What to ask when Purchasing a Health Insurance Policy
When purchasing health insurance, there are myriad questions that you may want answered before money changes hands. You should be able to ask your agent anything and get a knowledgeable, patient answer in return. Some of the more frequently asked questions are outlined here.
You definitely want to inquire about the cost of your monthly premiums, deductibles, co-payments, and cap amounts. Find out if they all effect each other or if they function independent of one another. Ask about lifetime maximum caps. These are beneficial for people who have chronic or extensive illnesses.
Ask for a list of everything the policy will cover, including any exclusions and limitations. Policies can include all kinds of exclusions, and it is important to know going in what won’t be covered. Better to ask now than be surprised later! It is also helpful to ask if you are able to seek emergency care at urgent care services and hospitals in the case of sudden emergencies. Some policies cover this type of event, and some policies do not. Your best bet is to choose a policy that does cover these types of emergencies. Also ask about services like immunizations, mammograms, preventative care, and pap smears. Some insurance companies do cover these preventative care measures and some do not.
Some policies have a waiting period before coverage starts. This is important to know, too. Be sure to ask if your coverage begins immediately upon signing the policy, or if you have to wait a period of time.
Uninsured in the United States
According to recent statistics, 17% of the United States is uninsured. As the economy worsens and unemployment figures rise, this percentage is only going to go up. 46 million people under the age of 65 are lacking in insurance, with uninsured and underinsured people. Medical bills account for more than 60% of all consumer bankruptcies, according to a Harvard University study.
Some facts about the uninsured:
- People who do not have health insurance receive less preventative care, resulting in more illnesses. They are also less likely to have major diseases detected early. This results in more deaths from diseases that could have been prevented or treated.
- Uninsured people are statistically more likely to die prematurely than people who are insured. The mortality rate is estimated at between 1.2 to 1.6 times the rate of the insured.
- Uninsured infants have a mortality rate of 1.5 times higher than infants who are covered under insurance.
If you are uninsured or underinsured, there are some things you can look into to try and obtain health insurance. Programs like COBRA can enable you to extend healthcare coverage for at least 18 months, if you’ve been laid off. High-deductible policies, short-term coverage, and high-risk pools can all offer some form of help. You may have to pay more upfront, but the premiums will be cheaper. Some of these offer co-pays or deductibles that will enable you to at least get a percentage of coverage.
Programs like Medicaid and Medicare are also helping millions of people obtain health coverage. You may quality for these programs if you are pregnant, disabled, or unemployed. Your child may be eligible even if you are not. Most states also have tax payer funded health care programs specifically for children. Be sure to look into these as well.
Terms in Health Insurance Policies
A health insurance policy is a contract between the insurance company and you, the policy holder. It is an agreement that the health insurance company will pay for the health care costs that you may have, due to accidents, disease, or other illness or injury. These contracts can be renewed monthly or annually.
-Premiums. This is the amount the policy holder pays to the health plan each month to insure coverage.
-Deductible. This is the amount that the insured must pay out of pocket before the insurance company pays their share.
-Co-Pays. This is the amount that the insured must pay before the insurance company pays for a particular visit or service.
-Coinsurance. This is a percentage of the total cost that the insured might have to pay, instead of paying a fixed amount upfront.
-Exclusions. These are services that the insurance company will not cover under the policy.
-Coverage limitations. Some insurance companies will pay for certain procedures, but only up to a certain dollar amount.
-Out of pocket maximum. The insured payment obligation ends when they reach a certain dollar maximum, and then the insurance company will cover the rest of the costs
-Capitation. The amount paid by the insurance company to a health care provider in exchange for treatment.
-In-Network Provider. These are health care providers on a list, that have been selected by the insurance company. They tend to offer discounted coinsurance or co-pays, and sometimes have additional benefits.
-Prior Authorization. This is when the insured must get a certificate or authorization from the insurance company before beginning a certain treatment.
-Explanation of benefits. These are documents sent by the insurance company to the patient explaining what is covered under the policy, and any benefits.
Private Insurance Policies vs. Insurance through your Employer
Did you know that 30% of people who have health coverage through their employer pay more than half their monthly premium as a payroll deduction? This would have anyone scrambling to go the private ga insurance route.
There are things to be aware of, however, before you go changing plans. Employer based overage does have its benefits, and certain things are offered in these policies that might not be in private insurance.
For instance, employer-based coverage is guaranteed most of the time. Guaranteed coverage means that you will be accepted for insurance coverage, regardless of your health status. In privatized insurance, you can be turned down for pre-existing conditions and other factors. Employer based health plans also have guaranteed renew ability, so you will always be able to continue your plan, regardless of whether or not you get sick.
Employer based health policies also have the benefit of portability. This means that if you had private health insurance, or were with another provider before enrolling in your employer based policy, your new insurance company must reduce any pre-existing condition waiting time by the amount of time that you were covered o your previous plan. This can prove very beneficial to those with a pre-existing condition.
The lat benefit to group insurance is COBRA. If you are laid off from your job, the company is required to offer you the option to pay for an extension of your health insurance for at least 18 months. As long as the employer has 20 employees, you are entitled to this extension.
You will pay extra for these benefits, however. Ultimately, it is up to you as the policy holder to decide what is more important to you and will benefit you the most.
Buying Individual and/or Group Health Plans
If you have insurance through your employer, you might be considered lucky by some. It is easier to obtain this coverage, regardless of pre-existing conditions and changes in your health. If you’re looking to buy individual health insurance, you can be faced with problems. You may have more expensive premiums, less benefits, or even be denied coverage altogether.
If you are insured through an employer, review your coverage every year when you re-enroll. Make sure nothing has changed and the general layout of the policy still fits your needs. You may be able to choose from providers. Choose the one that has the best access to care and is covered most extensively under the policy. Look at the deductibles, co-pays, premiums, out of pocket expenses and maximum benefits. If your medical needs have changed, this may need to be overhauled. Also look into employee incentives and discounts that you may not be aware of.
If you are trying to obtain private insurance, there are options for saving money and finding a good, comprehensive policy. Check out the health savings account. These are available through your employer or individually. Whatever you invest into these policies will roll over every year, and you can make contributions up to age 65 .
Cost and availability of insurance policies for individuals vary from state to state. They can vary widely but consumers can find affordable health insurance pa. Be sure to visit the State Department of Insurance and brush up on anything you may need to know about in regards to your state and health insurance.
HIPAA states that a private insurance company cannot deny insurance or exclude coverage for pre-existing conditions if you have had coverage for 18 months without a 63 day break, if you are ineligible for COBRA, and are not eligible for group insurance. Most states also have high risk pools for people who meet the HIPAA guidelines and for those who are unable to afford coverage because of pre-existing health conditions. If you are over 65, you will be eligible for Medicare as well.
Health Insurance Policy
Most people need health insurance at one time or another. You may be wondering, what exactly does a health insurance policy consist of?
A health insurance policy is a contract, issued by an insurance company to an individual (or a group). The insurance company promises to pay for health care required by the policy holder to treat illnesses and injuries. Individual insurance policies are issued to one person who applies for the policy. They then pay for the premiums directly or through their paycheck (the amount gets deducted with their taxes). In some cases, if you pay a higher premium, an individual policy can cover your spouse or dependent family members.
In the case of group health insurance policies, health insurance is paid for by an employer or group. The policy is held by the collective group and each member gets a certificate of insurance. The insured are responsible for deductibles and co-pays. These are outlined in the policy.
What you pay for your policy is determined by many factors. Some include pre-existing conditions, your age, whether or not you smoke, your gender, credit history, employment, etc. Some of these factors can even result in the insurance company refusing you a policy.
Since the healthcare reform has been signed by President Obama, the health care system is being overhauled, and many changes are being made in the way insurance companies do business with those needing health insurance. We are going to see many changes being made in heath insurance policies in the near future.
Changing your Health Insurance Policy
If it is open enrollment time for your policy, you may be interested in making some changes. Here are a few things to consider if that is the case.
First and foremost, find out if you can make changes to the policy, and if so, what types of changes can be made. Find out if you can add dependents, a spouse, or correct any information that have changed. This is a good time to reevaluate your policy to see if it covers all of your needs. Are there benefits you feel you should take advantage of that your policy doesn’t offer?
Ask about premiums and co-payments. You may wish to switch to lower premiums and higher co-pays, or vice versa. Weigh the benefits of policy vs. price. Which is more important: a cheaper plan, or added benefits?
Be sure to inquire about maximum lifetime benefits. These are a cap on the amount of benefits that are available to you as the policy holder. These are designed to keep the cost of your policy affordable and to stabilize any future medical costs. Most health plans cap these plans at around $1 million, and a lot of the time these caps are applied to things like mental illness, drug and alcohol treatment, and organ transplants – costly procedures and treatments.
Open enrollment is the one time a year that you can make changes to your plan without having to get a screen for pre-existing conditions. At any other time you will have to sit out long waiting periods and go through screens, and can possibly be denied coverage, or watch your premiums rise exponentially.
Changing your Health Insurance Policy
If it is open enrollment time for your policy, you may be interested in making some changes. Here are a few things to consider if that is the case.
First and foremost, find out if you can make changes to the policy, and if so, what types of changes can be made. Find out if you can add dependents, a spouse, or correct any information that have changed. This is a good time to reevaluate your policy to see if it covers all of your needs. Are there benefits you feel you should take advantage of that your policy doesn’t offer?
Ask about premiums and co-payments. You may wish to switch to lower premiums and higher co-pays, or vice versa. Weigh the benefits of policy vs. price. Which is more important: a cheaper plan, or added benefits?
Be sure to inquire about maximum lifetime benefits. These are a cap on the amount of benefits that are available to you as the policy holder. These are designed to keep the cost of your policy affordable and to stabilize any future medical costs. Most health plans cap these plans at around $1 million, and a lot of the time these caps are applied to things like mental illness, drug and alcohol treatment, and organ transplants – costly procedures and treatments.
Open enrollment is the one time a year that you can make changes to your plan without having to get a screen for pre-existing conditions. At any other time you will have to sit out long waiting periods and go through screens, and can possibly be denied coverage, or watch your premiums rise exponentially.