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Posts Tagged ‘Healthcare Insurance’

‘Tis the season…for open enrollment in healthcare, from company benefits to Medicare. Unfortunately, most of us won’t be getting many sweets in our stockings this year. What we can expect to get is higher deductibles, higher out-of-pocket costs that will surely continue rising, fewer options in doctors or networks, more aggravation and longer waits.

The impetus behind increased costs to employees is simple: increased costs across the board for everyone. Employers can not absorb the increased costs in health care. They are being pushed into a corner with expenses. The only viable solution is to pass on the costs and encourage their employees to manage their own health care in better ways.

Some firms may offer financial incentives to stop smoking, start exercising, lose weight, what ever it takes to drop the increased risks of unhealthy living. If you are lucky enough to work for one of these companies, by all means, take advantage of everything you can to improve your wellbeing. After all, your boss will not be caring for you if you become unable to work from illness, you will have to manage yourself. You will be paying the costs for the consequences of living a sloppy lifestyle. To avoid calamity and unmanageable bills, take action now to prevent more problems. This is the message your employer will be sending.

Some people were caught flat-footed when employers changed to high deductibles mid-year. It is very difficult for a family to swallow a deduction of several thousand dollars. This reminds me of when my children were young and we had to HMO in our town. Every medical visit, prescription, and procedure an required upfront payment and then we had to wait for the reimbursement of 80% or less. Strict budgeting is necessary for families with young children who might see a doctor more frequently than someone who is older. This is a system requiring tough choices for families. And for employers.

People have to pay more attention to choosing their health care plans and reading the information on how the plan works. You might want vision insurance, but if your premiums are lower without it, leave it on the table. Unless you have serious eye problems, you can get an eye exam and glasses at discount retail places such as Eye Masters for less money than the premiums on vision insurance in most cases. This is not true for all people, but it behooves you to check it out. Do not waste precious premiums dollars on something you can buy for less elsewhere. The same is true of prescriptions: ask for generics, join a prescription plan at your pharmacy, or use a discount pharmacy. Be a smart consumer with health care!

The news will continue to get worse. You can expect prices to rise next year. You will have to find out how you can use Flexible Spending Accounts or Health Savings Accounts to complement a higher deductible. Expect fewer options in the future. If you are wondering why the squeeze, consider the following. If employers are pummeled by health care costs, they might decide to eliminate health care benefits for all employees. This could be especially true of small businesses that lack sufficient income to offset rising costs. The new health care rules require everyone to obtain health care insurance. If employees can not obtain health benefits at work, they will have to look elsewhere. Cynics might say this is a great way to force people into a healthcare system under government control. If it looks like a duck and quacks like a duck…

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Healthcare provision is known to eat into the budget of most countries as they strive to provide healthcare for its peoples as it is one of the responsibilities of the governments. To ensure that the peoples’ health is catered for, healthcare insurance is provided. This is insurance cover that is offered to a person to cater for their medical expenses. This type of insurance is either provided by the government or private organizations.

Healthcare insurance provided by the government mainly receives it premiums from all the insured people. Most people who are employed are mainly registered to a certain health scheme that provides the healthcare cover. Certain deductions are made on their pay slip which is directed to this scheme which provides healthcare cover to the person. Even with this cover, one can take an additional or private cover for other related health matters not covered.

Other than the government healthcare cover, private organizations also provide private healthcare insurance. Private insurance mainly covers for medical costs for a certain range of health problems and only for treatments done in private clinics and hospitals. This is unlike government health insurance which covers for costs incurred in public hospitals.

With the increasing demand in healthcare, many companies have come up that offer healthcare insurance to anyone who is willing to be covered. Each company has something unique to offer and this makes it difficult for a person to know which company to take an insurance cover with. To avoid such situations it is advisable that as the person wanting to take a cover you should do research on the best and most reputable insurance companies that will offer you exactly what you are looking for.

With life expectancy observed to have increased, insurance providers have come with healthcare packages that offer long term cover which means that if you have such a cover, your medical expenses even at an older age will still be catered for. This means that all you have to do is take the healthcare policy and be making premium payment as agreed on the policy.

Having a healthcare cover ensures that you have security as the insurance lasts a lifetime and you can use it even in your old age. It also ensures that you do not encounter any financial crisis and you get affordable healthcare. This type of insurance also allows for an older person to choose if they want home care or be taken to a nursing home.

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As a nation we are growing much older and therefore requiring much more medical attention as we are reaching ages that leave us vulnerable and prone to illnesses. And everyone who knows someone who has dealt with the NHS can explain the large queue times for many different kinds of treatment and operations added with the service which can be found to be quite poor.

Many do not realise the advantages and benefits of having private health insurance can offer. This can be down to how little of us within the UK use it and therefore not knowing the benefits that are created. Having the reliability and support that health policies can offer will not only help create assurance for an individual but for families with young children, being able to keep everyone healthy at all times and making sure that if there is something that happens along the line the care is there.

The advantages of having medical insurance are plentiful, such as:

- Access to regular health check-ups and screenings. Which can be paramount when becoming older and more prone to many illnesses.

- Peace of mind. Because you’ll never know when illnesses, diseases and possible breakages may happen it can help knowing that if anything does happen that instant care is available.

- Long-term savings can be made if any serious illness was to occur, that involves extensive periods of treatment.

- Increased privacy and space during treatments.

- Greater access and choice over hospitals and consultants with increased flexibility on times.

In recent years there has been a rise in websites that compare health insurance quotes online. As a result, many individuals or families that once could not afford health insurance can now achieve greater savings and value for money across all of the current insurance providers. Allowing for tailored quotes that can help create packages with different levels of cover.

Another option if currently the premiums are out of your price range and budget is the option to choose one of the many discount schemes that many current insurance providers offer. That can help bring a premium within your budget. By paying an excess, can reduce the overall price if the first part of a claim is paid. Also, there is co-payment. This reduces the premium by choosing to pay a percentage of any claim made. Plus many more.

It is highly advised that research is carried out before taking any kind of medical cover. An understanding must be made of the policies under offer and that each policy name may be different from each provider. To ensure that the correct policy is chosen, that best fit your individual or family requirements.

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.”

Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they “want” and the benefits they really “need.” Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.’s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or “ripped-off” by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, “I have to run my business, I don’t have time to be sick! “I think I have gone to the doctor 2 times in the last 5 years” and “My insurance company keeps raising my rates and I don’t even use my insurance!” As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals “BASIC” questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let’s see how many YOU can answer without looking at your policy.

1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-”Basic Blue”)

2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)

3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)

4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)

5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)

6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)

8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).

9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).

10. Do you have to pay a separate deductible or “access fee” for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health’s “CoreMed” plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit “caps” or “access fees” for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit “caps” could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 “access fee” per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you’ve read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn’t answer all ten questions don’t be discouraged. That doesn’t mean that you are not a smart consumer. It may just mean that you dealt with a “bad” insurance agent. So how could you tell if you dealt with a “bad” insurance agent? Because a “great” insurance agent would have taken the time to help you really understand your insurance benefits. A “great” agent spends time asking YOU questions so s/he can understand your insurance needs. A “great” agent recommends health plans based on all four variables; wants, needs, risk and price. A “great” agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a “great” agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a “great” agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a “great” agent. If you were able to answer the majority of questions, you may have a “good” agent. However, if you were only able to answer a few questions, chances are you have a “bad” agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don’t be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don’t feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the “fine print” in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can’t understand something, or aren’t quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, “Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a “captive” agent or an insurance “broker.” “Captive” agents can only offer ONE insurance company’s products.” Independent” agents or insurance “brokers” can offer you a variety of different insurance plans from many different insurance companies. A “captive” agent may recommend a health plan that doesn’t exactly meet your needs because that is the only plan s/he can sell. An “independent” agent or insurance “broker” can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use Ebay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make….your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state’s Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn’t being honest with you, your state’s Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: “If it sounds too good to be true, it probably is!” and “If you only buy on price, you get what you pay for!”