- Would you recommend a high-deductible health insurance plan?
- Is having health insurance mandatory and what will happen if I do not buy it?
- What are the alternatives to private health insurance and how do I know if I am eligible?
- Why isn’t health insurance sold like car insurance?
- How can Obamacare be explained in layman’s terms?
- Should you purchase long term care insurance?
- What are the best options for out of pocket healthcare?
- Is travel insurance really necessary?
- If an unconscious person requiring medical attention is brought into an emergency room, how does the hospital know if they’ll get paid?
- Do you have any recommendations for health insurance for freelancers?
- At what point in a startup do you start offering health insurance?
- What are the best ways for a startup to provide health insurance for the founding team and early hires?
- Are breast implants covered by medical insurance?
- How do health insurers gather full medical history of patients?
- Which is worse: turning away people from the ER based on inability to pay, or declining people health coverage based on pre-existing conditions?
- I just got a bill from the local emergency room. I don’t have health insurance. I can’t afford to pay the bill. What should I do?
- What are good cost effective health plans for those not yet on Medicare?
- What should I do about “balanced billing” from the ER?
- Will insurance cover the cost of plastic surgery for formerly obese people or women who have had children?
- What should people consider when shopping for health insurance?
- What should I do if my health insurance is about to end?
- What is the cost structure of a typical health insurance plan to an employer?
Would you recommend a high-deductible health insurance plan?
Question: Todays question comes from Deborah in Pennsylvania and is Would you recommend a high-deductible health insurance plan?
There is not a cut and dry way of answering this question. You have to sit down and look at your personal situation to know if a high deductible health insurance plan will work for you. Granted, it’s one of the best ways to save money on your health insurance policy but coverage should be your main motivator, not price. First, you can have a normal insurance plan and raise your deductibles. This is going to lower your annual premium significantly because of the way deductibles factor into premium pricing. Each deductible level is based on the average risk assumed by the insurance company so if you pose less of a risk, raising your deductible is a smart move. It’s going to save you some major money.
If you seek individual coverage, a high-deductible health insurance plan (HDHP) might work for you. This is going to combine low premiums with a high deductible and a health savings account, also known as an HAS account. Keep in mind that this type of coverage is classified as catastrophic so it’s primarily meant for people that rarely frequent the doctor except for preventive visits and the occasional cold. If you know that you have to visit the doctor or a specialist at least once a month, a HDHP probably isn’t the best plan for you.
If you choose to raise your deductible on your traditional insurance policy or participate in and HDHP with an HSA account, make sure that you have enough savings to cover you actual deductible amount. Your coverage won’t kick in until you meet that limit.
Is having health insurance mandatory and what will happen if I do not buy it?
Question: Dan from Utah asked: Is having health insurance mandatory and what will happen if I do not buy it?
Currently, health insurance is not mandatory but that will change in 2014 because of the Affordable Care Act. After that you will be required by law to have health insurance or you will face a fine. It’s important to know that your options should increase by the time the law takes effect so finding affordable insurance should not be as big of an issues as it is now. States will offer health exchanges you can participate in if you cannot find private health insurance. There are some exemptions that exclude certain people from the penalty of the law if they don’t health insurance.
But, if you don’t have a policy and don’t meet any exemptions, you will be hit with a fine. The government is still trying to determine how the fee will assessed. There is a possibility that it could be placed at the same rate as the national average for minimal coverage. In that case, it would make more sense to spend your money on health insurance rather than just turn it over to the government. Another proposal is that the feel will be a flat rate and will continue to rise over the years based on cost of living estimates. Right now, the proposed fee for 2014 is $95, which wouldn’t exactly break the bank. Try to educate yourself on the different options that will be available to you once the law is implemented to make sure you have coverage you need and avoid a fee that you don’t.
What are the alternatives to private health insurance and how do I know if I am eligible?
Question: Martin from San Francisco asked us: What are the alternatives to private health insurance and how do I know if I am eligible?
If you don’t have an employer sponsored program and private health insurance is just too expensive, you may feel as if you are between a rock and a hard place. Fear not. If you under the age of 65 and meet certain requirements, you may be able to apply for the federally funded health insurance program known as Medicaid. Signed into law in 1965 by President Lyndon B Johnson, Medicaid caters to low- income families and individuals, some seniors, and people that are blind and have disabilities. If you are over 65, you may qualify for Medicare, which provides health insurance for seniors. Regarding Medicaid, there are some federal mandates regarding qualification that all states must follow.
Certain groups of individuals must be covered if they do not have access to another form of health insurance. This includes children, pregnant women, low-income parents, the elderly, and those who are blind and/or disabled. Income is measured against the federal poverty level. All Medicaid programs are regulated at a state level and if you aren’t sure if you meet the requirements, check with your state’s Medicaid office to find out specific requirements. Be prepared to release personal information but if this is what you must do to gain insurance coverage, it is worth it. Medical costs are through the roof in today’s society and not seeking proper treatment due to cost can ultimately lead to bigger problems for everybody. Take advantage of the preventive services that are covered by Medicaid and Medicare. Having health insurance is an invaluable means of protection but ultimately, you are responsible for your own health.
Why isn’t health insurance sold like car insurance?
The current reformatory Affordable Care Act mandates that all U.S. citizens must have health insurance. There are those that challenged this, claiming it was unconstitutional. While the Supreme Court ultimately upheld the bill and had a more sound reasoning for doing so, some people argued that if car insurance was mandatory, how could it be unconstitutional to make health insurance mandatory? On the surface, it might seem like a valid reason but health insurance isn’t sold like car insurance for a very good reason. Our bodies are not like a car and even though the Affordable Care Act makes health insurance mandatory, it still isn’t comparable to car insurance.
One big difference is that car insurance is only required if you drive a car. If you don’t drive a car, you aren’t required to have health insurance but it’s in the coverage that the major differences begin to show. Health insurance is required to cover a large range of different procedures where as your car insurance is meant to provide protection from accidents. This is because owning a car and being a healthy individual are two completely different things. It’s reasonable to expect health insurance to cover such preventive procedures like annual checkups, dental cleanings, and the occasional visit to the doctor. This is part of what keeps us healthy and when we’re healthy, we’re contributing to society as a whole.
On the other hand, your car isn’t necessary to make sure that you’re a functioning member of society. Someone living in Los Angeles may argue this point but essentially, you’ll find a way to function. This is why car insurance doesn’t cover regular maintenance on your car. Driving is considered to be a privilege, health, or at least the method to maintain it, is considered to be a right in the United States.
Another big difference between car insurance and health insurance is that car insurance uses many different factors like age and driving history to set rates. It’s possible that you can be denied coverage, but again, driving is a privilege. Currently, health insurance can use pre-existing conditions as a way to deny coverage but that disappear in 2014 with the Affordable Care Act. Your bad driving history is your fault so you should pay more but just because you’re born with a disease, does that mean you shouldn’t get health insurance at all? Healthcare reform supporters don’t think so. Car insurance and health insurance aren’t meant to cover the same things so they shouldn’t be sold the same way and they aren’t even close.
How can Obamacare be explained in layman’s terms?
By now, the wheels have been turning for Obamacare for some time but some people still claim that it’s difficult to understand. Overall, trying to understand health insurance is a difficult task which is why many rely on insurance agents to help explain policies. It’s important to understand the Affordable Care Act though because it’s going to affect all Americans and especially business owners need to make sure they understand what their options are. Individual Americans also need to take the time to understand how the bill will impact not only their health care but also their wallets, whether it’s good or bad.
One of the main tenants of the bills states that health insurance will be mandatory for all U.S. Citizens. This has caused some controversy and was challenged in the Supreme Court but upheld. It does have certain applicable exclusions and by providing affordable health care, obtaining it will not be hard for many people. If you do not have health insurance and aren’t considered an exclusion to the law, you will pay a penalty. The argument is that for the price of the penalty, you will be able to find health insurance.
Affordable healthcare will be offered by states through exchanges. Individual and small businesses will be able to go to an independent, state run website to compare health insurance plans much like you do with auto insurance companies now. This is expected to encourage competition between health insurance companies, lowering the cost for Americans.
Small businesses that offer health insurance to their employees will receive a 35% tax credit and that will increase to 50% in 2014. Medicare will be expanded to cover more individuals and free preventive care.
Restrictions will be placed on insurance companies. They will no longer be able to impose lifetime limits or deny people coverage that have pre-existing conditions or charge them a higher premium. The ACA is doing many things for healthcare and it’s important you understand how you’ll be affected. Ask your insurance agent or state department about individual concerns.
Should you purchase long term care insurance?
This isn’t a cut and dry answer to this question. There are many people who believe that everyone should purchase a long term care insurance policy while others don’t think the benefits are worth the cost. It’s ultimately a very personal decision and may help some people feel more at ease about there care as they get older. For others, it may simply be a burden. It’s best to look at your current situation and see what works best for you. Here are some of the arguments for and against long term care insurance to help you decide.
Those that advocate for long term care insurance understand that people are living much longer in today’s society. Even if you’re a healthy 75 year old, long term care may still work well for you because it will allow someone to come into your home and help you with daily chores as well as minor medical concerns. It’s important to note that long term care insurance isn’t just made for people 65 and older. Some younger individuals may qualify if they suffer from a debilitating disease that requires care. For the elderly and disabled, Medicare and Medicaid can only cover so much. If you’re very wealthy, you may not a long term care policy because your savings can cover your costs. If you’re in the middle, a long term care insurance policy may help protect the savings that you do have while providing the care you need.
Those that don’t believe long term care insurance is necessary say the costs are too high and many people rarely experience the full benefits. Many policies requires that customers wait 90 days before they’re eligible for benefits but many seniors and disabled individuals won’t spend that amount of time in a long term care facility. They will be discharged first. And for those in the middle class, opponents of long term care insurance recommend saving the amount you would pay in premiums to help cover the unlikely cost of permanently ending up in a nursing home.
What are the best options for out of pocket healthcare?
When trying to cover health care costs upfront, it can be a very expensive matter. Even people that have comprehensive health insurance often have to deal with a certain amount of out of pocket costs and everyone always to save money. But how do you do this? There are several different ways that you can manage out of pocket costs. While they may not be easy, if you must have medical attention, it’s better to pay the cost and be healthy than put yourself at risk because of inability to pay.
One of the first things that you need to do when paying upfront is do your research. Many doctors may try to make you feel as if you have to get something done immediately but if your medical situation is not an emergency, you can spend a couple days researching the issue. Make sure that the test or procedure is absolutely necessary and get to know more about your medical condition. Are there any alternative tests or procedures that may be cheaper but just as effective? Also, once you understand exactly what procedure you need, try to find the location that offers the cheapest services. Your standard doctor’s offices may have set rates but an ACO participating office may be able to offer lower rates. Additionally, there are clinics in many cities that cater to those who are considered low income or have no health insurance.
Many time, clinics offer discounted and even free services but they limits as to what they can perform because funding can be low. If the medical procedure you need is more serious, such as a surgery, shopping around may not make much difference when you can’t pay $3,000 or $5,000. If you have to have the surgery, you should. It could mean the difference between life and death. There are several credit cards that you can open but obtaining one is still subject to approval through credit history. If this isn’t an option and you don’t want to add more debt to your financial name, try going down a different route.
Some doctor’s offices may offer payment plans so if you find someone that can perform the surgery but all of them seem out of reach, consider choosing the office that offers a payment plan. This may be the best way to stay healthy both physically and financially.
Is travel insurance really necessary?
This is a tricky questions and it really depends on you and the type of trip that you’re taking. Whenever you purchase any kind of insurance policy, you have to weigh the risk that you’re taking by not purchasing the insurance with the money that you’re paying for the extra protection. Some people prefer to travel completely covered while others think that it’s a waste of money. Unless you can afford to adopt a blanket attitude either way, it’s worth it to look at each individual trip you take and see how insurance can help you.
Travel insurance may be sold in packages or it could come with various options from which you can pick and choose. There’s a chance that if you automatically go with a package, you could be wasting money because you’re buying excess coverage. Always try to check what kind of coverage you have in place already and what risks it covers. One of the first things that enters a travelers mind may be getting sick in a foreign country. Would your health insurance pay for this and if they don’t, how much would it cost?
Without checking your individual policy, it’s hard to tell what would and wouldn’t be covered. It’s likely doctors in China are out of your network and if you know your health insurance won’t cover that stomach bug you caught eating street food, investing in medical travel insurance is a good idea. On the other hand, if your regular policy covers you, there’s probably not a need to get extra insurance unless you know you will be doing something very dangerous.
When it comes to insuring your property, check your homeowner’s policy. Many personal property clauses will cover items if they’re stolen even when they aren’t in your home. Your homeowner’s liability policy will also insure you while you’re abroad. It’s just important to make sure that on both clauses you have the proper amount of coverage. Most personal property homeowner policies will only cover up to a certain percentage of your home value and after that, you will need to purchase additional coverage. Same goes for liability insurance.
One travel insurance option that may be worth it is insuring your trip. This is often sold with the agency you use to book your hotel or plane tickets and can provide reimbursement if you have to cancel or move dates. This is normally fairly affordable and you never when an accident can happen so this could be one policy worth your money.
If an unconscious person requiring medical attention is brought into an emergency room, how does the hospital know if they’ll get paid?
The hospital can’t be sure they will be paid if an unconscious individual is dropped off at their doors but they are required by law to treat the person. The Emergency Treatment and Labor Act (EMTALA) was passed in 1986 and requires that anyone who shows up to the emergency be treated accordingly. If the hospital doesn’t participate in Medicare though, they do not have to treat you if you cannot pay. But if you’re unconscious, they wouldn’t know and would likely treat you.
If you are conscious and show up at the emergency room with a bad headache and can’t pay, they are not required to treat you. You have to be able to prove you have a medical emergency or the emergency room staff will direct you somewhere to get treatment. You are only considered to be having a medical emergency when: your condition is placing your health in jeopardy or it’s causing impairment or dysfunction to your normal bodily functions. If hospitals don’t treat you when you really need treatment, they can be fined. But how do they get paid if you can’t pay?
If you don’t have health insurance and visit the emergency room, there’s likely going to be some high costs associated with the procedures and tests done. Somebody has to pay for those. If you can’t, work with the hospital to see if you qualify for any kind of state or federal aid. Many financial offices have forms readily available and will not move forward with bills until your application is approved or denied. If you’re approved, it may only cover a portion of the bills. If you still owe hospital a large sum of money, ask if they have any discount programs that you could apply for. Normally, these programs will help take care of a certain portion of your hospital bill but may not cover it all. Hospitals aren’t in the business of giving away free procedures so the remaining amount, you’ll be expected to pay.
You can set up a payment plan with the hospital and even if it’s just $5.00, as long as you can prove you will pay something, the hospital is willing to work with you. But sometimes, people can’t spare $5.00 and if you truly can’t pay the bill, you may have to go to court but the hospital will write off your bill. Unfortunately, your credit takes a significant hit, making it hard to get back on your feet. If possible, try to purchase insurance so that you can avoid any of the above situations.
Do you have any recommendations for health insurance for freelancers?
Working for yourself can seem like a dream come true until you start to shop for health insurance. You realize that the 9-5 you hated so much certainly had some perks with it but there are also perks that come with being a freelancer. You just have to know what your options are regarding health insurance to make sure that you still have adequate coverage while enjoying the freelancer life.
In fact, even if you have a traditional job, many employers are cutting insurance benefits so they have to look for insurance just like many self-employed people. There are several things that a freelancer can do to obtain health insurance but until 2014, you may have to shell out quite a bit of money to be covered. One of the more affordable options is to seek insurance through a spouse if they have employer coverage. Adding you to the policy will be more expensive but it won’t cost nearly the rates that a private individual policy would cost you.
Another option is to try to find a freelancer professional group that offers health insurance. This may be more affordable than purchasing an individual policy because the group takes advantage of different coverage rates. The more people that take advantage of a health plan, the cheaper it is because the risk is distributed among a larger group of people. Plans are still going to run at least $200 per month and you will need to select the appropriate amount of coverage for yourself, which could be more costly.
If you have no choice but to purchase an individual insurance plan, consider using a high deductible health plan (HDHP). These are more affordable because you agree to pay at least $1,000 out of pocket before insurance covers anything but you can combine this health plan with a health savings account (HSA) which has tax advantages. Any money that you deposit into this account grows tax deferred and you can use it for all your medical purchases. This is often the most affordable route and if you can manage to save up enough money, you will actually have some extra perks with this health care.
In 2014, things change though and you may start to see a variety of affordable healthcare options as the Affordable Care Act institutes state healthcare exchanges. These will be individual run by each state and will let you compare plans and pricing to find the best coverage. Ultimately, it’s hoped that this will encourage competition among insurance companies, lowering premiums for you which is a good thing because health insurance will be mandatory. Start your research now.
At what point in a startup do you start offering health insurance?
Currently, there are no laws that govern when startups should offer health insurance so it’s really up to you. You have to take stock of your current situation to see if it makes sense. There are advantages and disadvantages to both the employees and the employer but offering health insurance could make you a more desirable employer.
Take a look at the number of people that you employ. If it’s only you and your best friend working together as a team, offering health insurance may not make sense because each of you can probably find individual policies for the amount that it will cost to buy group insurance. If your small business begins to grow and you must hire new employees, don’t be afraid to ask what their healthcare needs are. If they are covered under a spouse’s plan or already have insurance, you may not need to offer healthcare.
In 2014, if your business employees more than 50 people, you are required to offer health insurance that meets the standard set forth by the Affordable Care Act. If you choose not to offer health insurance, you will have to pay a penalty but the majority of businesses in the U.S. don’t employee 50 people so they will not be affected.
Deciding when to offer health insurance to employees is a personal decision. There are some large companies that still don’t offer health insurance but many small businesses think that offering health insurance is just the right thing to do. You may not be able to afford some of the best plans available but having any form of health insurance is better than no coverage at all.
What are the best ways for a startup to provide health insurance for the founding team and early hires?
When you first setup your business, there are many things to take care of and health insurance may get pushed to the back burner of your thoughts. As you begin to get into a smooth business routine, or you get the flu, the idea of health insurance may be pushed back to the forefront. For the founding team, there are several ways that you can get coverage.
If anyone has come from former jobs, they are eligible for COBRA which extends their former employer health insurance plans although the only difference is that now they’re paying the full premium amount. It’s expensive but at least you have coverage. Founding members can also look for individual plans although technically, a group of two can apply for group policies. If the founding team and even early hires are all healthy with no pre-existing conditions, individual plans may provide just as much coverage with the same cost. You also won’t have to deal with the details of making sure everyone’s covered.
It’s important to note that right now though, insurance companies that offer individual policies can deny coverage or charge extremely high rates for anyone with a pre-existing condition. If your founding partner is diagnosed with diabetes and you have a history of depression, choosing to get insurance through a group plan may work best because you won’t be denied coverage. Of course, with the Affordable Care Act, 2014 brings a new year where no one can be denied coverage because of pre-existing conditions.
As you hire new members, it really depends on how many people you hire as to whether buying insurance is a good idea. In 2014, you may find that it’s more affordable to buy group plans for multiple employees so waiting 2013 out may be your best plan. In the meantime, just make sure that you have some form of health insurance and encourage all your employees to do the same thing.
Are breast implants covered by medical insurance?
Breast implants aren’t typically covered by medical insurance because it’s considered a cosmetic surgery. Only under some circumstances will breast augmentation be covered. Most insurance companies cover surgeries that are intended to enhance the functional aspects of a body. In an insurance companies’ mind, breast implants aren’t necessary to daily functioning.
The one instance where breast implants are covered is if you’ve had breast cancer and had to get a mastectomy. Be sure to speak with your health insurance company to see how much of the surgery will be covered. In an operation like this, there will also be additional fees for the actual implants, medication, anesthesia and other add on options. If you don’t need breast implants, it’s important to think of the long term consequences on your health insurance.
If you need to switch insurance companies, some will regard breast implants as a pre-existing condition. Of course, this policy will be eliminated in 2014 due to the Affordable Care Act but you may find that you still pay more for insurance. Breast implants place you in a higher risk category because they can cause health problems through leaking or bursting. Some insurance companies may even limit your coverage related to breast health. For example, if you have breast implants and then got breast cancer, that disease would be subject to special exclusions or deductibles.
Another thing to think about is additional surgeries. Many women, after having one breast implant procedure, must get another eventually. Although some implant manufacturers have a lifetime guarantee, accidents happen. Implants can rupture but if you have a silicone implant, getting the recommended MRI’s can help prevent that situation but the added cost of an MRI may not be covered by your insurance.
If you’re thinking about getting breast implants, contact your health insurance company.
How do health insurers gather full medical history of patients?
Insurance companies can normally only access your medical records to determine if you’re eligible for coverage. HIPAA, the Health Insurance Portability and Accountability Act, limits access to your medical records. You may be familiar with signing HIPAA forms at the doctor’s office, which allows specific named people you give authorization to view your medical records. If an insurance company is trying to figure out whether to extend coverage to your or not, they review your medical records through the Medical Information Bureau (MIB) if they’re a member.
This is a database that contains medical information significant to underwriting insurance policies and the information that appears is only that which you’ve consented to give or has appeared on your insurance applications. If you haven’t applied for health or life insurance in the past 7 years, you have no MIB record. Not all insurance companies are members of the MIB and they must pay a fee to join as well as when they request information.
Insurance companies that access MIB records are required to let you know but it may be stuck in the middle of a large amount of information. Things like pre-existing conditions may appear on your MIB record so if you know that it will show up, it’s a good idea to ask your insurer whether it will make your rates higher. Starting in 2014, health insurance companies cannot deny coverage based on pre-existing conditions but you should always let your insurance company know about certain conditions. It will be necessary to getting the right coverage limits. MIB insurance companies will notice any inconsistencies within your application.
Once you receive coverage, your insurance company may request medical records from a doctor’s office before covering services. If you have questions about privacy, speak with your insurance company and doctors office for more information.
Which is worse: turning away people from the ER based on inability to pay, or declining people health coverage based on pre-existing conditions?
One situation isn’t worse than the other. It’s a simple fact of understanding how the healthcare system works to get the care that you need. If you’ve been turned away from an ER because you can’t pay, there may be several reasons that the doctors wouldn’t see you. There could also be other affordable alternatives that you can explore. Currently, people can be declined health insurance coverage based on pre-existing conditions but that will change in 2014.
According to the Affordable Care Act, denying coverage based on pre-existing conditions will be illegal. This provision was added to the law based on the staggering number of people who needed healthcare the most but wasn’t receiving coverage. Based on research by the Department of Health and Human Services, anywhere from 19% to 50% of non-elderly American citizens had some type of pre-existing condition. 1 in 5 of those people were completely uninsured while others could have dealt with higher premiums, condition based exclusions or condition based deductible. In 2014, citizens with pre-existing conditions can obtain affordable insurance to assist them when they need it the most.
But, getting turned away from a hospital could still happen but certain conditions must be met. In 1986, a law was passed that requires all hospitals who receive Medicare benefits to accept any patients, regardless of insured status. It must truly be an emergency though. Any situation that places a person’s life in jeopardy or a pregnancy in progress calls for immediate attention. If you arrive to the ER with a non-emergency situation, such as a headache or virus, and are uninsured, you will likely be turned away. Try visiting a 24 hour physician’s assistant center, which will cost money but can also provide a payment plan and recommend future methods to prevent sickness.
I just got a bill from the local emergency room. I don’t have health insurance. I can’t afford to pay the bill. What should I do?
If don’t have health insurance and/or you can’t pay your hospital bill, you’re not alone. Millions of Americans have thousands of dollars’ worth of medical bills and they are actually the number one reason people declare bankruptcy. Before you go to the hospital, check to see if you’re eligible for federal programs made for the elderly and low-income citizens. If you qualify for either of these programs, your hospital bill will be cut substantially. If you’re already in a situation where you can’t pay your medical bills, there are avenues you can take to get assistance. In the end, you will likely end up having to pay your medical bills one way or another.
The first thing you should do is request a total bill with itemized charges. Review this carefully. Hospitals are busy institutions and whether it’s done purposely or not, sometimes an extra charge may show up on your bill. It’s your responsibility to check for accuracy. Are you charged for a procedure that never happened? Did the doctor really use a whole box of gloves during your procedure? Question charges you don’t understand.
Once you’ve established a correct and final total, speak to someone about any kind of assistance that hospital offers. If you visited a non-profit hospital, programs may already be in place to assist you with your bills. This assistance could come in the form of partial debt forgiveness or lowered monthly payments. If, at first, you don’t receive all the information you need, don’t be afraid to talk to someone else or request to speak to a manager.
Always make sure that you receive a bill and if you haven’t gotten one in the mail, don’t assume that your debt is forgiven. Sometimes, hospitals simply send a bill to collections without ever notifying the patient. Take an active role in eliminating medical bills.
What are good cost effective health plans for those not yet on Medicare?
Finding affordable healthcare is always a top priority. The right coverage is necessary for preventive services that fend of long term illness and emergency care when an accident happens. Unfortunately, affordable healthcare isn’t always easy to find. Things may become easier in 2014 once state exchange become available and some states expand Medicaid but the results have yet to be seen. For now, you have several options that are worth exploring.
If you need low cost healthcare, most experts will steer you away from private health insurance but, depending on your plan and how much you can afford, this may work for you. Keep in mind that insurance companies can now charge more or even deny coverage if you have a pre-existing condition and those seeking out individual coverage are more vulnerable. Consider looking into a combination High Deductible Health Plan (HDHP) combined with a Health Savings Account (HSA). This plan offsets risk with an agreement that you pay more out of pocket. You can also contribute money to your HSA to help pay for the high deductible but only use it for medical costs. This is one way that you can save money.
If you don’t yet qualify for Medicare, consider Medicaid. This is made for low-income American citizens and an income threshold must be met. It will help cover preventive services and offer reduced charges for many other services. Programs are run by the state and representatives can help you find coverage that meets your needs. If you have children that need health insurance but don’t qualify for Medicaid, check to see if your child can be enrolled in the Children’s Health Insurance Program (CHIP). This won’t provide coverage for your or other adults but does ensure that your children get the care they need. Affordable insurance is hard to find but, it’s possible.
What should I do about “balanced billing” from the ER?
Getting a balanced bill from the ER might not mean what you think it should.
When you visit a hospital, clinic, or any other medical facility that isn’t within your health insurance network, you’re billed for the difference between what your health insurance pays and what the hospital charges.
Some of the most common forms of health insurance, HMO and PPO plans work within a specific network of healthcare facilities to provide you with low cost options. Unfortunately, even if you visit a hospital that’s within your network, there’s a chance that one of your treating physicians or surgeons may not be. So, if the hospital charges you $500 and the physician charges you $500, let’s say your health insurance pays each party $250. Since the hospital is contracted with your health plan, it only charges you for the appropriate co-pay or co-insurance amount minus your deductible. But, the physician can charge you for the remaining balance of $250 because he or she isn’t contracted with your health insurance.
So what you can do to prevent this problem? Advance action is necessary. While we never know when we’re going to be visiting a hospital or clinic, knowing which providers are in network is essential to avoiding a “balanced bill.” Speak to your insurance company to find out which hospitals and other medical facilities cooperate with your plan.
Many health insurance companies should have a list on hand that can be provided. Those facilities are not allowed to balance bill. In the circumstances that you’re in an emergency, ask that only contracted specialists work with you. If that’s not an option speak to the hospital about payment plans and how balanced billing is handled for specific services. Even when you’re in pain, do your best to manage hospital bills.
Will insurance cover the cost of plastic surgery for formerly obese people or women who have had children?
For those who want to have reconstructive plastic surgery after a huge weight loss or pregnancy, there may be a surprising variety of services that are and are not covered.
It really depends on your insurance plan. Only recently have insurance companies began paying for weight loss procedures like gastric bypass surgery. Normally, there are requirements that must be met, including a certain BMI, but how are insurers dealing with the byproduct of weight loss: excess skin? If you don’t like the way your saggy skin and the procedure is purely cosmetic, it’s likely your insurance company won’t pay for the procedure.
Just like a breast enhancement, excess skin removal isn’t medically necessary unless it’s causing a health problem. But, if it’s causing a rash or other condition that can’t be treated, it may be possible to get coverage. Expect to provide lots of documentation regarding the reason for the surgery and if it’s approved, pay close attention to specific exclusions that may creep into your coverage. The same principle applies for pregnant women who want to achieve their pre-pregnancy body with cosmetic surgery.
Some women opt for breast augmentation to cure sagging after breast feeding, others want liposuction to get rid of that extra baby weight and others desire a tummy tuck to get the stomach back in shape. Plastic surgery is a personal choice, but don’t rely on your insurance company to foot the bill. Pregnancy is a natural condition, often entered into voluntarily. The side effects of pregnancy affect women differently and if the changes that occur aren’t hindering your health in any way, the insurance company won’t pay to have them fixed.
Of course, if you have an extremely difficult birth and need vaginal reconstruction, your insurance company might pay because it’s not a normal circumstance. Before getting any cosmetic procedure, speak to your primary care physician and find out what’s covered.
What should people consider when shopping for health insurance?
Shopping for health insurance can be stressful.
Even if you’ve got group health insurance through an employer, you’re still required to pick a plan that works for your needs. But how are you supposed to know which plan is best?
Here are a few considerations to keep in mind when choosing a health insurance policy:
- Do you have a pre-existing condition? If you need insurance right now, you may find that affordable healthcare is hard to come by. Currently, insurance companies can charge higher premiums and even deny coverage if you have a pre-existing condition. As 2014 approaches, that will become illegal, but make sure that your policy is ratified once the measures become official law.
- Do you mind network healthcare? Some health insurance policies, like HMO and PPO plans, work within a network of healthcare providers. If you have a primary care physician that you want to keep, ask which insurance policies he or she works with. Additionally, some plans can be restricting on which providers are offered, while others are more flexible. If saving money is important, a network plan may work well. If having the flexibility to see any doctor you want is more important, a network plan may cost you more.
- Do you want preventive care for free? In 2014, the majority of health insurance plans will incorporate preventive screenings like regular physicals as well as men and women’s yearly check-ups. Preventive maintenance is a key component to long term good health.
- What’s your family dynamic? A single, healthy individual isn’t going to need the same health care plan as a family of four. Other things to consider include how often you visit the doctor and whether you have special healthcare needs.
What should I do if my health insurance is about to end?
If you know your health insurance is coming to an end, it can be stressful to find new health insurance, but it’s essential.
There are multiple reasons that your health insurance could be coming to an end. Maybe you’ve lost your job or are finally starting your own company. You can lose your health insurance if you’ve recently been divorced and were on your spouse’s plan. You can also lose your insurance when you retire, when you come off your parents’ health insurance, or if your policy is coming to an end. The best way to maintain coverage is to know your options. Going without health insurance for an extended period of time can make getting coverage much more difficult so try to make sure you have coverage set up for when your current health insurance policy comes to an end. There are several ways to do this.
If you’ve lost your job, the most affordable method of finding health insurance is to get another job with employer sponsored healthcare. Of course, this is much easier said than done. Instead, look into COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985). This will allow you to continue your current benefits for 18 months. The only downside is that you’ll pay for 100% of the premium, which can be very expensive. If you’ve gotten divorced, COBRA is also an option through your ex-spouse’s plan.
Another option is to purchase individual health insurance. This will be more costly than your current health plan, but you also have the ability to compare policies and quotes to find one that still provides insurance at an affordable rate. You may not have the same benefits as before, but it’s better than nothing at all. Check into low-cost or free healthcare options as well. You may be eligible for Medicaid if you meet the income requirement.
What is the cost structure of a typical health insurance plan to an employer?
If you’re lucky enough to have employer sponsored healthcare coverage, you’re only paying a tiny portion of your healthcare bill.
While it may seem like your healthcare costs are rising, your employer is paying more as well. In 2013, the average cost of a standard healthcare plan was just over $12,000. As an employee, you’re paying just over 25% of the total cost of the policy. Your employer is paying nearly 75% of the cost. But, as healthcare costs increase, you could be paying more for healthcare. It’s even possible that some employers may completely change the pricing structure of the insurance.
The Affordable Care Act is bringing many changes to how employers and employees obtain health insurance coverage. One of the key components of the ACA is that employers with over 50 employees must offer some form of health insurance to employees or face a fine. Employers with less than 50 employees, which comprises nearly 96% of all American businesses, are exempt from this portion of the law.
Of course, with the state exchanges being implemented, employer coverage may become a thing of the past. While employers who don’t offer health insurance will be fined, the fine is much cheaper than actually offering health insurance. Employees, who are eligible for tax credits to help offset the cost of purchasing health insurance, will be able to find more affordable coverage under the state health exchanges.
Additionally, businesses with less than 50 employees will also be offered tax credits if they choose to offer health insurance. Before, small businesses found it extremely expensive to offer health insurance even with employee contribution, but now risk is pooled and insurance is more affordable. Only time will tell how the employer-employee-health insurance relationship will play out, but keep your eyes and ears open for change.