Health Insurance 101
It can be scary to get sick, with the doctor's visits, medication and the feeling that you don't quite know exactly what is going on.
However, possibly more frightening than that is going through all that without the safety net of health insurance to lighten the amount of medical costs you will incur through inevitable treatment and care.
There are roughly 46 million people in the U.S. currently living with no health insurance, and while the government is working on a way to reform the healthcare industry, a new kind of healthcare plan may still be a couple of years away.
For the uninitiated, this may be a good time to get familiar with the basics of healthcare because aside from some its confusing aspects, it's more important to live with health insurance than live without it.
Do I even need healthcare insurance?
Without health insurance, a person or family may be forced to incur the full costs of their doctor's visits and hospitalizations, which can quickly accumulate to a small fortune. Also, it isn't enough to just get treatment when you are sick. Preventative care is another important element of healthcare and could save on costs in the future.
Getting regular checkups and physicals with a doctor within your healthcare network can ensure that you are keeping an eye on your body and maintain optimal health.
Finally, people who are under a health insurance plan will pay less for doctor's visits and hospitalizations when compared to people who are not enrolled in a plan. And given the current state of the economy, isn't the name of the game being fiscally responsible?
But how does this system work?
In a typical healthcare plan, which is called a fee-to-service plan, an enrollee pays a monthly premium (which is like a monthly subscription for a certain service) and when the patient has to visit a doctor or a hospital, the health insurance provider pays a portion of the bill.
The customer pays a lower portion of the bill for the healthcare service, called a co-pay. This may include routine medical visits, visits to the emergency room and dental checkups. Without health insurance, a routine physical can cost as much as $200. With coverage? $20.
Which plan is for me?
Good question and it's one that only you can answer since there's a lot of different factors that go into choosing a healthcare plan.
One thing to keep in mind is a term called "pre-existing conditions." If you had a known illness or injury prior to you signing up for healthcare, it may affect your coverage. Some plans only consider a condition pre-existing if treatment was involved. Other plans may have a wider definition.
After that, it's important to determine what exactly you need from a healthcare plan. Older people may want coverage that includes surgeries and prescription medication while younger people may be more inclined to embrace a plan that's more about preventative care.
Another element to factor in is whether or not you have a certain doctor you are comfortable with or a family doctor who knows your medical history well. Some healthcare plans have specific networks that only allow you to visit certain doctors, while others allow you to see whoever you choose.
The co-pay may be a bit higher for the out-of-network physician, but if it's with someone you trust, it may be worth it.
If you are between jobs and waiting for the start of your coverage from another health insurance, or if you are on strike or laid off, or if you are a seasonal employee or recent college graduate and your need is for only a specific period of time, short term health insurance may be a great option for you.
Who has these plans?
Most people in the U.S. get their healthcare insurance through the company they work for, which most likely has a relationship with a certain healthcare insurance provider.
However, some people like to investigate the kind of coverage a different provider has or may want to have health insurance that isn't tied to their job, in case they leave that company or get laid off.
In that case, some people have employed a health insurance agent to help them determine which public healthcare plan might be best for them.
Staying with the same healthcare plan may also help people avoid experiencing gaps in coverage if they lose their job. Gaps in coverage can be a potentially dangerous situation because you will be solely responsible for any medical bills.
About The Author
Sandra is an experienced health insurance consultant with an immense educational background in the insurance industry. Having worked at a major health insurance agency, a leading brokerage firm, and as a consultant since entering the health insurance industry in 1992, Sandra has acquired an extensive and varied background in the health insurance industry.
by: Sandra Cohen
Getting Covered: How To Find The Right Health Insurance Plan
Posted by gandalf Labels: Health insuranceYou probably have health insurance in Australia, right? So, shouldn’t you make sure that your health and emergency medical costs are also covered when you travel abroad? Travel health insurance covers your medical costs when you travel overseas. Your Australian health cover and Medicare are unlikely to cover you for overseas travel and medical costs overseas can be a lot higher than those you are used to in Australia.
Even if you don’t have regular health insurance at home, you should consider travellers’ insurance to cover you for a medical emergency or accident. The reality is that even normally healthy people often get sick or even worse on holiday. Ever noticed how as soon as the pressure comes off and you get to relax, you come down with the flu or worse? Overseas holidays for Australians generally start with a reasonably long flight. Flying is a great way to pick up a disease before you even reach the resort’s poolside bar!
Having arrived at your holiday destination, there is, of course, the usual risks of a climate you are not used to and local food - again, food poisoning is not just a cliché; it can result in a serious medical emergency if you get unlucky.
Often, your average holidaymaker gets into trouble when they go from a sedentary office job in real life to deep sea diving or skiing on holiday. It seems that we all feel invincible on holiday, and in some cases, the joy of the moment overcomes common sense safety precautions. Or our unfit body is just not up to our athletic ideals!
Plus, things do sometimes work differently overseas; for instance, how many tourists have ended up in the hospital because they forget, just for a minute, that they are driving on the wrong side of the road? It’s particularly easy to forget if you hire a scooter, as is commonly done in the Pacific and some Asian countries. Scooters don’t have an offset steering wheel to remind you that you should be keeping right on the road!
Travel health insurance can help if the worst happens while you are overseas. For most people, it won’t happen, but just because you have never had an accident or a serious illness at home doesn’t mean it can’t happen to you at some point. You should not assume that it can’t happen to you on holiday – unfortunately, it can. Being ill or injured on holiday is bad enough, but you don’t want to return home to a lifetime of debt to pay off the bills!
A good travel health insurance policy is a small price to pay for peace of mind. It will cover you not just for serious medical assistance, but also for English-speaking assistance if you need advice for a condition that is worrisome. Is it a bad cold or malaria? If the worst happens, it will pay for the MediVac home too. If that skiing accident resulted in a broken leg - you may need a first-class seat to get home - travel insurance will normally pay for that too.
Travelling is great fun generally, but sometimes, it’s a bit tough on your health. That’s why travel health insurance is a must have for your packing list.
by: Mark James
The economic crisis is making it hard for everyone to earn a decent living. During the last year, millions of Americans lost their jobs because of the recession. But aside from the emotional and financial consequence of losing a steady paycheck, there are other concerns you need to deal with as well. One of the issues that a lot of laid-off employees are concerned about is their health care.
An employer effectively stops paying for the employee’s health care on the last day of the month when employment ended. It is critical for a person to look for health insurance while he is in-between jobs. This is because even if he finds employment immediately, his health coverage will only restart after 30 days of employment on the first day of the next month.
There is at least a two-month gap that should be filled. In addition, a person can be considered lucky if he is able to find work immediately. Today’s tough economic times have effectively halted hiring in a lot of industries. Below are some alternatives a laid-off employee can look into:
Short Term Medical Insurance – this health insurance plan can range from a single month to three years. It has been specifically designed to fill the gap from one plan to another. This insurance is inexpensive but it does not cover the cost of treating existing medical problems. Another drawback is that it also cannot cover serious long-term illnesses and pregnancy. But those with predictable expenses such as prescription and outpatient therapy should consider this insurance.
COBRA – if you worked for a company with 20+ employees, you are allowed to keep your health insurance for up to 18 months at your own expense. Because of its high monthly premium, a lot of people avoid this option unless they have an existing condition that requires ongoing medical care.
Individual Conversion – this has the same results with the COBRA option but it is designed for the employees of smaller enterprises. Individual conversion allows employees to convert their program from a group plan to an individual plan without the need to provide eligibility requirements.
These three options allow employees who had been laid-off to enjoy medical benefits until their next employment.
by: Bernz Jayma P
Since Danna Walker lost her $37,000-a-year salary, the government’s recently enacted 65% break on Cobra health-insurance costs would still mean paying $476 a month for continuing coverage.
With little more than her unemployment check of $688 every couple of weeks as the family’s only predictable income, the Walkers say they can’t afford it, the New York Times reports this morning. So they’re searching, with little luck, to find something more affordable that would cover their 21-year-old son, whose metastatic testicular cancer is in remission, and provide him with the costly tests he still needs.
The son, Jake Walker, has already gotten nearly $2 million of care, almost all of it paid for by the insurance plan his mother had through her former employer, DHL. Now they’re being told that without coverage, they’ll have to pay upfront for his care at Houston’s M.D. Anderson Cancer Center, which the family credits for the son’s remission and where they’re applying for the charity program. (He got last-minute relief from making an advance payment last month, though the family says it can’t pay the $1,507 bill.)
The hospital told NYT it was “good financial counseling” to suggest Jake get his tests elsewhere; one of the criteria for charity care is whether a family can get comparable treatment somewhere else. (See more on controversy over upfront payments there.)
It’s an example of how much tougher it can be to pay for care without an employer in the mix. Due to his illness, Jake doesn’t qualify for an individual plan on the open market. He’s too old for Texas’s Medicaid program for kids, and it’s extremely difficult for adults to qualify for Medicaid in the state. Cobra coverage is costly, as is coverage through the state’s “high-risk pool” for patients who can’t obtain insurance on the open market.
“You feel like you’ve been kicked to the curb,” Jake’s mom told NYT. “It’s like, ‘As long as you have insurance, we’re willing to go over the moon to see you and make sure that everything is taken care of.’ And the minute you don’t, they don’t want you.”
by: Chad Levin
Individual Health Insurance - Advantages and Disadvantages
Posted by gandalf Labels: Health insuranceIn a country like the United States, if you do not want to be buried in debt; you need a good health insurance for yourself and your family. Whether you are an employee or self-employed, it is necessary that you have a good health insurance coverage to cover your medical bills. However, there is no unique health insurance plan good for every one; benefits and costs vary from an individual to another (due to age, medical condition, etc.). To make a good choice, you need to know what benefits you are looking for, and examine each plan to find the one that best responses to your needs.
Although you have many options in choosing your health insurance, finding the right plan can be difficult. In general, individual health insurance is a form of contract between you and an insurer (insurance company )to repay all or almost all of your medical bills, which may includes hospitalization, medications, dental care, seeing a specialist, and certain therapies (radiotherapy, chemotherapy, etc.). Whatever your needs, you will most likely have to choose one of these plans, Fee-for-service, HMOs (Health Maintenance Organizations), or (PPOs) participating provider organization.
Fee-for-service - also known as indemnity plans, is a type of insurance plan where you, patient, have to pay all medical expenses out of your own pockets, and then request a reimbursement from your insurance company. These types of plans have their advantages and disadvantages.
Advantages: they offer more flexibility in choosing your own doctor. You can decide the time to see your health care provider, and what type of treatment you want; as long as you remain in the limit that your insurer will repay.
Disadvantages: in indemnity plans, most doctors require upfront payment, so you have to submit claim forms to the insurance company to receive a reimbursement. That requires paper work, and sometimes many phone calls. Fee-for-service plans offer limited benefits; they do not cover annual physical exam and educational programs.
HMOs (Health Maintenance Organizations)- Health maintenance organizations (HMOs) are managed care plans that offer health care coverage to their members through hospitals, doctors, and other health care providers that are in their network. That is, having their service, you are limited to members of their network.
Advantages: unlike Fee-for-service plans, you do not have to pay up front; although some of them require a copayment. You do not need to submit forms after forms to receive reimbursement. In addition, HMOs usually charge a lower cost.
Disadvantages: you can use only health care providers who are associated with the organization. Most HMOs (Health Maintenance Organizations) tend to disapprove certain treatments. Although some HMOs accept their members to see physician or specialists who are not in their network, they often charge you additional costs.
(PPOs) participating provider organization - also known as Preferred Provider Organizations, is a form of managed care organization of physicians , hospitals, clinics and other health care providers that sign a contract with an insurer to provide health services to its member at reduced rates . Usually, PPOs cost more than traditional HMOs, but offer more options to their members.
Advantages: Preferred Provider Organizations provide more flexibility to their members; they have a bigger network of doctors and hospitals. You can take service from health care providers that are not part of their networks (certain charges often apply). You pay Lower copayments for care from primary care physicians. In addition, you do not need a referral to see a specialist.
Disadvantages: PPOs cost more than traditional HMOs. You will more likely to make co-payments (usually from $10 to $30) when you visit a health specialist.
Do some health insurance companies offer better service to their members than others?
Yes. Some insurers offer better service to their members. To learn more about health insurance companies that provide satisfying individual health insurance plan in the US, visit our top rated list visit http://www.careand.com
by: Remy Vixama
Throughout the current economic crisis, the insurance sector has been struggling, with many people who are feeling the pinch choosing to cut back on many types of insurance.
The life insurance sector has really felt the effects of shrinking household budgets, as has the home contents insurance industry and the travel insurance business.
It seems that when struggling families look at their outgoings, insurance is one of the first things to go, seen as an unnecessary luxury which can easily be cut out.
What many are not thinking of when making this choice, is the long term effects. If the worst should happen, families will soon regret cutting out insurance.
However, despite all this woe for insurance in general, it seems that the health insurance industry is doing well during these difficult times.
Bupa, Britain's largest private health insurance provider, has released figures which show an increase in the number of customers by 2 per cent and Simplyhealth reveals that sales of HSA's employee paid Health Cash Plan were up 25% in the final quarter of last year.
For many, private medical insurance really feels like a necessity, with speedier access to healthcare services at the top of most users agendas.
Despite the NHS hitting their target of a minimum wait of 18 weeks for treatment, research has shown that 80 per cent of people think that this is still too long to wait.
49% of respondents believed hospital waiting times should be less than one month, while, 69% of people were concerned their health could deteriorate further if they went without medical attention for as long as 18 weeks.
Eamon Hynes, protection insurance expert at BeatThatQuote.com, says, "Once consumers experience making a claim under a PMI policy, they generally have an immediate understanding of the benefits of the policy and why they need it.
"Many other forms of insurance are much more intangible and are therefore easier to let go when money feels tight. However, people can more easily perceive the advantages of private medical insurance and may feel a stronger, more emotional pull towards these types of policies."
Others have been concerned by standards of cleanliness in NHS hospitals, so have decided that in order to have access to a high standard of care they must take out private medical insurance.
David Royle, Chief Executive of CS Healthcare said “The UK public is sometimes presented as being unconcerned about their health, which is clearly not the case. However, the fact that people are saving or prepared to break into their precious savings, especially in today’s economic climate, signals that there is not only concern over the NHS’s ability to cope, perhaps unfairly, but also confusion about the role and cost of PMI.”
He also pointed out that many customers over-estimated the cost of private health insurance, with some estimating the cost to be three times more than the actual cost of private care.
Royle continued: “PMI can be a low cost route to peace of mind when it comes to medical treatment. However, as an industry, we need to break down misconceptions over cost and make our products clear and easy to buy.
by: Carys Robshaw
