Beyond the Benefits: Finding the Right Health Insurance for You - Episode 24
Health Insuance is expensive and complicated, especially if you don’t have access to an employer sponsored plan. Many people struggle with understanding what they are paying for and what is covered. With so much misinformation out there and with medical bills being so hard to understand, you need someone you can trust to help you navigate. Oxana has been getting people the right coverage they need since 2020. Learn how she can help you navigate these rough health care waters. See works with the self employed, the early retired, retired or people seeking options outside of their employer plans. Make sure you follow Oxana on IG.
Resources Mentioned:
My episode with Angel Celluci about Medical Billing Errors
About Our Guest: With over 12 years of hospitality experience, Oxana started her journey as a health insurance agent when pandemic hit in 2020. Within 3 years in the new industry she started her own company Simple Health Quotes, as a response to constant complains from her clients on how difficult and frustrating the process of shopping for health insurance was. The hospitality background has helped her a lot to connect with people, hear and care about their concerns and work on simplifying the process of comparing and selecting plans. She now networks with dozens of agents to provide a one stop shop experience for her clients, focusing on everyone's individual situations, as health insurance isn't one size fits all outside of your typical employer coverage. Contact her today to check for your best available options, or if you have any general questions about health insurance at all. All consultations are free of charge.
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TRANSCRIPT:
Naseema: [00:00:00] hey. My financially intentional people. We have an amazing episode today with our guests, Oxana Pernova. Got it. I was gonna mess that up.
And we're gonna talk about healthcare options outside of traditional employment. So people who are self-employed I have a lot of nurses who follow me, travel nurses, people in early retirement. One of the biggest questions is, how am I gonna be able to afford health insurance And That's because health insurance and paying for medical care in the United States is a cluster F and it's extremely expensive.
So you don't ever wanna be caught slipping in these streets without insurance, cuz even the healthiest person can have some catastrophic medical expenses if they don't have. Health insurance. So welcome, Oxana. I'm so happy to have you here. Love that you get to talk to my people. So let's get [00:01:00] started on your background, like how did you get introduced to this healthcare insurance space?
Oxana: First of all, thank you for having me. Happy to be here. And spill the knowledge I started I'm an immigrant, so I moved to United States from Russia in 2008. I started working in hospitality industry. So I come from a long working in hotels, bars, server, bartender, name it, and um, with Covid, all the bars.
No restaurants, everything closed, so did my hotel. And I was forced to look for something that is recession proof, something that I don't have to, rely on a place to be open or pandemic, close it down. So I started venturing out and I ended up in health insurance, which I'm really grateful and I'm happy that I did because not only that I am able to, Help people make money and actually help people.
Making the right choice about health insurance. Picking the right plan because it is very complicated. Unless you actually work in the industry, it's just [00:02:00] not that easy. But in reality, I'll simplify it for you. It's. It's not that hard.
Naseema: I work in the healthcare industry, in healthcare in, and I have a master's degree in healthcare administration, but healthcare in health insurance is so dynamic.
It's always changing and it's, it is a struggle to understand. And so I find myself often having to call my health insurance company to ask what's covered, what's a co-payment versus. What is, my out of pocket, like all of those kind of crazy things. It's still hard to navigate and I have I'm blessed to have really good p O insurance, but still it can be rather expensive.
I'll give you an example. So this time I'm pregnant and I'll, that if you, if I go to the hospital and the medical group associated with the hospital basically everything is covered through my health insurance, but there are different medical groups associated with the hospital, so I chose to go with a different medical group, and so I have [00:03:00] co-payments associated with that.
Even though when my whole hospital stay will be covered. There's co-payments associated and so that's not always outlined in your coverage, so you need to understand that. And those copayments aren't small. They've added up to, Five figures right now. So you need to understand what's covered and what's not, and then you need to have a plan in place to cover that.
And luckily I have a F s A, so that's just going to show that, the costs are not just straightforward. And so it's really something that we all need to understand. But a lot of people are super curious if they don't have traditional employment or their healthcare at their job is super expensive, what their options are.
So I'm really happy that you're in this industry and you can break it down in a simple way. Perfect. So that we can understand it. And so, perfect. Um, Yeah, let's talk about insurance and what kind of insurance you help people attain.
Oxana: So I help [00:04:00] all self-employed to get insurance if they don't qualify for, if they don't get offered insurance through work, if they don't qualify because they're part-time or simply if they have their own business.
So I help them explore the options.
Usually all of your options will depend on your state or zip code sometimes. So don't blame the agent if we can't find you a plan that works, that you want. Obviously the best insurances you can possibly have is through your employer simply because they have to contribute.
Towards your premiums a lot. It's usually 50, 60, 70, sometimes even 90%. That's what, it makes it super inexpensive. And those plans are some of the best plans on the market where they actually, especially the big corporations, they allow you to pick, from three or four different options and then you can pick and choose your deductibles.
Now it doesn't work. The same with the smaller companies. They usually just have one plan for all. But you know, if you are employed and they paying for your coverage, it's amazing.
Now for what happens when you lose that coverage. Everybody kind of panics here because, and they discover really quick [00:05:00] that insurance is very expensive in the United States unless it's sponsored by the employer.
So there's only two ways to get coverage outside of your employer. First will be through your marketplace. So each state will have their own exchange programs. Obamacare websites marketplace each state calls it a little bit different, but everything is done through one website.
It's called healthcare.gov, not dot com, not any other versions of it. It has to be dot gov, and that's where you can go simply put your zip code. They do not ask your phone number or any information they'll simply just route you to your state marketplace and then you can check for options. So marketplace is going to be based on your family size and your family income.
It's very important to stay true to the income and then try to manage it and lower it down so you can get a better rate, simply because when you file your taxes at the end of the year, they reevaluate the tax credits they gave you, and you can find yourself in a really bad situation when you owe.
Thousands of dollars. It happened to so [00:06:00] many people I know. So yeah, so the first one will be marketplace.
Sometimes it's really affordable because your income is low, or your family's big. And after Covid, they started giving more tax credits. So they expanded that actual the family size and the income brackets.
So that's became more affordable because of the pandemic.
Now there are also private options that are available to you. They're not a part of the marketplace. Private options, the biggest difference. They're, they have a lot more Rules and exclusions and what they cover, what they don't cover.
So it is important to understand what you signing up for and whether you need those benefits or not. Private options usually, for example, don't cover maternity. They don't cover alcohol. Drug rehabilitations, they don't cover mental health. So if those things are important to you, at least one of those things, you have to go with the marketplace.
But if you are young and healthy or just don't use your insurance that much, and you wanna lower the cost. And the marketplace is too expensive for you, then you can take a look at the [00:07:00] private route and see if that works for you. But like you said it's important to understand the benefits and it's important to read into it and see what's covered, what's not covered.
Because even, like you said, your amazing employer, PPO plan doesn't cover certain things. And what I think the most important thing is always to make sure that you go in network.
Because a lot of plans, especially. Marketplace. They have really small networks,
so it's really hard to find a good PPO plan through the marketplace.
Not a lot of states have that. California does, by the way, but a lot of states like Florida, Texas, they only offer HMO plans. And it's just it's a disaster here. But going in network and especially what I've been hearing a lot lately probably with. Also with the pandemic that if you go to an emergency room, for example, the hospital will be in network with your insurance, but it, the physician they may assign you at er may not be.
Yeah. And it happened, a couple of my clients [00:08:00] and they've all had different insurances and they were like, why Oxana? We call the hospital, we'll try to figure it out. And they simply don't care. They're overworked, they're underpaid, they assign you the first physician that they see.
And just a tip. If you are conscious or if you're taking somebody else to emergency room, just make sure that they assign you that.
That doctor that accepts your insurance
Naseema: as well as the hospital,
I'm gonna tell you right now, that's not gonna happen.
They're gonna, they're gonna, especially in an emergency room, that's, they can't prioritize that in, there's other laws that's gonna say that you have to get So if you're in that position where you can ask for a certain doctor to be assigned to you, you probably don't need to be in an emergency room.
That's number one. Number two is that because of our EMTALA laws, it's is not very often that you could just go in the emergency room and demand a certain doctor because you have to be seen within a certain amount of time and all of those kind of things, right? And in order to provide quality care, You need to [00:09:00] be able to be seen by the first available doctor or who, whoever is there. So that's a, that's just forget about it, right? No, you can try, but the chances are it's not gonna happen and not, that's just like me knowing how the system works. And yeah, and maternity and labor and delivery is, we have our own emergency department. And so we assign, we'll assign you to whoever your provider in your network is.
That's just because of our specialty, so we're able to do that. But if you come in and if you don't go to the right hospital, like if you don't go to the hospital you're assigned to in your insurance, then all bets are off. That's just something to note.
Yeah.
Oxana: But e even if it's not emergency room, I've had the situations where a client of mine went to just a primary care doctor and they sent the labs to a lab that doesn't accept their insurance. So that happens all the time too. Yeah, and that is something you can definitely control, and you have to make sure that [00:10:00] everything is billed properly.
You have to make sure that. They assigned you the, actually the doctor's office ended up paying for that bill. They're picking it up because they were the one
Naseema: who sent it to the wrong place. Sent it to the wrong place. Yeah. But the thing is that what if they didn't catch that? They wouldn't have, they wouldn't pay for that.
So most people don't pay attention to their medical bills, by the way. They're A 70% chance that 70% chance that there are errors on your medical bills. So you should always be looking at your medical bills and not just the overall, like total. You need to look at the itemized things on your bill, cuz chances are, this bill is wrong.
That's one aside to second aside. To mention like the subspecialties and the doctors that are covered, for example. So I always have to give labor and delivery examples because that's my world. Yeah. But when you go into labor, you have your doctor, your OB GYN, that's gonna see you. But if you want an epidural, there's a anesthesiologist that is another doctor who's [00:11:00] not gonna be associated with your group.
They have their own billing process. So that's another thing that you have to check for. So these are just all good to knows, aside, like things about our crazy healthcare system, which if you don't know, can be very expensive for you.
Oxana: That's fine. I can't tell you how many times I have my clients just reach out to me like, oh, the bill looks so big what's going on?
So I, what I actually do, I help all my personal clients just go through it and we'll analyze it together. And very often it's a, it could be like a simple billing error that you can be, you can fix which either I can contact the company or they have to contact the company depending on the insurance carrier.
But it is something that I do help my clients with because I understand how frustrating it is and people don't understand how health insurance works in general. Like some people think that you just pay for your premiums and everything has to be included. When it's not. It's just not the reality.
Or some people think that if they have a copay and they pay that copay, then they're [00:12:00] not gonna get a bill after. But then what happens then if the doctor schedules labs prescribes you medications? You have to pay for all that stuff separately. Yep. Yeah. So you're just important to understand and help somebody if you don't understand.
Then have somebody help you understand how that works.
Naseema: Yeah, and I actually have an episode that was from the Nurses on Fire podcast. So before I changed the name to this podcast to financially intentional, it was Nurses on Fire. And so I'll reference the episode that I have in there, in the show notes with Angel Sal Luci.
She's A registered nurse, family nurse practitioner, that all she does is look at medical bills and analyzes them for people to help mitigate those errors. So she used to work for insurance companies. She used to do it on the insurance company side and has identified millions of dollars of Medical billing errors.
And so she's she has like a keen eye for those kind of things. And so I'll link her episode here if you're interested in nice. Definitely all the ways to mitigate [00:13:00] medical billing errors as well, because I think that's super important. And we all have to be financially intentional. And I think this is one of the areas that a lot of people struggle in because they just don't understand.
But Medical bills, medical charges are, all those things are the number one causes of bankruptcy. So we have to be hypervigilant about these things. So do you provide services for people for both private insurance and the marketplace, or just private insurance? Yes,
Oxana: correct. I do help with both.
Okay. So my process is very simple. It's just based on your situation, based on your family size and the income. We'll take a look at the marketplace, we'll see what you qualify for there. Over there I will ask you a few questions. To determine, whether you're healthy enough to get approved on the private plan, as well as I will let you know what they don't cover.
And then I just basically evaluate your situation. I'll give you all your options, and then you can make the decision what works best for you. And like I said, sometimes it's just they don't have great options through the [00:14:00] marketplace. And it is, it's just, it depends. Yes. But I will help definitely.
To take a look at everything and then you can make your decision to what works best for you.
Naseema: I love that because it is and can be very overwhelming and I love that you even offer the service for your clients to walk 'em through their medical bills. And I think that's amazing and that speaks to why you should have someone and work with someone in your corner.
Don't go into this Just willy-nilly and just going in and picking in insurance and not really understanding, it's really good. Yeah. To have an ally in this space to help handhold and walk you through these process, definitely processes.
Oxana: And there's so much also misinformation out there. Yes. Like I wanna share like a really, like tragic story, but obviously I won't mention any names, but
one of my clients mentioned that
she had a nurse in her
hospital that she lost insurance and she was uninsured. She was just taking assignments and didn't take the agency insurance. And then she discovered she had a lump in her breast [00:15:00] and she was told by someone that she cannot qualify for health insurance now that she has a preexisting condition.
And she tried to get a full-time job with full benefits and it took about, 30 to 60 days to kick in. She ended up passing away simply because she was, and I don't know if this wouldn't have happened if she obtained insurance right on time, but, She had a fear of not being able to get insurance because she has a preexisting condition That's wrong.
And I dunno, she
Naseema: asked say that getting proper like that is, since Obamacare that's not even a thing. Not anymore. It's against the law too.
Oxana: Maybe she thought because she missed the open enrollment, but she didn't know she basically has a 60 days Special up enrollment if she loses insurance through her job.
And it's just not, it's not that hard if you have the right person helping you to, but it's just so sad to me that people would do that. And I'm not saying it could be somebody did it intentionally, but maybe she didn't qualify for [00:16:00] their plans and they said, no, sorry, we can't insure you. And then she just thought that, She couldn't get any insurance, but
misinformation about health insurance is left and right and people just don't know.
Naseema: And it's so let, I wanna pull that out because I really wanna highlight this point. You can get health insurance with a preexisting condition. That used to be something when I was younger. I remember like in my early twenties, before Obamacare, before there was major changes to healthcare legislation.
That was a thing, but that is no longer a thing. So I just wanna pull that out because yeah, I'm sure a lot of people believe that is a myth.
Oxana: Yes it is. It is a hundred percent a myth when Obama did the whole healthcare reform. No more pre-existing conditions, discrimination. They don't ask you any medical questions.
Now, that's how those plans can be very expensive because if you are a healthy 30 year old [00:17:00] that makes, I don't know, a hundred thousand dollars a year, you going to pay the same price as a diabetic 30 year old who makes a hundred thousand dollars. That's when you have private options that come into place.
And if you're healthy, you can qualify for them. Hey, they're not gonna cover a few things, but maybe you don't need them. So it's good to like research and talk to somebody who knows about all the ins and outs and. Just make sure that you speak to somebody who's also not trying to push you. Just get one plan, one policy, because that just to me, that's
Naseema: sketchy right away.
Exactly. So you need somebody who doesn't have a vested interest in a particular insurance company and that's a thing. Like you said, like the misinformation. Somebody can click healthcare.com and then be led into these people that are just trying to pirate your information and kind of.
Not working your best interest. So this is one of those markets where you can easily be paying a lot more because the prices are so different [00:18:00] across the board and for the same coverage. You can be paying super different prices for your insurance, co-payments the judicious medical costs in general.
But what you need to understand is that. You have to get the healthcare that is right for you, for your existing conditions, for your kids, your family size, for what's going on. So that's why it's super important to have an ally in this space that you know does not have a vested interest in this company.
Not in these companies, non-biased, that is going to research specifically. Insurance is for you that has years of experience like Sana. So I think that what you're doing is super important and a lot of people don't even know that people like you exist. And so that's why I'm glad that you're here talking about it.
Let's talk about pricing and like how variable it [00:19:00] is.
Oxana: Yeah, so prices will depend If you go through the marketplace, it's always going to be based on your income. Like I said it's how they de, determine how much to contribute and help you pay for insurance. Now there's a few different state programs.
There's Medicaid, And then there's healthcare dot gov, which is Obamacare. So the one thing to remember if sometimes, you go in through series of you lost your job, you don't have any in income and income, you can apply for Medicaid. Usually the cutoff is about 13, 14,000 of income.
That if you make under 13, 14, you qualify for Medicaid yearly and you can apply for that. And as soon as you get a job, they can potentially kick you off. And once you start making income, just make sure that you adjust that with Medicaid or healthcare.gov whenever you're working with them. Just so you don't get.
Build at the end of the year or get it taken out of your taxes. Like I said, I have a lot of people that are going through that and they didn't know or they [00:20:00] got a wrong advice or just lower it a little bit. Like I've heard that so many times do not do that. I always tell my people to overshoot a little bit, even if you not gonna make that much.
But if you do, maybe you pick another assignment or stay longer at another assignment. Basically if you put a little bit more but you make less, they'll give you some money back. So that's how it works. But if you don't qualify for any financial assistance, like for example, I don't, and I am 35, I pay $400 for my insurance.
Privately I pay about 400. And that's the average cost. It would be anywhere between three to 400. Now what I like to add, all kinds of like supplements on my policy just because I know I see those bills all the time and I don't wanna get hospitalized. I do have a deductible. I do have a max out of pocket, but I personally purchase a lot of supplements just to help me with accident protection.
Supplements that help me pay for my deductibles if I ever get a surgery or hospitalization. So I have all that stuff on [00:21:00] myself. But yes,
usually pricing depends on the family size and and your income. If you go through the marketplace, it's literally just it. There's no one price or per state, the state charges, the state star charges that.
It's not one size fits all. It's all very personal. On a private insurance market, you usually. Looking at three to 400 if you're in your thirties, and if you're in your forties, four to 500 and so
Naseema: on.
So a lot of my listeners are gonna fall either like in one of three categories, so they're gonna be.
If they're not tradition, if they're not employed through they don't have insurance through their employer either they're gonna be somebody who's in early retirement who is not traditionally employed, but maybe living off of like investment income, which is, can easily fall in that Medicare range or someone who is 10 99 employee. I have a lot of people who just do [00:22:00] contracts and all that stuff. And then I have people who, are getting close to retirement age but don't, won't have coverage from their employers. So these are people that you can typically help. So I wanna, yes, I just wanna walk through an example of somebody who's like me in their early forties and.
I wanna take a gap year off where I don't wanna be employed. I won't be really drawing any income. I can live off of some of my investment accounts and I fall in that Medicare range. What would that look like for me in that little early mini retirement or gap year?
Oxana: If you qualify Medicaid is free.
And I know you said Medicare is for 65 and enough? No. Oh, I see. I used to do the same thing, but Medicaid, think about it like it's a financial aid when Medicare, it's like care for all. Elderly. So yes. So if you qualify for Medicaid, Medicaid is free. So you'll get free insurance through state, all you're preventative.
If you [00:23:00] are, once you get kicked off of the Medicaid, if you start bringing in a little bit of income, you automatically go to. Onto the marketplace. Yep. And that will start most likely also from zero. It could be $20 for your plan. I know that you have children, so you have dependents. That plays a huge role.
If you have dependents, if you are single mother with, multiple dependents, they'll help you a lot more versus you having an actual spouse who also contributes. So it just depends. It really depends. But as long as your taxable income is, and if you're. Not an individual if you're a family, but it's it goes up.
So if an individual you have to make under 15,000 for a family, it has to be a little bit more like 2025. So you'll be fine as long as it's not like a taxable income that you are getting and. Sometimes I know people like sell houses and they don't count that into the income. All that stuff that is taxable.
Naseema: That's interesting. Counts. Oh, okay. [00:24:00] So the people don't count that into it. But people, the government is gonna count that. You were clarifying that. Cause yeah, the government is definitely gonna count that. Double count that yeah, if you're a real estate agent, don't say you didn't make any money this year.
But you sold a couple of houses. That's all income. Okay? Yes, I got it.
Oxana: If you sell your own house, does it count as an income?
Naseema: Yes it does. There you go. That's, oh, ok. That's what you mean. Yeah. So if you're selling
Oxana: something Yes, and it's gonna be registered counts as the income too.
Cuz you cannot be, maybe not working, but you just sell, decided to sell your multimillion house, Milton million dollar house and then God counts as income.
Naseema: And if you're drawing off of your retirement accounts or you're drawing off of like savings accounts, does that, that counts as your income for that year too, right?
Correct.
Oxana: Yes. So you have to be,
Naseema: Careful. Just to be explicit about it. So there's no questions. So there's no question. Yeah. So there's a lot of people that fall [00:25:00] within that category of this self-employment. With kids without kids that just need to know their options. And I think it like even in this conversation you'll see that, there's so many things that you just don't know.
Like I said, this is something I have a master's degree in, but I'm not particularly in health insurance. And it still it still can be very confusing. Walk us through how people can. Work with you, get into contact with you.
Oxana: It's pretty easy. You just can just go to my website. It's simplehealthquotes.com.
It'll give you a a simple form to fill out with just a couple questions. And then I will reach out to you or one of my team members, reach out to you and we'll schedule consultation where we can actually walk you through everything and show you all the available options. Now it will depend on the state again.
Some of the states I personally don't have a license in because it's. Pretty impossible to get licensed in all states for health insurance agents. But if I don't have a [00:26:00] license there, I will definitely either recommend you to one of my colleagues who does, or I'll definitely point you in the right direction with at least a website
Naseema: where to go to.
Nice, nice. And what states are you do you primarily focus on?
Oxana: So I cover over 30 states. Okay. So I'm not going
Naseema: to mention all of that. You not have to list them out. Yes.
Oxana: Yeah. Lemme just mention the ones that have their own systems. So states like California, New York, New Jersey there's a few others.
Idaho. They have their own. Marketplace and they don't allow, like a lot of agents, you have to be a resident to be able to offer insurance there or they just don't allow enough private options for agents to even be interested in getting a license there. Because to be honest with you, like the marketplace split doesn't pay very much to the insurance agents.
But states like New York California and New Jersey, what are some of the big ones too? Any e everything, like around California, pretty [00:27:00] much like all that, like Oregon, Washington, dc you just have to go through healthcare.gov for
Naseema: some states like that, okay? Okay. But. If somebody from California reached out to you, you wouldn't be able to help them or you?
I have.
Oxana: Oh, no. I would, I have an agent that I network with Okay. In California. So he helps me with all my California inquiries. Same thing with New York and New Jersey. And
you have to also keep in mind Some states I don't know if you remember, there was used to be a penalty for not having insurance through the marketplace of employer. So Trump actually removed it in 2019, I believe. But there's certain, there's some states that still have that. I believe New Jersey's one of them. There's like maybe three or four states, so you have to be
Naseema: careful too. So not only was there a federal penalty for not having insurance, you would get a state penalty for that as well.
Now
Oxana: it's only a few states. Yes. Wow.
Naseema: That have that. See, the more, yeah. I didn't know that at all. [00:28:00] At
Oxana: all, right? Yeah. You don't, I don't think it applies in California you're fine. But in. Yeah, definitely like New Jersey. I don't know New York if they do or not, but it's listed. It's all on healthcare.gov
Naseema: though.
Okay. And what if people are employed but are like exploring options, like early retirement, gap years, self-employment, like a nurse that's wants to go from being a staff nurse to being a travel nurse. Can they reach out to you and get help And just thinking through that process and what it would look like.
Of
Oxana: course, a lot of my clients, they're they reach out to me for that exact same reason. They need to be more educated on health insurance before they make that decision to move forward with their plans. And yeah, as for the most part, I can help everybody and just to give them peace of mind.
Knowing that they could pursue their dreams and not having to depend on employer insurance. Yes.
Naseema: And another thing that offers peace of mind is that your consultations are free, correct.[00:29:00]
Oxana: Yes, correct. Consultations are free and no charge, no obligation. Yeah, my, the majority of my clients I get is just by word of mouth.
So people recommend me, refer me. Yeah, I'll happy to help as many people as I possibly can.
Naseema: Cool. And the thing is that sometimes a a lot of people feel overwhelmed by the process and there can be a lot of scammy people out there. So just to know that there's somebody, a face that you can actually trust is a lot of reassurance.
So again, Oxana, I really appreciate what you're doing. Thank you for always dropping gems. You always teach me something every time I have a conversation with you, so I, so do you, I always learn so much from you. If you don't have friends that you can learn from, yay. Exactly. But anyway all your resources will be in the show notes.
Make sure you guys, even if you're not in a situation that you might need Oxana, make sure you keep her information in your back pocket because [00:30:00] things do change and there may be a time where you need to step out. Of being under employment insurance for whatever reason. So make sure you know what your options are and know that you have an ally that's gonna look out for your best interest.
So thank you again, Oxana. Thank you so
Oxana: much, Naseema. Thank you.
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