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Shopping for Health Insurance
Serious sickness and personal accidents hit you without any advance notice much of the time. Individuals who are admired for being both strong and healthy can suddenly find themselves incapacitated. It is a scary proposition by itself. What can shake a fearless individual to the core is the medical bills that go hand in glove with required medical treatments. This is when it becomes critical to have a complete health insurance plan in place. Only such a comprehensive insurance policy will save victims from enormous personal costs that can easily lead to ruin financially.
Once upon a time, having health insurance was a matter of personal choice. These days, purchasing a qualified health insurance plan is required to avoid being financially penalized. Employees are no longer required to accept the employer-provided insurance policies. Instead, all Americans can select from one of many different choices. It is hard to make such choices that can cause fear and confusion.
Good Health Coverage is Required
Those financial penalties depend on how much money you earn in a year. If you are healthy and young, then it could be financially viable to pay a little penalty. People who are self-employed and make a smaller annual income could reach this decision. The government will allow you to choose this path, but dangers in life can make it hazardous.
No one should be amazed that many financial bankruptcies for individuals occur as a result of families and individuals dealing with devastating medical costs and bills. The choice often comes down to paying for rent and utilities, clothing, and food or covering medical bills. People forfeit their houses to the bank prioritizing medical bills over their monthly mortgage payment. Waiting to buy health insurance until it is late nearly always costs consumers higher insurance rates.
Significant Things to Think About When Purchasing Health Insurance
There are a number of things that you need to think through before you select health insurance coverage. These include the following:
- You should know that the company from whom you buy your insurance policy is reputable. Such a firm should be well rated by other consumers for offering great customer service and reliable payouts.
- The plan you choose should work within the family or personal budget.
- A coverage selected by one individual is not necessarily adequate for another. Fortunately the many insurance companies offer numerous plans, with a range of medical coverage choices and cost.
The Correct Insurance Coverage is Vital
You should come up with a short list of the best personal options for your family or personal needs. Some health insurance plans are basic ones called "major medical" policies. They provide adequate coverage for hospital visits and Emergency Room bills. This kind of plan is viable for young people and healthy adults who seldom pay a visit to the doctor. Basic plans do not cover the needs adequately for families, people suffering from chronic illness, or aging adults. These are the times in life when a more thorough health insurance policy is in order. Such a policy should provide coverage for doctor appointments, diagnostic tests, outpatient services, and chronic conditions.
How to Get Started
The best way to start the process of picking out insurance is through coming up with a basic list. On the one side of the list, detail your personal medical needs. Below it should be a listing of less important requirements. This will make it easy for scratching off insurance firms that do not provide the policy options to address your own needs.
What is the Location of My Medical Providers?
It might be that your medical providers are located within your own neighborhood. Perhaps you want to stay with a physician who has treated you for a number of years. Look carefully at the doctors who accept a certain health insurance policy before making your selection. Should you need to choose a new doctors' office, will their practice be sufficient to address your personal needs? You also have to ask if that medical practice is within your policy network. If they are not, then you will pay a higher out of pocket cost to have appointments at their office. Like with anything you buy, you need to make sure that all of your questions are sufficiently answered before you sign up to the program.
Employer Offered Policies and Plans
When your present job or a new one makes a health insurance coverage offer to you, you should start with going to see the Human Resources staff to discuss your choices. It is true that these company health insurance policies charge employees a less expensive co-payment. The trade off could be a more basic level of coverage. If you take this insurance by paying premiums from payroll deductions then you might decide to pick up supplemental insurance separately to make sure all medical needs get covered.
Self-Employed Insurance Coverage
An individual who is self-employed bears full responsibility for providing his or her health insurance coverage. It is essential to talk with the agents from any health insurance firm and policy that you are contemplating. Human nature is to take the cheapest cost policy, but beware the plan limitations. Generally higher quality plans will pay for themselves over time.
Compare Your Choices
Most health insurance policies come with different coverage levels, or tiers. Every tier will provide more coverage for extra costs. Consider all of the policies, thinking about what coverage they provide and really cost. There are three elements to consider carefully:
- Premium - the policy cost
- Deductibles - amounts you pay before the policy starts to pay
- Co-Pay - your personal contribution to any doctor visit or service
The trade off for higher deductibles is less expensive premiums. Conversely, more expensive premiums equate to lower deductibles when you need medical treatment.
Consider Your Options Carefully
- You should call the insurance providers, who are more than happy to talk with you.
- Any family should choose to prioritize their children's needs when
- selecting insurance.
- Investigate the doctors, specialists, and medical facilities (hospitals) within your preferred network.
- Ask concerning the ability to delete or add on more coverage for future needs.
Remember These Things
People who consider carefully their various choices will generally pick the wisest course with their health insurance. You do this by thinking not just about your present needs but also possibilities for the not-too-distant future. If you select the optimal health insurance policy, then you can focus on healing your body instead of worrying about financial disaster.
I want to learn more about Health Insurance.
Both the Patient Protection Act and the Affordable Care Act were passed on March 23, 2010 with the intention of protecting American citizens from increased healthcare costs and discrimination by private health insurance companies. These acts were healthcare reform bills design to ensure that U.S. citizens had access to reasonably priced health insurance options. A series of guidelines regulate these options. They were meant to help with the development of federal healthcare programs in addition to federal subsidies.
Insurers have to apply a series of modifications within the bill, including the following:
- For health insurers, new guidelines and regulations have been added into the Affordable Care Act
- There is a pre-existing condition clause that states all applicants must be insured
- All applicants with pre-existing conditions, regardless of age or gender are eligible for fixed rates
The Affordable Care Act provides the Health Care Marketplace to ensure that small businesses and families have access to insurance policies. The marketplace must comply with the Affordable Care Act.
Under the bill, all United States citizens, regardless of age, race, or sex, are required to purchase healthcare insurance if they are not already enrolled in a plan. Each year there is a tax penalty assessed for U.S. citizens who do not purchase health insurance.
Affordable Care Act Benefits
- Health Insurance policies are regulated to minimum standards.
- Small businesses are granted subsidies when purchasing insurance through the marketplace platform.
- There are no copay requirements, no coinsurance, or deductibles for preventative care.
- People in lower-income brackets may be eligible for Medicaid in the form of subsidies.
Significant changes were made to the Affordable Care Act in 2014. Rates were lowered and are to be fully implemented in the year 2020.
To summarize, the ACA was passed for the following reasons:
- To reduce the cost of health insurance while improving availability and the quality of care for American citizens.
- To reduce the number of Americans without health insurance. It was intended to cap health insurance premiums charged by private insurance companies based on pre-existing conditions, age, race, and gender.
- The ACA was also intended to lower health care costs for individuals and government.
Obamacare, which is officially called The Patient Protection and Affordable Care Act, was an initiative spearheaded by former President Barack Obama and supporters that was eventually signed into law. The landmark piece of legislation is sure to go down in history due to the complicated passage through Congress that required several compromises and rewrites due to tough opposition mainly from lawmakers on the Republican side. Still, the law faced some logistical challenges after all of the legal hurdles were cleared due to its complexity and wide breadth.
In the latter half of June 2012, there was a decision published by the US Supreme Court that determined the constitutionality of what had become known as Obamacare. After that important ascertainment, the law was officially put into practice. As a result, health care benefits were available to millions of people across the US.
How Health Insurance Benefits Are Provided by Obamacare
The primary goal of the law was to ensure that Americans who were lacking access to affordable health insurance might finally be able to pay for services and medicine that they need. An additional aim was to make sure insurance companies couldn't deny coverage when an individual being insured was in desperate need. Through a set of subsidies, monthly premiums that were once too high are now more affordable. To be sure, the existing insurance marketplace wasn't intended to be replaced by Obamacare.
In order to comply with the law, insurance companies have to offer a determined amount of fundamental benefits in each policy. This is a strategy of health management and prevention. When an insurance company wants to provide a medical insurance policy, it has to provide some essential benefits. These include contraception, pregnancy care, laboratory tests, physical exams, and emergency care. One of the other major benefits is families being able to keep their children on their policies up until the age of 26. Young people can remain insured while filling introductory roles that don't typically offer comprehensive coverage.
Those who suffer from a chronic illness are now free from suffering under lifetime limits that some insurance policies used to deny coverage. Also, pre-existing conditions aren't considered factors of discrimination. There are many other limits within the healthcare system that were removed due to the Affordable Care Act.
Varying Levels of Coverage Offered by Obamacare.
There are four different levels of insurance coverage within the Affordable Care Act. Bronze is the starting level. Those insured at this level pay 40% out-of- pocket. The higher Platinum Plan only requests 10% of every dollar in copayments but comes with an increased monthly premium. Generally speaking, the total amount of co-payments rises as the levels get lower.
What Seniors Need to Know About Medicare
Seniors who are 65 or older are eligible for Medicare. Often, the process of signing up for Medicare is very confusing. There are Parts A, B, C, and D of Medicare, and then there are all the Medicare Advantage plans that you can get in addition to Medicare. Medicare itself is much less costly than other health insurance. However, often, a Medicare Advantage plan can benefit you even more than just straight Medicare. It is a good idea to study all the available plans to make sure you are getting the best coverage for your needs.
Coverage Within Medicare
Medicare itself has four parts, each designated by a letter: A, B, C, and D. Each of these covers a different aspect of health care for seniors. Before deciding on a plan, be sure to know what each of these letters means.
Medicare Parts A and B
Most seniors will find that about 75 or 80 percent of their healthcare costs fall under Parts A and B. First, Part A covers you in a hospital or other medical facility if you are an inpatient, that is, you are there overnight. Part B covers outpatient visits to hospitals or other facilities. It also covers visits to your doctor. Other items that may be covered are physical and occupational therapy, home health services, mental health services, X-rays and lab tests. Medicare will pay a certain amount for these services. If the cost is more than what is covered, the patient is responsible for the rest of the bill.
Medicare Part C
Medicare Part C plans are also called Medicare Advantage plans. A person would enroll in one of these plans instead of regular Medicare Parts A and B. These plans are offered by private insurers who are reimbursed by the government. They often cover more than standard Medicare. Often dental and vision benefits are included. Some of these plans also offer prescription drug coverage. Some plans also offer free fitness memberships. After you first enroll in one of these plans, if you decide you don't like their coverage, you can change plans once a year during the open enrollment period.
Medicare Part D
If a senior does not have prescription drug coverage under one of the Medicare Advantage plans, the government offers Medicare Part D plans to cover prescription drugs. There are a variety of Plan D plans offered through private insurers. If you already have prescription drug coverage through a Medicare Part C plan, you cannot enroll in Medicare Part D, or you will be removed from your Part C plan. If you don't have any prescription drug coverage, it would be best to enroll in Part D right away. There is a penalty for enrolling in Part D later, unless you have other prescription drug coverage in the meantime. If your income is low, you may qualify for assistance with your Part D premiums through the Social Security Administration.
Additional Supplemental Coverage
Even if you have Medicare coverage under Parts A and B, or C, as well as Part D if needed, you might still not be covered for all your health care needs. You may have deductibles or copays to pay, or some costs may just not be covered. Private insurers offer a variety of Medigap plans to take care of these gaps in coverage. You should evaluate the medical needs that you expect to have and look at your Medicare and Medicare Advantage coverage to see what coverage you may be missing. Then you will be able to choose a Medigap plan that best fits your needs.
All these parts of Medicare may still seem confusing to you. As an overview, remember that Parts A and B are for standard inpatient and outpatient coverage, Part C is Medicare Advantage, which offers a higher level of coverage, and Part D covers prescription drugs.
A majority of Americans have the option of signing up for short-term, low-cost health plans. However, they shouldn't be confused with standard insurance plans.
Sure, they do provide health coverage, but some of these fall short of what the Affordable Care Act deems as actual health insurance.
The ACA once restricted plans of short-term length to younger individuals and other Americans who find it hard to afford this form of insurance. The federal government has changed this so anyone can apply for a shorter plan.
It's important to keep in mind that these aren't high-deductible plans. As the name suggests, those plans have very high deductibles.
A high-deductible plan comes with an increase in out-of-pocket costs and a decrease in premiums. They still offer all of the standard protections that normal health insurance plans provide. On the other hand, short-term plans aren't widely considered as insurance plans due to the limited number of protections offered. Essentially, they're yearlong selections that can be extended by two additional years. In the past, these short-term plans were only meant to last three months with the option to renew for a year.
What are short-term health plans?
In general, a short-term health plan is low-coverage and low-cost. People can sign up for these plans with the limit of a year with the possibility to extend the plan twice. This means that you could potentially have this plan for three years. Shor-term plans differ from standard health insurance because it sets a limit.
Not every state allows these short-term plans. Here is a list of some states that have made it illegal to sell short-term options:
New York
New Jersey
Massachusetts
Hawaii
California
Some other states haven't made these plans illegal but have input restrictions that go beyond federal rules:
Washington, Vermont, New Mexico, Maryland, DC, and Delaware - These states only allow a short-term plan to be offered for three months without any chance for renewal.
Illinois and Colorado - Short-term plans here are limited to six months.
What kinds of things are covered by short-term health plans?
A short-term plan can cover a wide variety of things. Unlike regular health insurance plans, short-term plans aren't bound by any federal regulations when it comes to making their own coverage. This means that one plan may offer something not found in any other plan. For example, one short-term plan might cover treatment for substance abuse and another may not cover anything in that area. It truly all depends on that specific plan.
The Affordable Care Act ensures that health insurance plans provide for at least 10 fundamental benefits, including:
- hospitalization
- emergency services
- ambulatory services
- prescription drugs
- substance abuse disorder and mental health
- newborn and maternity care
- pediatric services such as vision and oral care
- laboratory services
- rehabilitation services
- wellness and preventive services
These 10 items have now become the standard foundation of health insurance. However, this is not the case for short-term plans. You might not even be able to find many short-term plans that are offering most of the aforementioned services.
Again, these plans vary, so you might be able to find a short-term plan covering prescription drugs, while most others don't.
Naturally, a short-term plan rises in cost with the more benefits that are added. Those with very little protection are more affordable.
Those settling for short-term plans also have to deal with the potential of being denied. The Affordable Care Act requires associated plans to approve all patients regardless of their health status. A short-term plan isn't bound by this requirement. "Guaranteed issue" might be required by some states, meaning a plan has to cover you. However, the federal law isn't currently demanding that for a short-term plan.
Under a short-term plan, you can be rejected due to pre-existing conditions or the plan can charge ridiculous premiums. However, this isn't allowed in plans through the ACA.
In reality, over half of the people who aren't enrolled in Medicaid or Medicare are suffering from some form of a pre-existing condition. Short-term plans aren't likely going to be solid choices for these Americans.
Imholz has said that a short-term plan also has the choice of capping the total amount paid to cover clients annually and that it can put a limit on how much will be spent on some services.
For example, if a short-term plan only covers hospitalizations up to $5,000, clients will have to pay for anything that exceeds this amount. This is one of many reasons why it's imperative to what these short-term plans cover before closing the deal.
In addition, a short-term plan can cost you a significant amount on out-of-pocket costs. There are many short-term plans that have set lifetime limits regarding what's to be covered. With a short-term plan, you might stop receiving coverage after hitting a certain limit if you develop a costly illness. For example, coverage might be cut off at $100,000.
A short-term plan also has the ability to limit how much is covered with regards to hospitalization and specific treatments.
What kind of person should consider short-term plans?
Those individuals with good health might be able to benefit from the low premiums offered by short-term plans, as long as they don't require health services.
Short-term plans might be able to offer some form of coverage, but it might lead to heavy out-of-pocket expenses. If you're planning to have a family, short-term plans aren't likely a good idea.
Short-term plans are offered by some recognizable health insurers like UnitedHealthCare. It's important to not confuse these short-term plans with the regular insurance options. Short-term plans don't necessarily offer more coverage just because an insurer with a bigger name is behind the option. Sometimes, it's difficult to identify the differences between the plans, so it's always important to read carefully.
Those with pre-existing conditions or any illnesses such as diabetes or asthma should avoid these short-term plans. A pre-existing condition can lead to very high premiums even if you're lucky enough to find a short-term plan that covers you. Furthermore, the short-term plan probably won't offer sufficient coverage that would make it worthwhile.
If you don't have plans to use healthcare services very often and are quite healthy, then short-term plans might not be a bad choice. Just cross your fingers that the year will be healthy and that you'll spend barely any time at the hospital or doctor's office.