Tuesday, December 6th, 2011 | Kevin Sloan | |
The purpose of health insurance is to cover and reduce the cost of health-related expenses. A good health insurance plan saves you money and protects you from having to pay in full for high medical expenses, now or in the future.
You may no longer be covered by your employer or may be self-employed, which puts the burden of getting health insurance coverage squarely on your shoulders. It may seem like a maze of information, but here are some tips to make it easier to find the best coverage for you.
To pick the health plan that’s right for you, balance the cost of the plan (the premium, usually paid monthly) with the level of coverage and the amount it saves on your medical expenses. Consider a plan’s deductible (how much you pay in expenses before coverage starts), co-payments (the fixed amount or percentage you pay of the full cost of products or services) and out-of-pocket limit (also referred to as out-of-pocket maximum, the most you may pay out-of-pocket for healthcare costs in the year).
Evaluate Your Needs
So what is the “best” health plan? It varies for each individual. The best health-care plan for you depends on your health, medical needs, level of coverage desired and plan cost.
- Examine your current health expenses and others you expect to incur. Where are your health-care dollars going currently: doctors, drugs, procedures, etc.? Based on this assessment, decide which areas need strong coverage, and which can be low- to no-coverage (so you only pay for what you need).
- Research plan coverage levels and costs for your specific needs. For example, someone who requires regular medications for a chronic condition may want a plan with full pharmacy coverage and low co-payments for drugs. A person who is otherwise healthy but planning to have knee surgery should closely check the policies and rates for major medical procedures.
- Then consider unforeseen medical expenses, small and large. It may be worth paying a little extra now for safety from future unexpected (and high) bills, or even peace of mind.
Research Your Options
Different health plans and configurations can protect you and save money in varying amounts. Use online tools such as health insurance comparison websites to see a quick and easy overview of several plans side by side. You can filter plans by cost and even compare copay amounts and charges for common medical expenses.
Be a well-informed consumer. The consequences of ill-fitting health insurance can be extreme. Based on a cross-section of plans, the average family out-of-pocket limit is $4,033. However, on some plans, you can be on the hook for $30,000 before coverage takes care of the remainder. Always make sure you know what’s covered, what’s not and how much you may need to pay in any situation.
There are many resources online to help you find the best health plans, so research thoroughly and make an informed decision about your health and future. Your family and your wallet will thank you.
Thursday, October 27th, 2011 | Carrie McLean | |
Now more than ever, you need to take the time to review your health plan to ensure you’re not leaving money on the table. Going on “auto-pilot” during open enrollment season can be costly mistake. A new survey from Kelton/eHealthInsurance shows that workers tend to be lethargic about selecting their benefits for the following year and this can bite them in their wallets. Here are some tips to help you save money on your health insurance.
1. Review all your options. Review every plan available from your employer as soon as you receive your open enrollment packet. For good measure, check your 
options in the individually-purchased health insurance market, too. While group plans may still provide more robust coverage and will cover pre-existing medical conditions, individually-purchased plans may offer a stronger alternative than they did a couple years ago.
2. Shop smarter. If possible, enroll in a plan that only covers the services you need: It may mean a lower monthly premium. For example, a plan with robust maternity coverage may not be the best match for single guy. And if you don’t care about brand-name drugs, see if you’re offered a plan that covers only generic drugs instead. Choosing a high deductible plan may be smart for some individuals and families because it typically reduces monthly premiums, but be prepared to pay the amount of the deductible in the coming year as health-care needs arise.
3. Consider a Health Savings Account. Many employers offer a high-deductible option with an HSA. Some may even contribute to the HSA for you. Depending on your health-care usage, this can be a good option for saving because money can be deposited pre-tax in your HSA to cover unexpected health expenses not covered by your health plan. Unused savings can also roll over year-after-year until retirement.
4. Mix and match, if appropriate. Depending on your own and your family members’ health and how much an employer contributes toward dependent coverage, it may be less expensive for certain family members to be on a separate, individually-purchased health plan. Do the math on separate policies if there are special needs. It’s easy to price individual and family plans online. But remember that it’s possible to be declined coverage for an individually-purchased plan based on an applicant’s medical history, so don’t cancel an existing line of coverage until you’re approved for a new one.
5. Look for innovations in the individual market. If you can no longer afford employer-based health insurance, or if your employer plan doesn’t meet your needs, look for some new options in the individually-purchased health insurance market. Carriers in some states are offering incentives for you to avoid over-utilizing your coverage. For example, some may substantially reduce your deductible next year if you don’t use up your full deductible this year; others may incentivize healthy habits by sending you gift cards and other rewards for positive health outcomes.
6. Track your health expenses. Regardless of what plan you choose for 2012, be sure that you are tracking all of your health care costs including insurance premiums, copayments and drug expenses. This will give you the knowledge you need to evaluate your health insurance choices for 2013.
Carrie McLean is an open enrollment specialist with eHealthInsurance.com.
You just celebrated your 65th birthday. It’s time for you to enroll in Medicare, but do you understand the various components of the Medicare program? Here are some guidelines from the July/August issue of the NYSBA Journal.
Medicare Part A is hospital insurance. It helps cover inpatient care in hospitals and skilled nursing facilities, hospice and home health care.
Medicare Part B is medical insurance. It helps cover doctors’ services, hospital outpatient care and home health care, as well as some preventive services to help you maintain your health and keep certain illnesses from getting worse. If you are currently employed and covered under your group insurance health plan, you don’t need to enroll for Part B now.
Medicare Advantage Plans (also known as Medicare Part C) are health plans run by Medicare-approved private insurance companies. These plans are similar to health maintenance organizations (HMOs) and preferred provider organizations (PPOs). They include Part A, Part B coverage, and usually other coverage like Medicare prescription drug coverage (Part D), sometimes for an extra cost.
Medicare Part D is the prescription drug option run by Medicare-approved private insurance companies. It helps cover the cost of prescription drugs and may help lower prescription drug costs and help protect against higher costs in the future.
So if you’re a working senior, what should you do when you turn 65? Should you maintain private health insurance or switch to Medicare? The decision is not an easy one, particularly for those enrolled in PPO plans because their doctors are not “in network.” The decision is further complicated by many factors, including analysis and comparison of the following costs:
Employer Plan:
• Employee premium cost
• Policy annual deductible
• Insurance company reasonable charge
• Co-insurance (Reimbursement is typically 80% of reasonable charge, but to keep costs down some employer plans now only allow 70% or 60%)
Medicare:
• Part B (physicians) and D (prescription drug) premium cost
• Medicare Part A, B & D annual deductibles and the “gap” for Part D
• Medicare reasonable charge
• Co-insurance (Medicare reimbursement is 80% of reasonable charge)
• Medigap policy premiums
Sound confusing? I turned 65 last year and had to go to my group health insurance agent to determine what worked best for me. This is a very complicated and important decision, and you don’t want to make mistakes that may have unwelcomed repercussions.
Contact your agent, financial advisor or benefits manager at work for proper guidance. If you don’t have someone to turn to, look for an agent or advisor on LIFE’s website here.
Wednesday, January 26th, 2011 | Joel Ohman | |
What would happen if you were to find out that you had cancer six months from now and you didn’t have any health insurance coverage? Let’s imagine for a moment that you went to your doctor for you annual checkup feeling great, and she tells you that have cancer. It’s expensive but definitely treatable. The cost for the entire course of treatment is $375,000, since you don’t have a health insurance policy. Would you be able to write that check without batting an eye? Would you be able to comfortably work out a repayment schedule with the hospital and assume the payments of what would be essentially an additional monthly mortgage payment? If the answer to either of those questions is no, then you need a comprehensive
health insurance policy, don’t you think?
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Yesterday the very first provisions of the Patient Protection and Affordable Care Act (PPACA) became effective.
While there is plenty of time to debate the merits of which plan provisions are good for American consumers and which provisions insurance carriers prefer or dislike, make no mistake, the rhetoric has only just begun.
Humor me, while I explain. One such provision of PPACA is that no children under age 19 shall be denied any health insurance that they apply for. Sounds like an easy fix that we all can agree on, right? On the contrary, in my home state of Tennessee, every major carrier that writes individual health insurance policies has announced this week that they will no longer accept applications for children only.
Why? While the law demands guaranteed access, it failed miserably to give carriers and consumers access to the so-called “state exchanges” before the Sept. 23 deadline. Without these safeguards in place, a carrier could be forced to accept an application on a child as he or she was in the ambulance on the way to the hospital. Without the rest of the law taking effect simultaneously with the Sept. 23 guaranteed access provision (complete with required and established state defined “open enrollment periods” and a sufficient penalty for those who chose not to buy coverage), the unintended consequence is that carriers are running for the hills.
Should someone be able to buy fire insurance on their house as the fire trucks are pulling up? Of course not! Without the safety net provisions of the full law, you can see why the carriers are reacting the way they are. This makes it nearly impossible for even a healthy child to secure coverage with an individual health insurance policy. Now, a whole family will have to apply together, and risk assessment and underwriting will be reviewed for each family member. (Of course, if you get your coverage through your employer, this lack of access doesn’t affect you, as you are covered by your group plan.)
There will be lots in the press about how horrible this is. Just remember, there are two sides to every story. My sincere hope is that regulators and carriers will find a way to correct this “unintended consequence.” I suspect there will be many more to come.
