Health Care Insurance 101 for Individuals and Families
by: Michael H. Ertel
The changing healthcare and health insurance landscape in the United
States has resulted in more individuals and families purchasing health
insurance coverage on their own. Rather than touch on the number of
reasons why this is the case, I would like to provide individuals and
families finding themselves in this position with ten basic ideas to
assist them with getting the best health insurance policy for their
specific situation. Below is a combination of ten questions and
suggestions that will provide the tools necessary to get a medical
insurance policy that will best work for you and your family.
-
What are your typical health and medical care expenses in a
calendar year? Most people are surprised when they go through this
exercise to learn that they would be financially better off in most
years to purchase a high deductible health insurance plan and use
the premium savings to directly offset heath care expenses
throughout the year.
-
How long do you anticipate needing the health insurance coverage?
For example, many companies sell temporary policies that can be put
in force for 1-6 months and they are relatively inexpensive. If you
are in between jobs or in a waiting period for employer coverage,
this may be your best option.
-
What is your budget? If your budget is tight, having a $1000,
$2500 or even $5000 deductible is better than having no coverage at
all. The ability of doctors and hospitals to save and prolong life
in the United States is in many cases extraordinary. However, their
treatment is not free and going without health insurance coverage
can in some cases result in you and/or your family losing an entire
life’s worth of savings and assets.
-
Be careful to choose a plan that covers the “big stuff”. It is
nice to have a policy that covers items such as: physician office
visits, routine physicals, outpatient testing, and blood work.
However, it is essential to have coverage for major services such as
cancer treatment, transplants, critical illness, traumatic
accidents, and infectious diseases. Find out the lifetime maximum
amount as well as if the policy contains “internal” dollar
limits.
-
Always carefully read and understand the pre-existing condition
clause and policy exclusions so that you will not be surprised down
the road if a claim is denied. This is important whether you are
purchasing a standard medical, temporary, or student health
insurance policy.
-
Does the insurance company you are considering have a substantial
network of preferred doctors and hospitals in your area? In addition
to family doctors, what type of access will you have to specialists
and the best hospitals in the event you or a family member is
diagnosed with an illness that requires specialized care? Also, what
are your options for preferred health care providers when traveling?
-
If you need to go “out of network”, will you still have
coverage? Most insurance policies will have coverage in the event
you need to go outside of their network for care. However, review
how these out of network claims will be paid. Will there be an
additional deductible? How are reimbursement levels determined for
out of network claims? What is your maximum out of pocket for out of
network claims?
-
Are you looking for an opportunity to reduce your taxable income?
If so, make sure your plan qualifies as a high deductible health
plan and look into all of the aspects of a Health Savings Account.
In the right situation, HSAs can be an excellent way to pay for
eligible health care expenses, reduce your taxable income and save
for retirement.
-
What are the financial ratings of the insurance company you are
considering? A.M. Best, Standard & Poor’s, and Moody’s are
organizations that rate the financial stability of insurance
companies.
-
What type of customer service will you get from your insurance
agent? Do they specialize in health insurance? Do they have a staff
that is willing and able to assist you in the event you have a
claim, billing, or other customer service problem?
If you do not have the time or patience to look into all of the items
mentioned above, develop a relationship with an independent insurance
agent that specializes in evaluating and servicing health insurance
policies. A good independent insurance agent will be able to save you
time, money, and be an excellent resource for evaluating all of the
items mentioned above.
keywords: child
insurance, child health care, children's health care insurance
|
