Aug
13
2019

Health Insurance – Tips to Help You Choose the Right Policy

Choosing the best health insurance plan involves the following:

Finding the health insurance plan with the lowest cost (but only with respect to the other two criteria)
Finding the health insurance plan with a network that meets your needs
Finding the health insurance plan with coverage that meets your needs

Choosing the right health insurance policy involves finding the lowest price amongst the policies that meet your needs as to network and coverage. Choosing the lowest price is of course very easy. Determining whether the health insurance plan’s network of doctors meets your needs is only a little more difficult. Choosing a health insurance policy that covers you well can be complex. Most of this article focuses on this area. I’ve been a health insurance agent since 1985 and have helped many families find affordable health insurance. You can find out more about me by visiting 1800insuranceCT.com. These are the strategies that I use when helping a family find good medical coverage in my home state of Connecticut. To help find out what health insurance plans are available and approved in your area, I’ve put together a list of Insurance Departments for each state.

Choosing the Health Insurance Plan with the Right Network

Most companies have websites that will list the doctors and hospitals that participate in their plan. All that I’m aware of will have a printed list that they can mail to you. The right plan will have your doctor on their list or at least doctors who serve your home area. If you travel it is important to find a plan that covers you well in other geographic areas as well.

Choosing the Health Insurance Plan with the best coverage

Health insurance contracts may be the most complex of the insurance policies purchased by the average family. Understanding how your health insurance policy will pay for your medical bills can be difficult. Fortunately most of the brochures and outlines of coverage that you may receive from a health insurance provider will have a similar structure.

They will have sections similar to the following: What is Covered? Health Plan Exclusions and Limitations What is Covered?

This section will detail what medical procedures your health insurance policy will cover. The policy should have a phrase like “reasonable and customary” or “usual, reasonable and customary” or something similar when describing how much they will cover.

Watch out for health insurance policies with:

Dollar amount limits for each procedure

A long list of procedures that the health insurance policy will cover Better health insurance policies will not list dollar amounts for each procedure. They will pay using a formula that is based on what other doctors or medical providers will charge you in the same geographic area. A phrase like “usual and customary” indicates that they use such a formula. The cost of medical care rises so quickly that a dollar amount that seems impressive today may not fully reimburse you even a year from now.

Solid health Insurance policies will not have a long list of procedures that they will cover listed on the policy. The long list seems impressive because the list takes up a lot of space. Look at the statements below. It should be easy to choose between one and two.

“Our health insurance policy will cover you for everything except for expenses caused by self-inflicted injuries and substance abuse.” (“I’ve been to every state in the union except Alaska.”)
“Our health insurance policy will cover your nose, your ears, your toes, your hands, your right lung, your calf and your knee” (“I’ve been to New York, Connecticut, Nebraska, Washington DC and Vermont”)

Health Plan Exclusions and Limitations This section will tell you what is excluded. Typically elective surgery will not be covered. Also experimental procedures and expenses caused by self-inflicted injuries will not be covered. You should understand each of these exclusions and limitations before you commit to a policy. Most policies will not include maternity insurance, so if you want to get pregnant, make sure that you know how your policy will cover maternity expenses. Unfortunately, maternity insurance is not available in many states except as part of a group insurance plan. To summarize:

* Determine what health insurance plans will cover you in your area

* Determine which health insurance plans offer adequate coverage

*Choose the plans that offers the best value based on price and coverage

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Aug
05
2019

The Pros and Cons of Group Health Insurance

The health insurance marketplace is certainly challenging, but count your lucky stars that at least you have choices. To that end, this article is going to explore the pros and cons of group health insurance.

Group Health Insurance Pros

Group health premiums are subsidized by the employer. Generally, an employer must contribute at least 50% of the “employee only” premium. As such, if you are the employee, you can likely get a richer health plan for less premium than you would pay in the individual health marketplace. However, the cost to add your dependents to the employer’s plan, may be cost prohibitive. In this case, and assuming that your dependents can qualify, then you may want to put them on an individual health plan.
Group health premiums for large families are the same as for small families; whereas in the individual market, you pay a separate premium for every family member. So, if you have a large family, you may be able to get a better deal by adding them to your employer’s plan. As with any insurance change though, don’t make any changes without consulting with an experienced insurance advisor in your state.
Group health insurance in most states is guaranteed issue – meaning that you can’t be turned down because of pre-existing health conditions. This is a real blessing if you or a family member has a medical condition that prevents you from qualifying for a individual plan. But, this is a double-edged sword. While being guaranteed issue is a huge benefit for those with pre-existing medical conditions, it does come at a price. This one feature alone accounts for most of the disparity between group and individual insurance premiums. Yes, that is right – in most states, individual health premiums are almost always less expensive than group health premiums.
Most group plans cover maternity. So, if you are planning on having more children, you should definitely consider hopping on to a group plan. While you can add a “maternity rider” to individual plans, these riders tend to be expensive, restrictive, and otherwise provide less value than the coverage you can get in a group health plan. That being said, if you are considering having more children, we recommend that you contact a health insurance advisor in your state for advice about what is best for your family. The right answer is different for each unique family.
Economies of scale can benefit employees of large employers. It is true that the larger the group, the larger the risk pool is in which to share the risk which CAN result in lower premiums than are available in the individual health market. However, the guaranteed issue “issue” CAN wreak havoc on this type of plan. For example, a large employer with good benefits tends to retain employees for long periods of time. Eventually, the average age of the group starts to creep up and so do premiums. In addition, people with large medical needs (expensive medical conditions) tend to be attracted to large plans because they are guaranteed issue with good coverage. And so, over time, not only is the group’s average age increasing, but the group is also attracting employees with large expected health costs. This is the dilemma that we see with large health plans like the U.S. auto-makers and even government plans. Eventually, those with lots of medical needs begin to outnumber those with little or no needs and so premiums are driven higher and higher.

Group Health Insurance Cons

Group health insurance can be more expensive than individual health insurance. ln fact, if you don’t factor in the employer’s contribution towards premiums, then individual plans are almost always more affordable than group plans. However, as we discussed earlier, not every one can qualify for an individual plan.
What happens if your employment is terminated (by you or your employer)? Yes, you will likely have some benefit continuation rights (through COBRA or state continuation programs), but these benefits can be very expensive and the term limited. So, eventually, you either have to secure another job with benefits, an individual health plan (assuming you are insurable), or possibly join a government health insurance program for the uninsured (if you are not insurable). Let me emphasize, that you should NEVER be without some form of major medical health insurance. Being without this insurance puts you and your family in serious financial jeopardy. In fact, a recent Harvard University study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.ยน To the same point, every 30 seconds in the United States, someone files for bankruptcy in the aftermath of a serious health problem. Don’t let this happen to you.
Group health insurance premiums are rising faster than individual health insurance premiums. Why? Because most group plans are guaranteed issue and since they accept “all comers”, they tend to attract those with high medical costs. On the other hand, most individual health insurance plans are medically underwritten. This means that the insurance company can say “no thanks” to any application that it deems to not be in its interest. Put yourself in their shoes – would sign a contract to provide $30,000 in annual benefits to someone that was only going to pay $3,000 in premiums (for a net loss of $27,000) if you didn’t have to? Hmm…let me me think about that one. The answer is a resounding “NO!”. Because of this underwriting process for individual health insurance, insurance companies can control their risk and more effectively manage their profitability, resulting in more stable prices.

As you can see, there is no clear cut answer as to which type of insurance is the best. The answer depends on a number of factors and is different for every unique situation. The best advice I can give you as you consider your health insurance options — get good advice from an experienced health insurance advisor.

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