Jay and Heather Gray have over 20 years of experience managing affordable health insurance plans. If you are and individual , family, or a small, medium or large sized business we can work with you to create a customized program that will meet you and your employee’s needs. Jay and Heather are independent agents who support clients in
Escondido, San Marcos , Vista and all communities in San Diego, Riverside and Orange Counties. Receive a free quote Please contact Heather Gray at 1-619-933-9517
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Health Insurance is insurance against loss by illness or bodily injury. Health insurance provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses. Policies differ in what they cover, the size of the deductible and/or co-payment, amounts of coverage and the options for treatment available to the policyholder. Health insurance can be directly purchased by an individual, or it may be provided through an employer. Medicare and Medicaid are programs which provide health insurance to elderly, disabled, or un-insured individuals.
Individual and Family
One person or family is covered with an individual health insurance policy. You purchase this kind of plan directly from a health insurance company rather than through an employer intermediary
Student Insurance
Student Insurance is needed when a child or young adults health insurance is no longer covered as a dependent under their parents health policy, or when a student is required to have coverage but chooses not to participate in a college-sponsored plan.
Medicare Eligibility:
Initial Election Period- 3 months prior to the month you turn 65 or your disability month, the month of, and 3 months following unless your birthday is the first day of the month. Annual Election Period- November 15- December 31. You can make plan enrollments and disenrollment’s in the Medicare Advantage and Part D programs. The effective date is January 1.Open Election Period- January 1-March 31. You can make one Medicare Advantage plan enrollment or disenrollment as long as there is not a Part D program addition or deletion. The effective date is the first date following the month of your plan change.
Special Election Period- This is a year round 63 day election period which accommodates such events as moving out of a Medicare Advantage plan service, a Medicare Advantage plan leaves Medicare, or a beneficiary leaves a group health plan and enters Medicare past age 65.
Medicare Supplement Plans
A Medicare Supplement Insurance policy, also called a Medigap plan is private insurance that pays in varying degrees based upon a standardized letter grid of coverage ( A-N) that all insurance companies have to follow. The combination of certain plans will generally pay 100% of the Medicare approved amounts for health care costs and pay Part B medical excess charges. Plans are guaranteed renewable as long as premiums are paid. Your open enrollment period is the guarantee issue period starting from the first day of your 65 birthday month for 6 months. During this period you can not be denied coverage for pre-existing conditions. If you have had creditable non-Medicare health insurance past age 65, move out of a Medicare Advantage plan’s service area, or your Medicare Advantage plan leaves Medicare, you will have special guarantee enrollment rights, which last for 63 days past the date your health coverage ends
Medicare Advantage Plans (Part C)
Private Insurance that provide insurance for hospital and medical services in the form of HMO’s, PPO’s, and Private Fee For Service. These plans sometimes include prescription drug coverage. These plans pay instead of Medicare and work differently than Medicare Supplements, as the government pays private insurance companies to administer Medicare. It is important to check with provider network and plan acceptance. These Plans have guarantee issue with no underwriting; no pre-existing conditions, and requires no physical exam. A beneficiary must live in the plan’s service area. Plans, benefits, and premiums can vary by your county of residence. Plan changes are subject to the appropriate Medicare election periods.
Medicare Part D (Prescription Drug Coverage)
Private insurance that provides prescription drug benefits. These benefits are subject to the same requirements set forth by the Department of Medicare and Medicaid, including the donut hole, formularies, and tiers of prescriptions. Enrollment is not required; however, a penalty can occur for not having creditable prescription coverage during Medicare eligibility. Low-income subsidy benefits are available, where premiums, copayments, and the donut hole on prescriptions are reduced or eliminated.
Group Insurance
As an employer, benefits such as health insurance can attract the best and brightest to your company.The problem with providing health insurance for your employees is the cost. Health care costs are rising all for everyone for physicians, insurance companies, and consumers Businesses of all sizes have a variety of group health plans to choose from.
Consumer-directed health insurance plans are becoming a popular choice among small and large businesses. They’re called “consumer-directed” because the policyholders take control of their health care dollars. These plans feature low monthly costs for you and your employee, along with tax-advantaged savings.
Health Savings Account (HSA) Plans. An HSA is a bank account where you and your employees can contribute tax-free income to be used for almost any health-related cost. If savings aren’t used, the funds roll over to the next year and they build interest. Alongside an HSA, your employees will have catastrophic coverage with a high-deductible health plan which features low monthly premiums to fit your budget.
The most common plan compatible with an HSA is a managed care PPO with a high deductible. If you want to add an extra benefit for your employee, you can also contribute to a worker’s Health Savings Account.
Managed care plans create networks of doctors, specialists, hospitals, and other health care professionals who provide discounted medical care. For you and your workers, that means lower monthly premiums, copayments, and coinsurance.
Here are the most common managed care group health insurance plans:
A PPO or Preferred Provider Organization provides comprehensive health benefits from an extensive network of care providers. When your employees receive care from in-network doctors, they’ll save money. But they also will have coverage with any physicians or specialists even if they’re not in the preferred network. PPO plans with a high deductible are also compatible with Health Savings Accounts
An HMO or Health Maintenance Organization is one of the most affordable group health insurance options available. Your employees must go to doctors within the network and choose a primary care physician, but HMO networks typically include thousands of health care professionals in your state.
A POS or Point of Service group plan is a combination of the HMO and PPO. You’ll choose a primary care physician, as you would in an HMO. But you won’t have to get a referral for specialist care. Your employees will have group health insurance coverage with both in and out-of-network doctors and hospitals, just like a PPO.
Please feel free to contact Heather Gray at 1-619-933-9517
or fill out our Health Quote
Just Us Insurance is located in Sunny San Marcos, Ca.
To assist you ,we offer Phone / Zoom / Home – Office appointments
Oceanside, Carlsbad, Vista, San Marcos, Escondido, Temecula,
Murrieta, Santee, El Cajon, San Clement, Mission Viejo, and Big Bear Lake.
Just Us Insurance operates in San Diego, Riverside, Orange and San Bernardino Counties.
