The most of people, who buy their own medical health insurance, rely heavily on the insurance professional selling the policy to clarify the plan's coverage and advantages. This being the case, many people who purchase their own medical health insurance plan can tell you hardly any about their plan, other compared to, what they pay in premiums and how much they need to pay to satisfy their insurance deductible.
For many consumers, purchasing a health insurance policy by themselves can be an enormous task. Purchasing a health insurance policy isn't like buying a car, for the reason that, the buyer knows that the actual engine and transmission are regular, and that power windows tend to be optional. A health insurance plan is a lot more ambiguous, and it is often very hard for the consumer to determine which kind of coverage is standard and the other benefits are optional. In my estimation, this is the primary reason that many policy holders don't realize that they don't have coverage for a specific treatment until they receive a large bill in the hospital stating that "benefits had been denied. "
Sure, we all complain about insurance providers, but we do know they serve a "necessary evil. inch And, even though purchasing health insurance can be a frustrating, daunting and time eating task, there are certain things that can be done as a consumer to make sure that you are purchasing the type of medical health insurance coverage you really need in a fair price.
Dealing with small businesses and the self-employed market, I have come to the realization that it's extremely difficult for people to distinguish between the kind of health insurance coverage that they "want" and also the benefits they really "need. inch Recently, I have read various remarks on different Blogs advocating health plans that provide 100% coverage (no deductible as well as no-coinsurance) and, although I agree that those kinds of plans have a great "curb attractiveness, " I can tell you from personal experience these plans are not for everybody. Do 100% health plans provide the policy holder greater satisfaction? Probably. But is a 100% medical health insurance plan something that most consumers actually need? Probably not! In my expert opinion, when you purchase a medical health insurance plan, you must achieve the balance between four important parameters; wants, needs, risk and cost. Just like you would do should you were purchasing options for a brand new car, you have to weigh each one of these variables before you spend your hard earned money. If you are healthy, take no medications and rarely navigate to the doctor, do you really require a 100% plan with a $5 co-payment for prescription medications if it costs you $300 dollars more per month?
Is it worth $200 more a month to possess a $250 deductible and a $20 manufacturer name/$10 generic Rx co-pay versus an 80/20 plan having a $2, 500 deductible that also provides a $20 brand name/$10generic co-pay after you pay a one per year $100 Rx deductible? Wouldn't the 80/20 plan still provide you with adequate coverage? Don't you think it might be better to put that additional $200 ($2, 400 per year) in your money, just in case you might have to pay your $2, 500 deductible or purchase a $12 Amoxicillin prescription? Isn't it wiser to maintain your hard-earned money rather than pay higher premiums for an insurance company?
Yes, there are many ways you are able to keep more of the money that you simply would normally give to an insurance company as higher monthly premiums. For instance, the federal government encourages consumers to buy H. S. A. (Health Cost savings Account) qualified H. D. THEY WOULD. P. 's (High Deductible Health Plans) so that they have more control over how their healthcare dollars are spent. Consumers that purchase an HSA Qualified THEY WOULD. D. H. P. can put extra money aside every year in an interest bearing account to allow them to use that money to purchase out-of-pocket medical expenses. Even procedures which are not normally covered by insurance providers, like Lasik eye surgery, orthodontics, as well as alternative medicines become 100% taxes deductible. If there are no claims that year the cash that was deposited into the actual tax deferred H. S. A can be rolled over to another year earning an even higher interest rate. If there are no significant claims for quite some time (as is often the case) the insured eventually ends up building a sizeable account which enjoys similar tax benefits like a traditional I. R. A. The majority of H. S. A. administrators now offer a large number of no load mutual funds in order to transfer your H. S. THE. funds into so you could possibly earn an even higher interest rate.
In my experience, I think that individuals who purchase their health plan depending on wants rather than needs have the most defrauded or "ripped-off" by their insurance provider and/or insurance agent. In truth, I hear almost identical comments from nearly every business owner that I talk to. Comments, such as, "I need to run my business, I do not have time to be sick! "I think I have attended the doctor 2 times within the last 5 years" and "My insurance provider keeps raising my rates and I don't use my insurance! " As a company owner myself, I can realize their frustration. So, is there an easy formula that everyone can follow to create health insurance buying easier? Indeed! Become an INFORMED consumer.
Each time I contact a prospective client or call among my client referrals, I ask a number of specific questions that directly connect with the policy that particular individual currently has within their filing cabinet or dresser cabinet. You know the policy they bought to protect them from needing to file bankruptcy due to healthcare debt. That policy they purchased to pay for that $500, 000 life-saving organ transplant or even those 40 chemotherapy treatments that they might have to undergo if they are identified as having cancer.
So what do you think happens almost 100% of times when I ask these people "BASIC" questions about their medical health insurance policy? They do not understand the answers! The following is a summary of 10 questions that I frequently ask a prospective medical health insurance client. Let's see how many You are able to answer without looking at your own policy.
1. What Insurance Company have you been insured with and what may be the name of your health insurance policy? (e. g. Blue Cross Azure Shield-"Basic Blue")
2. What is your calendar year deductible and would you need to pay a separate deductible for every family member if everyone inside your family became ill simultaneously? (e. g. The majority of health plans possess a per person yearly deductible, for instance, $250, $500, $1, 000, or even $2, 500. However, some plans will only need you to pay a 2 person maximum deductible every year, even if everyone in your loved ones needed extensive medical care. )
3. What is your coinsurance portion and what dollar amount (stop loss) it is dependant on? (e. g. A good strategy with 80/20 coverage means a person pay 20% of some buck amount. This dollar amount is also called a stop loss and can vary in line with the type of policy you buy. Stop losses can be less than $5, 000 or $10, 000 or around $20, 000 or there are some policies available on the market that have NO stop reduction dollar amount. )
4. What's your maximum out of pocket expense each year? (e. g. All deductibles in addition all coinsurance percentages plus just about all applicable access fees or additional fees)
5. What is the Lifetime obtain the most the insurance company will pay should you become seriously ill and will your plan have any "per illness" maximums or even caps? (e. g. Some plans might have a $5 million lifetime optimum, but may have a obtain the most cap of $100, 000 for each illness. This means that you would need to develop many separate and not related life-threatening illnesses costing $100, 000 or less to be eligible for a $5 million of lifetime protection. )
6. Is your strategy a schedule plan, in that it only pays a specific amount for a specific list associated with procedures? (e. g., Mega Existence & Health & Midwest Nationwide Life, endorsed by the National Association from the Self-Employed, N. A. S. AT THE. is known for endorsing routine plans) 7. Does your plan have doctor co-pays and therefore are you limited to a certain quantity of doctor co-pay visits per 12 months? (e. g. Many plans have a restrict of how many times you navigate to the doctor per year for the co-pay and, quite often the actual limit is 2-4 visits. )
8. Does your plan offer prescription drug coverage and when it does, do you pay a co-pay for your prescriptions or is it necessary to meet a separate drug deductible before you decide to receive any benefits and/or would you just have a discount doctor prescribed card only? (e. g. Some plans provide you with prescription benefits right away, other plans require that a person pay a separate drug deductible before you receive prescription medication for the co-pay. Today, many plans offer no co-pay options and only will give you discount prescription card that provides you with a 10-20% discount on just about all prescription medications).
9. Does your plan have any decrease in benefits for organ transplants and when so, what is the maximum your plan will pay if you want an organ transplant? (e. grams. Some plans only pay the $100, 000 maximum benefit for organ transplants for any procedure that actually costs $350-$500K which $100, 000 maximum may also consist of reimbursement for expensive anti-rejection medications that must definitely be taken after a transplant. If this is actually the case, you will often have to cover all anti-rejection medications out associated with pocket).
10. Do you need to pay a separate deductible or "access fee" for every hospital admission or for each er visit? (e. g. Some programs, like the Assurant Health's "CoreMed" plan possess a separate $750 hospital admission fee that you simply pay for the first 3 days you're in the hospital. This fee is along with your plan deductible. Also, numerous plans have benefit "caps" or even "access fees" for out-patient providers, such as, physical therapy, talk therapy, chemotherapy, radiation therapy, and so on. Benefit "caps" could be less than $500 for each out-patient remedy, leaving you a bill for that remaining balance. Access fees are additional fees that you simply pay per treatment. For instance, for each outpatient chemotherapy remedy, you may be required to pay for a $250 "access fee" for each treatment. So for 40 chemotherapy remedies, you would have to spend 40 x $250 = $10, 000. Once again, these fees would be charged along with your plan deductible).
Now that you have read through the list of questions which i ask a prospective health insurance coverage client, ask yourself how many questions you could answer. If you couldn't answer all ten questions you shouldn't be discouraged. That doesn't mean that you're not a smart consumer. It might just mean that you handled a "bad" insurance agent. So how may you tell if you dealt having a "bad" insurance agent? Because a "great" insurance agent might have taken the time that will help you really understand your insurance advantages. A "great" agent spends time asking questions so s/he can realize your insurance needs. A "great" agent recommends health plans depending on all four variables; wants, requirements, risk and price. A "great" agent gives a person enough information to weigh all your options so you can make the best purchasing decision. And lastly, a "great" agent looks out for the best interest and NOT the very best interest of the insurance organization.
So how do you know for those who have a "great" agent? Easy, if you could answer all 10 questions without taking a look at your health insurance policy, you've got a "great" agent. If you could answer the majority of queries, you may have a "good" broker. However, if you were only able to answer a few pre-determined questions, chances are you have the "bad" agent. Insurance agents are no diverse from any other professional. There are some insurance agents that actually care about the clients they use, and there are other brokers that avoid answering questions and duck client telephone calls when a message is remaining about unpaid claims or skyrocketing medical health insurance rates.
Remember, your health insurance purchase is equally as important as purchasing a house or perhaps a car, if not more essential. So don't be afraid to ask your insurance professional a lot of questions to make certain that you understand what your health plan does and doesn't cover. If you don't feel comfortable with the kind of coverage that your agent suggests or if you feel the price is too higher, ask your agent if s/he may select a comparable plan to help you make a side by side comparison before you decide to purchase. And, most importantly, read all the "fine print" in your health plan brochure so when you receive your policy, take time to read through your policy on your 10-day free look period.
If you cannot understand something, or aren't quite sure what the asterisk (*) alongside the benefit description really means when it comes to your coverage, call your agent or contact the insurance provider to ask for further clarification.
In addition, take the time to perform your personal due diligence. For example, should you research MEGA Life and Wellness or the Midwest National Life insurance coverage company, endorsed by the National Association for that Self Employed (NASE), you will find that there has been 14 class action lawsuits brought against these businesses since 1995. So ask your self, "Is this a company which i would trust to pay my medical health insurance claims?
Additionally, find out in case your agent is a "captive" broker or an insurance "broker. inch "Captive" agents can only provide ONE insurance company's products. " Independent" agents or insurance "brokers" can provide you with a variety of different insurance plans from a variety of insurance companies. A "captive" agent may suggest a health plan that doesn't exactly be practical because that is the just plan s/he can sell. An "independent" agent or insurance "broker" can usually provide you with a variety of different insurance items from many quality carriers and may often customize a plan to satisfy your specific insurance needs as well as budget.
Over the years, I've developed strong, trusting relationships with my clients due to my insurance expertise and the amount of personal service that I supply. This is one of the main reasons that I do not really recommend buying health insurance on the web. In my opinion, there are too many parameters that Internet insurance buyers do not often consider. I am a firm believer that the health insurance purchase requires the amount of expertise and personal attention that only an insurance broker can provide. And, since it doesn't cost a penny more to buy your health insurance through an broker or broker, my advice is always to use Ebay and Amazon for the less important purchases and to utilize a knowledgeable, ethical and reputable independent agent or broker for probably the most important purchases you will actually make.... your health insurance plan.
Lastly, if you have any concerns about an insurance provider, contact your state's Department of Insurance Before you decide to buy your policy. Your state's Department of Insurance can let you know if the insurance company is registered inside your state and can also tell you if there has been any complaints against that company which have been filed by policy holders. If you suspect that your agent is selling you a fraudulent insurance plan, (e. g. you have to enroll in a union to qualify with regard to coverage) or isn't being honest along with you, your state's Department of Insurance can also determine if your agent is licensed and whether there has ever been any kind of disciplinary action previously taken towards that agent.