incur through an accident or sudden illness. A catastrophic medical crisis can result in thousands—even tens of thousands—of dollars in medical bills, wiping out your savings, siphoning off equity in a home, or even forcing you into bankruptcy. A high deductible health insurance plan can protect you against big-ticket injuries and illnesses while costing a modest sum each month.

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And the answer is...

The best way to limit expenses for physicals, screenings, immunizations, and routine childhood illnesses is to enroll in a managed care health insurance plan, such as a PPO or HMO. This kind of health insurance plan emphasize wellness, rather than treatment. The co-pays are nominal because the doctors agree by contract to keep their costs down. A managed care health insurance plan still gives you and your family access to all the specialists and laboratories you need when you are ill, but the premiums are smaller because the health care providers in the network agree to keep their charges low in exchange for the steady volume of patients. However, you and your family must see the doctors within the network to receive the full benefits of the health insurance plan.

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And the answer is...

Surprisingly, many consumers actually save money when they change to a new health insurance plan. However, finding a health insurance plan with comparable benefits at a lower cost can require hours of research. Wilshire Health Insurance will gladly do the health insurance shopping for you, making sure you get free quotes for a better health insurance plan at a price that fits your budget. The service is free, and you are under no obligation to follow our recommendations.

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The 63-day rule applies only to people who have lost their health care insurance due to job loss, relocation, or other circumstances. The name of the rule comes from the amount time—63 days—that a consumer has to obtain a new health plan before being deemed to not have “continuous coverage.” Once 63 days have passed without health care insurance and you have lost your continuous coverage, health insurers can delay or deny coverage of ongoing medical conditions diagnosed before the 63-day period began. Such conditions are known as pre-existing conditions. If you have lost your health care insurance and are inside the 63-day window, call Wilshire Health Insurance immediately. We will provide free quotes so you and your family do not lose your continuous coverage.

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HIPAA stands for Health Insurance Portability and Accountability Act. Enacted in 1996, this federal law ensures that a person who has lost his or her health care insurance due to job loss, relocation, spousal death, divorce, or any other qualifying reason will be able to obtain health care insurance, regardless of pre-existing conditions. HIPAA established the 63-day window in which to find a new health insurance plan to maintain “continuous coverage.” (See the 63-day rule above.)

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If the company you work for has 20 employees or more, it is required to provide the same health insurance benefits to employees over age 65 that it provides to everyone else. Even so, you should enroll in Medicare Part A as soon as you turn 65. Medicare Part A is a health insurance plan paid for with taxpayer dollars; you do not pay a health insurance premium for Medicare Part A. You only pay premiums for Medicare Part B, but you do not have to enroll in that health insurance plan at age 65. If your company-provided health insurance offers better health insurance coverage than Medicare does (and most private health insurance plans do), you can designate your employer’s health care insurance plan as your primary health insurance plan and use Medicare as a secondary health insurance plan. Medicare will be billed only for services not covered by your private health insurance plan, providing a safety net to pay for uninsured medical expenses.

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