PickaplanUSA Inc

PickaplanUSA Inc

Helping you pick the best plan!

Operating as usual

Timeline photos 03/24/2022

Most long-term care expenses are not covered by Social Security or Medicare, Medicare Supplement ("Medigap"), or private health insurance. Medicaid pays for nearly half of all nursing home care, but you must meet federal poverty guidelines and may have to "spend down" most of your assets on health care.

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Living Benefits are an advance cash payment of a portion of the life insurance before the insured person dies. It allows for financial assistance to the insured individual while he or she is still alive.

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Essential Health Benefits are a set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.

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Fast Fact: 2022 HSA limits rise to $3,650/individuals and $7,300/families. HSAs are a versatile way to save for both medical care and retirement.

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The journey of a thousand miles begins with one step. Lao Tzu

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Out-of-Network Copayment Is a fixed amount (for example, $30) you pay for covered health care services from providers who don't contract with your health insurance or plan. Out-of-network copayments usually are more than in-network copayments.

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“State Continuation Coverage” is a state-based requirement similar to COBRA that applies to group health insurance policies of employers with fewer than 20 employees. In some states, state continuation coverage rules also apply to larger group insurance policies and add to COBRA protections. For example, in some states, if you're leaving a job-based plan, you must be allowed to continue your coverage until you reach the age of Medicare eligibility.

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Quick Tip: You must have Part A and Part B to buy a Medigap policy.

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Many people new to Medicare feel surprised to find that Medicare covers only 80% of your Part B expenses. The other 20% can be devastating to you financially if a serious illness arises. You can choose a Medicare Supplement that will pay some or all of that 20% for you, among other things. Supplemental insurance for seniors with Medicare essentially buys you peace of mind by eliminating that cost-sharing responsibility.

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Tell me and I forget. Teach me and I remember. Involve me and I learn. Benjamin Franklin

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The Medical Loss Ratio (MLR) is a basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws.

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70 percent of people said they needed a life insurance policy in 2020, according to LIMRA. The same study found that only 54 percent of Americans actually had life insurance coverage.

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Fast Fact: According to the data, among all firms the percentage of employees covered by self-funded plans had increased from 44 percent in 1999 to a record high of 67 percent in 2020 before decreasing slightly to 64 percent in 2021.

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What does self-funded mean in health insurance?
Self-insurance is also called a self-funded plan. This is a type of plan in which an employer takes on most or all of the cost of benefit claims. The insurance company manages the payments, but the employer is the one who pays the claims.

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Never bend your head. Always hold it high. Look the world straight in the eye. Helen Keller

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With Life Insurance “Evidence of Insurability” is a statement of the prospective policyholder’s physical health and other information, such as assets and income, which helps the insurance company decide whether the applicant is eligible for insurance, the amount of risk they pose to the company and what premium the company will charge.

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Lump-sum cancer insurance is a form of supplemental insurance that pays a one-time cash benefit upon the diagnosis of internal cancer or malignant melanoma. The benefit you receive — the lump sum — is designed to help you cover out-of-pocket medical expenses not covered by your health insurance.

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Health Insurance 101: Under a point of service (POS) plan, you can’t receive care from a specialist without a referral from your main doctor. Your medical expenses will be higher if you seek help from an out-of-network physician, but on the bright side you’ll likely have a greater number of doctors to choose from than you would with an HMO.

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The general rule for workers at companies with at least 20 employees is that you can delay signing up for Medicare until you lose your group insurance (i.e., you retire).

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The journey of a thousand miles begins with one step. Lao Tzu

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How is a Cancer Plan different from a traditional medical plan?
Medical insurance reimburses the insured, or provider, for covered and approved medical services, procedures, equipment, and prescription drugs. The Cancer Plan pays an immediate one-time, lump-sum payment directly to the insured upon initial diagnosis of covered cancer. The cancer insurance policy benefit can be used for any purpose you choose.

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Health Related Spending Accounts (HSA). Contributions and earnings in these health related spending accounts are tax-free as long as the proceeds in the account are used to pay for qualified health care expenses.

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Fast Fact: Medigap comes through private insurance companies and aims to fill in the “gaps” left in the traditional Medicare coverage.

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A professional employer organization (PEO) is an organization that enters into a joint-employment relationship with an employer by leasing employees to the employer, thereby allowing the PEO to share and manage many employee-related responsibilities and liabilities.

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Success is not final, failure is not fatal: it is the courage to continue that counts. Winston Churchill

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Fast Fact: An HSA's Establishment Date is critical: An HSA's establishment date is key. While you can wait years to reimburse a medical expense, the expense must have incurred after the HSA's establishment date. That means one should open an HSA, assuming they have a high deductible plan, as soon as possible.

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An HSA can grow from year to year: Unlike a Flexible Spending Account, an HSA is not "use it or lose it." Your balance can continue to grow year after year. In fact, one could wait for decades before using the funds in an HSA.

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With Health Insurance, “Cost Sharing” means the share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.

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A Medigap plan must cover what Original Medicare covers.
True! Though, the amount of coverage varies from plan to plan, the perk of Medigap plans is that they agree to help pay for the gap in the services that Medicare covers but not in full.

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Adopt the pace of nature: her secret is patience. Ralph Waldo Emerson

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An HRA (Health Reimbursement Account) is an account that lets an employer set aside funds for healthcare costs. These funds go to reimburse Covered Services paid for by employees who take part. An HRA has tax benefits for employer and employees.

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An FSA (Flexible Spending Account) is often set up through an employer plan. It lets you set aside pre-tax money for common medical costs and dependent care. FSA funds must be used by the end of the term-year. It will be sent back to the employer if you don't use it. Check with your employer's Human Resources team. The can provide a list of FSA-qualified costs that you can purchase directly or be reimbursed for.

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A Self Funded, or Self-Insured plan, is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, Self-Insured employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a Fully Insured plan. Typically, a self-insured employer will set up a special trust fund to earmark money (corporate and employee contributions) to pay incurred claims.

A Full-Service Independent Insurance Agency!

PickaPlanUSA Inc. is a full-service independent insurance agency specializing in Business, Individuals and Senior Insurance Solutions. We work with dozens of insurance companies so we can offer our clients appropriate coverage for them. Our clients are located all across Maryland, giving us a great feel for the insurance landscape. We design plans with a focus on low costs, and proper benefit structure, which we combine with personalized insurance advice aimed at helping our clients make better-informed decisions.



Sterling, VA

Opening Hours

Monday 9am - 6pm
Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm
Friday 9am - 5pm

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