Going outside ‘The Marketplace’

Going outside ‘The Marketplace’

Healthcare options vary in the Keys

U.S. Health Advisor’s Julie Crane knows the Keys – she’s been living, working and playing here for the past 20 years. When she took a year off from the hospitality industry, she started looking into her family finances and researching her insurance options when she came across U.S. Health Group.

“We were paying $858 a month for my husband and I, and we are two healthy, active individuals,” she said, when she came across plans running around the $400 a month price range. “Once I went through the process, I knew this was something I wanted to bring to Key West.”

She made a phone call to corporate and opened a Keys office. “They needed the right person here, and it was a perfect fit,” she said, adding that she has written 100 policies since June. “People from Miami couldn’t fit the niche. I know the unique factors of the Keys.”

The most popular plan she sells is for healthy individuals. “In 2014, 97.8 percent of claims on this plan were for less than $5,000,” she said. “Which passes the savings on to the other healthy people on the plan.”

The plans aren’t “Obamacare” compliant; however, there are exemptions available.

“When something goes wrong, I’m just a call or text away and I do all the work for you,” she said. “You’ll never have to wait on the phone for hours to talk to a representative.”

The difference with her plans, compared to the Marketplace, is a lifetime maximum cap of $5 million, and that the plans are sickness plans, not wellness plans, which help keep the costs down. “The plan won’t cover you to go to the doctor every year for a wellness visit, but covers patients when they need to get something checked out,” she said of the zero-dollar deductible plans. “Let’s say I have a certain mole I need to get looked at by a dermatologist or a cramp I want to have looked at, it’s covered.”

In Key West alone, there are more than 84 doctors in the plans network. All three major Keys hospitals, Lower Keys Medical Center, Fishermen’s Hospital, and Mariners Hospital are all networked. She said the plan pays out a set amount to each provider regardless of whether or not they are in network, but in-network dollars go further. Generic prescriptions and non-generic prescriptions are covered. “Another big difference is this our network is nationwide,” she said. “Most Marketplace insurances only consider Florida in-network.”

Another unique feature is the plans are upgradable, allowing 30 days after a medical incident to upgrade the plan if a prognosis dictates the need. “Why pay for it until you need it?” she said.

“This really isn’t too good to be true,” she said. “I’m on a one-man mission to help the people of Key West.”

Crane can be reached at 305-797-6361 or [email protected]

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Lower Keys Medical Center and Womankind can help locals navigate the Affordable Healthcare Marketplace, healthcare.gov. To make an appointment at LKMC, call 305-294-5531, Ext. 4786. To make an appointment with Womankind, call Anissah Tomas at 305-804-3257.

All of the health plans on the Marketplace offer a comprehensive set of benefits, and coverage cannot be denied for individuals with a pre-existing health condition. Mandatory health benefits include free preventive care and wellness services, doctor visits, prescription drugs, hospital and emergency department care, lab services and pediatric services.

Penalties for not having insurance in 2016 will be $695 per adult, $347.50 per child, and up to $2,085 per family or 2.5 percent of family income – whichever is higher. The Marketplace offers financial assistance for qualifying consumers.

 

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