May
20
2010
One of the more annoying features of the insurance world is its habit of distilling options down to simple sets of letters and then failing to clearly explain what the letters mean. In other words, insurers hide behind jargon and prefer not to explain clearly what you are buying. You are expected to assume the insurer has your interests at heart and pay over your money without a second thought. In many cases it works. Over the years, we have given up the unequal struggle and just say prayers we never fall sick. But, as premium costs have risen and the recession has cut back our spending power, trying to understand the options is back on the menu. So let’s start with an explanation of HMOs and PPOs. In fact, they both rely on a network of physicians, clinics and hospitals, but they differ significantly in the detail of how they deliver healthcare to you and your family.
A Health Maintenance Organization (HMO) is a network of healthcare professionals that enters into a contract with an insurance company. The insurer offers a captive group of people to refer to the network and, based on the expected volume of business, the network agrees a fixed fee for all the main services on offer. In theory, this works well for everyone. The fees are discounted because of the volume of business, so the insurer saves money and charges lower premiums. This is usually the cheapest form of health plan with very low copayments and, often, no deductibles. But there are problems. HMOs are very reluctant to accept people with existing conditions requiring expensive treatments. They prefer most of their patients to be reasonably healthy. The reason is basic economics. Every physician has to meet a quota of patients in a day. This means spending the shortest possible time on each consultation. Long diagnostic sessions disturb the quota and can result in penalties to both the doctors who miss their numbers and the patients who have slowed down the queue. There are also significant restrictions on patient choice. A nominated primary care doctor decides what referrals shall be made and to whom. HMOs are the cheapest form of care, but you have little control over the treatment you or your family receive.
A Preferred Provider Organization (PPO) uses the same basic approach but, because you pay more, you buy greater control over the treatment. The copayments are around 20% and there are usually deductibles. But, you have freedom to choose your own doctors. So long as you go see a physician in the network, you are covered. If you want to see someone outside the network, you usually only pay the difference between the network rate and the actual fees your choice collects.
So, when it comes to cheap health insurance, an HMO is the better option. But if you have the money and a health problem likely to need more extensive treatment, you should opt for a PPO. It always comes back down to your own personal needs and what you can afford. Cheap health insurance always comes with limitations. Read the small print before you buy into any plan and see exactly what you can and cannot do before you agree to buy the policy.
Tags: Annoying Features, Basic Economics, Captive Group, Cheap Health Insurance, Deductibles, Health Insurance, Health Maintenance Organization, Health Plan, Healthcare Professionals, Hmo, Hmos, Insurance Company, Insurance World, Insurer, Jargon, Ppos, Quota, Recession, Second Thought, Spending Power
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May
11
2010
Well, after all the excitement and the best efforts of the GOP to say “No” loud and long enough to make a difference, the President signed the healthcare reform into law. The partisans are now into the equally exciting game of trying to decide whether this is the greatest victory since Abraham Lincoln, with a little help from General Ulysses S. Grant, won the Civil War or the greatest disaster since Hurricane Katrina reminded us Nature can be devastating. Allowing for the fact this is a complicated piece of legislation, this is a little difficult to predict because so much of it is not designed to take effect for years. Calling for immediate repeal does not seem helpful when no one can say how the future will turn out. As time passes and we dig ourselves out of the recession, it is entirely possible this may turn out to have been a good “thing” on balance. If “things” do not look quite as good, a little tinkering may set matters to right. History has a way of judging “things” rather differently than we expect. This leaves us with the next twelve months during which there are elections and an opportunity for voters to have their say. What is due to happen and will this make the reform look good enough to keep?
1. There will be a payment of $250 to people in Medicare. This is designed to close the Part D donut hole. In 2011, there will be a 50% discount on the branded drugs in the hole with the hole closing by 2020.
2. Starting on January 1, 2011 there will be no co-payments for preventative medical care. This care will also be exempted when calculating the deductible.
3. Starting in three months, there will be a temporary re-insurance program for employers to cover retirees in the age range 55 to 64.
4. Starting in six months, insurers shall not cancel a policy if a claim is made nor discriminate against children with a pre-existing condition. There are also to be new controls to prevent insurers from imposing caps on coverage.
5. Before the reform, the majority of people were insured by their employers. Starting immediately, small businesses can claim, tax credits of 35% of premiums if they decide to buy a health plan. This rises to 50% in 2014. Up to now, small businesses have always claimed they were the victims of discrimination, priced out of the market by the insurance industry. With a government subsidy, this argument looks less real.
Whether this will be enough to sway public opinion is anyone’s guess. Health insurance has provoked some seriously extreme reactions and it will take time for people to take a more calm view of what the reforms offer. The reaction of the insurance companies is also difficult to predict. Some may react to the new controls by increasing their premiums. Insurers are, after all, for-profit organizations and they have never shown themselves slow in coming forward with premium hikes. This makes it even more important to get the maximum possible number of health insurance quotes before deciding on which policy or plan to buy. When midterm elections come in November 2012, 36 seats in the Senate and all the seats in the House are up for grabs. Experts predict the Democrats will lose seats. But, with President Obama in the White House, no repeal will be signed into law.
Tags: Abraham Lincoln, Best Efforts, Branded Drugs, Cheap Health Insurance, Donut Hole, General Ulysses S Grant, Gop, Health Insurance, Healthcare Reform, Hurricane Katrina, Insurance Program, Insurance Quotes, January 1, Medical Care, Medicare, Partisans, Recession, Time Passes, Twelve Months, Ulysses S Grant
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May
02
2010
Many people are complaining about their health insurance costs, having a dramatic increase in rates over a short period of time. Some policyholders have noticed that their rates increased by 30% over the last two years and that definitely rings a bell, when a good portion of your income is spent on health insurance. In this time when every spare dollar counts, people are looking for ways to minimize their expenses and insurance, whether health, car or homeowners, is the first thing that comes in mind when cutting costs. Some people choose to drop health coverage altogether, ending up with astronomic bills for any medical service they get. Others are more careful with their decisions and first investigate what other types of health insurance can bring to the table. Here are some things to consider if you want to minimize your insurance costs.
Should I get individual or group health insurance plan?
There are a lot of questions about group and individual health insurance. Of course, group plans are very convenient in the sense that you can insure your entire family and pay out a single premium rather than have multiple separate policies, which only multiply the annoying paperwork. However, group health insurance usually has higher rates as it should guarantee that even high risk customers within the group have adequate coverage. This, of course, makes the healthier group members pay for the risk they share with the less healthy members. Such a situation can be acceptable if there are different health issues among different members. But if your family is healthy in general it would be more cost effective to purchase separate individual policies for each member, because the rates in individual plans are based on your particular health situation and if it’s OK then you will get much lower rates than with a group health insurance plan.
Outline your exact insurance needs and get an appropriate plan
If you are looking for cheap health insurance you first have to determine what your exact insurance needs are. Analyze your conditions, see how often you go to the doctor and what particular services you are using most frequently, and choose a plan that gives you the base rates for your exact needs. With so many different plans out there on the market you should definitely find the one that will give you cheap health insurance and will address all of your needs to the proper extent.
Finding cheap health insurance while self-employed
Those workers who are self-employed often find it hard to get adequate coverage for a low price. The group health insurance benefits that an employer can give their workers don’t apply here, and in most cases self-employed specialists have to go with independent individual health insurance plans that can sometimes be quite expensive. However, if you are leaving a workplace with good group health insurance benefits, you may fall under COBRA regulations in certain circumstances and continue receiving group health benefits while already being self-employed. If your previous employer didn’t have any group health benefits, it would be better to go independently.
Tags: Adequate Coverage, Cheap Health Insurance, Course Group, Dollar Counts, Dramatic Increase, Group Health Insurance, Group Plans, Health Car, Health Coverage, Health Insurance, Health Insurance Costs, Health Insurance Plan, Health Issues, Health Situation, High Risk, Individual Health Insurance, Medical Service, Policyholders, Risk Customers, Spare Dollar
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Apr
24
2010
This year, the weather has been unfortunate. Indeed, those who take an interest in predicting such things suggest 2010 may be the worst year on record for seasonal allergies. It is all down to the late snow. The increased level of water that fell and was held in the ground will boost the early release of tree pollens. When added to the usual grass pollens, this will threaten a far wider range of people. Research results from the first ten years of this century show the number of people suffering from seasonal allergies rising quite steadily, with many now suffering from environmental allergies all year round. About 60% of those with allergies report it difficult to control symptoms with over-the-counter drugs, with some 20% forced to take time off from work. The majority of those with access to health plans report improvement. This is not simply a question of accessing a different range of drugs.
Medical science has been advancing rapidly and there is a clear understanding of the biology of allergies. The first step is a series of skin tests to discover exactly which elements in the environment you are sensitive to. The basic test covers about twenty of the pollens, molds, animals, insects and foods most commonly causing an allergic reaction. The results can be extremely helpful if you discover you not only have a major allergy to house dust but also a low-intensity problem with dogs. Changing your lifestyle can lead to a major improvement in your health even though it may mean losing your pet. An allergist can advise on strategies to remove carpets, fit different types of sheets and pillow cases on beds, regularly vacuum sofas, and so on. It may be necessary to keep windows closed at certain times, e.g. when it is damp and mold spores may be released and, if you have air-conditioning, fit a HEPA filter.
As it stands, discovering you have allergies is almost inevitably revealing a pre-existing condition, so you need to look carefully at the wording of your current health plan to see what coverage is available. If you are looking for your first health insurance coverage and know you have allergies, you must disclose the fact. Failure to do so gives your insurer the right to cancel the policy when the omission is discovered. Even when allergies are included, the extent to which the plan will pay out on the counseling and advice often necessary to make effective changes to your lifestyle can vary dramatically from one insurer to another. Some are genuinely supportive. Other have high co-payments on even the standard antihistamines. This places the burden very much on you to explore what can be built into the coverage. In this, there is one worrying statistic. The number of children who are developing more severe anaphylactic shock to different elements in the environment is rising. This means preventative as well as treatment care will be necessary.
If your allergies are serious enough to threaten your quality of life and restrict your ability to earn a living, adequate health insurance is a necessity. You are paying out on premiums to keep you functional, whether only through the season or the whole year. This is good value-for-money cover so long as the medical advice you receive does work. If in doubt, always get a referral to an experienced allergist. It may cost you a little more, but it is worth the extra money.
Tags: Allergic Reaction, Allergist, Carpets, Cur, Environmental Allergies, Grass Pollens, Health Insurance, Health Plans, Hepa Filter, Insects, Intensity, Medical Science, Mold Spores, Molds, Pillow Cases, Report Improvement, Seasonal Allergies, Skin Tests, Sofas, Tree Pollens
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Apr
18
2010
The business of insurance is called underwriting. The company enters into a contract (called a policy) and agrees to indemnify a group of people like you against defined losses. So it uses some heavy duty math to work out the probability of the losses being incurred. It’s called risk assessment and relies on a complicated use of statistics. For vehicle insurance, the companies collect the details from every reported traffic accident in the US looking at the age, sex and occupation of the driver, the make and model being driven, the time of day, the road conditions, and the extent of the damage. The insurers share the information on the current costs of replacement parts and the labor to fit them.
They also manage to talk the health insurance companies into sharing their current costs on medical treatment for those injured in traffic accidents. With all this information, they can make good estimates of the cost of loss, i.e. the total amount they may have to pay out if they insure, say, 100,000 drivers. They take this estimate, add the cost of running the insurance company and a profit margin. This total is then divided between all the 100,000 as their premiums. Some companies divide the total equally so the good drivers subsidize the bad. But the majority adjusts the individual amounts based on the driver’s safety record. That way, each policy holder pays more or less depending on how well he or she drives. This is more fair.
But, to cut costs, some insurance companies make more general assumptions about the likelihood of losses. Instead of personalising the risk assessment, they focus the assessment on generalities. The most common is the use of the zip code. In some areas of a town or city, there are higher levels of vehicle theft and vandalism. Some areas have more people driving while intoxicated or impaired through drugs. Because of the design of the local road system, there may also be a higher number of accidents. The insurers therefore charge everyone living in those areas a higher premium. Apart from the unfairness at an individual level, some lawyers believe it is active discrimination because many of the zip code areas loaded with higher premiums have higher concentrations of particular racial or ethnic groups. California has formally prohibited insurance companies from using zip codes, credit scores and other factors not directly relevant to the assessment of driver safety. In those states, insurers continue to trade and make a profit. It has not been the end of the world they predicted.
So, depending on the US state in which you live, your premium may either be calculated based on your personal driving record, or it may be based on your zip code and credit score. Either way, the task of finding the cheapest car insurance remains the same. You have to shop around the companies licensed to sell policies in your state and find the best deal. If there is active competition between the insurers, the premiums will be lower and you will find cheap car insurance without too much difficulty. But if the state is unregulated and insurers do not compete, it will be more difficult to find a cheap policy.
Tags: Age Sex, Car Insurance Companies, Generalities, Health Insurance, Health Insurance Companies, Insurance Company, Local Road, Medical Treatment, Premiums, Profit Margin, Replacement Parts, Risk Assessment, Road Conditions, Safety Record, Time Of Day, Traffic Accident, Traffic Accidents, Vandalism, Vehicle Insurance, Vehicle Theft
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