Getting a good health insurance policy these days takes some effort and a careful approach.
The information given below will give you the consumer an edge while shopping for the health
insurance plan you want. Not to worry, there are a lot of great plans out there. It's easy to make
these mistakes when buying health insurance. This information will help you save money and
get greater protection with your health insurance.
They buy a policy that shows a $5 million lifetime maximum per person, but the policy only pays
$1 million per illness or injury. The $5 million worth of coverage sounds and feels good, doesnít
it? Think about those people you know that have past away. Usually it is one illness or injury
that was the result of their demise. If you had one thing trying to kill you, what would you want to
defend yourself with, $1 million or $5 million?
In practical terms, is the policy above, a $1 million or $5 million plan? Itís $1 million of course.
It just appears to be the greater number. It is far more possible for oneís medical bills, from a
single health threat, to run over the limits of this type of plan than it is for two or more threats
to come our way.
So, when buying health insurance, the question to ask is ďWhat is the lifetime maximum and
what keeps me from getting it?Ē (When I need it the most)
The doctor office visit and itís benefits are shrinking. Just because a policy has a copay for a
doctors office visit, it doesnít mean there is a real benefit to go with it. Iíve seen plans with a
$15 copay for going to the doctors office, this is a great copay ! Upon reading the plan it
shows that it only pays a $50 benefit per office visit. So you pay $15, they pay $50 and you
pay the rest. Smoke and mirrors.
So the question to ask is ďWhat is covered in the doctors office after I pay my copay?Ē
There are two ways to have prescription drug benefits as part of a health insurance plan. You
can have a defined copay amount shown for generics and brand name drugs. Some companies
issue a generic only card and define what you would pay for those. These are true prescription
drug benefits because the copay amounts are spelled out.
The other way is the discount prescription drug card. Donít misunderstand, thereís nothing
wrong with a discount card per se. Itís just that some plans state that there are prescription
drug benefits included, but itís only a discount card. Almost all plans give a discount card if
you donít have the copay card. They arenít special and the discount is usually up to 15% off
retail. Itís not much and often you can get a better deal if you donít use the card at all.
So, if a true prescription drug benefit exists, the copays will be spelled out.
PPO plans are a great deal. The Preferred Provider Organization has agreed to give discounts
to the insurance companies for their services. The insurance companies turn around and give
us, the consumer, a discount on our health insurance premiums when we buy a PPO plan. I
know health insurance premiums are getting very high so this is hard to believe. Check out the
premiums on any indemnity plans and compare to the PPO. You will notice the difference. If
the insurance company is not going to get a predetermined discount for sending insured's to a
provider, the cost of care basically has no limits so non-PPO plans cost more.
The problem here lies in not understanding the way a PPO works.
If you the insured goes to providers that are not in network.You will pay completely out of your
pocket for that care. If you go, due to a medical emergency, usually defined as a threat to life
and limb, on most plans you will be treated as if in network.
Get the PPO and save money on the cost of health insurance, but understand who and where
the providers are so the highest benefits are enjoyed by the plan.
A multitude of factors that include which state and region you live in and the actuarial statistics
of each area, right down to the zip code determine health insurance premiums. Of course plan
design and benefits provided are important too. Once a plan design is chosen though, you really
only have control over two factors in determining the cost or premium of the policy. That is the
deductible and coinsurance. On PPO and indemnity plans thereís a deductible and coinsurance
to meet for any medical expenses not covered by copays; i.e. doctor visits, prescription drugs,
and emergency room. Think of it as a hospital deductible because that is the time one is most
likely to pay it.
So many people buy plans with low deductibles because they donít want to pay $2500 for
example, to go to the hospital. When you compare the cost of the low deductibles to the
higher ones, the value isnít always there. If the cost difference between them is close to or
greater than the difference in deductible, get the higher deductible.
PPO Insurance Plan $500 deductible is $550.00 a month
Same Plan $2000 deductible $435.00 a month
$115.00 X 12 months = $1380 less per year for the higher deductible plan.
Even if someone in the family goes to the hospital the first year of the policy you are only out
$120 in difference between premium and deductible. If no one goes $1380 is saved and you
are way ahead.
Statistically in a family of four, one person will go to the hospital every 8 years. Thatís 8 years
of saving money on premiums if the higher deductible is chosen.
Going back to number one. ďWhat is the lifetime maximum and what keeps me from getting it?Ē
One thing common on most plans that is understandable, are the limits on organ transplants, if
you donít go a ďCenter of ExcellenceĒ. Itís like the PPO example, and of course you want to go
to a facility that knows what itís doing.
But, there are plans that have extra deductibles and copays on every facet of health care
possible. These are extra costs that can be encountered every time you need medical care,
therefore your out of pocket expenses are unlimited. Even though the plan has a stated
deductible and coinsurance, it also has lots of other little out of pocket expenses that can
add up to big money.
The cost of health insurance is twofold. So the question is ďWhat will the cost of the premiums
be and what would it cost me to actually use the plan?" ( when itís needed the most)
The second part of that question is the most important.
Thatís too much money, Iím not paying that ! Every year greater numbers of people are going
without health insurance. When it comes down to money for rent, food and a car payment for
job access, it's understandable. Beyond that, many say ďIt wonít happen to meĒ, so I donít
need insurance. Real world, every year 50% of all bankruptcies are due to unpaid medical bills.
Without a crystal ball to foretell the future, itís a real crapshoot to go without some coverage.
The cost of health insurance is a bargain if you end up needing it. Unless you have no other
options, donít go without it.