Clear, Effective Health Coverage
Find plans for individuals, families, and businesses that make sense for your life.
Understanding Your Health Insurance Needs
At PWYB, we know that navigating health insurance can be challenging. It’s not just about having coverage—it’s about finding the right protection for your health and financial well-being. Our team is here to guide you through the process, ensuring you understand your options and find a plan that fits your unique situation.
Our Health Insurance Options
Individual Plans
Whether you’re self-employed, between jobs, or need coverage outside of work, we’ll help you find a plan that fits your health needs and budget.
Family Coverage
Protect your loved ones with comprehensive health plans that cover everyone’s needs without overstretching your finances.
Business Health Insurance
Attract and retain great employees with group health plans that balance quality coverage and cost-effectiveness.
Medicare Supplements
We’ll help you navigate Medicare and find supplemental coverage to fill any gaps, ensuring you’re well-protected in your retirement years.
Self-Funded Options
For businesses looking for more control over their health benefits, we offer guidance on setting up and managing self-funded health plans.
key considerations
When helping you choose a plan, we’ll look at:
Plan Types
We’ll explain the differences between HMOs, PPOs, and other options.
Provider Networks
We’ll help ensure your preferred doctors and hospitals are covered.
Prescription Coverage
If you have specific medication needs, we’ll find plans that offer appropriate coverage.
Costs
We’ll balance premiums with other out-of-pocket expenses to fit your budget.
Additional Benefits
Many plans offer extras like telehealth or wellness programs that might benefit you.
The PWYB Approach
We believe in making health insurance clear and accessible:
- Understand Your Needs: We start by listening to your health concerns, financial situation, and coverage priorities.
- Explain Your Options: We break down complex terms and plans into clear, understandable choices.
- Find the Right Fit: We use our industry knowledge to match you with plans that offer the best value for your specific needs.
- Provide Ongoing Support: As your life changes, we’re here to help adjust your coverage accordingly.
- Assist with Claims: If issues arise, we’ll help you navigate the claims process effectively.
Common Health Insurance Questions
Generally, you can change plans during the annual Open Enrollment Period, which typically runs from November 1 to December 15.
However, certain life events qualify you for a Special Enrollment Period, allowing you to change plans outside the standard timeframe.
These events include:- Marriage
- Having a baby
- Losing other health coverage
- Moving to a new area
If you have employer-sponsored insurance, your company will set specific enrollment periods.
A deductible is the amount you pay for covered health services before your insurance starts to pay.
For example, with a $1,500 deductible, you pay the first $1,500 of covered services yourself.
The out-of-pocket maximum is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.
For 2024, the out-of-pocket maximum for an individual plan is $9,450 and for a family plan is $18,900.
We can help you find a plan that balances these costs with your monthly premiums to best fit your healthcare needs and budget.
It depends on whether your doctor is in the new plan’s network. Before switching plans, we’ll check if your preferred doctors and hospitals are in-network for the new plan.
If keeping your current doctor is a priority, we can focus on plans that include them in their network. If your doctor isn’t in-network, we can help you understand the costs of out-of-network care or assist in finding a new in-network provider.
The Affordable Care Act (ACA) has several key impacts:
- It requires most health plans to cover essential health benefits, including preventive care, prescription drugs, and mental health services.
- It prohibits insurers from denying coverage or charging more based on pre-existing conditions.
- It allows young adults to stay on their parents’ plan until age 26.
- It provides income-based subsidies to help lower the cost of insurance for many individuals and families.
We can help you understand how these provisions affect your specific situation and help you take advantage of any benefits you’re eligible for.
Businesses should consider several factors:
- Employee demographics and health needs
- Budget and cost-sharing between the company and employees
- Desired level of coverage and types of benefits
- Compliance with ACA and other regulations
- Administrative burden and resources
- Competitiveness of benefits package for employee retention and recruitment
We work closely with businesses to analyze these factors and find a group plan that balances employee needs with company resources. We can also explore options like Health Savings Accounts (HSAs) or flexible spending arrangements to enhance your benefits package.
Ready to Find the Right Health Insurance?
Your health and financial security are important. Let our experts guide you to a health insurance solution that fits your needs and goals.
