Health Insurance: Plans for Secured Healthcare

by Guest » Tue Dec 01, 2009 08:17 am

Our health is precious and we do all sorts of things to keep ourselves healthy. We know how it feels to fall sick and if it is something serious, how expensive treatment can get. So that we are able to afford the right treatment and not worry about the costs getting health insurance is a good idea.

The rising cost of treatment is a matter of worry for a lot of us. If we have health insurance, it helps us plan ahead and also save for future treatment costs. We do not have to worry about bearing the expenses out of our pockets. Your need for insurance may be different from the needs of others. Hence, there are different health insurance plans to suit different needs.

Health Insurance Plans

Health insurance plans are primarily of 2 types -
  1. Indemnity Plans (fee-for-service)
    According to this plan, the insurance holder can choose the doctor he wants to be examined by. The doctor/medical professional receives a fee-for-service. This claim is made either by the doctor or the patient himself. Indemnity health insurance has several other types.
    • Indemnity health plans: As a policy holder you may go to any doctor, hospital or any other medical provider for a fixed monthly premium. You may choose the health care provider you want and the plan will reimburse you or your doctor for the service rendered. There may be a certain portion of deductible that you need to pay or simply bear a portion of the fee. Certain expensive services or hospital care or any covered services may require you to have prior authorization for them in order to be covered. To know if indemnity plans are better than HMOs or PPOs click here.

    • Flexible spending plans: This is also known as cafeteria plan and is sponsored by the employer allowing the employees to design their own package. There are several benefits for this plan like pre-tax conversion plan, multiple option pre-tax conversion plan, flexible spending accounts, medical plan and employer credit cafeteria plans.

    • Basic health plan: This is a low cost health insurance plan that provides limited benefits. These plans do not cover certain basic treatments and it is advisable that you should go through the policy document before purchasing. Premiums for such affordable health insurance plans are community rated and are based on gender, age, occupation, geographic location or health status.

    • Health Savings Accounts (HSA): This plan is designed to help you pay for your present health treatment costs and also save for future costs on a tax-free basis. You do not have to pay a premium here. Instead this tax-free account covers your out-of-pocket medical expenditure. What types of investment you should make, which third party or insurer you should rely on is completely your own decision. Generally, HSA requires you to buy a High Deductible Health Plan too.

    • High deductible health plan (HDHP): This inexpensive health plan is active only after a high deductible of a minimum $1000 is paid for an individual or $2000 is paid for a family.

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  3. Managed Care Plan
    Managed care helps minimize unnecessary costs for healthcare. The policy holders receive extensive medical coverage while also giving financial incentives to the policy holders who opt for the medical providers listed in the policy. There are several types of managed care:
    • Health Maintenance Organization (HMO): There is an already existing network of participating physicians, hospitals as well as other health care professionals and facilities that you can choose from. The doctor you choose from the given list will then provide you with the required health treatment. If you need to go to a specialist your primary care doctor will refer. Generally there is a fee or a co-payment that you need to pay in HMP plan. Your out-of-pocket are fewer here.

    • Point-of-service (POS): In this plan the primary care doctors usually have the freedom to refer other medical providers listed in the plan. If the referral is not from amongst the listed doctors, it will still be covered but then you need to pay a certain co-insurance. If the doctor is listed in the plan, then the plan provides coverage for the same.

    • Preferred Provider Organization (PPO) : In this plan the listed doctors, hospitals and health care providers are paid by the insuring company. Often these payments are discounted and hence the costs will be lower if you choose a doctor from the network of doctors provided by the insurer. However, you may still go for a doctor outside the network but you will have to pay the difference between the medical provider's fees and what the plan pays.

    Other health insurance options

    Two of your other health insurance options may include:
    1. Self-insured health plans
      A self-insured health plan or self-funded plan is one where the employer assumes responsibility (with pre-conditions) to provide health care benefits for its employees. This plan is designed such that the employers pay for the out-of-pocket claim as and when they occur instead of depositing a fixed premium to an insurance providing company. Such a self insured plan is subject to all Federal laws and Budget Reconciliation Act.

    2. Medicare
      Medicare is a federal government program designed to insure senior citizens. You can avail the benefits provided by Medicare to secure your future.

    How insurance companies determine your coverage & rates?

    When you apply for a health insurance, your application has to undergo the insurance underwriting process. The underwriters evaluate how much of a risk you pose for the insurance company and accordingly approve or reject your application. Your rates and coverage limits are also determined if the application is approved.

    The following factors influence the health insurance rates of an individual:

    1. Age and gender of the person to be insured.
    2. Pre-existing conditions after a thorough check-up of the individual's medical history.
    3. Medical history of the family (whether or not the parents had heart disease, cancer etc.)
    4. Smoking habits of the individual.
    5. Previous records of mental health (whether the person had undergone counseling or used anti-depressants).
    6. Occupation.
    7. Choice of deductible, coverage and benefit limits, exclusions etc.
    8. Past records of health insurance applications.
    To know how the above mentioned factors have an effect on your health insurance costs, click here.

    Tips to buy affordable health insurance

    The premiums for medical insurance seem to be increasing every year. This leaves us with the question that how we can find affordable health insurance coverage that suits our pocket. It may seem very difficult but with a little research you can still look for a suitable health insurance plan. You may follow the 6 easy tips to choose a health policy which not only suits your needs, but also matches your pocket.
    1. Know your state rules: Be familiar with the rules that your state follows. This way you can make rational and mature decisions about your health insurance. Pay special attention to rules about pre-existing conditions (if any) and also about what coverage you will get.
    2. Find out your insurance needs: Knowing what type of health insurance coverage you need is important. You may need short term health insurance policy or a regular one depending on the status of your job and your family planning. Getting a cheap health insurance policy may not be the solution to all your problems. You will have to keep in mind the requirement that you have.
    3. Calculate the overall costs: Prepare a budget for yourself. Buying health insurance doesn't just mean paying premiums. There are co-payments, deductibles and also sometimes co-insurance. Keep all of these in mind when planning for your insurance.
    4. Compare your options: To be able to find an affordable health insurance you must have an idea of all what is available in the market. After you have shopped enough get hold of a broker who can help you in comparing the policies. A comparison between few different companies and their products will help you settle better with a policy.
    5. Do your insurance homework: You need to be acquainted with the jargons of the industry if you must find yourself a policy that suits you best. Do your homework; get your research done properly to be able to buy a suitable policy.
    6. Never conceal information: While doing the paper works you may have to answer a lot of questions. Don't be tempted to lie or hide facts. This will only create problems in the future for you, and raise your costs for health insurance.

    Individual Health Insurance vs. Employer Sponsored Insurance

    Most of you may have employer sponsored health insurance. But the number of people opting for individual health insurance is also increasing. This increase is due to the advantage that individual policies have over employer sponsored programs. They are:
    • Tailor-made coverage: Everyone has different health needs and individual health insurance recognizes it and provides policies to suit individual needs. Since the employer sponsored program is 'one-size-fits-all type, you may end up paying for coverage you don't need or not get a particular coverage that you may need.

    • Mobility of coverage: Unlike the employer sponsored insurance, you can still carry individual health insurance with you even if you are changing jobs.
    For more information click here.

    You must plan ahead to secure your future. With health insurance you can certainly prepare to face an undesirable situation arising from a medical condition.

    Related Readings:

    Useful letter

    Like temporary life insurance do we have any temporary health insurance options too?

    Total Comments: 105

    Posted: Wed Dec 09, 2009 05:28 am Post Subject:

    Please don't forget to opt for more coverage with your temporary insurance. Also check if your coverage offers protection for catastrophic health problems.

    Posted: Thu Dec 10, 2009 06:58 am Post Subject:

    I think the best way to deal with this is to continue with the same policy through COBRA. Short term insurance would be a good option for you if you don't find other coverage options once the COBRA period comes to an end.

    Posted: Fri Dec 11, 2009 01:48 am Post Subject: insurance

    I've been looking into COBRA, myself. Can ya'll please give me your positive/negative experiences with them?

    Posted: Fri Dec 11, 2009 06:38 am Post Subject:

    BIG (but common) MISCONCEPTION HERE! There is no such thing as "COBRA Insurance." COBRA is an acronym for . . . get ready . . . Consolidated Omnibus Budget Reconciliation Act of 1986. In passing that Act, Congress declared that employers with 20 or more full time employees (or equivalent) who also provide their employees with health insurance must continue to provide the insurance at the group rate to an employee or their spouse or dependents (all are "qualified beneficiaries") when one of six "qualifying events" occurs (termination of employment, reduction in hours [disqualifying from insurance eligibility], death of the employee, separation/divorce of employee and spouse, dependent child who loses dependency through age (19 or 23 is still a student) or marriage (becomes someone else's problem :P ). In declaring this, Congress also said that the employee can be required to pay 100% of the cost of the insurance (plus up to 2% for admin expenses). And COBRA sets the period of time that coverage may be continued (18 months for the first two contingencies, 36 months for the remaining 4).

    Up until this current economic crunch, Congress never provided any funding mechanism to assist the employees/dependents to pay the cost of insurance, which for some families has gone from $0/month to $1,000/month out of pocket. Temporarily, however, employers are required to fund 65% of the employee's/spouse's/dependent's cost (and then receive an equal employment tax credit on each quarterly tax return). The way the Obama Admin & Congress are printing and spending phantom money, it could be extended well into or beyond 2010.

    So what "COBRA" is is NOT an insurance company but a right to continuation of the same group insurance at the current group rate. But it's very common to hear people say something like, "I got laid off and I had to get that COBRA insurance, but it's really expensive, and I couldn't afford it."

    So you don't buy COBRA, you don't get COBRA, you continue courtesy of COBRA. If you can afford to.

    When continuation under COBRA expires at the end of 18 or 36 months (29 months for certain disabled beneficiaries), HIPAA provides for the employee's eligibility to obtain a Guaranteed Issue individual/family health policy from any insurer of their choosing, as long as they apply within 63 days of the expiration of COBRA continuation.

    Posted: Fri Dec 11, 2009 07:12 am Post Subject:

    Great info everybody! Just wished to add that these short term policies would cover for 30-365 days in general.

    They're hard on you if you have pre-exisiting conditions and even when you have one, please go through the conditions and exclusions carefully.

    Posted: Sat Dec 12, 2009 01:39 am Post Subject: health insurance choices for diabetic

    I'm single diabetic 47 yr old female not kids, in OC California, want to retire, but the health care choices are atroious.

    My CA company Cobra payments are $660/month. will last 36 months due to Cal - Cobra. After that HIPPA premiums are not much lower.

    I'm engaged to be married, and he (55) is self employed has health insurance that costs ~ $700/month.

    Is there any hope for me to get reasonable health insurance? or should I just wait until I am 55 and take advantage of my company's retiree health insurance plan, of $375/month

    Posted: Sat Dec 12, 2009 06:16 am Post Subject:

    If you're currently insured under the Cal-COBRA continuation privilege, at the time it ends, you'll be eligible for a Guaranteed Issue policy from any insurer still doing business in California, despite your otherwise unfavorable diabetic condition. You don't mention how many more months you have left on your continuation privilege.

    When you mention "health insurance" and premiums of $660 or $700, you don't indicate whether the coverage is for HMO or PPO, what the deductible is (if any), what the office copay is, or what the maximum out-of-pocket expense is, just to name a few. I can show you and your fiance OC rates for PPO coverage from Blue Shield/CA as low as $236 per month or as high as $705 for a person his age -- but that's unfair without knowing what he already has and being able to make an apples-to-apples quote for comparison.

    Also, if you were able to go to work for his business, the two of you would probably qualify for a Guaranteed Issue small group coverage (minimum of 2, maximum of 50).

    8 years is a long time to have to wait for a retiree benefit plan (and you can bet it won't be just $375/mo at that time). There is good coverage at reasonable cost to choose among from Blue Shield, PacifiCare, HealthNet, CIGNA, and Aetna (the companies I currently represent). HMOs, PPOs, and HSA-compatible High Deductible Health Plans. It's not as awful as you may believe.

    Your diabetic condition (and any other health challenges) is the primary obstacle. But if your height and weight are within normal range, you're not on an insulin pump, and you don't have high blood pressure, you would not be likely to be turned down, although you could expect to be rated "substandard" and pay a higher than standard premium.

    I'm in Pomona, very close to OC. Send me a private message and I will be happy to give you more information. You don't want to broadcast your health information on a bulletin board.

    Posted: Fri Jan 22, 2010 03:49 pm Post Subject: pre existing conditions

    cal me today 860 447 9040 any health insurance companies in conn that deal with pre existing bulging disks and space narrowing canal jan falk 860 447 9040

    Posted: Sun Jan 24, 2010 11:45 pm Post Subject: CANCELLATION OF POLICY


    Posted: Wed Jan 27, 2010 09:20 pm Post Subject: picked wrong coverage

    We picked wrong health insurance coverage, we can't afford what we picked (by mistake) can it be changed?

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