Health Insurance Articles

One unique as well as interesting feature of an HSA is that the money in the HSA account can be  invested in similar ways to how money in an IRA account can be invested.  The same kinds of rules and restrictions apply to HSAs in regards to investing money as well as deferring taxes on earnings.

• All earnings on investments in an HSA account are non-taxable for as long as the money stays in the account or is withdrawn for the purpose of paying medical expenses.
• If earnings are withdrawn for non-medical purposes, and the owner is under the age of 65, then taxes will have to be paid on the withdrawals.
• Because contributions to an HSA are made with pre-tax dollars, it gives you the ability to reduce your income taxes.

Combining an HSA with a HDHP also gives the account owner the ability to use funds in the HSA account to pay for their annual health insurance deductible and to pay for medical expenses that their policy doesn’t cover.

There are limits to the amounts to the amounts you can contribute to HSAs in one year.  The limit for individuals is $2,850 and for a family it is $5,650.

An HSA has more extensive coverage for medical expenses than most conventional health care plans.  The coverage may include the following:

• Preventative health care visits
• Physical therapy, including chiropractor visits
• Mental therapy, including psychiatry, psychotherapy and psychology
• Dental treatment
• Maternity expenses
• Prescription and nonprescription drugs
• Alternative health care for procedures like acupuncture and homeopathy
• Travel and accommodation expenses that relate to health care

HSAs are potentially a great option for individuals and families who want to have a high degree of flexibility in their health care that they can manage on their own without being required to visit network health care providers or complete lots of paperwork.

The ability for owners over the age of 65 to use the funds in the account for both medical as well as non-medical purposes means that an HSA, unlike many other types of health insurance plans, can benefit practically anyone, including individuals that have medical expenses on a continual basis as well as healthy individuals that do not have a lot of ongoing costs.

HMOs, or Health Maintenance Organizations, are entities that provide insurance for a large group of people.  Employer groups are the most common group and most people who have HMO health insurance obtained it from their employer.  HMOs usually offer the most commonly used and most well known of the managed care plans that are available in the US.

HMO plans, like many other forms of health insurance, are prepaid.  Policy holders pay a monthly fee, which covers all their medical expenses.  However this is with the provision that the user’s visits for health care are made to health care providers and specialists that are part of the HMO’s preferred providers (or network) list.  The HMO insurance does not pay for visits to non-network providers.

Most HMO plans require users to choose a primary care doctor from the network’s list of doctors.  The primary care doctor is basically equivalent to a family doctor.  You have the ability to see your primary doctor whenever you need to at no charge.  If you are in need of a specialist, you will need a referral from your primary care doctor to a specialist that is part of your HMO network.

It is important that you understand that the costs of any visits to a doctor or specialist that does not participate in your HMO network will not be covered by your HMO insurance.  In addition, if you see a specialist without getting a referral first from your primary doctor, then your specialist visits will probably not be covered by your HMO insurance either.

Typically, HMO plans cover either all or some of the following.  Not all HMO plans include prescription and emergency services.

• Primary care doctor visits
• Specialist visits, provided your primary care doctor gives you a referral ahead of time.
• Diagnostic laboratory services that have been referred by your primary care doctor
• Prescriptions
• Hospital service
• Emergency services (some HMO plans will cover network and non-network providers for emergency services)

Most HMO plans do not cover what are considered alternative treatments like acupuncture, homeopathy and aromatherapy.  Routine dental work and elective cosmetic surgery are generally not covered either.  However, coverage varies with HMO plans, so it is important that you understand what your HMO plan covers and what it does not.

HMOs generally only offer insurance to employer groups and not to families and individuals.  The biggest advantage of HMO plans is their low cost.  HMO plans are usually the least expensive form of health insurance available.  This is due to the fact that HMOs deal with a large volume of health care professionals and customers.

An HMO insurance plan may be a viable option for a family or individual who doesn’t have a lot of specialized medical needs.  If someone in your family needs to visit non-network specialists on a frequent basis, then an HMO plan would not be a good type of health insurance for your family to obtain.

All health insurance providers have underwriting criteria, whether it is a for profit organization or not.

One of the major factors effecting your health insurance is your age.  In general, the older you are the better the chances are that you will get sick or will need some form of medical treatment.  Because of this, the older you are the more expensive your insurance premiums will be.

Many people with concerns about health insurance are not just worried about themselves but their family as well.  Some insurance companies rate their premiums based on family size.  Other insurance companies have a basic family rate they charge no matter what the size of the family is.

In terms of life insurance, women tend to  pay lower rates than men do.  For health insurance, women’s premiums are generally higher.  This is due to the fact that health insurance statistics indicate that females have a tendency to need more medical care than males.

Your health history also plays a significant role in determining the cost of your health insurance premium.  Insurance operates on the basis of many statistical probabilities.  If your health has been poor in the past that means that you are more likely statistically to have higher health insurance expenses into the future, which results in either having to pay higher insurance premiums or not being able to obtain insurance at all.

Your occupation is also an important factor when it comes to health insurance.  The higher the probability is that you will suffer a work related illness or injury, the more likely you will be charged a higher premium to cover these risks.

Your health insurance application will also ask you questions regarding personal habits such as drinking and smoking.  If you are a heavy smoker or drinker, your premiums are going to be higher than someone who isn’t.

You need to be aware of certain provisions in insurance contracts.  Insurance policy exclusions remove certain procedures and other types of health care from coverage.  It is critical that you understand all the exclusions contained in your policy.

One common exclusion is preexisting conditions.  These are often defined as symptoms that a prudent person would seek diagnosis, care or treatment for in a five year period, or a condition where a physician either gave a recommendation or provided care for.

Many health insurance policies exclude coverage or injuries or illnesses that are caused by narcotic or other types of controlled substance abuse that was not prescribed by a doctor.

Some policies have an exclusion of benefits for emotional and mental illnesses that do not have a bodily cause.  Other policies may provide some limited benefits for certain items sch as psychotherapy.  It is important that you understand all the details of your health insurance policy, particularly if there is a possibility that you or a member of your family may need the services of a psychologist, psychiatrist or other form of mental health professional.

If your illness or injury qualifies for workers  compensation benefits, your own insurance will most likely exclude paying any of these medical bills.

If all of a sudden you were an accident, would you be able to cover your lost income as well as all the co-pays and deductibles without straining your finances?  There’s a good chance that even if your health insurance provides excellent coverage that an unforeseen medical emergency or stay in the hospital would hit your pocketbook hard.  Supplemental health insurance is intended to help bridge the gaps that regular health insurance policies don’t cover.  In addition, it can provide much needed cash to help replace any lost wages and pay for living expenses.

Supplemental health insurance works differently from standard health insurance.  With standard health insurance, your policy pays your health provider or doctor for their services that they provide to you.  You may have to pay a co-pay or deductible, and usually your health care provider takes care of the insurance paperwork.  The benefits from your health insurance are paid directly to your doctor or other health care provider.

With supplemental health insurance, you are usually paid a fixed amount when you utilize health care services on a specific incident.  As an example, if you were to fall and sprain your ankle your regular health insurance would pay the doctor bill, but you would need to pay your deductible or co-pay.  The doctor’s office would bill your insurance company and bill you if there was an excess.  If you had supplemental health insurance that pays $50 for a visit to the doctor, you would be able to file a claim and your supplemental insurance company would pay you $50.  You could then use the $50 to pay towards your co-pay or deductible and any other expenses.

The benefits on a supplemental health insurance policy vary from policy to policy, with the differences usually having to do with the specific purpose of the policy.  AFLAC, for example, is designed to help policy holders cover medical expenses that most health insurance policies do not cover by paying them in cash for doctor visits, hospital costs, or for being out of work due to an injury or illness.  Other types of supplemental policies are intended to help pay for prescription costs or for paying out benefits for disabling accidents or catastrophic illnesses.  Some policies are for hospitalization only and some for long-term care.  There are quite a few supplemental policies designed for the purpose of paying for costs that are not covered by Medicare health insurance.

Not everyone needs supplemental health insurance.  However it is a form of financial protection that can come in handy if you do not have savings or sufficient means to cover any unexpected medical costs that could crop up.  Supplemental health insurance should be considered if you have small children, are self-employed, are on Medicare, or if you do not have the financial means that it would take to be able to handle large medical expenses or be away from work because of injury or illness.

The best policy for supplemental health insurance will depend on the individual and his or her circumstances and specific needs.  For young families, as an example, supplemental insurance policies that pay for wellness care are very helpful.  Hospital indemnity policies that pay cash benefits for parents who are unable to work due to illness or for being hospitalized would also benefit young families.  For older adults, a long-term care or supplemental policy that pays a lump sum benefit for catastrophic illnesses could be very useful.  A prescription benefit plan could help both families and older adults to help meet medical expenses that regular health insurance and Medicare don’t cover.

Health Savings Accounts (has), which are also called Medical Savings Accounts, can be a great way to save on medical and health insurance costs.  An HSA offers a solution that can help you control the high price of health insurance.  You do this by paying less for your medical insurance and saving some of your own money to go towards paying for medical expenses.  It works together with a medical insurance policy with a high deductible and helps you to save money on your health care expenses in several different ways.

A Health Savings Account is a savings account that is tax-sheltered.  It is intended to help with the high cost of health insurance premiums.  The HSA was established with the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.  It was intended to improve upon the Medical Savings Account (MSA).  The HSA is like an IRA for medical costs and has similar regulations and rules.

One common way to save on health insurance premium costs is to choose a higher deductible.  An HSA works hand in hand with high deductible insurance plans to help you save money on medical expenses.  To do this you can enroll in a health insurance plan with a high deductible.  This can be done with either an employer or individual insurance plan.  Next you open an HSA, with its advantages and restrictions that are similar to an IRA.   You can contribute to your HSA each year up to a maximum amount.  Deposits made into your HSA are not subject to tax when you make the contribution and can be used for medical expenses at any time tax-free.  You can use funds from your HSA to pay for insurance policy deductibles as well as for medical expenses not covered such as vision, dental and alternative medical procedures by your health insurance plan.

You will save money with your HSA in two ways.  The first way you will save, is that you will pay a lot less for health insurance.  This is because you will be paying from your savings.  When you choose a high deductible, your insurance premium is less expensive.  You will also save money because the money you contribute to your HSA is all tax deductible.

If you medical costs in a year are more than your deductible, your health insurance policy pays your medical expenses just like any other insurance policy would.  It works the same as any other health insurance policy.  It’s just that your deductible is higher, but you are paying for it with tax-deductible money.

The money that is in your HSA belongs to you.  If you end up not needing it for medical expenses in a particular year, the amount remains in your account and either earns interest or can also be invested at your direction.  You will still be eligible to make the maximum contribution in the following year and the extra amount in your account does not change your deductible in any way.  You are not made to pay more medical costs before your health insurance coverage begins.

Any money that you don’t use for medical expenses stays in your account and earns interest that is tax-free.  The only time you will be required to pay taxes on the money in your HSA is if you end up withdrawing it and not using the money to pay for medical expenses.

Most adult Americans receive health insurance from their employers or spouse’s employer.  However, according to a survey done by the United Health Foundation in 2006, nearly 16% of Americans do not have health insurance.  Approximately 60% of Americans have health insurance through their employers and 27% have Medicaid.  Most of the remaining have some form of individual health insurance.

Many who are not insured are forced to go without health insurance because of a pre-existing medical condition.  They are considered to be too high of a risk by insurance companies to be eligible for health insurance.  Individuals that have pre-existing medical problems usually find it very difficult to obtain health insurance if they are not able to rely on some sort of employer-based health care plan.  They usually have very few option for obtaining health insurance, even at high costs.

For what are sometimes called the uninsurable, their only option may be to obtain insurance through a high risk pool that is state-run.  These plans are designed to provide health insurance to individuals who are not able to get health insurance because of a pre-existing medical condition.  34 states currently operate a high risk pool.

The way these work is a state-run high risk pool creates a pool of individuals who are unable to get individual health insurance.  All the members of the group are able to obtain health insurance through the state-sponsored program, although it is at higher rates than it would be for individuals without pre-existing medical conditions.

Usually members of high risk pools can select between PPO, HMO and FFS plans.  Each type of plan offers different degrees of flexibility in terms of how individuals are able to manage their health care.

However, there are disadvantages to these types of health insurance plans.  They are expensive.  Members that belong to high risk pools may have to pay as much as twice what someone who qualifies for a regular individual insurance plan would.

Many high risk pools also have an exclusion period for pre-existing conditions of six to twelve months.  This means you must wait for that period of time before you are eligible to make a claim for medical costs.  However, the high risk pool may be the only alternative for some individuals or face not having any health insurance at all.  Since the costs of not having any insurance can still be much higher than having expensive premiums, this still is an attractive option for some individuals.

In order to qualify for health insurance through a high risk pool, you will need to be a state resident and must also meet one of these conditions:

> Proof that at least one insurer has rejected you for health insurance
> Proof that your current insurance premium is higher than what could be offered by the state’s high risk pool
> Proof that your health insurance has a rider attached or is rated

Some states also have reciprocity agreements that make you eligible to apply when you were previously enrolled in another state’s high risk pool if you meet residency requirements.

Individuals who are excluded from the state high risk pools include individuals on or eligible for Medicaid or Medicare, as well as individuals who have exceeded their maximum benefits on their plan.  Some states also have their enrollments capped and will only accept a specific number of individuals.

It is very important if you have health insurance provided by your employer that you understand what your rights are under COBRA (Consolidated Omnibus Budget Reconciliation Act).  This important legislative act guarantees that workers participating in their employer’s health insurance program, as well as their dependents, have the ability to have their health insurance coverage extended after they leave their place of employment under specific circumstances and for specified periods of time.

Before COBRA was passed, as soon as an individual was not employed access to his or her group health benefits were immediately stopped.  Individuals with pre-existing conditions often could not obtain new insurance coverage.  Under COBRA, individuals can elect to continue participating, at their expense, in the employer’s group health plan after qualifying events that lead up to them leaving their employment are met.  It can expensive to do this, but it is better than becoming uninsured and all the consequences that follow.

If you quit your job voluntarily, you can elect to continue your employer’s group health insurance coverage for a maximum of 18 months after leaving your employment.  You are also eligible if your employer terminates you unless you committed gross misconduct.  For employees whose work hours are cut which results in them losing eligibility for full-time benefits, they can also choose to continue their coverage under COBRA.

There are certain conditions where COBRA coverage may be available for more than 18 months.  If an individual becomes disabled and is unable to go back to work, they become eligible for 11 additional months of health insurance coverage under COBRA, making the total amount 29 months.  If an individual dies who has covered dependents, the dependents are eligible for up to 36 months of coverage, as well as dependents who lose their coverage due to a divorce.

It is important to keep in mind that former employers are not responsible for covering any expenses of health insurance coverage for former employees who are continuing their coverage under COBRA.  If you decide to go with COBRA coverage you will have to pay the entire cost of coverage to your former employer and may also be subject to an administrative fee.

If you elect COBRA coverage and then fail to make your premium payments, your former employer can stop your coverage.  Your must make your first premium payment within 45 days of when you elect the coverage.  Your subsequent premium payment due dates will vary depending on your particular plan.  There is a 30-day grace period, which is required under COBRA, for making premium payments.  After the grace period is over, your former employer can terminate your coverage.

Instead of having to obtain individual coverage or go without insurance, COBRA gives individuals the ability to continue their coverage for a temporary period of time after their eligibility for health benefits is over.  COBRA can be quite expensive, but it is better than having no health insurance coverage at all.

A Preferred Provider Organization (PPO) is a network that includes doctors and other types of health care providers along with hospitals that work with a health insurance company or some other kind of third-party administrative organization for the purpose of providing a managed health care plan.  The providers that belong to the network provide health care and medical services to individuals and families who purchase the insurance company’s health insurance plan at reduced rates compared to what individuals without the insurance pay.

PPO plans are similar to HMO plans in some respects.  They both cover the full costs of health care visits made to network doctors and administrators.  Where PPOs difference from HMOs is in the fact that the PPO also offer their policy holders some flexibility in terms of being able to select a primary care doctor.  Under PPO plans, policy holders can elect to not have a primary care doctor.  With PPO plans, you can also see specialists without getting a doctor referral.  With an HMO a doctor referral is required for specialist visits.

Another way in which PPO plans are different than HMO plans is that with PPO plans, policy holders can visit specialists and doctors who do not belong to the network.  However, for non-network visits policy holders will have to pay part of the expenses, as the insurance only covers a portion of the costs.

Another advantage that PPO plans have is that there network extends further, providing wider geographic coverage than most HMO networks.  Most HMOs do not provide out-of-state coverage, but many PPOs do provide this.

However there is a price to be paid for the increased flexibility.  PPO plans usually cost more than HMO plans.  PPO policy holders will usually end up paying higher insurance premiums as well as covering some of the costs that are incurred when visiting non-network health care providers.  These costs are usually co-pays and usually have to be paid to the non-network provider at the time of the visit.

A typical PPO plan will cover all or part of these costs:

• Network primary care doctor visits
• Network specialist visits
• Prescriptions
• Diagnostic lab tests
• Hospital procedures including essential surgery
• Emergency treatment
• Partial reimbursements for the costs of non-network providers
• Some plans offer dental services

Most PPO plans don’t coverage alternative therapies and treatments like aromatherapy, homeopathy and acupuncture.  Surgery that is elective, for example cosmetic surgery, is also not covered.

PPO plans are available for individuals, families and businesses.  HMO plans can usually only be obtained through employers, but families and individuals can obtain PPO health coverage without having an employer.

PPO plans are well suited for individuals and families who are looking for inexpensive health care but still want additional flexibility to what HMO plans provide.  Families and individuals who require care from specialists will find that a PPO is more beneficial than an HMO.  This is due to the fact that a PPO does allow policy holders to visit specialists without requiring a referral from a primary care doctor and they also pay part of the expenses of non-network visits.  PPO plans are also beneficial for people who frequently travel out of state due to the fact that PPOs do provide out of state coverage.

Cost for health care are always increasing.  It is practically unheard of to hear of a health care provider cutting their fees.  If you are looking for ways to save money on your heath care costs, hear are a few tips to help you out.

Prevention is less expensive than the cure
Living a healthy lifestyle is probably the best way you can keep your medical expenses down.  Eat healthy foods, exercise on a regular basis, and quit smoking.  These are three easy, or for you maybe not so easy, ways you can improve your health, increase your lifespan and cut your insurance costs.

Select the best health care plan for your situation
If you have young children or a large family you will want a health care plan that emphasizes preventative checkups.  You need to do some upfront research on what your options are in order to find the right plan for you.  There are several different types of health care plans for you to choose from.  They all have different deductibles, premiums, co-pays as well as other types of features.  Choosing the wrong plan could end up costing you extra money.  The right plan could end up saving you a lot.

Make sure you understand exactly how your insurance plan works
It is crucial that you understand just how your plan works in order to maximize your benefits.  Be sure that you find out whether or not you need to have a primary care doctor, whether or not you are able to self-refer outside of the network, as well as any other important factors.  Learn everything there is to know about your health care plan and be sure that you take advantage of all possible discounts.  For example, even if you do not have a prescription plan separate from your insurance, your health care plan may still offer discounts on certain items like alternative medicines or vitamins.

Go generic on your prescriptions
All insurance companies will charger you higher co-pays on name brand drugs.  Most companies have three or four tiers that they classify prescription drugs into.  Each tier will have a certain co-pay.  Every time you choose generic drugs you will save money.

Check your bills for errors before you file them
Before filing your bills make sure you check them over thoroughly for any errors.  Billing errors do happen and you may end up paying more than you need to.  Once you have checked the bills over, be sure to file them.  If you ever get into a dispute with the insurance company, these bills will be essential.

Another excellent reason for tracking your medical expenses is that some may end up being tax deductible.  Some tax deductible expenses include hearing aids and glasses.  However, you do need to keep in mind that the total of your medical expenses will need to be higher than a specified percentage of what your gross income is.

Join your partner or spouse’s plan
If you and your partner or spouse each have your own health care plan, you may want to find out if one is less expensive or in some way more advantageous.  If this is the case, you may want to join your spouse’s plan or your spouse join yours.

Watch for free services
Many clinics and hospitals provide free tests and screenings for things like blood pressure, cholesterol and blood sugar.  Be alert for what local medical clinics have to offer, particularly if your health insurance doesn’t cover certain things like preventative health care.

A Self-Directed Health Plan (SDHP) is a very flexible type of health insurance.  An SDHP combines parts of PPO plans and Health Saving Accounts.  It provides the user with the ability to choose whatever health care provider they want, whether they are inside or outside the managed care network.

An individual with a SDHP owns a savings account that contains funds intended to cover their health care costs.  However, the individual with the account is not required to make contributions, although they can if they want to.  The main contributor to the plan is the insurer.

The account is restocked every three months with approximately $500 for families or $250 for individuals.  This money can be used to pay for preventative health care that is covered under the plan.  Any money that is not used in the quarter can be rolled over to the next quarter, and any money that is not used in a year can be rolled over into the next year.

SDHPs focus much more on preventative health care than traditional types of managed health care plans. SDHPs have fairly low monthly premium costs, but have high deductibles.  However visits for preventative health care don’t require a co-pay or deductible.  Non-preventative visits require a co-pay and deductibles for non-preventative visits need to paid for the year in full before subsequent visits will be covered.  Unused deductible amounts do not roll over.

SDHPs also provide accessed to health care professionals through a preferred provider network.  Visits to network providers is optional and policy holders don’t need referrals to see specialists.  However visits to specialists and non-network doctors does require a co-payment.

Most SDHPs cover a wide range of preventative health care, including:

• Regular checkups, routine physical exams and consultations
• Pre-natal and post-natal care
• Immunizations
• Cervical screening and mammograms for women
• Screening and diagnostic tests like x-rays
• Home Visits
• Some plans include prescription coverage

Emergency health care and in-patience hospital care like surgery are not covered under the preventative section of the insurance plan.  For medical costs other than preventative health care, there will be a deductible that has to be paid before there is any insurance coverage.

SDHPs are well suited for families and individuals with low ongoing health care costs that include mostly preventative care costs like yearly check ups and routine physical exams.  People who enjoy good health can usually minimize their health care costs quite a bit with a SDHP.

One advantage to an SDHP is any unused funds can be carried over on a quarterly as well as yearly basis.  This means that unused funds can keep accumulating and then be available when expensive medical expenses come up.

For individuals with chronic health conditions like diabetes, a self directed health plan would not be suitable.  Chronic illnesses usually require frequent visits to the doctor as well as other medical care, and these types of visits and care are not considered preventative health care.