Individuals with preexisting conditions (like diabetes, cancer, heart disease, heart attack, stroke, kidney disease, liver disease, AIDS, depression, and a long list of other health conditions) are considered “uninsurable” by many insurance companies, and may find it almost impossible to find affordable healthcare.
If you are one of the thousands in this situation looking for health insurance, you know how hard a task it can be. Being uninsurable due to preexisting conditions will limit your health insurance choices, but there are ways to provide you with affordable healthcare coverage. Using creative insurance planning and the knowledge and understanding of what’s available, you can greatly reduce the potential financial strain on you and your family.
Below are the 5 options for Health Insurance Coverage in Washington State, and how each option can potentially work for the “uninsurable”:
1. Group Health Insurance. Group health coverage is generally provided by your employer or your spouse’s employer, and is by far the best choice for individuals with preexisting conditions and the uninsurable. Usually premiums are a split between the employer and the employee, and the employee normally has little or no choice in deciding what features will be available to the employee and his/her family. One of the main advantages of group insurance is that coverage is usually available to newly hired employees without any medical questions or concern for a preexisting condition, though there may be a short waiting period before full coverage is available. Insurance typically ends when the employee's job ends.
2. Professional Organization. Some professional organizations offer members a health insurance program as a membership benefit. This coverage could be a way to obtain insurance if you are uninsurable. Depending on the organization, a paid membership may be all that is required to start a health insurance plan. For others, you may be required to have certain career experience or a certification. Some associations accept membership from anyone interested in joining. Even if membership is expensive, it still may be money well spent.
3. Private Individual Health Insurance. If you don’t have access to an employer sponsored or a professional organization’s health insurance plan, but you have extensive health care needs, you may find obtaining individual health insurance coverage extremely difficult. Insurers can decline coverage if preexisting conditions exist although there are some exceptions. We will help you determine if an individual medical plan is an option for you.
4. State Risk Pools. Washington provides access to health plans for the uninsurable through a high-risk health insurance pool. Consumers in this pool have access to comprehensive private coverage plans. Premiums can be very high, sometimes costing twice as much as those for regular private health insurance. You may find that this risk pool can be closed to new enrollments or has a waiting list. However, it is an important last resort for someone who has been denied medical coverage because they have preexisting conditions. We can help you determine if you are eligible for the Washington Insurance Pool, just call us!
5. Discount Health Cards. Many companies sell discount health cards to consumers seeking affordable healthcare. The cards claim to save subscribers money by offering discounts on physician visits, hospital stays, prescription drugs, dental, vision and chiropractic care. But discount health cards can be confusing, because they are not really insurance. You are still responsible for paying the medical bills yourself. These cards simply offer lower prices on services from the healthcare providers who agree to accept the discount terms. Sometimes, they make grossly inflated promises about the expected savings and benefits. Use caution when purchasing these cards as they can cost you more money than you’ll save.
Appealing Medical Insurance Claims Washington
Despite many consumers paying insurance premiums faithfully for years, insurance companies regularly deny claims. How do you know if the claim was denied correctly? How do you know if you should fight? And, if so, who do you fight and how?
Luckily, when you are a client of My Health Insurance of Washington we help you every step of the way. We know the insurance company games, and we know who to call on your behalf.
Below are some helpful hints to help you understand the appeal process:
1. Call Us: At My Health Insurance of Washington our goal is to get you the maximum value out of your health insurance. Many times we will know the answer to your denied claim right away. Often we can save you the frustration sitting on hold with the insurance company, only to get passed from one person to the next.
2. Appeal the claim: The denial may have been caused by human error, which does occur as insurance companies and medical providers are overwhelmed with paperwork. Each insurance company has its own appeals process, the details of which are in your contract. Don’t worry, we already know all about your policy!
3. Get medical help: from your own doctor. Your doctor can provide the evidence required by the insurance company proving that the care you received was a medical necessity.
4. Keep records: Record all correspondence between you and your insurance company. For telephone conversations, write down the name of the person you spoke with, the date and time, and confirm the important parts of the conversation. Follow up with #5 below.
5. Put it in writing: Mail a complaint to the insurance company headquarters, to every name you have on file, to the president of the insurance company, and to the head of the customer service department. All correspondence should be sent by certified mail to confirm receipt. Include copies of all relevant supporting documentation.
6. Contact the authorities: When the former attempts fail, file a formal complaint with The Washington State Office of the Insurance Commissioner www.insurance.wa.gov
7. Negotiate the bill: You ask for discounts when shopping for new cars and appliances, and you can ask for a discount from your medical doctor or hospital. If the insurance doesn’t cover a procedure, ask whether or not payment in cash would warrant a discount, or if you can make regular payments over time.
8. When all else fails - Get a lawyer: An attorney with medical insurance and appeals experience, who focuses in health law would be your best option. Hiring a lawyer is not a cheap proposition, but it can be significantly less expensive than laying out hundreds of thousands of dollars for medical care you have been wrongly denied.
Luckily, when you are a client of My Health Insurance of Washington we help you every step of the way. We know the insurance company games, and we know who to call on your behalf.
Below are some helpful hints to help you understand the appeal process:
1. Call Us: At My Health Insurance of Washington our goal is to get you the maximum value out of your health insurance. Many times we will know the answer to your denied claim right away. Often we can save you the frustration sitting on hold with the insurance company, only to get passed from one person to the next.
2. Appeal the claim: The denial may have been caused by human error, which does occur as insurance companies and medical providers are overwhelmed with paperwork. Each insurance company has its own appeals process, the details of which are in your contract. Don’t worry, we already know all about your policy!
3. Get medical help: from your own doctor. Your doctor can provide the evidence required by the insurance company proving that the care you received was a medical necessity.
4. Keep records: Record all correspondence between you and your insurance company. For telephone conversations, write down the name of the person you spoke with, the date and time, and confirm the important parts of the conversation. Follow up with #5 below.
5. Put it in writing: Mail a complaint to the insurance company headquarters, to every name you have on file, to the president of the insurance company, and to the head of the customer service department. All correspondence should be sent by certified mail to confirm receipt. Include copies of all relevant supporting documentation.
6. Contact the authorities: When the former attempts fail, file a formal complaint with The Washington State Office of the Insurance Commissioner www.insurance.wa.gov
7. Negotiate the bill: You ask for discounts when shopping for new cars and appliances, and you can ask for a discount from your medical doctor or hospital. If the insurance doesn’t cover a procedure, ask whether or not payment in cash would warrant a discount, or if you can make regular payments over time.
8. When all else fails - Get a lawyer: An attorney with medical insurance and appeals experience, who focuses in health law would be your best option. Hiring a lawyer is not a cheap proposition, but it can be significantly less expensive than laying out hundreds of thousands of dollars for medical care you have been wrongly denied.
Coverage of Holistic, Homeopathic, and Alternative Medicine Treatments
Many insurance plans now cover a number of alternative treatments that were once thought to be outside normal medical procedures. This is especially true in Washington State, where alternative and homeopathic treatments are widely sought out and accepted. However, there is no hard and fast rule governing coverage of alternative medicine, so be sure you check into the coverage of your specific plan before you seek alternative medicine treatments.
The most commonly covered alternative treatments include chiropractic, acupuncture, and massage therapy. Keep in mind that most insurance plans will require a referral from your primary care provider before you can see any type of specialist, including alternative medicine providers.
Additional questions to ask your insurance provider before receiving holistic, homeopathic, or alternative medicine treatments:
* Does this care need to be pre-authorized or pre-approved?
* Do I need a referral from my primary care provider?
* What services, tests, or other costs will be covered?
* How many visits are covered and over what period of time (for example, 6-10 visits per year of acupuncture)?
* Is there a co-payment?
* Will the therapy be covered for any condition or only for certain conditions?
* Will any additional costs be covered, such as lab tests, dietary supplements, equipment, or supplies?
* Will I need to see a practitioner in your network? If so, can you provide me with a list of practitioners in my area?
* If I use a practitioner who is not part of your network, do you provide any coverage? Are there any additional out-of-pocket costs?
* Are there any dollar or calendar limits to my coverage?
It can be tricky to understand which services are covered and under what circumstances. A service representative at My Health Insurance Washington would be happy to do the investigating for you and to explain your plan’s benefits and limitations in terms you understand.
The most commonly covered alternative treatments include chiropractic, acupuncture, and massage therapy. Keep in mind that most insurance plans will require a referral from your primary care provider before you can see any type of specialist, including alternative medicine providers.
Additional questions to ask your insurance provider before receiving holistic, homeopathic, or alternative medicine treatments:
* Does this care need to be pre-authorized or pre-approved?
* Do I need a referral from my primary care provider?
* What services, tests, or other costs will be covered?
* How many visits are covered and over what period of time (for example, 6-10 visits per year of acupuncture)?
* Is there a co-payment?
* Will the therapy be covered for any condition or only for certain conditions?
* Will any additional costs be covered, such as lab tests, dietary supplements, equipment, or supplies?
* Will I need to see a practitioner in your network? If so, can you provide me with a list of practitioners in my area?
* If I use a practitioner who is not part of your network, do you provide any coverage? Are there any additional out-of-pocket costs?
* Are there any dollar or calendar limits to my coverage?
It can be tricky to understand which services are covered and under what circumstances. A service representative at My Health Insurance Washington would be happy to do the investigating for you and to explain your plan’s benefits and limitations in terms you understand.
offer range of benefits to bridge Medicare coverage gaps
When it comes to health insurance, Medicare is definitely the 800-pound gorilla. The federally funded program covers more than 40 million Americans – those aged 65 and older, plus some younger folks who may be eligible due to certain health conditions, or because they're disabled.
There's plenty the program covers – services that include hospitalization through Medicare's Part A, and doctor visits and other outpatient expenses through Part B. But – as with most health plans – Medicare won't pick up the tab for everything.
That means that the millions who make the decision to enroll in "original" Medicare must also make decisions about Medicare Supplement Insurance – or "Medigap" – that fills the considerable gaps in Medicare's coverage. Consumers pay premiums for these plans through private insurance companies in addition to their Medicare Part B premium.
A collection of 12 different plans – identified by the letters A through L – give Medigap policy holders varying combinations of benefits. The plans cover expenses ranging from copayments, coinsurance and deductibles, to foreign travel emergency expenses, at-home recovery and preventive care.
The plans are standardized, meaning that each policy must offer the same basic benefits, regardless of which insurance company issues the policy to you. However, there are some variations in the way Medigap policies are standardized if you live in Massachusetts, Minnesota or Wisconsin.
Also, in some states, not all types of Medigap policies will be available. In other states, you may be able to purchase a Medigap policy called Medicare SELECT – a policy that requires plan holders to use specific hospitals and, in some cases, specific doctors.
You should also know that while Medigap fills many gaps, it doesn't fill them all. Policies don't cover long-term care, vision or dental care, hearing aids, eyeglasses and private duty nursing. If you want prescription drug coverage, you may want to join a Medicare Drug Plan (Medicare Part D), offered through private companies approved by Medicare.
Anyone enrolled in Medicare Part A and Part B can purchase a Medigap policy. The best time to purchase is during a six-month open enrollment period. The period beings on the first day of the month in which you are 65 years or older and enrolled in Medicare Part B. During this period, an insurance company can not refuse to sell you any Medigap policy sells, generally can't make you wait for coverage to start, and can't charge you more for a policy because of your health issues.
There's plenty the program covers – services that include hospitalization through Medicare's Part A, and doctor visits and other outpatient expenses through Part B. But – as with most health plans – Medicare won't pick up the tab for everything.
That means that the millions who make the decision to enroll in "original" Medicare must also make decisions about Medicare Supplement Insurance – or "Medigap" – that fills the considerable gaps in Medicare's coverage. Consumers pay premiums for these plans through private insurance companies in addition to their Medicare Part B premium.
A collection of 12 different plans – identified by the letters A through L – give Medigap policy holders varying combinations of benefits. The plans cover expenses ranging from copayments, coinsurance and deductibles, to foreign travel emergency expenses, at-home recovery and preventive care.
The plans are standardized, meaning that each policy must offer the same basic benefits, regardless of which insurance company issues the policy to you. However, there are some variations in the way Medigap policies are standardized if you live in Massachusetts, Minnesota or Wisconsin.
Also, in some states, not all types of Medigap policies will be available. In other states, you may be able to purchase a Medigap policy called Medicare SELECT – a policy that requires plan holders to use specific hospitals and, in some cases, specific doctors.
You should also know that while Medigap fills many gaps, it doesn't fill them all. Policies don't cover long-term care, vision or dental care, hearing aids, eyeglasses and private duty nursing. If you want prescription drug coverage, you may want to join a Medicare Drug Plan (Medicare Part D), offered through private companies approved by Medicare.
Anyone enrolled in Medicare Part A and Part B can purchase a Medigap policy. The best time to purchase is during a six-month open enrollment period. The period beings on the first day of the month in which you are 65 years or older and enrolled in Medicare Part B. During this period, an insurance company can not refuse to sell you any Medigap policy sells, generally can't make you wait for coverage to start, and can't charge you more for a policy because of your health issues.
The Best Health Insurance Providers in the United States
In order to obtain the best medical insurance for your own as well as for your family members, it will be wise to look for the most well known health insurance companies in the market. If you don't have any idea, this article may be able to assist you.
WellPoint Incorporation
It is the leading health plan provider in United States with approximately 35 million medical members. One of every nine Americans receives coverage for their medical care through WellPoint's affiliated health plans. It offers a broad range of medical and specialty products.
United Health Group
It is the second largest health insurer in United States which is right behind WellPoint. It is famous for its health benefit plans with lower medical costs. In addition, it offers specialty care programs such as vision and dental care, as well as Health Savings Accounts and Health Reimbursement Accounts.
Aetna Incorporation
It is one of the most active and popular health insurance companies in United States. It offers a broad range of traditional and consumer based medical insurance products and related services which include medical, pharmacy, dental, behavioral health, group life, long term care and disability plans as well as medical management capabilities.
CIGNA Corporation
It is one of the top US health insurers. It is a global health service company, dedicated to helping people to improve their health, well-being and security. CIGNA covers more than 9 million people in United States with its large variety of medical plans. It also offers other health coverage in the form of dental, vision, pharmacy, and behavioral health plans.
By knowing which companies are nationally recognized, it will be more convenient for you to obtain "quality" medical coverage.
WellPoint Incorporation
It is the leading health plan provider in United States with approximately 35 million medical members. One of every nine Americans receives coverage for their medical care through WellPoint's affiliated health plans. It offers a broad range of medical and specialty products.
United Health Group
It is the second largest health insurer in United States which is right behind WellPoint. It is famous for its health benefit plans with lower medical costs. In addition, it offers specialty care programs such as vision and dental care, as well as Health Savings Accounts and Health Reimbursement Accounts.
Aetna Incorporation
It is one of the most active and popular health insurance companies in United States. It offers a broad range of traditional and consumer based medical insurance products and related services which include medical, pharmacy, dental, behavioral health, group life, long term care and disability plans as well as medical management capabilities.
CIGNA Corporation
It is one of the top US health insurers. It is a global health service company, dedicated to helping people to improve their health, well-being and security. CIGNA covers more than 9 million people in United States with its large variety of medical plans. It also offers other health coverage in the form of dental, vision, pharmacy, and behavioral health plans.
By knowing which companies are nationally recognized, it will be more convenient for you to obtain "quality" medical coverage.
What Are the Best Health Care Systems in the World?
Health care reform is on everyone's mind these days. New proposals are coming from the Senate and from the House. President Obama has made reform a priority.
Universality of access to health insurance is the most pressing issue. Universal health care simply means coverage for all eligible residents of a political area. The United States is the only industrialized country that has not implemented a universal system for citizens under age 65.
Universal health care can be implemented in several ways. In some countries the government directly manages the health care system. This is usually called socialized medicine. In most countries universal coverage is achieved by a mix of public and private funding. Taxation is the primary source of funding but is supplemented by private payor arrangements.
In 2000 the World Health Organization (WHO) produced a report which ranked all the health insurance systems used by its member countries. The is the report usually quoted when discussing both the good and bad features of a health insurance system.
It should be noted that the WHO has indicated it will no longer produce a ranking table because of the complexity of the task. The criteria for ranking the health care systems was based on a wide variety of findings, including but not limited to, life expectancy, infant mortality and cost.
Many people know that the United States ranked 37th out of 198 countries and that Canada ranked 30th. But do you know what the top 10 best health care system in the world are?
The top 10 in the order determined by the World Health Organization
1. France
2. Italy
3. San Marino
4. Andorra
5. Malta
6. Singapore
7. Spain
8. Oman
9. Austria
10. Japan
When the United Nations was formed in 1945 one of the entities that the delegates discussed was setting up an organization to monitor and assess global health trends. The World Health Organization (the WHO) came into being on April 7,1948. World Health Day is celebrated every year on that date in recognition of the WHO.
Headquartered in Geneva, Switzerland, the WHO is the directing and coordinating authority for health within the United Nations system. All countries which are Members of the United Nations may become members of the WHO by accepting its Constitution which currently has 198 participating nations.
Universality of access to health insurance is the most pressing issue. Universal health care simply means coverage for all eligible residents of a political area. The United States is the only industrialized country that has not implemented a universal system for citizens under age 65.
Universal health care can be implemented in several ways. In some countries the government directly manages the health care system. This is usually called socialized medicine. In most countries universal coverage is achieved by a mix of public and private funding. Taxation is the primary source of funding but is supplemented by private payor arrangements.
In 2000 the World Health Organization (WHO) produced a report which ranked all the health insurance systems used by its member countries. The is the report usually quoted when discussing both the good and bad features of a health insurance system.
It should be noted that the WHO has indicated it will no longer produce a ranking table because of the complexity of the task. The criteria for ranking the health care systems was based on a wide variety of findings, including but not limited to, life expectancy, infant mortality and cost.
Many people know that the United States ranked 37th out of 198 countries and that Canada ranked 30th. But do you know what the top 10 best health care system in the world are?
The top 10 in the order determined by the World Health Organization
1. France
2. Italy
3. San Marino
4. Andorra
5. Malta
6. Singapore
7. Spain
8. Oman
9. Austria
10. Japan
When the United Nations was formed in 1945 one of the entities that the delegates discussed was setting up an organization to monitor and assess global health trends. The World Health Organization (the WHO) came into being on April 7,1948. World Health Day is celebrated every year on that date in recognition of the WHO.
Headquartered in Geneva, Switzerland, the WHO is the directing and coordinating authority for health within the United Nations system. All countries which are Members of the United Nations may become members of the WHO by accepting its Constitution which currently has 198 participating nations.
Cheap Health Insurance - Student
The cost of medical procedures and medical insurance is rising by the day. The whole country is embroiled in health care debates but nothing seems to get done. Insurance rates are high for everyone but the student is the one looking for a cheap way out.
Many companies are vying for the student end of the health care question and that is what makes looking for cheap health insurance student just a little bit easier.
The insurance that the student is looking for is not always the best but it is not the costliest either. And that is good. Since most students are young they don't have to be insured for most of the big item procedures that middle aged or older people need.
Besides students are more prone to go without insurance than other people and that is what makes it easier to find the policies that students are looking for. When talking with a representative just be sure to let him know that what you are looking for is some basic health insurance. Make certain he understands this and he will probably find something right down your ally.
Since one of the determining factors in the cost of the insurance is age you can probably get a policy pretty cheap. Even if you are on a limited budget there are low cost options out here for you to shop around for.
Most colleges and universities offer a low cost, short term student health insurance plan. These plans however cover a whole student body and are a cheap way out for the family that wants to go that route.
It shouldn't be too difficult to find a cheap health insurance student plan if you just do the research work and be diligent about it.
Many companies are vying for the student end of the health care question and that is what makes looking for cheap health insurance student just a little bit easier.
The insurance that the student is looking for is not always the best but it is not the costliest either. And that is good. Since most students are young they don't have to be insured for most of the big item procedures that middle aged or older people need.
Besides students are more prone to go without insurance than other people and that is what makes it easier to find the policies that students are looking for. When talking with a representative just be sure to let him know that what you are looking for is some basic health insurance. Make certain he understands this and he will probably find something right down your ally.
Since one of the determining factors in the cost of the insurance is age you can probably get a policy pretty cheap. Even if you are on a limited budget there are low cost options out here for you to shop around for.
Most colleges and universities offer a low cost, short term student health insurance plan. These plans however cover a whole student body and are a cheap way out for the family that wants to go that route.
It shouldn't be too difficult to find a cheap health insurance student plan if you just do the research work and be diligent about it.
How to Use Your Health Insurance to Save Money
I'm going to tell you about a government-approved, tax-favored program that could have you saving money on your healthcare expenses as soon as next month. This law lets you reclaim money that had been going into the health insurance company coffers. It offers you tax breaks. You could be using pre-tax dollars for some things that are not otherwise allowed to be included in your health care expenses deduction. You will have more flexibility and control over your health-related expenses than you ever thought possible, if you take advantage of what I'm about to tell you.
Wow! Just writing that down got me energized! It surprises me that what I'm writing about, though not a secret, is way under-utilized, and is misunderstood by the much of the public and health insurance agents alike.
You will see the real power of it once you put it into practice.
Now you should know, up front, that what I'm about to tell you wasn't designed for everyone. For instance, people who have ongoing medical problems - chronic conditions that keep them going back to the doctor or being admitted to the hospital on even a semi-regular basis - or people who have a hard time managing their own money are not good prospects for this program. It requires self-discipline in setting aside money into a special account. This special account has tax advantages - even if you don't itemize - but you must be able to keep the money separate from your spending accounts.
If you can do this, many opportunities open up for using this pre-tax money. You can buy things you never thought possible. Things like braces for your child - or any dental work. Things like eyeglasses and contact lenses. And many common purchases that you buy anyway can now be, in effect, tax-deductible.
Have you ever had a cold and bought some medications for the sniffles? Or - speaking of sniffles - allergy medicine? Pain relievers? Nicotine medications? Motion sickness pills? All of these qualify as eligible expenses!
Have you figured out what type of plan I'm talking about yet? I'm sure you've heard of it. President Bush mentioned it in many of his addresses to the nation. The major problem with the plan is it is not well understood, and that's my mission today.
The plan is known as an HSA. HSA stands for Health Savings Account, and it is more correctly referred to as HSA-compatible, meaning the plan fits the IRS rules which allow the owner to open an HSA account to take advantage of all the neat deductible things I've been talking about.
A little about the plans themselves: As I said in the beginning, they are not for everyone. If you go to the doctor a lot due to chronic or sever conditions, you don't want one of these plans because you would be paying more out-of-pocket than you would save with the lower premium.
And they do have lower premiums, generally. There are many different ones from many different companies, of course, so their premiums vary widely and are far too many to name them here. But the rules are the same for all of them, regardless of where you are.
The whole theory behind these accounts is this:
Higher deductibles equals lower premiums. The trick is to save the difference - put it into your pocket instead of the insurance company's. You've probably heard when it comes to life insurance the axiom to buy term and invest the difference. The principle is the same here. Only here, you are putting the difference (and more, really, up to a maximum of $5,950 annually for a family of two or more) into an HSA account. The money is deductible, on the front of the 1040 or 1040A and is what is known as an above-the-line deduction. (Ask you tax adviser as I am not in that business, but I've been assured that above-the-line is better than a Schedule A deduction.)
The trade-off: Lower premium (money saved) versus higher deductible (money out-of-pocket before the insurance starts paying its share).
So you see, if you are generally healthy and don't pay much in doctor bills or prescriptions, rather than paying a higher premium for coverage you won't take full advantage of, you pay a lower premium and save the difference (which, again, is deductible). The account savings is expected to be used to pay for doctor visits, dentist visits, et cetera . There is a whole list of eligible items that money can be spent on.
But here is the best part: Money that you don't use can accumulate and earn interest. The interest is also tax-free. And if you don't use the money in any given year (which you probably won't and don't want to anyway), it can be rolled over to the next year....and the next, and the next... Indefinitely. As long as you use it for eligible expenses, you never pay any taxes on the earnings, regardless of your income.
Be aware, though, that if you do use the money for non-qualified medical expenses, you not only get taxed on the money you use, but you also get hit with a 10% tax penalty. Once you reach 65, you no longer are required to use the money on medical-eligible expenses. You are now free to spend it on anything you want, as the 10% penalty no longer applies.
That's like an IRA. No, wait - it's better than an IRA. With a traditional IRA, if you deduct the contributions, you pay tax on the money when it is withdrawn. And you pay taxes on the earnings either way. With a Roth IRA, you don't pay taxes on withdrawals or earnings, but you weren't able to deduct the contributions. With the HSA, you get triple tax savings: (1) deduct the contributions, (2) tax free earnings, and (3) you don't pay tax on money withdrawn for qualified medical expenses.
Ah, so you smart ones who know about IRAs are thinking already, "With an IRA I can invest in mutual funds and earn a lot more than what the bank is going to pay interest on an account." And you'd be right. Except for one thing: With the HSA-compatible account, once you reach a minimum balance (usually $2,000), any additional contributions can be invested in mutual funds, just like an IRA.
Let me give you an hypothetical example of an HSA in action:
John enrolls in a PPO plan that is HSA-compatible, and simultaneously opens an HSA. The PPO has a deductible of $3,500. John can set aside up to $2,850 for 2009, but chooses to only put aside $2,500.
During the year, John has health-related expenses (doctor visits, medications, etc) of $1,000. Because his deductible is $3,500, John is responsible for all $1,000. This is how it would look:
Estimated Income Tax Reduction: $ 583
Amount Added to HSA: $2,500
Amount Paid From HSA: $1,000
Amount Remaining (Includes 3% interest): $1,545
The amount remaining in the HSA is carried over to the next year with no tax owed.
Now, suppose John continues to add $2,500 to his HSA for each of the following five years. During this time, John's expenses that he opts to pay out his HSA is $300 per year. Now his account would look like this:
Estimated Income Tax Reduction: $ 3,498
Amount Added to HSA: $15,000
Amount Paid From HSA: $ 2,500
Amount Remaining (Includes 3% interest): $13,625
It's looking pretty good for John, isn't it? Now, let's suppose in the seventh year, John has a fall on the basketball court and breaks his wrist. The total bill for this comes to $6,000. How would his account look now?
Estimated Income Tax Reduction: $ 4,081
Amount Paid Into HSA: $17,500
Amount Paid From HSA: $ 6,000
Amount Remaining (Includes 3% interest): $13,690
As you can see, that slowed John down some. But not all that much, because John only had to use $3,500 from his HSA to cover the deductible, and the health insurance policy paid the rest.
So, now that you know all about HSA-compatible health plans, what are you waiting for? If you have health insurance through your employer, call HR today and ask what your options are for changing your coverage. If they don't offer an HSA, or you don't have insurance through your employer, or you are an employer who wants to install an HSA-compatible health plan as part of your employee benefits package, contact me and I will be happy to help get you started.
Wow! Just writing that down got me energized! It surprises me that what I'm writing about, though not a secret, is way under-utilized, and is misunderstood by the much of the public and health insurance agents alike.
You will see the real power of it once you put it into practice.
Now you should know, up front, that what I'm about to tell you wasn't designed for everyone. For instance, people who have ongoing medical problems - chronic conditions that keep them going back to the doctor or being admitted to the hospital on even a semi-regular basis - or people who have a hard time managing their own money are not good prospects for this program. It requires self-discipline in setting aside money into a special account. This special account has tax advantages - even if you don't itemize - but you must be able to keep the money separate from your spending accounts.
If you can do this, many opportunities open up for using this pre-tax money. You can buy things you never thought possible. Things like braces for your child - or any dental work. Things like eyeglasses and contact lenses. And many common purchases that you buy anyway can now be, in effect, tax-deductible.
Have you ever had a cold and bought some medications for the sniffles? Or - speaking of sniffles - allergy medicine? Pain relievers? Nicotine medications? Motion sickness pills? All of these qualify as eligible expenses!
Have you figured out what type of plan I'm talking about yet? I'm sure you've heard of it. President Bush mentioned it in many of his addresses to the nation. The major problem with the plan is it is not well understood, and that's my mission today.
The plan is known as an HSA. HSA stands for Health Savings Account, and it is more correctly referred to as HSA-compatible, meaning the plan fits the IRS rules which allow the owner to open an HSA account to take advantage of all the neat deductible things I've been talking about.
A little about the plans themselves: As I said in the beginning, they are not for everyone. If you go to the doctor a lot due to chronic or sever conditions, you don't want one of these plans because you would be paying more out-of-pocket than you would save with the lower premium.
And they do have lower premiums, generally. There are many different ones from many different companies, of course, so their premiums vary widely and are far too many to name them here. But the rules are the same for all of them, regardless of where you are.
The whole theory behind these accounts is this:
Higher deductibles equals lower premiums. The trick is to save the difference - put it into your pocket instead of the insurance company's. You've probably heard when it comes to life insurance the axiom to buy term and invest the difference. The principle is the same here. Only here, you are putting the difference (and more, really, up to a maximum of $5,950 annually for a family of two or more) into an HSA account. The money is deductible, on the front of the 1040 or 1040A and is what is known as an above-the-line deduction. (Ask you tax adviser as I am not in that business, but I've been assured that above-the-line is better than a Schedule A deduction.)
The trade-off: Lower premium (money saved) versus higher deductible (money out-of-pocket before the insurance starts paying its share).
So you see, if you are generally healthy and don't pay much in doctor bills or prescriptions, rather than paying a higher premium for coverage you won't take full advantage of, you pay a lower premium and save the difference (which, again, is deductible). The account savings is expected to be used to pay for doctor visits, dentist visits, et cetera . There is a whole list of eligible items that money can be spent on.
But here is the best part: Money that you don't use can accumulate and earn interest. The interest is also tax-free. And if you don't use the money in any given year (which you probably won't and don't want to anyway), it can be rolled over to the next year....and the next, and the next... Indefinitely. As long as you use it for eligible expenses, you never pay any taxes on the earnings, regardless of your income.
Be aware, though, that if you do use the money for non-qualified medical expenses, you not only get taxed on the money you use, but you also get hit with a 10% tax penalty. Once you reach 65, you no longer are required to use the money on medical-eligible expenses. You are now free to spend it on anything you want, as the 10% penalty no longer applies.
That's like an IRA. No, wait - it's better than an IRA. With a traditional IRA, if you deduct the contributions, you pay tax on the money when it is withdrawn. And you pay taxes on the earnings either way. With a Roth IRA, you don't pay taxes on withdrawals or earnings, but you weren't able to deduct the contributions. With the HSA, you get triple tax savings: (1) deduct the contributions, (2) tax free earnings, and (3) you don't pay tax on money withdrawn for qualified medical expenses.
Ah, so you smart ones who know about IRAs are thinking already, "With an IRA I can invest in mutual funds and earn a lot more than what the bank is going to pay interest on an account." And you'd be right. Except for one thing: With the HSA-compatible account, once you reach a minimum balance (usually $2,000), any additional contributions can be invested in mutual funds, just like an IRA.
Let me give you an hypothetical example of an HSA in action:
John enrolls in a PPO plan that is HSA-compatible, and simultaneously opens an HSA. The PPO has a deductible of $3,500. John can set aside up to $2,850 for 2009, but chooses to only put aside $2,500.
During the year, John has health-related expenses (doctor visits, medications, etc) of $1,000. Because his deductible is $3,500, John is responsible for all $1,000. This is how it would look:
Estimated Income Tax Reduction: $ 583
Amount Added to HSA: $2,500
Amount Paid From HSA: $1,000
Amount Remaining (Includes 3% interest): $1,545
The amount remaining in the HSA is carried over to the next year with no tax owed.
Now, suppose John continues to add $2,500 to his HSA for each of the following five years. During this time, John's expenses that he opts to pay out his HSA is $300 per year. Now his account would look like this:
Estimated Income Tax Reduction: $ 3,498
Amount Added to HSA: $15,000
Amount Paid From HSA: $ 2,500
Amount Remaining (Includes 3% interest): $13,625
It's looking pretty good for John, isn't it? Now, let's suppose in the seventh year, John has a fall on the basketball court and breaks his wrist. The total bill for this comes to $6,000. How would his account look now?
Estimated Income Tax Reduction: $ 4,081
Amount Paid Into HSA: $17,500
Amount Paid From HSA: $ 6,000
Amount Remaining (Includes 3% interest): $13,690
As you can see, that slowed John down some. But not all that much, because John only had to use $3,500 from his HSA to cover the deductible, and the health insurance policy paid the rest.
So, now that you know all about HSA-compatible health plans, what are you waiting for? If you have health insurance through your employer, call HR today and ask what your options are for changing your coverage. If they don't offer an HSA, or you don't have insurance through your employer, or you are an employer who wants to install an HSA-compatible health plan as part of your employee benefits package, contact me and I will be happy to help get you started.
Basics of COBRA
It is very important if you have health insurance provided by your employer that you understand what your rights are under COBRA (Consolidated Omnibus Budget Reconciliation Act). This important legislative act guarantees that workers participating in their employer’s health insurance program, as well as their dependents, have the ability to have their health insurance coverage extended after they leave their place of employment under specific circumstances and for specified periods of time.
Before COBRA was passed, as soon as an individual was not employed access to his or her group health benefits were immediately stopped. Individuals with pre-existing conditions often could not obtain new insurance coverage. Under COBRA, individuals can elect to continue participating, at their expense, in the employer’s group health plan after qualifying events that lead up to them leaving their employment are met. It can expensive to do this, but it is better than becoming uninsured and all the consequences that follow.
If you quit your job voluntarily, you can elect to continue your employer’s group health insurance coverage for a maximum of 18 months after leaving your employment. You are also eligible if your employer terminates you unless you committed gross misconduct. For employees whose work hours are cut which results in them losing eligibility for full-time benefits, they can also choose to continue their coverage under COBRA.
There are certain conditions where COBRA coverage may be available for more than 18 months. If an individual becomes disabled and is unable to go back to work, they become eligible for 11 additional months of health insurance coverage under COBRA, making the total amount 29 months. If an individual dies who has covered dependents, the dependents are eligible for up to 36 months of coverage, as well as dependents who lose their coverage due to a divorce.
It is important to keep in mind that former employers are not responsible for covering any expenses of health insurance coverage for former employees who are continuing their coverage under COBRA. If you decide to go with COBRA coverage you will have to pay the entire cost of coverage to your former employer and may also be subject to an administrative fee.
If you elect COBRA coverage and then fail to make your premium payments, your former employer can stop your coverage. Your must make your first premium payment within 45 days of when you elect the coverage. Your subsequent premium payment due dates will vary depending on your particular plan. There is a 30-day grace period, which is required under COBRA, for making premium payments. After the grace period is over, your former employer can terminate your coverage.
Instead of having to obtain individual coverage or go without insurance, COBRA gives individuals the ability to continue their coverage for a temporary period of time after their eligibility for health benefits is over. COBRA can be quite expensive, but it is better than having no health insurance coverage at all.
Before COBRA was passed, as soon as an individual was not employed access to his or her group health benefits were immediately stopped. Individuals with pre-existing conditions often could not obtain new insurance coverage. Under COBRA, individuals can elect to continue participating, at their expense, in the employer’s group health plan after qualifying events that lead up to them leaving their employment are met. It can expensive to do this, but it is better than becoming uninsured and all the consequences that follow.
If you quit your job voluntarily, you can elect to continue your employer’s group health insurance coverage for a maximum of 18 months after leaving your employment. You are also eligible if your employer terminates you unless you committed gross misconduct. For employees whose work hours are cut which results in them losing eligibility for full-time benefits, they can also choose to continue their coverage under COBRA.
There are certain conditions where COBRA coverage may be available for more than 18 months. If an individual becomes disabled and is unable to go back to work, they become eligible for 11 additional months of health insurance coverage under COBRA, making the total amount 29 months. If an individual dies who has covered dependents, the dependents are eligible for up to 36 months of coverage, as well as dependents who lose their coverage due to a divorce.
It is important to keep in mind that former employers are not responsible for covering any expenses of health insurance coverage for former employees who are continuing their coverage under COBRA. If you decide to go with COBRA coverage you will have to pay the entire cost of coverage to your former employer and may also be subject to an administrative fee.
If you elect COBRA coverage and then fail to make your premium payments, your former employer can stop your coverage. Your must make your first premium payment within 45 days of when you elect the coverage. Your subsequent premium payment due dates will vary depending on your particular plan. There is a 30-day grace period, which is required under COBRA, for making premium payments. After the grace period is over, your former employer can terminate your coverage.
Instead of having to obtain individual coverage or go without insurance, COBRA gives individuals the ability to continue their coverage for a temporary period of time after their eligibility for health benefits is over. COBRA can be quite expensive, but it is better than having no health insurance coverage at all.
Health Insurance Plan Satisfaction Study
A new study by J.D. Power and Associates shows that customer satisfaction with health care providers varies widely across the United States. The J.D. Power and Associates 2009 National Health Insurance Plan StudySM reports on the results of more than 33,000 health plan subscriber interviews, conducted online between December 2008 and January 2009. In the survey, health plan members were asked to rate their health insurance company on seven key factors: coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes.The study finds that people working for small employers (50 employees or fewer) are less likely to be satisfied with their health plan than those working for larger organizations. Satisfaction among people working for small employer groups averages 692 points on a 1,000-point scale, while members of health plans sponsored by large employers (501-5,000 employees) and jumbo employers (more than 5,000 employees) have satisfaction levels averaging 717 and 725 points, respectively. Health plan members working for larger organizations are also more likely to re-enroll and recommend their plan to others, compared with members working for small employers.
“As unemployment rates rise across the nation, more members are moving to individual health plans from employer-sponsored plans,” said Jim Dougherty, executive director of the healthcare group at J.D. Power and Associates. “By more effectively managing the member experience for this growing segment of subscribers, health plans could reap considerable financial benefits through increased retention and recommendations, and prepare themselves for the anticipated healthcare reform measures facing the industry, which are likely to drive additional enrollment among previously uncovered individuals and small employers.”
Results Vary By Region, Age, Gender
Health plan members in New England (regional index score of 732) report the highest levels of satisfaction among the 17 geographic regions covered in the study, while those in Colorado (694) are the least satisfied. Closely trailing New England are Michigan (731) and Pennsylvania-Delaware (728). Among demographic groups, satisfaction is significantly higher among members age 65 or older compared with other age groups, while females (715) are, on average, slightly more satisfied with their health plans than males (706). Also, African-Americans (750) are, on average, more satisfied than Caucasians (712) and Hispanics (705). In fact, satisfaction among Hispanic members declined compared to the previous year’s study (721).
Other highlights of the study:
* Overall satisfaction remains fairly consistent between plan types (HMO, PPO, and POS), with HMO members having the highest level of satisfaction (719).
* National plans are highest in customer satisfaction in just two of 17 regions, and have problems delivering a consistent experience across the country.
* The Coverage and Benefits factor has the most impact on satisfaction, accounting for 30% of the health plan experience rating, while Provider Choice remains the most satisfying health plan factor in 2009, accounting for nearly one-fourth of the health plan experience rating.
* Information and Communication is the third most important factor for members but, on average, health plans get very low scores in this area. Consequently, improving satisfaction for this factor provides an opportunity for health insurance providers to improve overall member satisfaction.
Health Insurance Reform in 2009
President Obama made this bold promise to hopeful Americans in his recent address to Congress. Few listeners debate the importance of health care, but providing quality affordable health care for every American will clearly challenge Democrats and Republicans to work together to meet this goal.
As unemployment rises, even fewer Americans will have health insurance through an employer. And, rising medical costs are forcing small and large businesses to reduce coverage, increase co-pays and deductibles and raise the amount that employees must pay each month. Some small business owners have even converted traditional health insurance plans to high deductible plans.
Insurance.com offers these tips for evaluating your health care options and saving money on your medical bills.
My employer offers an HMO and a PPO. How do I decide?
Both provide excellent care, but you may want to choose an HMO if its network of doctors and hospitals matches your needs. Health insurance with a Health Maintenance Organization (HMO) is generally less expensive. You're required to select an HMO physician to be your primary health care provider. This doctor will coordinate all of your medical care, including referrals to specialists within your HMO network. If you seek treatment from a non-network physician, you will generally pay most of the cost yourself.
A Preferred Provider Organization (PPO) is more flexible than an HMO plan, but it still operates with a list of physicians and hospitals that are "within the PPO network." You may visit an out-of-network provider, but you will pay the difference between the PPO network and out-of-network prices. Both plans usually offer a prescription drug benefit, as well. Some companies are offering options that allow you to combine features of both HMO and PPO plans.
I can't afford full health insurance, but I want coverage for major emergencies.
A high deductible health insurance plan or catastrophic health insurance offer coverage for major illnesses or accidents. For example, a plan with a $5,000 deductible requires you to pay all of your medical expenses up to $5,000 before your insurer begins to pay. If you choose a high deductible plan, try to save a small amount of money each month in a Health Savings Account (HSA) so that you're not overwhelmed by routine medical expenses.
I have health insurance, but it seems like I'm always paying for something.
Sad but true. You may owe a co-payment for doctor's visits or a trip to the ER. Usually, this is a flat fee, but it can get expensive if you don't stay within your plan network.
Secondly, payment for expenses is subject to your annual deductible, which is the amount you pay toward your medical expenses before the insurance company begins to pay claims. Some HMO plans do not have deductibles but do have co-payments.
Lastly, there's co-insurance, which is the percentage of your medical costs that you pay after you reach your annual deductible. 80/20 co-insurance is a common option, and that means that your insurer pays 80% of your bills and you pay 20%—after your deductible. So, anything you can do to reduce your medical bills will help you reduce your out-of-pocket expenses, too.
I don't have health insurance. What can I do?
Almost every hospital has a financial aid office that will evaluate your personal situation and determine your ability to pay for required care. Generally, a hospital will provide sliding scale fees if your income is 400% or less of federal poverty limits and may eliminate bills entirely if your income is 200% or less of federal poverty limits. But hospitals have to make money, too, so they may not publicize these programs or provide much assistance in applying. Be prepared with recent copies of your tax returns and W-2's to prove your need.
As unemployment rises, even fewer Americans will have health insurance through an employer. And, rising medical costs are forcing small and large businesses to reduce coverage, increase co-pays and deductibles and raise the amount that employees must pay each month. Some small business owners have even converted traditional health insurance plans to high deductible plans.
Insurance.com offers these tips for evaluating your health care options and saving money on your medical bills.
My employer offers an HMO and a PPO. How do I decide?
Both provide excellent care, but you may want to choose an HMO if its network of doctors and hospitals matches your needs. Health insurance with a Health Maintenance Organization (HMO) is generally less expensive. You're required to select an HMO physician to be your primary health care provider. This doctor will coordinate all of your medical care, including referrals to specialists within your HMO network. If you seek treatment from a non-network physician, you will generally pay most of the cost yourself.
A Preferred Provider Organization (PPO) is more flexible than an HMO plan, but it still operates with a list of physicians and hospitals that are "within the PPO network." You may visit an out-of-network provider, but you will pay the difference between the PPO network and out-of-network prices. Both plans usually offer a prescription drug benefit, as well. Some companies are offering options that allow you to combine features of both HMO and PPO plans.
I can't afford full health insurance, but I want coverage for major emergencies.
A high deductible health insurance plan or catastrophic health insurance offer coverage for major illnesses or accidents. For example, a plan with a $5,000 deductible requires you to pay all of your medical expenses up to $5,000 before your insurer begins to pay. If you choose a high deductible plan, try to save a small amount of money each month in a Health Savings Account (HSA) so that you're not overwhelmed by routine medical expenses.
I have health insurance, but it seems like I'm always paying for something.
Sad but true. You may owe a co-payment for doctor's visits or a trip to the ER. Usually, this is a flat fee, but it can get expensive if you don't stay within your plan network.
Secondly, payment for expenses is subject to your annual deductible, which is the amount you pay toward your medical expenses before the insurance company begins to pay claims. Some HMO plans do not have deductibles but do have co-payments.
Lastly, there's co-insurance, which is the percentage of your medical costs that you pay after you reach your annual deductible. 80/20 co-insurance is a common option, and that means that your insurer pays 80% of your bills and you pay 20%—after your deductible. So, anything you can do to reduce your medical bills will help you reduce your out-of-pocket expenses, too.
I don't have health insurance. What can I do?
Almost every hospital has a financial aid office that will evaluate your personal situation and determine your ability to pay for required care. Generally, a hospital will provide sliding scale fees if your income is 400% or less of federal poverty limits and may eliminate bills entirely if your income is 200% or less of federal poverty limits. But hospitals have to make money, too, so they may not publicize these programs or provide much assistance in applying. Be prepared with recent copies of your tax returns and W-2's to prove your need.
Short-Term Health Insurance
You've just graduated from college or moved out on your own, and you're no longer covered under your parents' health insurance plan. Or perhaps you've flown the coop on your cubicle job and you're looking for the next big thing. Maybe you've found a new job, but your new employer's group health insurance plan won't kick in until you've been with the company for three months. These are good reasons to look into short-term health insurance if it's available in your state.
What's in a name...
As the name implies, short-term health insurance typically offers coverage for 30 to 180 days, although some plans will cover you initially for up to 12 months. If your short-term need runs longer than the coverage, you may be able to renew the plan, but don't count on anything beyond a year.
Most short-term plans will cover you in the event of an accident or a sudden illness. As you might expect with almost any health insurance plan, short-term plans may have benefit limits, and you'll be required to cover an initial deductible and to make co-payments. You'll be allowed to pick your own doctors, hospitals, or other health-care providers. You'll get coverage for inpatient and outpatient services, hospital room (including intensive care unit) and board charges, lab examinations, and X-rays. These plans rarely require a physical exam, and coverage often begins as soon as the insurer receives your application and first premium payment. Applications may be mailed in or submitted over the Internet, and payments may be made by check or credit card. Check with the provider for complete information on coverage and the application process.
...And what's not
To keep the premiums down, short-term health insurance plans don't offer all of the benefits of permanent plans. Most won't cover treatment of a pre-existing condition (i.e. an illness or injury that has produced signs or symptoms, or for which you've received treatment, in the past five years). In addition, these plans don't cover routine medical exams, preventive care, dental or optical care, or pregnancy and childbirth expenses.
Short-term health insurance policies are exempt from the portability requirements in Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Insurance carriers issuing these policies don't have to guarantee their renewability, and most don't. They also don't have to waive any pre-existing condition limitations for individuals otherwise eligible for those waivers.
But despite their limitations, short-term health insurance plans can help you fill the gaps in your health insurance coverage. And that's just what the doctor ordered!
What's in a name...
As the name implies, short-term health insurance typically offers coverage for 30 to 180 days, although some plans will cover you initially for up to 12 months. If your short-term need runs longer than the coverage, you may be able to renew the plan, but don't count on anything beyond a year.
Most short-term plans will cover you in the event of an accident or a sudden illness. As you might expect with almost any health insurance plan, short-term plans may have benefit limits, and you'll be required to cover an initial deductible and to make co-payments. You'll be allowed to pick your own doctors, hospitals, or other health-care providers. You'll get coverage for inpatient and outpatient services, hospital room (including intensive care unit) and board charges, lab examinations, and X-rays. These plans rarely require a physical exam, and coverage often begins as soon as the insurer receives your application and first premium payment. Applications may be mailed in or submitted over the Internet, and payments may be made by check or credit card. Check with the provider for complete information on coverage and the application process.
...And what's not
To keep the premiums down, short-term health insurance plans don't offer all of the benefits of permanent plans. Most won't cover treatment of a pre-existing condition (i.e. an illness or injury that has produced signs or symptoms, or for which you've received treatment, in the past five years). In addition, these plans don't cover routine medical exams, preventive care, dental or optical care, or pregnancy and childbirth expenses.
Short-term health insurance policies are exempt from the portability requirements in Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Insurance carriers issuing these policies don't have to guarantee their renewability, and most don't. They also don't have to waive any pre-existing condition limitations for individuals otherwise eligible for those waivers.
But despite their limitations, short-term health insurance plans can help you fill the gaps in your health insurance coverage. And that's just what the doctor ordered!
Health Insurance for Unmarried Partners
Generally, and unfortunately, if an employer offers health insurance coverage to the spouses of employees, they usually don’t extend the coverage to unmarried partners too. Under the Employee Retirement Income Security Act (ERISA), employers are not required to offer health insurance to any employees, spouses, or "domestic partners" (this term is often used to include same-sex couples and unmarried opposite-sex couples, as well as common law marriages). ERISA also does not compel employers that provide health insurance for employees and legal dependents to extend coverage to domestic partners.
Nevertheless, thousands of employers across the country have begun offering domestic partner benefits in the last several years, and the number continues to grow. Employment experts predict that this trend will continue, as small companies start to follow the lead of large employers that have introduced domestic partner benefit plans in recent months.
In addition, some state and local laws have recently been passed in favor of domestic partner rights. San Francisco, Los Angeles, and Seattle have ordinances requiring all businesses with municipal contracts to offer same-sex benefits if they offer benefits for married couples. Vermont recently enacted the country's first "civil union" law, which grants same-sex couples nearly all of the benefits to which the state's married couples are entitled. Provisions regarding health insurance are still being written, and it is not yet known what they will entail.
When benefits are offered to domestic partners, the level of coverage varies depending on the employer. Domestic partner benefits may include long-term care, group life insurance, family and bereavement leave, and most commonly, health, dental, and vision insurance. The definition of domestic partner may also vary from employer to employer. Some companies include same-sex couples, unmarried opposite-sex couples, and common law marriages. Others cover only same-sex partners on the grounds that opposite-sex couples can receive spousal benefits by getting married, while same-sex couples do not have this option. Regardless of how the term is defined, employers typically require domestic partners to sign an affidavit stating that they are in a lasting, committed relationship. They may also require that a couple live together for a specified period of time before they become eligible for domestic partner benefits.
All You Need to Know About Health Insurance
With medical expenses soaring higher every year, health insurance is an expensive necessity. Knowing more about health insurance can help you get the coverage you need while keeping your expenses down.
What types of health insurance are available?
Health insurance plans generally fall into one of two categories: indemnity plans (also known as reimbursement plans) and managed care plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. (Learn more about HMO, PPO, and POS plans.)
* An indemnity plan allows you to choose your own doctors and pays for your medical expenses—totally, in part, or up to a specified amount per day for a specified number of days.
* Managed care plans generally provide broader coverage, but they all involve an arrangement between the insurer and a selected network of health-care providers (doctors, hospitals, etc.). This arrangement provides a strong incentive for you to stay in-network, usually by covering less for services received outside the network.
No matter which type of health insurance you buy, you'll need to make sure it offers the right kinds of coverage.
What should be covered?
A good health insurance policy contains several types of coverage.
* Hospital expense coverage pays your room, board, and incidental services costs if you're hospitalized
* Surgical expense coverage covers surgeons' fees and related costs associated with surgery
* Physicians' expense coverage pays for visits to a doctor's office or for a doctor's hospital visits
* Lab coverage pays for laboratory services like X-Rays and other diagnostic lab tests
What might be covered?
When comparing health insurance plans, check to see if they provide additional benefits that you may need, including:
* Prescription drugs
* Preventive care
* Mental health benefits
* Maternity care
* Vision care
* Dental care
* Chiropractic coverage
What will it cost?
In addition to the monthly premium expense, you may have other out-of-pocket costs. These costs can really add up, especially if you have children or other family members who visit the doctor frequently. Check to see if the health insurance plan you're considering requires you to pay any or all of the following:
* Co-payment: The flat fee you'll have to pay each time you visit a health insurance provider (can vary by provider type).
* Deductible: The amount you'll have to pay toward your medical expenses (usually annually) before the insurance company begins to pay claims (generally required by indemnity plans).
* Coinsurance: The percentage of your medical costs you'll have to pay after you reach any deductibles that apply.
Where can I get health insurance?
You may get health insurance through a group plan at work or through another group affiliation (a school, a club, etc.) or by purchasing an individual plan on your own. By purchasing an individual plan, you may be able to customize the health plan.
A good way to compare rates, plans, and options for your individual needs is to shop online. Comparing online health insurance quotes helps to ensure you get your best rate.
How do I decide which plan is best?
The best health insurance plan for you is the one that gives you the greatest flexibility and the most benefits for the lowest cost. Unfortunately, there's no such thing as a standard health insurance plan. As you would when making any major purchase, you'll need to shop around and get several quotes before choosing a plan. Here are a few points to consider:
* What co-pays, deductibles, and coinsurance requirements apply?
* How much freedom do you have to choose your own health-care providers?
* Does the plan cover the health services that you need?
* Does the plan cover the health-care providers you're currently using?
* Does the plan offer family, as well as individual, coverage?
* Does the plan cover pre-existing conditions? If so, is there a waiting period?
* Does the insurance company have a good reputation in the industry and a positive rating from a major ratings organization and your state's department of insurance?
What types of health insurance are available?
Health insurance plans generally fall into one of two categories: indemnity plans (also known as reimbursement plans) and managed care plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. (Learn more about HMO, PPO, and POS plans.)
* An indemnity plan allows you to choose your own doctors and pays for your medical expenses—totally, in part, or up to a specified amount per day for a specified number of days.
* Managed care plans generally provide broader coverage, but they all involve an arrangement between the insurer and a selected network of health-care providers (doctors, hospitals, etc.). This arrangement provides a strong incentive for you to stay in-network, usually by covering less for services received outside the network.
No matter which type of health insurance you buy, you'll need to make sure it offers the right kinds of coverage.
What should be covered?
A good health insurance policy contains several types of coverage.
* Hospital expense coverage pays your room, board, and incidental services costs if you're hospitalized
* Surgical expense coverage covers surgeons' fees and related costs associated with surgery
* Physicians' expense coverage pays for visits to a doctor's office or for a doctor's hospital visits
* Lab coverage pays for laboratory services like X-Rays and other diagnostic lab tests
What might be covered?
When comparing health insurance plans, check to see if they provide additional benefits that you may need, including:
* Prescription drugs
* Preventive care
* Mental health benefits
* Maternity care
* Vision care
* Dental care
* Chiropractic coverage
What will it cost?
In addition to the monthly premium expense, you may have other out-of-pocket costs. These costs can really add up, especially if you have children or other family members who visit the doctor frequently. Check to see if the health insurance plan you're considering requires you to pay any or all of the following:
* Co-payment: The flat fee you'll have to pay each time you visit a health insurance provider (can vary by provider type).
* Deductible: The amount you'll have to pay toward your medical expenses (usually annually) before the insurance company begins to pay claims (generally required by indemnity plans).
* Coinsurance: The percentage of your medical costs you'll have to pay after you reach any deductibles that apply.
Where can I get health insurance?
You may get health insurance through a group plan at work or through another group affiliation (a school, a club, etc.) or by purchasing an individual plan on your own. By purchasing an individual plan, you may be able to customize the health plan.
A good way to compare rates, plans, and options for your individual needs is to shop online. Comparing online health insurance quotes helps to ensure you get your best rate.
How do I decide which plan is best?
The best health insurance plan for you is the one that gives you the greatest flexibility and the most benefits for the lowest cost. Unfortunately, there's no such thing as a standard health insurance plan. As you would when making any major purchase, you'll need to shop around and get several quotes before choosing a plan. Here are a few points to consider:
* What co-pays, deductibles, and coinsurance requirements apply?
* How much freedom do you have to choose your own health-care providers?
* Does the plan cover the health services that you need?
* Does the plan cover the health-care providers you're currently using?
* Does the plan offer family, as well as individual, coverage?
* Does the plan cover pre-existing conditions? If so, is there a waiting period?
* Does the insurance company have a good reputation in the industry and a positive rating from a major ratings organization and your state's department of insurance?
Saving on Group Health Insurance
Here are the frightening facts: the past three years have seen double-digit increases in group health insurance premiums and these increases were largest for the smallest companies. All indications are that this trend will continue for the foreseeable future.
As a business owner, if you think this is good cause to panic, you’re not alone. The rising cost of providing health insurance for employees is regularly cited as the number one concern of smaller companies today. Employers know how highly their workers value medical coverage, but many feel that they’ve been pushed to the wall and are now facing a fatal dilemma: pass the crippling rate hikes on to their employees, or cut benefits entirely.
The truth is that you don’t have to settle for one of two equally bad choices. If you currently have a health plan that’s straining your budget or have no health plan but would like to offer one for your employees, here are three tips to help you find a quality group health insurance plan at a reasonable rate:
Compare quotes and benefits from multiple insurance companies.
You wouldn’t buy a car without first familiarizing yourself with the different makes and models available. Similarly, when shopping for group health coverage, don’t limit yourself to the offerings of a single insurance company. The most convenient way to get an overview of the insurance options in your area is by working with an online agent. A licensed group health insurance agent can provide you with the benefits and rates from a large number of insurance companies and plans. With more to choose from, an agent will help you match your business to the best plan and save you money by making sure you’re not paying for “extras” that you and your employees don’t need. Make sure that any agent you work with, on or offline, is licensed in your state.
Consider a high-deductible plan.
Another way to save is by opting for a high-deductible plan. If your employees are healthy and don’t make frequent visits to the doctor, this may be a good option for you. You can save money and still retain valuable coverage for your employees through a high-deductible plan. Though they will face deductibles before coverage kicks in, your employees will be protected from the catastrophic consequences of having no coverage in the event of serious illness or injury. Your licensed agent can provide you with information on high-deductible plans in your area and help you determine if such a plan makes sense for your business.
Take advantage of available tax incentives.
Educate yourself on the tax benefits available to you as a business owner when you provide group health insurance for your employees. You may be able to fully deduct the premiums paid on your group health plan, and offering coverage as part of a total compensation package may reduce your payroll tax. Health Savings Accounts (HSAs) provide another important tax break for you and your employees. These tax-favored accounts can be used in conjunction with certain high-deductible plans and your contributions to them are exempt from payroll tax. Talk to your agent about HSAs and HSA-eligible plans. All these incentives contribute to the affordability of your group health insurance plan.
As a business owner, if you think this is good cause to panic, you’re not alone. The rising cost of providing health insurance for employees is regularly cited as the number one concern of smaller companies today. Employers know how highly their workers value medical coverage, but many feel that they’ve been pushed to the wall and are now facing a fatal dilemma: pass the crippling rate hikes on to their employees, or cut benefits entirely.
The truth is that you don’t have to settle for one of two equally bad choices. If you currently have a health plan that’s straining your budget or have no health plan but would like to offer one for your employees, here are three tips to help you find a quality group health insurance plan at a reasonable rate:
Compare quotes and benefits from multiple insurance companies.
You wouldn’t buy a car without first familiarizing yourself with the different makes and models available. Similarly, when shopping for group health coverage, don’t limit yourself to the offerings of a single insurance company. The most convenient way to get an overview of the insurance options in your area is by working with an online agent. A licensed group health insurance agent can provide you with the benefits and rates from a large number of insurance companies and plans. With more to choose from, an agent will help you match your business to the best plan and save you money by making sure you’re not paying for “extras” that you and your employees don’t need. Make sure that any agent you work with, on or offline, is licensed in your state.
Consider a high-deductible plan.
Another way to save is by opting for a high-deductible plan. If your employees are healthy and don’t make frequent visits to the doctor, this may be a good option for you. You can save money and still retain valuable coverage for your employees through a high-deductible plan. Though they will face deductibles before coverage kicks in, your employees will be protected from the catastrophic consequences of having no coverage in the event of serious illness or injury. Your licensed agent can provide you with information on high-deductible plans in your area and help you determine if such a plan makes sense for your business.
Take advantage of available tax incentives.
Educate yourself on the tax benefits available to you as a business owner when you provide group health insurance for your employees. You may be able to fully deduct the premiums paid on your group health plan, and offering coverage as part of a total compensation package may reduce your payroll tax. Health Savings Accounts (HSAs) provide another important tax break for you and your employees. These tax-favored accounts can be used in conjunction with certain high-deductible plans and your contributions to them are exempt from payroll tax. Talk to your agent about HSAs and HSA-eligible plans. All these incentives contribute to the affordability of your group health insurance plan.
Early Intervention Can Help Cut Disability Costs
Sun Financial Life, an international wealth management and insurance company, and the Integrated Benefits Institute (IBI), a non-profit benefits research organization located in San Francisco, states that employers who intervene soon after employees are first disabled can help them return to work faster and happier, while cutting disability-related costs.An IBI study of Steelcase, a Michigan manufacturer of office furniture, showed that worker satisfaction shot up 48 percent from 1997 to 2001 after the company introduced a disability management program that integrated aspects of workers compensation, short and long term disability, and the federal Family Medical Leave Act.
Employers who move quickly to communicate with and accommodate their disabled workers can help them return to work 20 percent faster, according to Sun Life's study, “Early Intervention Programs Can Speed Disabled Employees Back to Work.”
The reason Steelcase decided to try a program like this was because many employees were confused by traditional, disjointed employee benefits. Often, employees didn’t know who to call or who to turn to, resulting in employees feeling like they weren’t getting good service. In addition to the program, Steelcase also implemented an early return-to-work component for employees.
The Sun Life Return-to-Work Study
The Sun Life return-to-work study tracked the outcome of nearly 1,000, non-maternity, short-term disability claims. The claims were then divided into 2 groups – those who received early intervention disability, and those who did not. Available services included:
* Claimant and physician coaching about return-to-work expectations
* Employer education on disability issues
* Identification of viable job alternatives, including light duty positions
* Job site modifications to accommodate disabled workers
* Medical intervention to ensure the employee was receiving appropriate medical care
* Three-way coordination and communication between the employer, employee, and physician
* Vocational counseling
Those who received early intervention worked with their employers and physicians to develop return-to-work plans and set expected return-to-work dates that were the earliest recovery date (to be determined by the physician or medical disability advisor). The final outcomes were compared, including the date the employee returned to work, whether it was full- or part-time, and if the claim transitioned into the long-term disability stage.
The study showed that the early intervention services yielded a high success rate in returning disable employees to work. Among the findings:
* On average, employees receiving early intervention services returned to work 2.7 weeks sooner, saving the employer approximately $810 per claim
* 47 percent more employees returned to work during the short term disability states with early intervention
* 33 percent fewer claims extended into the long-term disability stage with early intervention
Services Make All the Difference
“Nine times out of 10, disabled workers stay out on disability longer than they have to — or don't return at all — due to employment problems rather than their medical problems,” says an official from John Hewitt & Associates Inc., a disability risk management and consulting firm with headquarters in Portland, Maine. “Usually it isn't the disability that prevents them from returning to work, but all kinds of extraneous job issues,” notes the official. “Maybe the company has just been sold, or the worker just got a new boss, or the worker's duties are changing and the employer hasn't put any kind of support mechanism in place. If the employer doesn't recognize that the disabled worker has value and they aren’t communicating this idea directly to the worker, then the employer risks losing that employee.”
Sun Life concluded that early intervention in short term disability cases can overcome two main barriers:
* Psychological: The disabled employee hasn't mentally adjusted to not working; nor have they adjusted to their new lifestyle without work.
* Work: A close relationship still exists between the employer and employee, and everyone remains focused on recovery and return to work. Before long, an employee can quickly become “out of sight, out of mind.”
Real Savings
“Employers who ignore the importance of early intervention risk higher absenteeism, higher staffing costs, and lower productivity,” says Sun Life. “Conversely, employers that implement early intervention programs can reap real savings.” In the long run, employers that don’t pay attention to potential rewards of return-to-work programs will pay a higher price than those that actually do use the programs.
According to a Sun Life’s study, with an average company of 10,000 employees, 600 employees can expect to receive short-term disability benefits in any given year. If just 10% of these employees receive early intervention services, that may mean an annual savings of $48,000 per year. This is based on a $300 weekly, short-term disability benefit payment that is multiplied by the shorter average disability duration of 2.7 weeks.
These findings complement those discovered by Watson-Wyatt Worldwide and the Washington Business Group on Health in their fourth annual survey report for 1999/2000 called “Staying@Work.” The study examined 178 major companies with an average of 13,500 workers and found that those which implement short term disability claim management activities — such as independent medical exams, behavioral health interventions, case management, and transitional return-to-work programs — reported savings between 18 percent and 19 percent.
Eating Your Way into the Hospital and the Poorhouse
Ballooning costs and ballooning waistlines. When it comes to health and health insurance, these are the two biggest issues on the plate today. But are these really two separate problems? You already know that too many super-sized meal deals will cost you in the long-term, but you may not have realized how much of a price you`re paying now --in health insurance dollars-- for the national weight problem.
Dollars & Pounds
Health insurance rates have long been on the upswing, with double-digit increases in each of the past three years. Most analysts blame an increased use of medical services for driving up costs. But are we really just a nation of doctor`s office junkies? Surely we don`t go for fun. Why are we seeing the doctor so much anyway? The answer may be: obesity. Curiously, insurance started getting more expensive at about the same time Americans really started getting heavier. It`s impossible to know exactly how much obesity contributes to the increase in insurance costs, but take a look at some numbers: Over 60% of Americans presently qualify as overweight or obese. Even among children, obesity rates have tripled over the past decade. And obesity is known to result in a higher risk of heart disease, diabetes, stroke and certain types of cancer, as well as respiratory problems. And get this: The Surgeon General`s office estimates that, all told, obesity cost the economy $117 billion in the year 2000 alone.
Obesity and Health Insurance
Insurance companies understand that obesity isn`t profitable. If you`re an obese person trying to get health coverage on your own, chances are that you`ll be turned down due to the risks associated with your weight. And if you`re not turned down, you`ll probably pay more for coverage, up to twice as much as a slim person. Even though you can`t be turned down for employer-sponsored health insurance based upon your weight, the increased cost of insuring you is still there, borne not only by yourself but by your coworkers as well.
Now this doesn`t mean that slim folks should blame heavier folks for the annual insurance rate hikes that everyone dreads. There are other factors involved, like the increased use of prescription drugs and the renegotiation of rates that insurance companies pay to doctors. But, these examples serve to demonstrate the fact that this problem touches most all of us in one way or another. And if so many Americans across the country are obese and it`s twice as expensive to profitably insure an obese person, you can begin to see how big a role expanding girth may play in expanding health insurance costs.
Our Prospects for a National Diet
So, what can be done, and who`s responsible? In the United States, it`s expected that obesity will soon overtake smoking as the number-one cause of preventable death. Through a combination of government action and an aggressive public persuasion campaign, smoking is on the decline. These tactics can be employed in the battle on obesity as well.
Perhaps a greater awareness of the connection between obesity and health insurance costs will encourage government and public health organizations to step into the fray. Perhaps it will prod health insurance companies to expand coverage for weight-loss programs and procedures. And if we as individuals can`t bring ourselves to take our health more seriously, perhaps we can bring ourselves to take our pocketbooks more seriously.
Dollars & Pounds
Health insurance rates have long been on the upswing, with double-digit increases in each of the past three years. Most analysts blame an increased use of medical services for driving up costs. But are we really just a nation of doctor`s office junkies? Surely we don`t go for fun. Why are we seeing the doctor so much anyway? The answer may be: obesity. Curiously, insurance started getting more expensive at about the same time Americans really started getting heavier. It`s impossible to know exactly how much obesity contributes to the increase in insurance costs, but take a look at some numbers: Over 60% of Americans presently qualify as overweight or obese. Even among children, obesity rates have tripled over the past decade. And obesity is known to result in a higher risk of heart disease, diabetes, stroke and certain types of cancer, as well as respiratory problems. And get this: The Surgeon General`s office estimates that, all told, obesity cost the economy $117 billion in the year 2000 alone.
Obesity and Health Insurance
Insurance companies understand that obesity isn`t profitable. If you`re an obese person trying to get health coverage on your own, chances are that you`ll be turned down due to the risks associated with your weight. And if you`re not turned down, you`ll probably pay more for coverage, up to twice as much as a slim person. Even though you can`t be turned down for employer-sponsored health insurance based upon your weight, the increased cost of insuring you is still there, borne not only by yourself but by your coworkers as well.
Now this doesn`t mean that slim folks should blame heavier folks for the annual insurance rate hikes that everyone dreads. There are other factors involved, like the increased use of prescription drugs and the renegotiation of rates that insurance companies pay to doctors. But, these examples serve to demonstrate the fact that this problem touches most all of us in one way or another. And if so many Americans across the country are obese and it`s twice as expensive to profitably insure an obese person, you can begin to see how big a role expanding girth may play in expanding health insurance costs.
Our Prospects for a National Diet
So, what can be done, and who`s responsible? In the United States, it`s expected that obesity will soon overtake smoking as the number-one cause of preventable death. Through a combination of government action and an aggressive public persuasion campaign, smoking is on the decline. These tactics can be employed in the battle on obesity as well.
Perhaps a greater awareness of the connection between obesity and health insurance costs will encourage government and public health organizations to step into the fray. Perhaps it will prod health insurance companies to expand coverage for weight-loss programs and procedures. And if we as individuals can`t bring ourselves to take our health more seriously, perhaps we can bring ourselves to take our pocketbooks more seriously.
Pros and Cons of Catastrophic Health Insurance
Catastrophic health insurance plans—more formally known as High Deductible Health Plans (HDHPs)—were created as a way to lower overall medical costs by providing a lower monthly premium in exchange for a higher annual health insurance deductible. With catastrophic health insurance plans, you pay for almost all medical care until you reach the annual deductible amount. After that, traditional health insurance coverage begins.
About High Deductible Health Plans
Under a high deductible plan, you pay out-of-pocket for most medical bills until the total of your payments reaches the amount of your annual deductible. After that, the catastrophic health plan will cover most medical expenses, although you usually have to pay co-insurance until you reach your total out-of-pocket maximum amount. If your catastrophic health plan is eligible for a Health Savings Account (HSA), you can use the HSA funds to pay the deductible and out-of-pocket expenses. Even if you don't use an HSA, it's smart to set aside some money each month to pay for future medical expenses that you may incur. If you never need the money, it's a bonus.
For 2008, the IRS requires that people with tax-exempt HSAs have catastrophic health insurance plans with deductibles starting at $1,100 for an individual and $2,200 for a family. The total out-of-pocket maximum (which includes the deductible and co-payments) for these HSA-linked catastrophic health plans is $5,600 for singles, and $11,200 for families. The U.S. Department of the Treasury has more information on HSAs and high deductible health plan requirements for 2008 and 2009.
Many HDHPs have high lifetime maximum benefit payment limits (also known as "caps"), usually between $1 million and $5 million. Once you reach the cap, your health insurance company will not pay for any of your medical costs and your policy will be cancelled.
Where to Get Catastrophic Health Insurance
High deductible health insurance can usually be purchased either as an individual plan or as a group plan. Certain pre-existing conditions, such as diabetes and mental health disorders, might mean you can't qualify for an individual catastrophic health plan without prior qualifying group coverage, or at least that you can't get coverage for those pre-existing conditions. Group catastrophic health plans are subject to HIPAA regulations, meaning you can't be denied enrollment or coverage, but may have to wait for coverage of pre-existing conditions, depending on your prior health insurance coverage.
What Do High Deductible Health Plans Cover?
The type of coverage varies based on which high deductible health insurance plan you choose. Always read and understand the full policy and what it covers when comparing health insurance plans. Ask your agent or company to explain anything that seems unclear, and make sure you will get or can add coverage for medical conditions you might develop. In the past, catastrophic health plans did not cover things like routine care and prescriptions. Today, however, many high deductible health plans offer coverage for routine and non-catastrophic care. However, as a general rule, the more a plan covers, the higher the premium will be. Agreeing to pay more out of your own pocket shifts some of the risk away from the health insurance company on to you, resulting in a lower monthly premium. Be aware that the IRS currently specifies that if your high deductible health plan provides prescription benefits before you meet your annual deductible, your HDHP does not qualify for use with an HSA.
Catastrophic Health Insurance Considerations
The reason you pay generally lower premiums with a high deductible health plan is that the health insurance company knows you'll pay for a larger portion of your costs if you need medical care. You will have to pay out-of-pocket for the majority of medical costs you incur before reaching your annual deductible. If the sole reason you choose a catastrophic health plan is to save money, you'll need to carefully weigh the benefits against the risks. If you're truly worried about money, will you be able to pay medical expenses until you meet your deductible? For example, if your annual deductible is $4,000 and you have emergency surgery that costs $5,000, you are required to pay $4,000 of that out-of-pocket, assuming you have not yet paid any of your deductible. The remaining $1,000 would be paid by your health insurance. Ask yourself if a lower monthly payment is worth the risk of paying your deductible or a large portion of it all at once.
Should You Get a High Deductible Health Plan?
If you're sure you can cover the deductible and want to save money on the monthly premiums, a high deductible health plan may make sense. If you qualify for an HSA or other tax-exempt medical savings account and can contribute the deductible amount, you may have an easy way to pay your out-of-pocket medical costs while saving on premiums. Most people who consider catastrophic health insurance either are getting their own health insurance for the first time or are nearing retirement. The younger group tends to be less likely to incur medical expenses because they are young and healthy, while the older group tends to have enough money to pay for most medical care unless they experience a serious illness or emergency. Typically, high deductible health plans provide the most benefit to those who don't require frequent prescriptions or office visits.
About High Deductible Health Plans
Under a high deductible plan, you pay out-of-pocket for most medical bills until the total of your payments reaches the amount of your annual deductible. After that, the catastrophic health plan will cover most medical expenses, although you usually have to pay co-insurance until you reach your total out-of-pocket maximum amount. If your catastrophic health plan is eligible for a Health Savings Account (HSA), you can use the HSA funds to pay the deductible and out-of-pocket expenses. Even if you don't use an HSA, it's smart to set aside some money each month to pay for future medical expenses that you may incur. If you never need the money, it's a bonus.
For 2008, the IRS requires that people with tax-exempt HSAs have catastrophic health insurance plans with deductibles starting at $1,100 for an individual and $2,200 for a family. The total out-of-pocket maximum (which includes the deductible and co-payments) for these HSA-linked catastrophic health plans is $5,600 for singles, and $11,200 for families. The U.S. Department of the Treasury has more information on HSAs and high deductible health plan requirements for 2008 and 2009.
Many HDHPs have high lifetime maximum benefit payment limits (also known as "caps"), usually between $1 million and $5 million. Once you reach the cap, your health insurance company will not pay for any of your medical costs and your policy will be cancelled.
Where to Get Catastrophic Health Insurance
High deductible health insurance can usually be purchased either as an individual plan or as a group plan. Certain pre-existing conditions, such as diabetes and mental health disorders, might mean you can't qualify for an individual catastrophic health plan without prior qualifying group coverage, or at least that you can't get coverage for those pre-existing conditions. Group catastrophic health plans are subject to HIPAA regulations, meaning you can't be denied enrollment or coverage, but may have to wait for coverage of pre-existing conditions, depending on your prior health insurance coverage.
What Do High Deductible Health Plans Cover?
The type of coverage varies based on which high deductible health insurance plan you choose. Always read and understand the full policy and what it covers when comparing health insurance plans. Ask your agent or company to explain anything that seems unclear, and make sure you will get or can add coverage for medical conditions you might develop. In the past, catastrophic health plans did not cover things like routine care and prescriptions. Today, however, many high deductible health plans offer coverage for routine and non-catastrophic care. However, as a general rule, the more a plan covers, the higher the premium will be. Agreeing to pay more out of your own pocket shifts some of the risk away from the health insurance company on to you, resulting in a lower monthly premium. Be aware that the IRS currently specifies that if your high deductible health plan provides prescription benefits before you meet your annual deductible, your HDHP does not qualify for use with an HSA.
Catastrophic Health Insurance Considerations
The reason you pay generally lower premiums with a high deductible health plan is that the health insurance company knows you'll pay for a larger portion of your costs if you need medical care. You will have to pay out-of-pocket for the majority of medical costs you incur before reaching your annual deductible. If the sole reason you choose a catastrophic health plan is to save money, you'll need to carefully weigh the benefits against the risks. If you're truly worried about money, will you be able to pay medical expenses until you meet your deductible? For example, if your annual deductible is $4,000 and you have emergency surgery that costs $5,000, you are required to pay $4,000 of that out-of-pocket, assuming you have not yet paid any of your deductible. The remaining $1,000 would be paid by your health insurance. Ask yourself if a lower monthly payment is worth the risk of paying your deductible or a large portion of it all at once.
Should You Get a High Deductible Health Plan?
If you're sure you can cover the deductible and want to save money on the monthly premiums, a high deductible health plan may make sense. If you qualify for an HSA or other tax-exempt medical savings account and can contribute the deductible amount, you may have an easy way to pay your out-of-pocket medical costs while saving on premiums. Most people who consider catastrophic health insurance either are getting their own health insurance for the first time or are nearing retirement. The younger group tends to be less likely to incur medical expenses because they are young and healthy, while the older group tends to have enough money to pay for most medical care unless they experience a serious illness or emergency. Typically, high deductible health plans provide the most benefit to those who don't require frequent prescriptions or office visits.
Top 10 Ways to Cut Your Health Insurance Bills
With health care costs constantly rising, you may be looking for ways to lower your medical expenses. These 10 ideas can get you started.
1. Practice prevention
This may seem basic, but one of the most effective ways to lower your medical expenses over time is to maintain a healthy lifestyle. For example, you can:
* Take advantage of wellness programs
* Maintain a healthy weight
* Exercise regularly
* Kick unhealthy habits (e.g. smoking)
* Have regular checkups
2. Shop around for health insurance
If you don't have employer-sponsored health insurance, you may be ready to look for individual health insurance. Because premiums vary widely, you'll probably save money if you get quotes from several companies. Evaluate each plan's coverage and features, taking into account exclusions, limitations, and the freedom to choose health care providers, among other things. Also find out how much you'll end up paying out of pocket in the form of co-payments, coinsurance, and deductibles, because even relatively small amounts of money can really add up if you make frequent visits to your doctor. If you're healthy and just want protection for a major illness or accident, consider Catastrophic Health Insurance Coverage.
3. Cut the cost of prescription drugs
Try ordering your prescriptions through the mail, using a traditional or online pharmacy. If you belong to a prescription drug plan (e.g. through your health insurance), you may be able to get a three-month supply of your prescription drug through the mail for the same price you would pay for a one-month supply at your local pharmacy. You can also ask your pharmacist or doctor to recommend a less-expensive generic drug whenever possible. In addition, many groups and pharmacies offer prescription drug discount programs, although they usually offer small savings at best and large drawbacks at worst. Senior citizens and others on a limited budget may also apply directly to pharmaceutical companies for prescription assistance.
4. Check your medical bills
Check every itemized statement your receive from a hospital or physician to make sure that the bill accurately reflects the treatment you received and applies all available insurance coverage. Some errors, such as incorrect computer codes, are common, and you may be billed for health care you never received. Contact the billing office if you think you've found a mistake. If you've received an explanation of benefits from your insurance company that you believe is wrong, ask the company to review your claim.
5. Join your spouse's health plan
Many married couples maintain separate health insurance coverage even though it may not be cost effective to do so. Examine both your coverage and your spouse's coverage to see if it makes sense for either of you to join the other's plan. Keep in mind that most plans allow you to add a spouse to your plan within a certain period after you get married (e.g. 30 days). Otherwise, you may have to wait for the plan's annual open enrollment period.
6. Keep track of your medical expenses
Come tax time, you may be able to deduct certain medical expenses. The current IRS rules specify that you must itemize your deductions, and your total medical expenses must exceed 7.5% of your adjusted gross income. Allowable medical expenses include everything from health care services to medical aids (e.g. eyeglasses, hearing aids). And, don't wait until the end of the year to track these expenses, if there's a chance you'll be able to deduct them on your income tax return.
7. Negotiate a discount with your health care provider
Many people don't realize that you can sometimes negotiate to lower your medical bills. While it may not always work, it doesn't hurt to ask your doctor, hospital, or pharmacy if they're willing to come down in price. Before you begin to negotiate, do a little research to find out what other health care providers in your area are charging. You can also ask your health care provider if they'll lower their price if you pay in cash up front.
7. Investigate health care incentives
Health care providers sometimes offer wellness incentives to their customers. These can include regularly attending a gym, pledging not to smoke, and preventive care programs. Many health insurance companies will give an annual or monthly discount if you simply get a physical once a year and have a doctor certify that you're receiving proper preventive care.
8. Contribute to a tax-favored medical account
Your employer may offer a tax-favored health plan such as a flexible spending arrangement or health savings account (HSA) that allows you to put pretax dollars in an account. You can then use these funds to pay for or reimburse your out-of-pocket medical expenses, such as prescription drugs, dental care, and co-payments. Because these contributions are taken out of your pay before federal and state taxes are calculated, you get to use pretax dollars to pay your medical bills. In some cases, these accounts can provide an investment savings option as well.
9. Take advantage of free health screenings and immunizations
If your health insurance doesn't provide adequate coverage in some areas, or if you don't have any health insurance coverage at all, you may want to look into free health screenings. Local clinics and hospitals often provide a variety of screenings, such as blood pressure, cholesterol, and mammograms. You may also find free flu shots and well-child check-ups at government offices or your local WIC program.
10. Get to know your health insurance
Your health insurance may cover more than you think. Insurance companies often provide benefits designed to help you stay safe and healthy. For example, you may receive discounts on vitamins, alternative medicines, health club memberships, exercise equipment, and bike helmets.
You may also be surprised at the range of coverage your health plan offers. For instance, it may cover dental care for young children, chiropractic care, and acupuncture. Read your plan membership materials to find out what products and services are available through your health plan before you pay for them on your own.
How Healthy is Your Health Club?
With more and more insurance companies offering discounts on health and fitness club memberships, now may be a good time to join a health club, get into shape, and improve your overall health. But if your health club cuts corners when it comes to safety, sanitation, and staff training, you may actually be jeopardizing your health by working out there. Here are some signs that your club puts the health and safety of its members first.Club members are instructed on the proper use of equipment and facilities
When you join a health club, a member of the club's staff should ask you to fill out a health history questionnaire. If you have a serious health problem (e.g. a heart condition or a bad back), the club should require that you obtain medical clearance before beginning an exercise program. Then, you should be invited to a new member orientation session (usually a one-on-one session) in which you learn club rules and find out how to properly use the exercise equipment. Staff members should work with you to design an exercise program that meets your needs, taking into consideration any health problems or physical limitations you might have.
Staff members should test your fitness when you start an exercise program, then check on you periodically thereafter. Even long after you've joined, they should be readily available to answer questions and teach you proper exercise techniques. This may be possible only if there is an adequate instructor/member ratio. If only a few staff members are on duty, they may not be able to give you the personal attention you need to exercise safely.
Staff members are qualified and well trained
All staff members should be knowledgeable about health and fitness issues, and most should be trained in CPR and first aid. In addition, exercise instructors should be certified by a nationally or internationally recognized organization such as the Aerobics and Fitness Association of America or the American College of Sports Medicine.
Equipment and facilities are clean and safe to use
Check out the condition of the equipment and the cleanliness of the facility. Although health clubs must be licensed by state and/or local governments to do business, they may not be closely regulated. However, they may be certified by a national organization (such as the International Health, Racquet and Sports Club Association) that requires members to maintain clean, safe facilities and adhere to a code of ethics.
Regulated or not, your health club should be well maintained. Dirty locker rooms and broken equipment can sometimes signal that the club is in financial trouble, especially if the condition of the club has recently taken a turn for the worse. Look for the following signs that your health club is adequately maintained:
* The club should have routine sanitation procedures--find out what they are
* Members should be instructed to clean off machines after use (look for adequate paper towels and spray bottles of disinfectant)
* The facility should be spacious enough to accommodate members even during peak periods--find out if the club limits membership to prevent crowding
* Exercise equipment should be relatively new, not outdated
* All equipment should be clean and in good repair--worn or torn equipment may be a safety hazard
* Instructions for use should be attached to each machine
* Mats and flooring should be clean and resilient enough to protect against injury
* Showers and locker rooms should look and smell clean (no mold or mildew)
* The pool and hot tub should be adequately sanitized--signs of inadequate sanitation include pool water that burns your eyes or foam in the hot tub
* Rules of use should be posted in the pool/hot tub area (e.g. shower before entering the pool, limit use of the hot tub to 15 minutes)
* First aid kits should be well stocked and readily accessible
Security in and around the club is adequate
Health clubs often post signs warning members not to leave valuables in their lockers. Because lockers are notoriously easy to jimmy open, petty thieves often target them. This doesn't necessarily mean that the health club has lax security, but it does mean that you should find out if the health club is going the extra mile to protect you and your possessions. Determine whether the club you belong to has:
* Security measures in place to ensure that only members or their guests can enter or leave the building (e.g. membership cards, surveillance cameras, gates)
* Well-lit parking areas
* Security guards if the area is especially dangerous
* A well-attended child-care facility if the health club offers it
What if you find problems?
If you feel that your health club is not as clean or safe as it should be, talk to the club's director. If your concerns aren't resolved or if serious health violations exist, contact the local or state authority responsible for monitoring business and/or sanitary practices in your area (e.g. the Attorney General's office, Health Department).
Lack of Dental Benefits for Low-Income Children is a Serious Problem
A striking disparity in dental disease based on income can be seen within low-income children versus children who come from more affluent families. In this country, children, minorities and the elderly are said to have the worst oral health, due in part to a lack of dental insurance. In fact, about 108 million Americans do not have dental insurance, according to “The Surgeon General’s Report on Oral Health.”
Recent research findings have linked oral health infections to diabetes, heart and lung disease, stroke and low-birth-weight babies. In the long run, serious dental problems in children can lead to lack of self-esteem, long term stress and depression, and may also interfere with normal, everyday functions, such as eating, breathing, swallowing and speaking.
Tooth Decay
Tooth decay is the single most common chronic childhood illness. Children in families living below the poverty levels ($18,850 being the annual income for a family of four), have more severe and untreated tooth decay.
Publicly Funded Programs Are Falling Behind
Reports state that children from low-income families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. Uninsured children are 2.5 times less likely than insured children to receive dental care, and for each child without medical insurance, there are at least 2.6 children without dental insurance. Simply put, having medical insurance with dental benefits greatly influences whether consumers seek dental care.
A new program called The State’s Children’s Health Insurance Program is out in an attempt to get kids covered, and though it increases the number of insured children, many still are left without effective dental insurance. Medicaid has tried to fill the gap in providing dental care to low-income children, but not much progress has been made. Less than one in five Medicaid-covered children received a single dental visit, notes a recent, year-long study.
In addition to low-income children and minorities, the elderly are also at risk, due to the fact that when they retire, Medicare does not cover their dental services.
The Health Insurance Association of America, an industry trade group, says it “recognizes the inexorable link that exists between coverage and increased access to dental services, and good oral health.”
Delta Dental Plans Association is a national network of independently operated not-for-profit dental service corporations that provide dental benefits and community-outreach programs. They say oral diseases are a “silent epidemic”. Dr. Roger C. Smith, chairman of Delta Dental's dental policy committee says, “We have the ability to drastically reduce some of our nation's most common dental diseases, like dental cavities and periodontal disease. Legislators, educators, communities, and providers need to work together to focus on this important issue and continue improving our nation's oral health.”
Recent research findings have linked oral health infections to diabetes, heart and lung disease, stroke and low-birth-weight babies. In the long run, serious dental problems in children can lead to lack of self-esteem, long term stress and depression, and may also interfere with normal, everyday functions, such as eating, breathing, swallowing and speaking.
Tooth Decay
Tooth decay is the single most common chronic childhood illness. Children in families living below the poverty levels ($18,850 being the annual income for a family of four), have more severe and untreated tooth decay.
Publicly Funded Programs Are Falling Behind
Reports state that children from low-income families without dental insurance are three times more likely to have dental needs than children with either public or private insurance. Uninsured children are 2.5 times less likely than insured children to receive dental care, and for each child without medical insurance, there are at least 2.6 children without dental insurance. Simply put, having medical insurance with dental benefits greatly influences whether consumers seek dental care.
A new program called The State’s Children’s Health Insurance Program is out in an attempt to get kids covered, and though it increases the number of insured children, many still are left without effective dental insurance. Medicaid has tried to fill the gap in providing dental care to low-income children, but not much progress has been made. Less than one in five Medicaid-covered children received a single dental visit, notes a recent, year-long study.
In addition to low-income children and minorities, the elderly are also at risk, due to the fact that when they retire, Medicare does not cover their dental services.
The Health Insurance Association of America, an industry trade group, says it “recognizes the inexorable link that exists between coverage and increased access to dental services, and good oral health.”
Delta Dental Plans Association is a national network of independently operated not-for-profit dental service corporations that provide dental benefits and community-outreach programs. They say oral diseases are a “silent epidemic”. Dr. Roger C. Smith, chairman of Delta Dental's dental policy committee says, “We have the ability to drastically reduce some of our nation's most common dental diseases, like dental cavities and periodontal disease. Legislators, educators, communities, and providers need to work together to focus on this important issue and continue improving our nation's oral health.”
Living Abroad and Your Health Insurance Needs
Taking an extended trip abroad requires an enormous amount of planning. Although it may not be foremost in your mind, your health insurance coverage is an important part of this planning.
Standard health insurance plans are generally not designed to cover extended periods of international travel. Most managed care plans do cover emergency treatment regardless of where it is administered, but other types of care are typically limited to a local network of providers. Health maintenance organizations (HMOs) may pay nothing if you seek routine care from a non-network provider, while preferred provider organizations (PPOs) generally cover only a portion of these costs. And most Americans do not qualify for the national health-care programs offered to citizens of many European nations. Before you go abroad, find out what coverage you will have. Tell your insurance company how long you will be overseas and what countries you will visit.
For some travelers, travel insurance may be an adequate solution. However, travel insurance may provide only limited coverage, typically for no more than six months.
If your stay abroad will last more than six months and you want to get the most comprehensive health insurance available, you may want to look into expatriate health insurance. Many larger insurers such as Lloyd's of London offer this type of insurance specifically for Americans living in other countries.
Expatriate health insurance plans can be customized in many ways. In addition to standard medical and emergency coverage, you can get a plan that includes maternity coverage, specialty treatments such as acupuncture and chiropractic, and even emergency evacuation. Choosing the right features depends on your family's needs, your financial situation, and your travel plans.
If you decide to purchase an expatriate plan, you can expect to complete an extensive application. You'll need to disclose any health problems your family members have had in the past 10 years, from broken bones to hereditary conditions to substance abuse. The cost of an expatriate plan varies depending on the features you choose; the number of family members to be covered; the age, sex, and state of health of each family member; your travel itinerary; and various other factors.
Standard health insurance plans are generally not designed to cover extended periods of international travel. Most managed care plans do cover emergency treatment regardless of where it is administered, but other types of care are typically limited to a local network of providers. Health maintenance organizations (HMOs) may pay nothing if you seek routine care from a non-network provider, while preferred provider organizations (PPOs) generally cover only a portion of these costs. And most Americans do not qualify for the national health-care programs offered to citizens of many European nations. Before you go abroad, find out what coverage you will have. Tell your insurance company how long you will be overseas and what countries you will visit.
For some travelers, travel insurance may be an adequate solution. However, travel insurance may provide only limited coverage, typically for no more than six months.
If your stay abroad will last more than six months and you want to get the most comprehensive health insurance available, you may want to look into expatriate health insurance. Many larger insurers such as Lloyd's of London offer this type of insurance specifically for Americans living in other countries.
Expatriate health insurance plans can be customized in many ways. In addition to standard medical and emergency coverage, you can get a plan that includes maternity coverage, specialty treatments such as acupuncture and chiropractic, and even emergency evacuation. Choosing the right features depends on your family's needs, your financial situation, and your travel plans.
If you decide to purchase an expatriate plan, you can expect to complete an extensive application. You'll need to disclose any health problems your family members have had in the past 10 years, from broken bones to hereditary conditions to substance abuse. The cost of an expatriate plan varies depending on the features you choose; the number of family members to be covered; the age, sex, and state of health of each family member; your travel itinerary; and various other factors.
The Truth About Lies-When Doctors Change Information To Get HMO Approval
The relationship between doctors and health insurance companies can be a rocky one at that, and much of the tension stems from the hassles doctors encounter when it comes to HMO denials. The potential for HMO's to deny a request, coupled with the hassles surrounding the denial, have risen to the point of doctors actually misrepresenting their patients, just to get approval. If a patient's HMO denies their request, a doctor can appeal the decision, but the process to get a health insurance company to change their decision is a troublesome one.
Studies have shown doctors are more willing to lie about their patient's medical condition to get them approved when their case is considered severe, or when there is a high likelihood that an appeal will be denied. If the appeal has a higher probability rate for acceptance, doctors and physicians are less prone to stretch the truth when it comes to medical records and conditions. The more likely the HMO will deny coverage, the more likely a doctor will consider lying about the patient's condition.
The potential problem that may arise if a doctor lies to a health insurance company about a patient's medical condition is that the lie will also be reflected in the patient's medical records. A little white lie to the HMO company may seem innocent at the time; but the lie could wreak havoc if the patient switches doctors or develops a more serious illness. And while doctors think they are helping their patients through the HMO approval process, in reality, they could be setting them up to fall.
Many solutions have been suggested, but it really comes down to doctors and health insurance companies working together to control cost and provide access to the best health care for patients.
If you are interested in getting a health insurance quote, log on to Insurance.com. Here you will be able to evaluate multiple rates from best-in-class health insurance providers - helping you find the best health insurance coverage at the most affordable rates.
The A to Zs of Alternative Medicine
Americans are increasingly looking for ways to improve their health and well-being. If you're like others, you may consider your mental and spiritual health to be equally as important as your physical health. Alternative medicine—or nontraditional health care—may meet your needs by caring for both the physical and spiritual aspects of your life.What is alternative medicine?
Alternative medicine is a holistic or whole mind/body approach to health care that complements, rather than competes with, conventional medicine. When diagnosing and treating a patient, an alternative medicine practitioner considers not only the patient's physical health, but his or her mental and spiritual condition as well. Many different alternative treatments exist, including some that are becoming accepted by practitioners of traditional medicine:
* Acupuncture, which is commonly used for pain relief
* Herbal medicine, including agrimony, which can be used for swelling, indigestion, or muscle tension relief
* Chiropractic techniques—the manipulation and adjustment of the spine and other joints—which are used to relieve pain and associated problems
* Mind/body techniques such as relaxation, visualization, talk therapy, hypnotherapy, yoga, and meditation
Should you use alternative medicine?
People who use alternative medicine often believe that good health is not just the absence of disease—it also means being physically, mentally, and spiritually fit. You may decide to use alternative medicine if you believe that:
* It's important to use the best or most promising treatment available, whether conventional or not
* The conventional medicine you are using has been unsatisfactory
* Since no two people are the same—i.e. one person may respond differently to a medication or a treatment than another—a single approach may not work
* Common antibiotics or other prescription drugs may have unknown long-term side effects
* Many of the major causes of disease, including stroke and heart disease, might be prevented or reduced through simple lifestyle changes that include diet, exercise, and stress reduction
* Preventing the cause is better than treating the symptom
* Meditation, deep breathing, yoga, and tai chi can promote physical, mental, and spiritual health
What is the difference between conventional and alternative medicine?
Conventional and alternative medicines share the same goal—they seek to cure patients. However, they go about treating the patient's symptoms differently. Alternative medicine will often stimulate the body's natural recuperative powers—the immune system—to assist in the healing process. Alternative medicine is more apt to treat with natural substances such as zinc.
Conventional medicine often uses medications that have an immediate impact on the patient's symptoms. These are often manufactured drugs containing synthetic chemicals. The side effects of these medications can be more severe than those of alternative medications.
Alternative medicine often works best when combined with conventional medicine. In some cases, you may have little choice—although alternative medicine may work well over time, your condition may require immediate treatment, and more conventional methods of medicine may be your only option.
Is alternative medicine really safe?
Although it may seem like alternative medicine is a recent development, it has actually been around for longer than conventional medicine. Many of the medications and practices considered nontraditional today have their roots in traditional African, American, Asian, and European medicine. Because of their widespread popularity overseas, some alternative medications used in the United States may have already been tested abroad. Many alternative medicines—and many alternative treatments—don't receive official approval from the Food and Drug administration or conventional medical community because their effects are hard to quantify. Conversely, these same medications and treatments are usually not as dangerous or invasive as more conventional treatments.
Here are some commonsense ways to make using alternative medicine safer:
* Look for a practitioner who is licensed by the state or by a recognized medical association. If the practitioner is licensed, the licensing board will provide you with information about his or her education, training, and background (including disciplinary background).
* Choose a practitioner who uses several alternative therapies or who is trained in both conventional and alternative medicine. The practitioner should listen to you and be sensitive to your needs. You should be able to communicate comfortably and develop a good working relationship.
* After you have chosen a practitioner, ask him or her about the safety and effectiveness of the proposed treatment and mention any therapies and treatment you are already receiving
* Buy medications from reputable sources, and pay attention to the active and inactive ingredients, dosage instructions, and drug interactions listed on the label
Will health insurance cover alternative medicine?
Some health plans offer coverage for alternative therapies, such as chiropractic care and massage therapy, but not for alternative medications—these are treated like traditional medications sold over-the-counter. However, many insurers are recognizing that the demand for alternative medications exists and are helping customers learn more by providing information about them. You may even be able to buy alternative medications through your insurer at a discount.
Tips for using alternative medicine
* Avoid treating yourself—seek the advice of a physician
* To find a practitioner of alternative medicine, talk to your current doctor. Your insurer may also be able to provide you with a referral.
* Always do your homework before trying out alternative medicine. Libraries, bookstores, health food stores, and the Internet are good places to start. Your physician or insurer may also be able to provide you with information.
* Continue to gather information even after you have selected an alternative practitioner and/or alternative treatment—this will help you practice the treatment and monitor its effectiveness
If you're interested in finding out which health insurance companies support alternative medicine, get a health insurance quote at our Health section. You can compare multiple quotes from top health insurance companies, which helps you find the insurance that's right for your situation.
College Student Health Plans
By the time your children toss their high school graduation caps into the air, they'll probably have a good idea about their intended college and course of study, but is their health insurance something you've thought about?
Many times, a parent's medical plan will cover their children until they're 24 years old. If your health insurance plan does not cover college students, it would be beneficial to look into what college health plans are offered at your child's university.
College health insurance basics
College health insurance plans may be subsidized by tuition at some schools, and may ultimately save parents money. College health insurance plans are not free, and the benefits may vary from college to college. Health insurance companies meet with committees from different schools to design a plan, specifically tailored to that school's students. Free services may be offered at the health center.
If you choose to purchase the college health insurance plan for your student, office visits will usually be fully covered, but students may be charged a co-pay for lab work, x-rays, physical therapy, prescriptions, and procedures such as treatment for a wound. Other services that may be covered include mental health, newborn and infant care, routine pap and pelvic exams, routine AIDS/STD testing, as well as cholesterol screenings. Premiums and benefits vary from college to college, sometimes due to state laws.
Out-of-network problems
A key question-if you're considering keeping your student on your family plan-is whether doctors from your network will be easily available if your student is out-of-state. All HMO-only plans require referrals for visits to out-of-network providers and to specialists. And, PPO plans will reimburse less for visits to out-of-network physicians. If your child chooses a college out of state, and you want them to get prompt medical care without having to call home for a physician's referral, it would be a good idea to consider the college health plan offered by their school. What are health insurance networks, and what are the different types of plans? Learn more about HMO, PPO, and POS plans.
Things to consider when evaluating a college health insurance policy
Several factors can make a crucial difference in timely care. Be sure to find out:
* Are there restrictions on the providers a student can use?
* If the student is on vacation, what kind of coverage do they have?
* If the student is not enrolled in classes (during summer or winter break) do they still have health insurance coverage?
* Are the most efficient treatment facilities at the college easily accessible?
* What are the low-cost or free services that are offered through the campus health clinic?
Don't let your child's coverage lapse
If your child has a pre-existing medical condition, a lapse in health insurance coverage could cause problems later. Under HIPAA (the Health Insurance Portability and Accountability Act), pre-existing conditions can only be subject to coverage exclusions for 12 months (or 18 months in the case of late plan enrollment). However, if qualifying coverage is maintained without a lapse of 63 days, the health insurance company must subtract the length of coverage from the exclusion period. For example, 8 months of prior coverage would result in a 4-month exclusion period, whereas 18 years of coverage would result in no exclusion period. Therefore, it's important to maintain continuous coverage of all conditions, even if it means buying new health insurance or enrolling in a high-priced plan for a short period.
Many times, a parent's medical plan will cover their children until they're 24 years old. If your health insurance plan does not cover college students, it would be beneficial to look into what college health plans are offered at your child's university.
College health insurance basics
College health insurance plans may be subsidized by tuition at some schools, and may ultimately save parents money. College health insurance plans are not free, and the benefits may vary from college to college. Health insurance companies meet with committees from different schools to design a plan, specifically tailored to that school's students. Free services may be offered at the health center.
If you choose to purchase the college health insurance plan for your student, office visits will usually be fully covered, but students may be charged a co-pay for lab work, x-rays, physical therapy, prescriptions, and procedures such as treatment for a wound. Other services that may be covered include mental health, newborn and infant care, routine pap and pelvic exams, routine AIDS/STD testing, as well as cholesterol screenings. Premiums and benefits vary from college to college, sometimes due to state laws.
Out-of-network problems
A key question-if you're considering keeping your student on your family plan-is whether doctors from your network will be easily available if your student is out-of-state. All HMO-only plans require referrals for visits to out-of-network providers and to specialists. And, PPO plans will reimburse less for visits to out-of-network physicians. If your child chooses a college out of state, and you want them to get prompt medical care without having to call home for a physician's referral, it would be a good idea to consider the college health plan offered by their school. What are health insurance networks, and what are the different types of plans? Learn more about HMO, PPO, and POS plans.
Things to consider when evaluating a college health insurance policy
Several factors can make a crucial difference in timely care. Be sure to find out:
* Are there restrictions on the providers a student can use?
* If the student is on vacation, what kind of coverage do they have?
* If the student is not enrolled in classes (during summer or winter break) do they still have health insurance coverage?
* Are the most efficient treatment facilities at the college easily accessible?
* What are the low-cost or free services that are offered through the campus health clinic?
Don't let your child's coverage lapse
If your child has a pre-existing medical condition, a lapse in health insurance coverage could cause problems later. Under HIPAA (the Health Insurance Portability and Accountability Act), pre-existing conditions can only be subject to coverage exclusions for 12 months (or 18 months in the case of late plan enrollment). However, if qualifying coverage is maintained without a lapse of 63 days, the health insurance company must subtract the length of coverage from the exclusion period. For example, 8 months of prior coverage would result in a 4-month exclusion period, whereas 18 years of coverage would result in no exclusion period. Therefore, it's important to maintain continuous coverage of all conditions, even if it means buying new health insurance or enrolling in a high-priced plan for a short period.
Elusive Affordable Health Insurance Coverage for Individuals and Businesses
Welcome to this edition of the Weekly Health Insurance News Roundup. Today we will look at a couple of articles that discuss why affordable health insurance is an elusive problem that won't be solved easily, which is especially hurtful to small businesses and individuals who are uninsured.
The first article, entitled, "Affordable health care elusive for many, though optimism builds" in the Business First of Columbus magazine takes a look at the problem through several viewpoints, such as a business owner, an uninsured small business owner, and an expert, for example. Each of these people have different viewpoints on the health insurance situation in this country, and a lot of them point fingers, mostly at politicians. Many people said that the big hurtles are legislation and financing.
Business owners are particularly feeling the pinch of higher health insurance costs, as many believe that to have good employees, they need to be offered health insurance. This means that less and less businesses are able to offer health insurance to their employees. This also, some believe, prevents a person from even starting their own business to begin with, which doesn't help our economy, since it thrives on small businesses.
There is hope on the horizon, at least in Ohio, where this article is centered. Legislators are proposing bills that help cover children in low-income families across the state, which many see as a positive step in the right direction. This also more confirms my personal belief that, if we are to have universal health insurance coverage, it'll have to be done on a state level if it's to be effective.
The other article we will look at is called "A Crummy Health Bill's Better Than Nothing" on MSNBC in which the author looks at legislation which will help small businesses cope with the rising costs of health insurance and health care. This bill, called The Small Business CHOICE Act, would help make health insurance more affordable for employees by offering tax breaks and buying pools which would help make it easier to find affordable health insurance coverage as well as take the risk out of insuring small businesses in the first place.
These measures will undoubtedly help ease access to affordable health insurance, but to me, they seem like only stopgap measures, band aids that are being put on something that needs much more widespread healing. Hopefully we'll see more positive legislature in this same vein. Until next time, have a happy and healthy day.
The first article, entitled, "Affordable health care elusive for many, though optimism builds" in the Business First of Columbus magazine takes a look at the problem through several viewpoints, such as a business owner, an uninsured small business owner, and an expert, for example. Each of these people have different viewpoints on the health insurance situation in this country, and a lot of them point fingers, mostly at politicians. Many people said that the big hurtles are legislation and financing.
Business owners are particularly feeling the pinch of higher health insurance costs, as many believe that to have good employees, they need to be offered health insurance. This means that less and less businesses are able to offer health insurance to their employees. This also, some believe, prevents a person from even starting their own business to begin with, which doesn't help our economy, since it thrives on small businesses.
There is hope on the horizon, at least in Ohio, where this article is centered. Legislators are proposing bills that help cover children in low-income families across the state, which many see as a positive step in the right direction. This also more confirms my personal belief that, if we are to have universal health insurance coverage, it'll have to be done on a state level if it's to be effective.
The other article we will look at is called "A Crummy Health Bill's Better Than Nothing" on MSNBC in which the author looks at legislation which will help small businesses cope with the rising costs of health insurance and health care. This bill, called The Small Business CHOICE Act, would help make health insurance more affordable for employees by offering tax breaks and buying pools which would help make it easier to find affordable health insurance coverage as well as take the risk out of insuring small businesses in the first place.
These measures will undoubtedly help ease access to affordable health insurance, but to me, they seem like only stopgap measures, band aids that are being put on something that needs much more widespread healing. Hopefully we'll see more positive legislature in this same vein. Until next time, have a happy and healthy day.
