Is there a best health insurance? Ani Miller explains on Desiguales

On Desiguales, Ani Miller explained in plain language how health insurance works and why the best plan depends on each person's needs.

What we talk about

• The difference between an HMO plan and a PPO plan.
• What the premium and the deductible are.
• Coverage options: private insurance, Obamacare and employer benefits.
• Why people feel frustrated with claims and what changes may be coming.

The full conversation

In December 2024, amid the public conversation that erupted in the United States after the attack on the CEO of UnitedHealthcare, the show Desiguales invited Ani Miller, founder of Ani Miller Services, to talk about a topic that frustrates many families: health insurance. With the show's hosts, among them Amara, Ani explained what a premium is, what a deductible is, how to choose a plan and why so many people feel their insurance is not there for them when they need it most.

Why so many people are upset with insurance

The hosts opened with a complaint they hear every day: most people do not understand their insurance, they pay every month and, when an emergency comes, they still have to pay out of pocket. Ani thanked them for the invitation and explained where that frustration comes from.

People have an insurance policy and expect the insurer to support them when a situation comes up. That's why they keep paying the premium every month, but it isn't always that way.

As she explained, when a claim is filed, in some cases insurers start delaying the process, and that leaves patients and policyholders feeling powerless.

HMO, premium and deductible: the basics

To understand the problem, they asked her to explain what a premium is and what a deductible is, that additional amount you have to pay even though you already pay a fee every month. Ani started with the two main types of plans: the HMO and the PPO. The HMO, she explained, is insurance designed so that patients receive care within a specific network of doctors and hospitals.

• The premium is the monthly fee the client pays to be able to see the doctors in that network.
• The deductible is an amount that some policies have and that the patient must cover before starting to enjoy the coverage.

To illustrate, she gave a simple example: if a person is told their monthly premium is $20, but their deductible is $5,000, they will not start receiving the benefits of that coverage until they have paid that $5,000. That is why a low premium does not always mean cheap insurance.

Is there a best insurance?

The hosts pointed out that, although the explanation is clear, many people still do not understand any of it and feel that insurance almost never covers real emergencies. So the question was direct: what is the best insurance? For Ani, there is no single answer.

That's always going to be based on the needs of the client or the patient.

What makes the difference, she said, is that the insurance expert takes the time to review each person's situation: whether they are undergoing treatment, whether they might need surgery. Based on those needs, the advisor should recommend the plan that fits best.

What it costs and what options a family has

Another reality that came up in the conversation is that today having health insurance is almost a luxury for a family with children. Ani acknowledged that insurance is expensive, but clarified that the cost depends heavily on income, and that low-income families have access to other types of coverage under the ObamaCare program. What you can receive there depends on two factors: how many people are in the household and how much they earn.

That is why, she stressed, the advisor should also carefully review both income and family size. The hosts added that it makes a big difference whether the person has coverage through their job, which helps pay for the insurance, or is self-employed and has to pay for it on their own. Ani summarized the types of insurance available:

• Private insurance, which the person purchases directly.
• Insurance under the ObamaCare program, designed for certain income levels and with certain limitations.
• Insurance through an employer, part of the benefits that many companies, especially large ones, offer their employees.

Deny, delay, defend

The hosts asked her about three words that circulated widely in the wake of the case: deny, delay and defend. Ani explained that, in her opinion, those words sum up the criticism many patients make of insurers.

These words are basically considered the battle cry of the insurance companies.

The problem, she explained, comes up when a patient files a claim and the insurer does not respond in time or delays the process. If that person has an illness and needs surgery, the wait can make their condition worse, and in the most serious cases even put their life at risk.

Will changes come?

To close, they asked her whether she thinks that, after what happened, there will be changes in policies and in insurance companies. Ani said yes. She commented that insurers devote a significant part of their budget each year to protecting their top executives, but that the public's message is getting through.

I think a change is definitely going to come, because a change has to come. People are exhausted.

The hosts signed off with a promise to invite her back when those changes arrive, so she can explain what measures are taken and how they affect families. The underlying message of the segment was clear: understanding the difference between a premium and a deductible, knowing the types of plans and choosing with the help of an advisor who reviews each person's real needs is the best way to avoid surprises when the time comes to use your insurance.

Video: Desiguales program.

This article is an English translation of the original Spanish version. Quotes have been translated from Spanish. Leer en español.