Insurance World

More than half of the 45 million Americans who lack health insurance are self-employed or work at small businesses. Most simply cannot afford the sky-high premiums associated with traditional health insurance policies.

Consumer-guided health plans offer an affordable alternative. The best plans, such as those powered by HealthMarkets, allow consumers to shop online for a doctor or hospital with powerful, user-friendly tools.

But not all consumer-guided health plans are created equal. Some offer little more than cheap rates and few benefits. Three questions can help you separate a real consumer-guided plan from a “look-alike,” ensuring you get the most for your money.

Question 1: Will the plan help stretch my health care dollars?

A well-kept secret is that doctors charge very different prices for the same medical procedure or service. One doctor might charge $90 for a routine office visit, while another in the same town charges $130.

Under a traditional managed care plan, patients don’t know and don’t have a reason to care about differences in price. They might pay the same $20 co-pay at either office.

A consumer-guided plan takes the mystery out of health care pricing. With a consumer-guided plan, patients seeking non-emergency care have a way to know how much things really cost, and a reason to care. By setting a reasonable maximum charge that the policy will pay for any given procedure or service, consumer-guided plans keep premiums low. By giving consumers new tools, they can compare out-of-pocket costs from one doctor to another.

A spending account for routine care helps too. On Day 1 of coverage, well-designed plans typically offer a spending account for routine or preventive services. Money left in the account at the end of the year rolls over. If the fund is depleted, routine services remain covered, but are subject to deductibles and coinsurance. The result: an incentive to go to the doctor for preventive care at a reasonable price.

Many consumer-guided plans also incorporate Health Savings Accounts (HSAs), which allow you to set aside money in a tax-advantaged account for health care needs, adding to a sense of ownership over healthcare spending.

Question 2: Does the plan provide information on quality?

To focus only on money misses the point of health care. Consumers also need quick, easy access to other information, including a doctor’s board certification, medical school, and years in practice, and a hospital’s adherence to patient safety standards, volume of procedures and clinical outcomes.

The best consumer-guided plans let consumers post feedback on physicians for other members to view, creating a powerful feedback mechanism such the one used on Internet auction sites. Rude doctors, beware!

Question 3: Does the plan offer education and support services?

Being a smart healthcare consumer can be complicated. A good plan offers customer service representatives trained to discuss the critical issues faced by healthcare consumers, such as how to compare cost among various providers and how to manage financial accounts.

EDITOR’S NOTE:

About HealthMarkets

HealthMarkets is America’s leading provider of affordable health insurance for the individual, self-employed and small business markets. HealthMarkets is also a leader in student and hourly employee insurance nationwide. HealthMarkets has a dedicated agent and broker force of more than 4,000 professionals who are trained and licensed through the company’s agency associates in 44 states.

HealthMarkets sells insurance in 44 states. Please note that HealthMarkets has consumer guided plans approved in the following states: Alabama, Arizona, Arkansas, Florida, Georgia, Illinois, Michigan, Mississippi, Missouri, Nevada, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas and Virginia.

It is estimated that more than 60% of the U.S. population that has health insurance receives their coverage through an employer that offers a group health insurance plan. It’s no secret that employees value health insurance benefits, perhaps above all other benefits. Employers, on the other hand, like to offer comprehensive group health insurance as it tends to attract and retain qualified employees as well as reduces the company’s turnover rates.

In most states, group health insurance is available to companies with 2 or more employees. Often the number of employees covered under the group health insurance plan determines the types of coverage available as well as the premium costs.
For example, companies with between 2 and 50 employees are typically classified as a small business. Such businesses are eligible for small business health insurance; however, each state has its own set of regulations that determines what business can be classified as a “small business”. It’s interesting to note that some insurance companies will market a “group” health plan to a single individual that is self-employed. In such cases, it’s important to realize that these “one-man” groups may not qualify for the same regulations that apply to larger groups.

Companies will thousands of employees may have their group health insurance plans customized for them by a health insurance carrier. Some large corporations will even choose to self-insure, with the health insurance carrier responsible for administering the health plans.

The primary difference between individual and group health insurance is that the plans offered to individuals (and “one-man” groups in some cases) are not “guaranteed issue”. This is a significant difference and means that the insurance company cannot deny coverage due to preexisting medial conditions of any of the eligible employees. The insurance company is allowed to ask medical questions, but can do so only for purposes of assessing the premium to charge for the group health insurance coverage.

The costs of group health insurance premiums is typically split 50/50, meaning the employer will cover 50% of the premium costs with the employee responsible for the remaining 50%. Even though minimum employer contribution varies by state, these percentages have changed in recent years due to the dramatic increase in health insurance costs, with employees bearing an ever-increasing share of the total costs.

There are tax incentives available to both employers who offer group health insurance and their employees. Business owners can generally deduct 100% of the premium costs and can reduce their payroll taxes by offering group health insurance as part of an employee’s compensation package. Employees, on the other hand, can pay their share of the insurance premium with pre-tax dollars.

In an environment of ever-growing health care and health insurance costs, eligibility in a group health insurance is becoming critical for many employees. Even with paying a higher percentage of premium costs than in the past, employees still are better off financially (and receive greater choices) with group coverage than with an individual health plan. At the same time, business owners are fully aware that offering quality group health insurance creates a more satisfied, and therefore more productive, workforce.