What health insurance is best for you? The answer to that question depends on your understanding of what health insurance is and what your particular needs are. First, it is not discounted health care. Generally speaking, insurance is a kind of risk management. Your premium is your monthly payment to the company to assume the risk of expense. In one sense, this is a sort of gambling. In this case, the health insurer is betting that you will not need care, and the premium you pay every month is your hedge to offset the consequences should you face large medical expenses. Your health insurance benefits are what you get when the company “loses” and has to pay out.

Now that we know that a health insurance policy is a way to manage risk, it is important to understand that there are a number different kinds of agreements, or policies, available depending on your needs. Generally, the subject of health insurance brings to mind questions about doctor and hospital care available for individuals and families through privately purchased policies, and/or employees through an employer group health insurance plan. When choosing a health insurance policy, you (or an employer) must decide what your tolerance for risk is and how much risk you want managed. To that end, there are many private companies selling insurance plans.

Some examples of household names that you are sure to recognize are Aetna, Blue Cross Blue shield, Humana, United Healthcare, Sterling, and Mutual of Omaha. Insurance companies are are also known as “payers” because they are responsible for paying out on your insurance claims when need arises. Though there may be a relatively small number of companies with instant name recognition, there are literally hundreds upon hundreds of health insurers, and these are all separate payers offering different policies with different selections of benefits catering to different kinds of insurance needs. There are so many because health insurance is largely managed by private insurance companies regulated by Federal and State laws. Single payer health insurance generally refers to a system where the government manages and pays on all insurance claims. Medicare would be an example of a single payer insurance managed by the Federal Government.

Now, the issue of which health insurance is best for you is answered in part by what specific health care needs are in question. There are many different kinds of policies, and the choices can be overwhelming. For example, there is disability insurance, accident and dismemberment insurance, temporary health plans, continuation of coverage insurance, hospital only insurance, catastrophic coverage, disease specific, long term care, supplemental, and fee for service and managed care polices.

How you choose a health insurance policy depends on your assessment of your costs, needs, and circumstances. If you need doctor and hospital coverage for specific period of time, them you might seek a temporary policy from Blue Cross or Humana, for example. If you need family health coverage, then you might, hypothetically, seek a comprehensive medical plan from Wellmark, Aetna, or John Deere. Some people take out a policy, to provide another example, from United Healthcare (or some other insurer) to pay only in the event of hospitalization as result of cancer. Other people, who work in a high risk environment, might take out a policy to pay in the event of dismemberment occurring under certain, specified circumstances. The policies can be quite specific and written to answer your specific needs.

About this Author

To find out more, easy to understand information about low cost, individual and family insurance coverage, group health plans, and Original Medicare and Medicare Advantage options, please visit http://www.find-health-insurance-online.com.

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With the rising cost of healthcare, more and more Americans’ are no longer provided health coverage through their employers, if your healthy that may not be a bad thing. Depending on your employer’s health insurance cost, an individual policy may cost less. With an individual policy you gain more control over your own benefits and cost, while with group you have very little say in the decision. Individual health insurance is not tied to your job and can provide you with piece of mind later if you lose your job or become un-insurable. The ability to reevaluate what’s important to you when needed can possibly save you hundreds of dollars. As the economy causes more employers and more people to tighten their budgets, it may be time to look at your health coverage differently, before it’s too late.

Group health insurance can be expensive in comparison to individual, and in the individual insurance market pre-existing health conditions can cause denial of coverage. By law no one in a group insurance plan can be denied coverage due to medical conditions such as heart surgeries, diabetes, bi-polar etc. and having to insure these individuals creates a high financial risk to the insurance carriers. To help with those cost associated with the risk, the State of Missouri allows insurance carriers to increase premiums as much as 107% over the preferred rates for healthy people.* Rules vary state to state so check with your individual states’ department of insurance. Medical underwriting determines the medical risk associated with the group. Premiums are then increased accordingly and all group members pay an equal cost for these medical conditions, not just though with the conditions. Evaluating the percentage your employer pays for you and your family’s health insurance, plus the portion you pay, are all important in determining if an individual policy would be less or more favorable. Your family’s portion of coverage could be drastically more expensive if you are pay 100% of the premium yourself and your group has lots of health conditions. Insuring family members on a separate family policy has become more common as families try to save.

With group insurance you have less control over deductibles, co-insurance and benefits unless you are the owner or decision maker, while with individual insurance policy the choice is yours. What one person can afford, another may not be able to. This can not always be taken in to account during the decision process when it comes to group health insurance. Needs may vary from one person who visits the doctor weekly to another who may only see a doctor every few years. Why pay higher premiums for benefits you might never use? Control over your money and your health for your individual situation can be maintained easier through an individual plan, not through a group.

Employer paid insurance benefits can be nice but, what if you lose your job? Your employee health benefits are only good while you are employed. COBRA could be available but you are 100% responsible for the health insurance premium. On COBRA you are responsible for the portion your employer has been covering. Another scenario to consider is what happens if during your employment you have had open- heart surgery, was diagnose with diabetes, had a severe car accident or can’t work? Your only options would be COBRA if there is an option and only during the allowable benefit period, a HIPPA plan, state option where available, or to go without insurance. The Missouri Insurance Health Pool is the state of Missouri’s resource, but it is very expensive and has limitation. With an individual plan you own it for as long as you pay the premiums. If the premium is considerably less than your group insurance it could be easier to pay.

Just as group insurance costs are on the rise, so are the individual insurance costs. Premiums do increase with age and your area’s claims history, not by your personal insurance usage with individual coverage. Insurance carriers are constantly battling for business and along with this battle they will bring out new plans, lower rates or both frequently. As long as you remain healthy, your health policy should be re-evaluated annually to help save you money. An independent agent’s job should include providing you with annual updated quotes, and most carriers should be available through the agent for honest comparisons. Individual policies can not be affect by other health conditions and/ or decisions, but are based on you alone while allowing you some freedom of choice.

Escalating insurance costs are currently causing more business’ to cut benefits or eliminate insurance all together. Consumers are also trying to cut their own cost as our economy brings more worry, what better time to save money than now? Evaluating between your employer health insurance options or purchasing an individual insurance policy could save you hundreds of dollars annually. Investigate all options available to you and then call an independent agent for a free second opinion. Most agents are happy to sit down, help educate you and give you an honest comparison of what is available for your situation. Make sure to ask all the questions you may have, after all you have nothing to loss and only money to gain.

About this Author

Sandra Reeves, owner of The Reeves Group in St. Charles Missouri, is an independent insurance agent who specializes in health, life and Long Term Care insurance. Educating consumers on insurance is not just a job but a pleasure with us. Visit our website for our monthly newsletter at http://www.thereevesgrp.com Resources used for this article are: *Missouri Department of Insurance website at http://www.insurance.mo.gov including articles found at this site- “Options after you health insurance is terminated” and Small Business Health Insurance”.

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Understanding Health Insurance

This article is written to assist consumers sift through multiple options, plans, exclusions and summaries of benefits and understand what Critical questions you should ask when researching health coverage. Finding the most beneficial health insurance plan to meet your unique and individual needs is difficult. This guide will help consumers understand the basics of health insurance and what to look for when comparing plans.

14 Costy Mistakes You’ll Want To Avoid

1-FREE – Do You Have a “30 Day FREE Look Period?” Can you get your $ back if you are not happy?

2- DEDUCTIBLES: How many deductibles do I have per year? Some plans will have more than 1 deductible per person per year!

3- NETWORK RATES: Prior to your deductible being met, will your insurance company extend their discounted network rates to you? Example: Insurance Company A – 5 stitches to finger – Total cost $2000, patient responsibility, $800, or Insurance Company B – 5 stitches to finger – Total cost $2000, patient responsibility, $2000. (no network break).

4- NEGOTIATED RATE: What is the AVERAGE negotiated rate? (Sometimes referred to Network Rate – very very important!)

5- UNCLEAR TERMS Is your $100 “co-pay” for an Emergency Room visit REALLY $100? Some companies the $100 copay is more like a fee AFTER your deductible, and you’ll still pay the co-insurance and the $100.

6- LIMITS on benefits, for example: $500 limit or $250 limit on Emergency Room expenses. $50 limit on Dr. Visits. Once the Limit is reached, YOU pay everything else out of pocket. $500 limit on hospital expenses per day (quick way to bankruptcy!)

7- PREVENTATIVE – Will you have to meet your deductible, or do you have a 1 year waiting period for preventative? Do you want to wait 1 year before you can have your female exam, or a mammogram?

8- TRAVEL – If you are out of state, are you covered for illnesses? If you eat something that doesn’t agree with you and become very sick and need a doctor, will you be covered? (Not just life threatening emergencies.)

9- RATE INCREASES – I am buying a “fixed rate”. Ask yourself if it makes sense to pay extra over the next 2 – 3 years for a fixed rate? Make sure your rate is set for at least 12 months but does it make sense to pay in advance for a fixed rate? Sometimes plans will naturally go down in price, so does it make sense to pay extra to have a fixed rate?

10- SUPPORT – After I buy this plan, MAY I CALL MY AGENT’S DIRECT LINE with billing issues, or plan questions, or technical problems, or claims questions or concerns of any kind?

11- EXCLUSIONS – Read the “Exclusions” in your plan. Are the exclusions available for you to read? Is there an exclusion that you cannot live with? For example: exclude well baby visits. Is this an exclusion that you didn’t catch in the plan details?

12- MAJOR MEDICAL plans are designed to pay for MOST of your medical expenses when you become ill or injured. You’ll want a Major Medical plan from a reputable company that has “Credible Coverage.” Discount plans or Limited Medical Plans are NOT designed to protect your losses like Major Medical plans are. They are marketed as “Insurance,” but you MUST ask, is it a Credible Coverage Major Medical plan?

13 – MATERNITY – Maternity plans. Do your homework. Does your plan have an outrageous deductible for maternity? Do you have a waiting period of 12 months, 24 months, or more? How many doctors do you get to choose from “In Network” that can deliver your baby? Are you happy with the choices of Doctors in the network that will deliver your baby? What if your doctor is not on-call the night you go in for delivery?

14- MEDICATIONS – Is there a limit on how much the insurance company will pay for medications. If you become very ill, this could be a very big problem. Do your research, ask questions. Do you have a deductible on medications?

*Did you know that key information about how coverage works is not always disclosed? *When comparing plans, is the language confusing? Why is the language confusing? *Did you know that many consumers compare prices of health insurance plans, but cannot always tell if they are comparing “apples to apples.”

How to avoid Medical Bankruptcy!

According to a Harvard Law and Harvard Medical School study, they found that ½ of all bankruptcies are caused by illnesses and medical expenses. If you are a breadwinner for yourself, or breadwinner for a family or spouse, and the breadwinner gets sick, you may loose your medical coverage, and a way to pay for your day to day expenses.

When you are shopping for a health plan to protect yourself financially from medical bills and bankruptcy, there are many things to consider. Probably the most important thing is to consider is what “Type” of plan you are getting. There are several types of health plans that are available. If you buy a plan that is not “Underwritten” and is “Guaranteed Issue” you are not buying a Major Medical Plan. Major Medical plans will go through a process called “underwriting.”

Some plans will pay a certain dollar amount for a procedure, or a certain dollar amount per day while in the hospital. IT IS CRITICAL you understand the implications financially if choosing a non Major Medical plan. Your chance for greater personal losses including Bankruptcy exist with non-Major Medical plans. If you are shopping price with health insurance, and you decide on a discount or limited liability plan, YOU HAD BETTER UNDERSTAND WHAT YOUR RISKS ARE if you end up needing to use that “insurance.”

Major medical plans are designed to cover most of your hospital expenses if you become hospitalized.

Do you have a disability plan? This type of plan will pay your day to day expenses if you loose your job due to an injury or illness. This should be a very important consideration when getting health insurance. If the breadwinner loses his/her income while injured or ill, how will the day to day expenses be paid for?

The 6 costly misconceptions about Health Insurance

1 – I don’t need medical insurance, I’m a healthy person, I eat right, exercise and take care of myself. This is risk-taking. You are gambling your financial future.

2- I’m not getting insurance because There is no benefit before my deductible. Some Major Medical Plans will A) extend their network rates to you before the deductible is met, but not all. Another benefit before your deductible is met is B) the copays for Dr. Visits and C) Copays for Prescription coverage. Again, check the individual plan.

3- If I get sick, or now that I’m pregnant I’ll get insurance. Once you are ill or pregnant, depending on the illness, you may or may not be eligible for health insurance. Certainly once pregnant, you will not be eligible for an individual plan. The insurance company will always reserve the right to underwrite your medical condition and elect to take you on as a risk, or not. You wouldn’t expect to run out and get auto insurance after you’ve banged up your car and have them pay for it. For this reason, it is important to not let your Major Medical insurance lapse for more than 63 days.

4 – I will get stuck with a bill that I thought should have been paid for, or the insurance company should have paid. Here again, you must do your homework on the plan you intend to purchase. Look for Limits, deductibles, exclusions, co-pays, and understand these details. Also, if you come into a plan with pre-existing conditions and did not have continuous “credible coverage,’ you can expect to pay for your pre-existing conditions for 1 full year.

5- I want excellent care at a cheap price. If you want Major Medical, shop between the competitors, and get the most for your money, but don’t expect the same benefits in a discount plan as in a Major Medical Plan.

6- I’m waiting for the President to take care of this mess. It is not a good idea to wait to purchase medical insurance ever!

Important to Know:

Many People Feel That Health Insurance Companies are Greedy and Corrupt According to the Wellpoint Institute of Health Care Knowledge:

“Popular theories suggest that health insurance premiums are driven by an aging population, excessive insurer profits or medical malpractice. Objective research, however, clearly indicates that these factors have a minimal impact on the high price of health insurance premiums.

If meaningful health care reform, including health care cost containment, is to occur, emphasis must be placed on the real drivers of increased health care costs and concomitantly, health care premiums. These include the following key factors: such as

* Advances in medical technology and subsequent increases in utilization

* Price inflation for medical services that exceeds inflation in other sectors of the economy

* Cost-shifting from people who are uninsured and those receiving Medicaid to the private sector

* High cost of regulatory compliance

* Patient lifestyles, such as physical inactivity and increases in obesity.”

Other Important Facts

Will they check my credit score. NO

Will they require a physical or blood work? In most cases, NO.

All insurance companies are the same. No they are not.

My Premiums keep going up. You can do very little about increases in health care costs. You may want to change plans or increase your deductible to try and save money. Try and find a company that will guarantee their rates for at least 1 year. No need to pre-pay for future rate increases.

Definitions:

DEDUCTIBLES (Phase 1)- Money that you pay out of your pocket before traditional insurance begins. Ranging traditionally from $0 to $10,000. Usually if you choose a lower deductible, your premiums will cost more, if you have a higher deductible, your premiums will be lower (you are assuming a higher risk in exchange for lower premiums).

CO-INSURANCE – (Phase 2) – After you meet your deductible, you’ll pay a “co-insurance.” “Co” meaning 2, two entities will share the burden of the bill; usually you’ll see “co-insurance” as a 70/30, 80/20, 50/50, 60/40, 90/10. The larger portion of the co-insurance the insurance company will pay, the lesser portion you will pay.

MAXIMUM OUT OF POCKET – (Phase 3) – After you’ve paid your deductible, and then your portion of the co-insurance, you finally reach your maximum out of pocket. From this point on, the insurance company will pay the rest of the bill. (Major Medical Plan.)

CO-PAY – A flat dollar amount to be paid at the Doctors office. Sometimes referred to as a “first dollar benefit” (before deductible). Meaning, you pay a flat $30 or $20 or $40 dollar copay, or whatever the copay is, and the visit is paid in full. WATCH FOR LIMITS! Make certain the copay is a flat dollar amount paid BEFORE your deductible.

HMO is Health Maintenance Organization, usually a limited regional/geographical area, with a certain number of providers in the HMO. You will select 1 Dr to manage your care, and your Dr. will “help you decide” if you need a referral or not. HMO’s usually have very low deductibles and copays.

PPO Insurance is Preferred Provider Organization. You may visit anyone you wish in the network, still you must know the geographical area of your Network, even with a PPO plan. If you are on vacation and become ill, will your plan out of state cover you (in network)?

CREDIBLE COVERAGE In order to cover your pre-existing conditions when moving from one plan to another, you must have a Credible Coverage Major Medical plan. It is a document given to you from your insurance company as proof that you had a Major Medical plan protecting you from a start date to an end date. You must not go further than 63 days from one Major Medical Insurance coverage to the next, if you do go beyond the 63 days, you will have a pre-existing condition clause in your new policy that states you will not be covered for any of your pre-existing conditions for 1 full year (at a minimum.)

If you go beyond 63 days without “Credible Coverage,” the new insurer will look to your previous 6 months (average) health history and condition, and not cover you for any ailment you have (pre-existing.)

Now don’t be mistaken, that when you want to go from one insurer to the next, if you were covered with “credible coverage” that you are automatically guaranteed a plan. This is not true. You will still need to be underwritten, and the new company is not obligated to take you on as an insured if you don’t fit their underwriting guidelines.

Please Note: This Free Consumers Guide is meant to be used as informational only. The author herein will not accept liability for any circumstances in which an outside company may define their features and benefits differently than in this document. Consumers will accept this document as informational only, and not a legal document. Consumers will be held responsible for their own purchases, and not hold the authors in this document liable for any actions taken by any consumer. Consumers must verify the plan in which they purchase, and will not hold the information in this document as a specific reason to take or not to take a certain action. This document is produced by a licensed health agent. The 14 Costly mistakes you should avoid when selecting your health plan.

About this Author

Shelly Rogers is a Retired Nurse and Licensed Health Insurance Agent In Nevada. Her desire is that those that are seeking for a Health Plan KNOW what questions to ask BEFORE they buy. This article deals with understanding deductibles, what happens before your deductible has been met, and know what important questions you should ask about deductibles.

Blog is found at: [http://www.ppoinsurancenevada.com/]

NEVADA RESIDENTS – Click Here for an INSTANT QUOTE http://www.GreenValleyHealthInsurance.com

Shelly may be reached at (888) 786-2685

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