Your source for health insurance quotes and plans.

  • the Coverage Corner

What is the difference between coinsurance and copayments?

by Lauren Mandel

When you shop for coverage this fall during Open Enrollment, will you know the difference between coinsurance and a copayment?

Both coinsurance and copayments help save health insurance companies money by making the consumer responsible for a portion of a medical bill, but the two health insurance terms have very different definitions.Health Care Reform Changes

A copayment is a specific amount you must pay for a covered health care service. For example, if you take a prescription drug, you may have a $15 copayment when you pick up your medication from the pharmacy. If the total cost of the drug is $75, your insurance company would pay the remaining $60 cost.

Alternatively, coinsurance is the portion of a bill you may be responsible for paying, calculated in a percentage format. For example, if you receive medical care that costs $200 and you’ve met your yearly deductible, your 10 percent coinsurance payment would come out to be $20.

Unlike a copayment (when you know the exact amount you have to pay for a service in advance), coinsurance can be more unpredictable. For example, if you receive an estimate of $2,000 for an upcoming surgery with 20 percent coinsurance, you would anticipate having to pay $400. However, if there are complications during surgery and the procedure ends up totaling $4,000, your expected costs would double.

In general, copayments tend to be a bit more affordable than coinsurance. With coinsurance, your percentage doesn’t go into effect until you’ve reached 100 percent of your deductible. Fixed copayment amounts go into effect immediately. Because of this, people with coinsurance usually end up paying more, especially in the beginning.

In both cases, once you pay your coinsurance or your copayment, your health insurance company is then responsible for paying the balance of your medical bills. It’s important to evaluate your copayment, coinsurance, and plan in general to ensure your coverage fits your needs. If you have questions about your coverage, call 888-322-7557 to speak with a licensed insurance agent.

General Healthcare, Health Care Reform || Leave a comment

Employees: Get ready to take charge of your health care

Gerry Leonard Headshot

ADP Benefit Services President, Gerry Leonard

by Gerry Leonard, ADP Benefit Services President

Now, more than ever, Americans have the power of choice when it comes to their own health care. The implementation of the Affordable Care Act (ACA) has opened doors for some to get subsidized health insurance for the first time. But, with this increased choice comes more complexity.

Case and point: employer-sponsored health coverage, which has not always been an easy decision for employees given the complexity of comparing plan options. Beyond the complexity alone, certain segments of an employer’s workforce haven’t historically been offered health care benefits, but the ACA has forced many to rethink their health care benefit strategies. While most large employers are now required by law to offer health care benefits to full-time workers (those working more than 30 hours per week), many have left part-time employees to navigate enrollment alone. What these part-time workers may not realize, however, is that they may be eligible for federal tax subsidies that will make these plans more affordable.

To remedy this process, ADP® partnered with GoHealth to give employers the tools to help their part-time, temporary or contract employees secure health benefits and receive federal subsidy estimates that could lower out-of-pocket costs.

Our new Exchange offers free enrollment assistance and application support for government subsidies. With GoHealth as our partner, we have created a user-friendly, online shopping experience that provides a wide range of plan choices, including those available on the federal and state public Exchanges. Our solution provides customized recommendations to the employee based on specific budgets and lifestyle needs, while allowing employers to keep the plans they currently offer.

Together, we have introduced a new benefits election process that is truly the best of both worlds.  Employers can now offer more assistance and support to part-time workers when it comes to their health insurance, while streamlining health care benefits data and cutting health care costs in the long term. And on the employee side, in addition to more plan choices, online support and real-time communication with licensed insurance agents will enable them to better understand their options, which in turn, will empower them to make smarter health care benefit decisions.

At ADP, we currently process payroll for more than one in six Americans and support more than 600,000 employers. As interest in Private Exchange solutions continues to grow, we are excited by the opportunity to deliver a new user-friendly, consumer-grade health care benefits shopping experience to our clients and their employees.

ADP Benefit Services President Gerry Leonard leads a division of ADP that provides Benefits outsourcing services to many of the largest companies and organizations in the United States. ADP, a leading global provider of Human Capital Management (HCM) solutions, is proud to have the largest Benefits Administration client base in the industry. Gerry leads a team responsible for the administration of Enrollment, Eligibility, Consumer-Directed Benefit Accounts (FSA, HSA, HRA, Commuter, Tuition), COBRA, Dependent Verification and Absence Management.

General Healthcare, GoHealth Community, Health Care Reform || Leave a comment

National Immunization Awareness Month: Vaccinations and your health

by Lauren Mandel and Adam Tock

It’s no secret that, over the past few months, immunization has been a regular news topic. First came the measles outbreak in California this past winter, which was later linked to Disneyland. Then just a few weeks ago, the U.S. experienced its first confirmed measles death in over 12 years. And that’s just one disease.

By the age of two, children are supposed to receive vaccinations to protect them from 14 different diseases. There are additional vaccine doses for children ages 4 to 6, and supplementary vaccines for children and adults of all ages.

However, more and more parents are choosing not to vaccinate their children. Although this is a personal decision, sending unvaccinated children out into the world – into schools, daycare, playgrounds, and other public spaces like Disneyland – puts other individuals at risk of contracting dangerous diseases.

To illustrate just how important the measles vaccine and other immunizations really are, and to highlight the importance of National Immunization Awareness Month, we’ve created the below infographic with important statistics and information.

National Immunization Awareness Month

Share this Infographic On Your Site

General Healthcare, Group Health Insurance || Leave a comment

The Cost of Going Uninsured

by Lauren Mandel

In an effort to showcase just how expensive it can be to go without health insurance, we’ve created a series of graphics to illustrate “The Cost of Going Uninsured.”

Many people – especially during the summer – make plans to grow their families. Although having a baby or adopting a child is extremely exciting and gratifying, it can also be very expensive.

Check out the below graphic that illustrates just how much you could save on a C-section by having health insurance – and how far that money could go when spent on newborn necessities instead.

And remember: Having or adopting a baby qualifies you for a special enrollment opportunity, which means you can get health insurance outside of Open Enrollment. Visit for more information.

Cost of Going Uninsured - diapers

General Healthcare, Health Care Reform || Leave a comment

10 Essential Health Benefits Your Health Insurance Must Cover

10 Essential Health Benefits straight north

Share this Infographic On Your Site

General Healthcare, Health Care Reform || Leave a comment

Fitness Trends: Are these 3 here to stay?

by Lauren Mandel

The ThighMaster and Shake Weight are fitness fads that have (hopefully) come and gone, but it seems like there are new trends emerging every day.  Although there’s nothing wrong with going for a good old-fashioned jog and eating a balanced diet, there are dozens and dozens of new ways to help you live your healthiest life. Let’s dive deeper into three of the biggest fitness trends happening right now. Are these trends here to stay, or will they be long gone before the year ends?   Screen Shot 2014-05-16 at 2.33.21 PM

Fitness trackers

We’ve shared our love for fitness trackers before, and for good reason. These sleek and simple devices do everything from tracking your sleep pattern and daily steps to providing you with personalized tips to improve your health. There are many models to choose from, so it’s important to do your research and test out a few fitness trackers from various brands before making a permanent commitment.

Traditional alternative: Stopwatches


Waist trainers

Thanks in part to the Kardashian family, waist trainers are having a moment. These contraptions fit tightly around your waist, essentially training your body to contract and become slimmer. But do they make a lasting impression? Many – including the whole Kardashian brood – seem to think so. However, others say that if the waist trainers are too tight, they can cause discomfort and trouble breathing.

Traditional alternative: Crunches and planks


Boutique workout classes

Thanks to the booming trend of boutique workout classes, Shred has become more than just a term used to describe the act of grating cheese. Shred451, SoulCycle, The Bar Method, and Barry’s Bootcamp are just a few of the new group classes churning out impressive results. Although much of the general public and many celebrities rave about these various classes, they usually don’t come cheap: Some can cost more than $30 for just one session.

Traditional alternative: Joining a gym



General Healthcare || Leave a comment

The truth about Obamacare birth control coverage

by Lauren Mandel

In the few years since the Affordable Care Act was signed into law, women who use birth control have saved an average of $255 a year on out-of-pocket costs. This is because now under the ACA, most health insurers must cover some form of contraception.capitol

However, until recently, many women were still paying high out-of-pocket costs for their birth control, even with Obamacare health insurance. Health insurers found ways to avoid paying some or all of birth control costs because of vague language within the health law.

Thankfully, the government recently issued a new document clarifying specific language surrounding this issue, and specifically, defining which forms of birth control must be covered.

Insurers must now cover at least one type of contraception in each of these 18 categories:

  • Sterilization surgery for women
  • Surgical sterilization implant for women
  • Implantable rod
  • IUD copper
  • IUD with progestin
  • Shot or injection
  • Oral contraceptives, combined pill
  • Oral contraceptives, progestin only
  • Oral contraceptives for extended or continuous use
  • Patch
  • Vaginal contraceptive ring
  • Diaphragm
  • Sponge
  • Cervical cap
  • Female condom
  • Spermicide
  • Emergency contraception, including Plan B, Plan B One Step, and Next Choice
  • Emergency contraception, including Ella

Without health insurance, an IUD can cost up to $900 and many birth control pills can cost up to $50 each month. The clarification concerning birth control coverage will save many women even more money than when Obamacare first went into effect.

Are you still paying too much for birth control, or have you been told that your health plan does not cover contraception? Remind your physician or pharmacy of the health law, and if needed, get a second opinion or seek new care.

General Healthcare, Health Care Reform, Politics and Legislation || Leave a comment

How to Face Obesity and Improve Your Health

by Lauren Mandel

In the United States, more than one-third of adults are considered obese. That’s equal to almost 80 million people.

Although obesity is now classified as a disease by the American Medical Association, there is hope for affordable care thanks to Obamacare. While some health plans have covered obesity medications, procedures, and treatments in the past, now under the Affordable Care Act, most health insurance companies are required to offer some sort of obesity coverage.

Obesity screenings and counseling for adults are considered preventive care services under the Affordable Care Act. Preventive care services require no copayment or coinsurance, even if you haven’t yet met your yearly deductible.

We’ve outlined what is covered by Marketplace health plans for obese individuals and what obese individuals can do to improve their health.Open Enrollment

Take advantage of screenings and counseling

If you’re unsure if you qualify as obese, you can receive a free obesity screening as part of the preventive care service. Individuals who are considered to be obese can also receive free counseling to help manage their disease. This oftentimes includes weight-loss programs, which can help individuals continuously maintain a healthy lifestyle.

Consider weight-loss surgery

As of 2014, 23 states were required to cover bariatric and gastric bypass weight loss surgeries for patients who are considered obese. These surgeries reduce the size of a patient’s stomach, minimize the urge to over-eat, and drastically improve their health. Before the Affordable Care Act, only five states mandated these surgeries be covered to aid in weight loss.

Get health insurance now

Remember: Under the Affordable Care Act, you can no longer be denied coverage for having a pre-existing condition, including obesity. Look for the health coverage that fits your medical and budgetary needs. Having health insurance will help with weight loss and also help you live your healthiest and safest life.

General Healthcare, Health Care Reform || Leave a comment

5 healthy recipes to make now

by Lauren Mandel

The struggle is real: Eating healthy during the summer is no easy feat, especially with barbecues and ice cream around every corner. But if you’re looking to stay healthy throughout the season, there are some delicious recipes that will keep you full and satisfied. We’ve rounded up a few of our healthy favorites we think you’ll enjoy.healthyFood


Chicken and watermelon both have amazing health benefits, including lots of protein and packed with water, respectively. When you put them both together and top the dish with a savory dressing, you have a perfect summer supper.

Find the Thai chicken and watermelon salad recipe here.


Wild salmon is often considered one of the world’s healthiest foods, high in protein and filled with omega 3 fatty acids. In this dish, it really comes to life thanks to a punchy sauce made of orange and lime juices, sake, and soy sauce. And at just 500 healthy calories per serving, your waistline will thank you, too.

Find the ponzu grilled salmon recipe here. 


Vegetarians, rejoice: Summer is high season for the best produce available. This summer vegetable sauté features corn, okra, red pepper, and lots of fresh cilantro. Even meat-lovers will enjoy this vibrant and healthy combination.

Find the corn and summer vegetable sauté recipe here. 


Meat, cheese, and fruit are a few of our favorite things year-round. This beautiful combination with prosciutto, mozzarella, and cantaloupe is sure to be a healthy crowd-pleaser this summer. Skewer the ingredients and drizzle with balsamic reduction for an easy appetizer.

Find the skewer recipe here. 


It’s pretty hard to find a healthy and delicious dessert, but these cherry lime ice pops are an exception. These sweet and tangy popsicles are the perfect treat for a hot summer day, and they can even help you and your family stay healthy and hydrated.

Find the cherry lime ice pop recipe here. 


Tell us: What’s your favorite healthy summer recipe?

General Healthcare || Leave a comment

5 Ways It Pays for Same-Sex Couples to Wed

by Elizabeth Fay

In a landmark decision, the U.S. Supreme Court ruled 5-4 in favor of legalizing same-sex marriage across the country. The ruling has several monetary implications that can benefit lesbian, gay, bisexual, and transgender couples that decide to tie the knot. Here are five ways the court’s ruling will level the playing field for LGBT couples while putting more money in their pockets. improving mental health care

1. Social Security

All married couples, regardless of sexual orientation, will be entitled to Social Security’s spousal and survival benefits. This change can have significant financial value for gay and lesbian married couples. Financial Engines, a large advisory firm, crunched some numbers for a hypothetical same-sex couple and found that marriage could earn a same-sex couple about $343,000 worth of additional government benefits.

The spousal benefit in particular helps when one person earns less than another. In that case, the lower-earning spouse’s payment could increase to half of the other spouse’s payment. On average, that could put an extra $780 a month in a same-sex spouse’s wallet, according to the Human Rights Campaign.

Same-sex married couples will also be able to take advantage of survival benefits. If a deceased spouse’s Social Security check is larger than the living spouse’s check, the surviving spouse can choose to receive the larger check instead of his or her own. Same-sex spouses will also be entitled to a one-time payment of $255 to assist with burial expenses.

2. Employer Health Benefits

Depending on where they live, same-sex couples are currently not guaranteed health benefits from their partner’s employer. Although about 77 percent of employers currently offer same-sex domestic partner health care coverage, that benefit is often taxed by the state as income. The recent ruling will eliminate those taxes and require employers who offer spousal health benefits to offer them to both gay and straight married couples.

3. Estate Planning
LGBT married couples living in states that have not recognized gay marriage stand to gain new rights to provide for their spouses and children after death. Same-sex couples will be able to inherit property from a spouse without paying any state estate or inheritance taxes. They will also gain the right to prevent relatives from contesting wills.

4. Medicaid
The legalization of same-sex marriage makes Medicaid more accessible to the LGBT community. Historically, the federal government allowed states to determine Medicaid eligibility for same-sex couples. Since many states did not recognize same-sex marriages, many gay and lesbian couples were denied health insurance through the government’s Medicaid program. As the legalization of same-sex marriage takes effect, more low-income gay couples will qualify for free or low-cost health coverage through Medicaid.

5. Subsidized Health Insurance

Under the Affordable Care Act, legally married couples – gay or straight – can jointly apply for federal tax subsidies to lower the cost of health insurance. However, some gay and lesbian couples have been waiting for same-sex marriage to become legal in their home state before officially tying the knot. With the legalization of same-sex marriage in all 50 states, gay and lesbian couples can wed in the state in which they live, and then apply for health insurance subsidies. According to the federal government, these tax credits generally save a person $272 every month.

Now that the high court has spoken, same-sex couples have a lot to gain financially if they wed. From inheriting property to saving thousands of dollars on health insurance, the financial implications of the court’s ruling have the potential to hit six figures for same-sex couples who say ‘I do.’

Health Care Reform, Politics and Legislation || Leave a comment