Copyright 2006 Lisa Ip
Are You Dreaming of Free Medical Care? Wake up! There’s been much debate over our current medical system and the insurance required to get quality care at a price we can all afford. While it would be great to have minimal costs for our medical care, we are still only in the debate of changing the system.
For now, all we can do is to learn how to get the health insurance policy to cover our needs without spending in excess or paying for coverage you’ll never use.
Obviously, you hope you and your family won’t have to use your health insurance policy, but in today’s society, the chances are great that you’ll need the coverage of a health insurance policy more than once during the course of a year. Without at least a minimum amount of coverage, just a visit to a general physician and lab fees can be astronomical. It’s important to get and maintain an adequate health insurance policy both in terms of health and financial security.
To get a health insurance policy that’s not outrageously priced, yet still covers your anticipated and unexpected healthcare costs there are three steps you need to take. 1) Careful evaluation of you and your family’s health insurance needs. 2) Compare health insurance policy benefits with your needs. Try to review at least three levels of coverage. 3) Your result will be a health insurance policy that’s not outrageously priced; yet still covers your anticipated and unexpected healthcare costs.
Determine Your Needs Whether you’re looking for an individual health insurance policy, or want to provide health insurance benefits for your employees, it’s a good idea to carefully evaluate your needs before committing to any health insurance policy.
For the individual, consider your overall health. Do you have chronic conditions that require regular medical visits? Are you on prescription medications on a continuous basis? Either of these situations will make you want to compare co-pays and drug coverage carefully.
Depending on your age, and stage of family planning, pregnancy coverage, and preventative care could be a major concern. If you’re nearing retirement age, getting supplemental coverage for impending Medicare benefits could be a major concern.
Everyone has his own special concerns and needs. Before you visit an insurance agent, be sure to list your concerns and questions. Don’t hesitate to ask questions until you’re confident you have enough information to make a confident decision as to which health insurance policy you need.
Understanding Health Insurance Coverage-Basic Health Insurance Policy Terms As you begin to compare each health insurance policy and the level of coverage provided make sure you understand clearly what the policy covers and what’s not covered. You’ll also want to know levels of coverage. Listed below are a few commonly used terms to describe health insurance policy benefits. As you read these terms, understand this is a very generalized definitions, specifics of each term may vary from policy to policy.
Co-Payment – Often stated as “co-pay”, co-payment is the amount you must pay for each service. In managed care plans, you do not need to know the full fee charged by a provider, as you will pay the same “co-pay” regardless of the fee. Co-Insurance – a policy provision, by which the insured person and the insurer share the covered losses under a policy in a specified ratio, i.e., 20 percent by the insured, and 80 percent by the insurer. Comprehensive Major Medical Insurance – A policy designed to give the protection offered by both a basic and a major medical health insurance policy. Normally have a low deductible amount, a coinsurance feature, and high maximum benefits. Deductible- the amount you as the policyholder must pay before benefits begins to cover costs. Generally the higher the deductible, the lower the monthly premium will be.
Endorsement- sometimes called a rider, an endorsement is written to change the terms of a health insurance policy. This can occur with pre-existing conditions (see definition below)
Major Medical Insurance -Health insurance to finance the expense of major illness and injury. Characterized by large benefit maximums ranging up to $250,000 or no limit, the insurance, above an initial deductible, reimburses the major part of all charges for hospital, doctor, private nurses, medical appliances, prescribed out-of-hospital treatment, drugs, and medicines. The insured person as coinsurer pays the remainder
Out-of-Pocket Cost – The out of pocket cost is the total of all costs you must pay for service. This includes the annual deductible, the co-pay amount, and any fees in excess of the approved maximum charges for a service.
Remember, as you’re reviewing health insurance policies, don’t hesitate to ask your insurance agent to explain or clarify anything you don’t understand. Comparing Health Insurance Policies Higher deductible, lower monthly premium, lower deductible, higher monthly premium, …. 80/20 coverage, 70/30 coverage for major medical, various drug costs, various co-pay amounts for primary physicians, specialists, laboratory services coverage, and the list goes on. There are many areas of a health insurance policy that can vary, from plan to plan. Some even have different levels from which to choose. It can be confusing, and difficult to make a decision, but as stated earlier, comparing your current health condition and your current finances to the policies offered, you’ll be able to make a much better decision.
For example if you’re planning to have a child, you’ll want to carefully investigate the pregnancy coverage for each policy you’re considering. If you take prescribed medication on a regular basis, you’ll want to make sure the terms of drug coverage meets your needs. Each health insurance policy has basic sections defining levels of coverage in each area. The most common are: physical exams, health screenings, specialists’ care, hospitalization, emergency care, prescription drugs, dental, vision care, mental health care, and drug and alcohol abuse services, family planning, and chiropractic and alternative care coverage.
By carefully reviewing the health insurance policy to determine what’s covered, and the level of coverage in each of the above areas, you’ll be able to confidently make a choice based upon coverage and costs.
Maintaining Continuous Coverage If you lose your job, you may be able to maintain your health insurance policy by COBRA (consolidated Omnibus Budget Reconciliation Act. This coverage normally lasts 18 months. Your employer can provide you more information on COBRA.
Maintaining adequate Michigan health insurance coverage can be a big concern for the self-employed. BlueCross BlueShield must sell “group -of-one” policies to sole proprietors. Other companies can offer small group coverage to individuals, but are not required to and prices may be higher.
Obtaining a Health insurance policy may seem stressful. By applying the suggestions above and getting quotes on more than one policy, you’ll be able to obtain adequate health insurance that’s priced within your budget without stress or worry.