Health Insurance Buyer’s Guide
Buying Shopping for health insurance can leave many people confused. Knowing which insurance company to choose or which insurance plan is the best may seem daunting impossible. But once you know the basics of health insurance, choosing the right health insurance plan is simple easy.
This article will provide some of the most basic and helpful tools and explanations for health insurance shoppers. First, it is important to learn about helps to understand the different types of health insurance plans and their benefits and drawbacks. Plans differ in the amount you pay out-of-pocket, which doctors you can visit, and how the your insurance bills are paid. Besides just helping you choose the most efficient and cost-effective plan, we’ll teach you about another way you can save on health insurance: a Health Savings Account. Additionally, it is important to learn about dental insurance as well. Many health insurance plans do not include dental insurance under their benefits, so we’ll go over how to shop for and obtain separate dental coverage. Then it is important to learn about ways you can save on health insurance. There are several ways you can save including Health Savings Accounts and Discount Cards. LastlyAnd finally, don’t forget to compare plans before you make your decisionwe’ll explain why it’s so important to put your new knowledge to good use by comparing health insurance plans.
Types of Health Insurance Plans
Health Maintenance Organization (HMO) Plans
Generally, HMOs have low or even no deductible and the co-payments will be relatively comparatively low as well. You pay a monthly premium that gives you access to coverage for doctor appointments, hospital stays, emergency care, tests, x-rays and therapy. You will have to choose a primary care physician (PCP) within your insurance provider’s network of physicians, and in order to see a specialist you need to receive a referral from your PCP. Under an HMO plan, only visits to doctors and hospitals with the insurance company’s network of providers are covered; you’ll have to pay for visits if you go to an out-of-network doctors or hospitals your insurance will not cover the costs.
Preferred Provider Organization (PPO)
Plans Under a PPO plan, you will use the insurance company’s network of doctors and hospitals for any services or supplies you need. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Generally, you will be able to choose doctors and specialists within this network without having to choose a primary care physician or get a referral. Before the insurance company will start paying for your medical bills you will usually need to pay an annual deductible. Also, you may have a co-payment for some services or be required to cover a percentage of the total medical bill.
Point of Service (POS) Plans
A POS plan is a combination of the features offered by HMO and PPO plans. You are required to choose a primary care physician, whose services are not usually subject to a deductible, but your PCP can refer you to out-of-network specialists whose services will be partially covered by your insurance company. Additionally, POS plans usually offer coverage for preventive healthcare, which includes regular checkups. Your PCP will be able to give you referrals for any specialists. If these specialists are out-of-network you will need to pay out-of-pocket and then apply for reimbursement from the insurance company. With a POS plan you will benefit from some of the savings of an HMO and will have greater flexibility in choosing healthcare providers, similar to PPO.
Dental Insurance
It is important to get a dental insurance plan along with your health insurance plan. In order to keep your teeth and gums health you need regular visits to the dentist. Without dental insurance, the cost of dentist appointments will be much higher making it difficult to keep up with the payments. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals. In order for the insurance company to cover your dental expenses you will need to send them a claim before they reimburse you for covered services. As a result, you will have to pay more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. On the other hand, managed-care plans will provide you with a dental provider network and you will need to visit dentists within this network in order to get coverage for these services. With a dental care network, the insurance company has arranged pre-negotiated rates that you will receive when you visit these dentists. With a managed-care plan, the dentists will submit the claim for you, lowering your out-of-pocket expenses.
Save on Health Insurance
Health Savings Account
Health Savings Accounts (HSA) are tax-free savings accounts designed to help consumers pay for healthcare services while limiting premium expenses for unwanted benefits. The plans have lower premiums and higher deductibles than other insurance plans because they offer fewer benefits and require you to use the money in your HSA to pay for certain qualified medical services. However, if you don’t need to visit the doctor frequently and don’t anticipate requiring regular medical attention, HSA plans are a cost-effective method of insuring against the worst without paying for coverage you won’t use. In order to open an HSA, you’ll need to have an HSA-compatible health insurance plan. You may only use the funds in your HSA to pay for qualified medical expenses. Usually, your HSA plan will have a deductible that, once met, requires your insurance company to pay for any additional qualified medical expenses for the rest of the year.
Dental Insurance
Health insurance typically does not cover dental services, but in order to keep your teeth and gums healthy, you need regular visits to the dentist. Without dental insurance, regular dentist appointments can prohibitively expensive. Make sure your mouth is covered by shopping for both health and dental insurance. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals for special services. In order for the insurance company to cover your dental expenses you will need to send them a claim for reimbursement. You’ll end up paying more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. By contrast, managed-care plans limit you to the doctors and services within a dental services network, and you will need to visit doctors within this network in order to get coverage for their services. Within the dental care network, your insurance company has arranged pre-negotiated rates that you will receive when you visit dentists in the network. Your dentist will submit your insurance claim for you, keeping your out-of-pocket expenses lower than with an indemnity plan.
Compare the Plans
Comparing insurance plans is an important step in buying health insurance. It will save you money in the long run if you take the time to compare premium prices, out-of-pocket costs, plan benefits, the network of physicians available with different plans, and the quality of insurance providers. If you have a favorite physician, make sure your health insurance covers visits to him or her. If you don’t need to see the doctor very often, don’t pay a high premium for low office visit copayments. Health insurance plans are designed to address specific healthcare needs, and you’ll save money and get the most effective coverage by comparing plans to find the health insurance plan that best fits your budget and lifestyle.
For more information on Health Insurance Plans and Dental plans, or to get advice on whether this type of health insurance plan is right for you, visit http://www.enetinsurance.com and talk to one of our licensed health insurance agents.
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Health Insurance As Currency A Different Perspective
The “Health Insurance Card” and Health Insurance have taken on an importance in everyday life. These two items have, in a way, taken on a life of their own. Amidst today’s fervent, raging and emotionally charged debate over health care reform, the whole concept of Health Care Insurance should be re-evaluated. This is just one Health Care practitioner’s perspective on one small aspect of health care delivery. It is fueled out of my confusion that patients don’t seem to understand their personal responsibility for payment of the services (care) that they receive (purchase). It is almost as though health care has been devalued to the point that we don’t comprehend paying for it.
There is much confusion regarding the role and use of health insurance. Health care coverage is a product. It is sold to you, the consumer, by businesses. The business’ product is “health care coverage.” Coverage varies depending on the plan that you purchase. Cost of the “plan” varies depending on the scope of the coverage. Just like the size, quality and performance of an automobile may vary depending on the price you are willing to pay. The more you pay, the more you get. Health care insurance coverage works the same way.
Companies providing health care insurance are profit making businesses. They are not charities. I am hearing a great deal of mumbling (ok it’s more like shouting) about the profits that these companies are making. Many of us own stock in these companies in the form of our mutual funds. They are supposed to be profitable. Why are we thinking that there are moral dilemmas inherent in profiting from helping someone improve their health? Why should saving a life, solving a skin rash problem or counseling someone on being a better parent be non-profitable ventures? Can I be the only one seeing the benefit in all of these? I would pay for these. And if we wouldn’t pay for these services, is it the services themselves or our own selves that we fail to value?
Most people don’t even realize the single largest benefit to being enrolled in a health insurance plan. The largest benefit to health care insurance is that it buys the consumer a discounted rate for any health care related services that it covers. This is the biggest single benefit and most consumers don’t even realize it. When a provider is “participating” with an insurance company they agree to accept a fee lower than their full regular rate. HMO and POS plans pay the lowest fee to providers. PPO plans pay better, but still lower than the provider’s full rate. When a provider is “participating,” they always accept a “negotiated fee schedule” which is lower than their regular rate. The patient is responsible for only a co-payment as long as services provided remain within the benefits of the plan that they purchased. If the desired service is not covered in the insurance plan, the consumer is responsible for payment in full. Referencing back to the automobile analogy, if your care didn’t come with 20 inch rims and you want them, you have to buy them. You don’t expect the car dealer to pay the auto store for your rims.
When a provider chooses to be “non-participating” with an insurance plan, they charge what they want for their service. The “plan” usually covers up to a percentage of a “usual and customary rate,” or UCR. A provider can charge the UCR exactly, or above or below it. The patient (consumer) is responsible for the balance of the unpaid bill. In many instances, the patient pays the provider directly and in reimbursed by the insurance company. HMO and POS plans usually do not cover services provided by non-participating providers. This is partly how the can keep the cost of the insurance to the consumer low. It does, however, limit the consumer as to which providers will be covered for payment.
So with this understanding, health insurance is a product that we convert into a form of “currency” accepted by some providers as partial or full payment for rendering a service. It is the equivalent of dollars, pesos, a check or credit card. It is, in a way, a “promissory note.” It is a promise to the provider that they will be paid several weeks later after sending the insurance company a bill. It covers what the creator (the insurance company) and the service renderer (the provider) agree that it covers. Just as your local grocery store may agree to accept dollars and credit cards but not checks or pesos, your health care provider may or may not agree to accept your insurance as payment for a service.
The dilemma faced by many providers is a patient’s lack of understanding of the scope of coverage, payment and benefits, and the role of the insurance card in all of this. Let’s compare the insurance card to a credit card or a check. Some merchants accept them. Some do not. It’s up to the discretion of the merchant. If the credit card goes through at the time of the billing with no problem, you get your merchandise. If the card is declined, you either provide alternative payment, cash, check or money order, or you leave the store without the merchandise. If your check bounces, you don’t get the product.
Maintenance of the card (or currency) is the responsibility of you, the consumer. If your credit card has run out of date, is over the limit or has insufficient funds, you need to provide alternative currency to leave the store with your merchandise. The same is true with the health care plan ID card. If your currency is invalid, meaning, your plan denies payment, you need to provide alternative currency. And it is your responsibility to maintain your currency (card) as current and active.
One of the most time consuming and costly activities in any doctor’s office is dealing with insurance companies. The following activities by a doctor’s staff cost money beyond what a consumer can imagine. They are: insurance verifications; insurance authorizations; billing; phone calls after denial; re-billing; bookkeeper recording and tracking; co-payment billing; and on, and on, and on.
Patient understanding of the concept of an insurance card as currency can go a long way to a smooth and successful transaction with the provider (the doctor). The health insurance plan covers what it covers. And doesn’t cover what it doesn’t. It is a product that has utility to the extent of the conditions of the purchase. And by purchase I mean the purchase of the insurance coverage. If the insurance doesn’t cover something, the consumer’s complaint is with the insurance company, or more likely with the employer whom negotiated the terms of the insurance coverage on behalf of the consumer. The provider (doctor) is not responsible for the terms of coverage of the insurance policy.
So let’s summarize and make a point. Health insurance is currency. It isn’t a carte blanche to any and all that the doctor may have to offer. It’s a product that you purchased. It allows you access to what you agreed to when you bought it. And most of us didn’t read all of the 2,000 pages (exaggeration) in the purchase agreement at our company “open enrollment” meeting. It is your (the patient’s) responsibility to make sure that the currency is valid and covers the procedure that your are requesting, just as it is your responsibility to be sure that the check will clear or that your credit card has room on it when you make any purchase.
I am concerned at the present use of the word “entitled” when we enter into the health care debate. Health insurance is a product that you purchased. We convert that product into currency to purchase other products, or various forms of health care. As far as what we are “entitled” to, I question if we are entitled to anything. Perhaps we are entitled to opportunity and access. If we see our health and health care as our personal responsibility, and that we may earn these, we may regard them more highly and take better care.
John B Hudome, DCH, LCSW
Dr Hudome ia a Doctor of clinical Hypnotherapy with a very active practice in Maple Shade, NJ. John has been a practicing clinician since 1984. He began studying and practicing hypnosis and hypnotherapy in 1989. His humorous style must not hide the fact that he is a serious and astute reader of people. He is able to cut through complex problems and simplify them into changeable parts. He can be found at http://www.johnhudome.com. John Hudome maintains copyright privileges over all Ezine Articles.
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Health Insurance And Dental Benefits In The U.S.
The dental benefits industry quickly grew out of the blossoming health insurance market. Hopefully, we can better appreciate the dental benefits industry by becoming more familiar with its roots and natural progression.
Health insurance began to appear in the United States around 1850 and it only offered benefits to those who were disabled by accidental injury.5 Benefits for medical treatment didn’t begin to emerge until 1910, and coverage for hospital, surgical, medical and nursing care expenses began in 1930.5 The earliest health insurance models were traditional fee-for-service plans (also known as indemnity insurance plans). They were quickly followed by numerous prepaid health plans, considered the precursors to today’s managed care insurance models including health maintenance organizations (HMO) and preferred provider organizations (PPO).
The first instance of managed care insurance came about in 1917 in Tacoma, Washington when the Western Clinic began providing the lumber industry with prepaid physician services.6 In 1929, Dr. Justin Ford Kimball was instrumental in establishing the Blue Cross brand by introduced a prepaid hospitalization plan for local teachers sponsored by Baylor Hospital in Texas.6 The Blue Shield program was adopted in 1939 for participating prepaid physician plans.6
One of the pioneers responsible for making quality healthcare and insurance available to Americans was industrialist Henry J. Kaiser. In 1938, Kaiser recruited Dr. Garfield to help create prepaid clinic and hospital care for his Grand Coulee Dam project.6 In 1942, Kaiser and Dr. Garfield established a prepaid healthcare program for the employees of Kaiser shipyards and Kaiser steel mills that helped popularize health maintenance organizations.7 Kaiser Permanente remains prominent in the HMO insurance market to this day.3
By 1949, there were 81 Blue Cross hospital plans and 44 Blue Shield medical insurance plans, covering a total of 24 million Americans.6 Blue Cross companies and Blue Shield insurance plans covered 52 million and 40 million Americans respectively by 1959.6 After merging, Blue Cross Blue Shield collectively covered 87.4 million Americans by 1979.6 So Blue Cross Blue Shield, one of today’s top insurance providers, was very influential in the early managed care insurance movement.
Benefits grew and expanded in the 1950s as traditional fee-for-service health insurance plans flourished and coverage expanded to include other expenses, such as vision care.3 Most insured individuals were covered by either Blue Cross Blue Shield or by private commercial insurance companies at this time.3 Despite this progress, the 1960s and 1970s brought about a tumultuous time for the health insurance industry.
The term “Health Maintenance Organization” was coined in 1970 by Paul Ellwood, who was instrumental in promoting the Health Maintenance Organization (HMO) Act.6 HMO insurance came about as the insurance marketplace adjusted to employers’ and individual consumers’ concerns with the high premiums associated with traditional indemnity insurance.
After debating various bills for a national health insurance plan in the 1960s and 1970s, Congress passed the Health Maintenance Organization Act in 1973.6 This Act provided grants to employers who implemented HMO insurance – considered cost-effective alternatives to private doctors and hospitals – and effectively encouraged employers to provide their employees with health benefits.
At first, HMO insurance was perceived as providing better value than traditional indemnity insurance, due to lower premiums. Yet employers and individual consumers quickly began to backlash against the strict restrictions, poor service and other limitations associated with HMO insurance. The first annual decline in national HMO enrollment was seen in 2000.6 As a result of employers’ and consumers’ concerns with restrictions and service, modern day PPO insurance began to surface in the 1980s as an alternative to HMO insurance. The choices and service provided by PPO insurance was very well received, despite having higher premiums. By 2006, the national HMO enrollment grew to 67.7 million and PPO enrollment grew to 108 million.6
During the 1970s, those responsible for paying for healthcare – consumers, employers, and taxpayers – saw that the associated costs were becoming unmanageable.3 This concern with the cost of benefits was not exclusive to the health insurance industry and it quickly crossed over into other markets, including the dental benefits industry.
The dental benefits industry in the U.S. began as a by-product of the health insurance industry. Supposedly, the nation’s first dental insurance plan was instituted in 1883 by the Denver and Rio Grande Western Railway’s Hospital Association.8 Introduced in 1959 on a group basis, traditional dental insurance plans encouraged preventive care and reimbursed the insured for the cost of dental services.5
Dental HMO insurance quickly became more popular than its more expensive counterpart, traditional dental indemnity insurance. Dental PPO insurance provided consumers with better service and fewer restrictions than dental HMO insurance, despite the higher premiums. Discount dental plans, an easy-to-use and cost-effective alternative to dental insurance, became a significant part of the industry during the mid-1990s.9 Discount dental plans provided consumers with the value they desired by offering access to affordable, quality dental care at a low price and with an emphasis on choice and service.
At first, the majority of people with dental benefits received them only through their employers. Despite this welcomed advancement, a large percentage of Americans still did not enjoy access to affordable dental care. Unfortunately, many employers did not offer dental benefits and individual dental insurance remained too cost-prohibitive to become a viable alternative. The dental benefits industry began to adjust and progress to fill the growing need for affordable dental benefits. The dental benefits industry began to experience a shift away from the high premiums of dental indemnity insurance as well as the poor service and strict limitations of dental HMO insurance, and toward the greater value, choice and service offered by dental PPO insurance and discount dental plans.
Dental Plan Expert http://tinyurl.com/34a799
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Health Care Reform and Small Business Health Insurance Plans
How will small business health insurance plans change starting in 2010? President Obama’s Affordable Care Act is all about helping small businesses insure their employees. While nearly 99 percent of large businesses offer benefits to their employees, not even half of small companies do. The act hopes to change that.
Here are some ways the care act aims to help small businesses:
-Small companies with fewer than 10 employees can qualify for a tax credit to help pay for their small business health insurance plans. Larger businesses may qualify for a portion of that tax credit.
-The smallest companies can get up to 35 percent of their contribution to premiums back in tax credits. Tax-exempt businesses can get back 25 percent.
-By 2014, small companies will also have the option of joining insurance pools within their state to help share and cut down the costs of insuring employees.
-Insurers can no longer set rates or exclude coverage based on pre-existing conditions. The same holds true for children if you are looking into buying a family health insurance plan.
-There can no longer be lifetime limits on coverage.
-Starting in 2014, businesses with more than 50 employees MUST supply insurance for all their workers or pay a hefty fine. These fines can cost $750 per uninsured employee or more.
For now, if you’re a small business owner (or an employee), you can take steps to get your employees insured sooner rather than later. Don’t wait until you’re up against the cut off date of 2014.
These steps include finding out if you qualify for tax credits, researching whether your state offers additional subsidies for small companies, and compare small business plans from several major carriers to see what your health insurance costs look like.
Adam Hallson is a health insurance expert who specializes in small business health insurance plans. For more information, go to HealthInsuranceQuoteFinders.com
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