Q&A with Martha Garcia
Medical Health Insurance Specialist
Authorized Agent for

A Question and Answer about Medical Insurance: How to Protect Your Family Affordably
By Linda Pliagas

One of the greatest ills of our society is the high number of uninsured people in our nation. But as Martha Garcia explains this does not have to be so.  Medical insurance can be quite affordable.  With the proper guidance, your family can choose the best plan to meet your medical needs. Here are some great tips to protect your family’s wellbeing and prevent the depletion of hard-earned assets due to a medical catastrophe.


Q: What are some ways a person can choose the best insurance plan for
their family?

A: “What I like to do is talk to the person inquiring on the policy and find out if the rest of their family has insurance.  Maybe the kids qualify for Healthy Families. Or maybe it's best to put each one on an individual plan based on their provider preference (whether they are on a network or not) and how often they frequent them.  It could be that the pediatrician takes an HMO but the parent's primary provider with whom they feel comfortable with does not and they prefer not to change.  So we try to look at how the benefit is going to be used so it meets their individual needs.”

Q: Tell me about the PPO Share 5000 plan, which is being advertised.

A: “The PPO Share 5000 is one of the many PPO plans that Blue Cross of CA offers.  It is a comprehensive PPO coverage. You can go to a doctor's office visit before meeting the deductible. Annual physical exams are offered before meeting the deductible. Well Baby and Well Child preventive care is also offered before meeting the deductible.  Acupuncture and Acupressure are within the benefit plan.  The premiums are low and the plan includes maternity.  There are other PPO plans with a variety of deductibles and with or without maternity.  As you can see, we can tailor the plan according to the family's needs.”

Q. How does one know whether it's better to have a PPO or HMO Plan?

A: “I usually ask the individual looking for insurance to first check with their provider whether or not they are in the PPO or HMO network -- if they want to keep the same doctors they have been using -- this would be the first step to narrow it to one or the other.  If the providers take both, then we start looking at costs, out-of-pocket, prescriptions (brand vs. generic, etc.), and of course based on what is important to each one, we can then identify the best plan and the lowest premium.”

Q: What are some tips on saving money? For example, I was told to have my husband on one policy and me and my daughter on a different one, because of my husband's age difference. 

A: “Absolutely, I have my two kids on separate plans because my plan is too expensive to have them on it.  Plus I end up going to the doctor's with the ear ache or broken finger more often than I do for myself.  We also use the youngest spouse as the main applicant (it doesn't matter if you are employed or not) because the older you are, the more expensive the premium.”

Q: Do you have any other tips, advice or suggestions for homeschooling parents who are trying to find affordable insurance?

A: “It doesn't cost you anything to have us run a quote for you to find out the range of premiums. In fact, you can do it yourself by logging on to my website, I have a client that has a high deductible plan.  She chose it because of the premium cost; it took quite a while for her to decide that it was worth having insurance, although she had never been sick a day in her life and she always went for an annual check-up on her own. After having the plan for a little over a year, she was diagnosed with a catastrophic illness.  After her treatment (luckily she is doing great now), she called me to thank me because she would not have been able to pay the bills for her hospitalization. Every time she sees the EOBs (Explanation of Benefits) for her hospital bills or tests, she is just amazed at the costs and realizes how little she has to pay in comparison. Keep in mind that each day in the hospital can cost you thousands of dollars, not to mention that the fees being charged by the hospital will not be the same negotiated fees the carrier and providers have agreed upon.  So the question is: Can you afford not to inquire?  Also, keep in mind that if you own your own business, maybe you can qualify for a group plan, this is yet another option that we can look into.”


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