Insurance World

Is there such a thing as cheap health insurance? It hardly seems possible when you look at the rise in hospital costs and physician services. Insurance companies have the task of underwriting the medical risk for insurance. The insurer then issues and delivers the policy to the insured once they are accepted into the plan. The policyholders then receive the policy declaration pages that list all of the benefits and features.

What are those benefits and features? How do they work after a hospital stay? When you begin to find the answers to those questions then you begin to understand what makes up the total premium. When you receive your first benefit statement after a hospital stay then you will begin to understand how the deductible is applied and how the coinsurance works.

Simple claims analysis

1. Total inpatient expense for 4 days in the hospital including physician services amounts to $4000.

2. Your policy has a $500 deductible with an 80/20 coinsurance clause with a maximum out of pocket $2000.

3. You must pay the first $500 for your stay leaving a balance of $3500.

4. You will pay 20% of that $3500 or $700 and the insurance company will pay $2800.

When your 20% reaches $2000 then the insurance company pays 100% of the remaining costs up to a million dollars (or 2 million etc).

The health insurance buying trends indicate that people are purchasing health insurance with higher deductibles. Deductibles bring down the premium dramatically. There are some plans with deductibles as high as $5000. This is called self-insuring because in essence that is what you are doing for the deductible amount.

Health Savings Accounts are also starting to become very popular. These savings accounts are tax deductible. They are like medical IRA’S. Contact your tax advisor or accountant for more details.

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A POS or Point of Service plan is kind of like an HMO and PPO combined type health care plan. You have more flexibility than a regular HMO, but pay a smaller fee and deducible than a PPO. It is perfect for those people who need more flexibility but want to pay less. You will be asked to select a general provider that is off the list of acceptable doctors. This will be your primary care physician and he or she will be the one to manage what care you receive. He or she will direct you to specialist and hospitals as needed that are also participants in the plan. Usually there are many providers from each specialization to choose from and typically covers a wide geographic area. With this type of policy, you will not have a large deducible if any, and still have a minimal co-pay on visits and prescriptions. Of course, this is if you stick with the preferred providers list. You also may want to make sure what drugs are covered under this plan and if you have to pay more for newer on not generic medications. Some doctors don’t think about what kind of insurance you have when writing out the prescription and you need to remind him or her if you are only allowed to buy generic to be covered.

You will also have a choice to see out-of-network providers when you need a specialist and they are not on the list. Most POS plans require you get a doctor’s referral prior to seeing another doctor or specialist. Once referred to a specialist within the network, you will have to be prepared to pay more. If you choose to do this, you will be billed directly and must submit the claim to the insurance company your self. Your insurance company will pay their flat rate for whatever you had done and you will be responsible for the rest. You may also be responsible at the time of service to pay the entire amount and wait to be reimbursed your self from your insurance. If you chose to see a specialist on you own, the cost will be higher and around 50% if you were not referred. You will be required to pay a higher amount if you go out-of-network. So in essence, you have the right to see whom you chose, but at your own expense. The POS plan will only pay their flat rate for specific medical issues and not above it, unless it is an emergency situation. Many people like the idea of having more say in their health care choices, while others care more about saving money and don’t care who they go to. What you chose will depend on what you personally want and what is more important.

The emphasis on this plan is prevention of illness or disease to cut the cost to both the individual and the insurer. Most other plans such as HMOs and PPOs have the same basic emphasis. You are encouraged to take an active roll in your health and do what it takes to remain not sick and disease free for as long as possible. The idea is to see the doctor less so both you and your carrier together spends less money. The idea with this plan is that if you have to put more money into your health care you will think twice at whether or not you really need to go. If you want to waist the insurance companies money you have to waist your own too to do it. Medical insurance companies are in business to make money, they want you to stay healthy so they can collect your premium and not have to pay it out to the health care provider. So, for those people who do not want to pay as high as a monthly premium tends to opt for this type of health insurance plan. This one will ensure a low rate with out having to worry about huge deductibles or co-pays if used more like an HMO. So, if you think that this sound like something you are interested in, talk to several different companies and get some policies to look at. Make sure to look at what is covered as well as the price. Do a little research in the various insurance policies that are available. The one that you need to pick will depend on your priorities.