Discount Plans versus Health Insurance

A woman from Las Vegas thought she was buying health insurance. It looked and sounded like health insurance. The Las Vegas woman is not 65 yet, which means she can't get Medicare. So, she went online looking for health insurance. She ended up finding something called Healthcare Advantage, and signed up after paying $100. Come to find out, this was not medical insurance at all and the sales representative never told this poor lady. She found that out when her cards arrived in the mail. In tiny writing at the bottom, it read, "not an HMO, PPO insurance or managed care company". This was a discount plan. These plans do not have the same coverage as a full medical health insurance policy. Make sure you know what you are getting and if it fits your needs.
So what is a discount plan? The plans claims to save people money by offering discounts on physician visits, prescription drugs, dental work, eye care and other treatments for a monthly fee. Unlike normal health insurance, which is very costly and very selective about who it covers, a discount health plan accepts everyone, no matter what health conditions they may have. You will use a list of doctors that are willing to charge discounted rates to the subscriber. Discount is not the same as coverage, and so you will pay more for visits and other services that you wouldn't with a regular medical plan. The average savings is only 25% that could be very expensive if you have to see a specialist or require surgery. These networks claim to have as many as 400,000 doctors and 50,000 hospitals available to choose from, but what if none of them are near you? You can get a savings of up to 30% on both generic and brand name drugs, which can also be costly if you have multiple prescriptions or they are costly ones. So if you have a health plan already but have a high deductible, this extra plan may help save you some money. But to use as a complete health plan, it really isn't designed for that and will cost you more than a great HMO.
HMOs and other medical plans can offer full medical coverage at great rates. Managed care plans are the way to go for those who are limited on funds. They offer the best policies for the least amount of money. Most of these plans are available to anyone and can save you a ton of cash. You can make the plan even more affordable by asking for a deductible, which will lower your monthly expense. Most HMO's do not have one at all but, you can request one, and most basic PPOs and POS only have a small one, usually $200 to $500 per year, which you can also asked to raised. The co-pays are also very reasonable with these types of plans. If you choose to purchase an HMO, expect to pay about $5-$10 per office visit and per prescription. With PPOs and POSs you will have a 20% co-pay with both visits and medications. The differences are how strict they are and you pay more of a co-pay to have extra flexibility. Usually a PPO or POS plan is less expensive and you have more freedom to see whom you want so the insurer makes you more responsible for payment. HMOs tend to be the least expensive and best policies for people with fixed incomes.
Make sure you know what your needs are and double-check what you are getting. If you need full medical coverage with low co-pay then a discount plan will not work for you. If you are already covered by a medical group but have a large deductible then you might benefit from the extra savings a discount plan can offer. Also, ask whether the plan is insurance that covers your treatment, or is a discount plan that still requires you to pay all medical bills yourself. Beware of slippery sales pitches. Make sure you know what's being offered. Discount health plans may only sell you access to a large mailing list of medical providers that it purchased commercially. Don't assume you're getting access to a large provider network just because your discount card displays the network's name and logo. If you plan to use a specific listed doctor, hospital, pharmacy or other provider, ask a few questions before you sign up.

Health Insurance – Know What's Not Insured!

Around 7 million people in the UK are covered by health insurance, the majority being covered through their employers. The problem is that few have really studied their policy documents and many misunderstand what is covered. And perhaps just as important, what isn't. If you expect health insurance to pay all your health costs, you're mistaken.
Health insurance is designed to provide protection for curable, short-term health problems and allow policyholders to jump the NHS queues to see consultants, be diagnosed, receive surgery or be treated. That sounds fine, but before you buy you need to appreciate the treatments and situations that fall outside the scope of the cover.
But first a word of warning. This article does not relate to any specific policy and the terms and conditions issued by individual insurers do vary. So please ensure you also check your policy documents. After reading this article, you'll know what to look out for!
Sorry – it's a chronic condition
If a condition can be cured and is not a long-term problem, your insurance company will classify it as acute and should meet the cost. If your problem is incurable or it's a problem that, despite appropriate treatment, will be with you for a long time, then your insurance company will classify it as chronic - and no, you won't be covered.
But drawing a firm line between what is acute and what is chronic is fraught with problems, and leads to the biggest area of conflict between insurer and policyholder.
Everyone agrees that diabetes and asthma are chronic conditions as you're likely to suffer from them for the rest of your life. So those sorts of condition are not covered.
Problems arise when the medical team initially considers a patients' illness to be curable, but the condition subsequently deteriorates and the doctors change their mind, it's now become incurable. This can happen especially in the treatment of some types of cancer.
In these circumstances, the condition is initially defined as acute and is therefore insured, but deteriorates and becomes chronic - and outside the terms of cover. This is possible as insurers retain the right to reclassify a condition from acute to chronic during treatment.
Sorry - it's too long term The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define “long-term”. You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.
Sorry – it's preventative Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.
Again, the problem of definition arises. Sometimes it is arguable whether a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be used in the early stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer returning for women who have a particularly virulent form of the cancer known as HER2. In this situation, is Herceptin offering a cure or is it a preventative?
Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Healthcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.
Sorry – the drug is not approved Two of the main attractions for taking out health insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But there's a rider.
Unless the drug has been approved for use by the NHS in England and Wales, by the Institute for Health and Clinical Excellence, your insurer is unlikely to approve its use. The problem is that the Institute's brief is not simply to decide whether a drug works, but to carry out a cost/benefit analysis to ensure that the benefits to the nation outweigh the financial costs of using it in the NHS. Not an easy brief - and one that has placed the Institute under scrutiny for the extended delays in drug approval.
The compromise hit on by the Financial Ombudsman is that if a health policy won't pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treatment is more expensive.
Sorry – it's a pre-existing condition
The basic principle is that if you are already suffering from a condition when you start a policy, then that condition “pre-exists” the policy and any claims for its treatment are invalid.
For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to insure you. After all they need a clear picture of your medical condition before they quote. For many applications, the insurer will, with your approval, also write to your GP for specific details of your medical history. They like to have a complete picture.
So lets say some years ago you injured your knee playing football. It appeared to recover but now it turns out that you have a torn cartilage and need an operation. The insurer could argue that this is a pre-existing condition and you have to pay for its' treatment.
Some insurers try to accommodate these grey areas with a moratorium provision within your policy. These provisions typically say that so long as you have been symptom free for two years relating to any condition you've suffered from within the last 5 years, then they will pay for subsequent treatment. Not all policies have these moratorium provisions and the time periods do vary between insurers. You should carefully read your policy.
Sorry – its not covered
Health Insurance is an annual contract – just like your car insurance. So when it comes to renewal, your insurer is at liberty to review not only your premium but also change the conditions on which your cover is provided.
Therefore, if your policy comes up for renewal mid way through a course of treatment, it's possible to find that your new policy no longer covers that particular treatment. This means that you will have to foot the bill for the balance of the treatment.
Furthermore, with ongoing advances in medical research, more and more conditions are becoming treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.
This hits the insurers' pocket in two ways. With more conditions being reclassified as acute, the number of claims is increasing. And there's also a trend for new treatments to cost more – Herceptin being a good example. The net result is that the insurers are finding themselves having to pay out far more. This is inevitably passed back to you through increased renewal premiums. And in an attempt to reduce their risk exposure, insurers have a tendency to adjust their definitions and exclusions. This means that you must read your renewal notice closely before you decide to renew.
So when you are considering Health Insurance, be aware that everything is not always black and white. And if you've got insurance and need treatment, always contact your insurer without delay and get them to confirm that your treatment is indeed covered

Basic Facts About Health Insurance Policies In A Bad Economy

1. DOES YOUR PLAN COVER YOU ON AND OFF THE JOB?
Many health insurance plans have specific exclusions that eliminate your benefits for anything that could have been covered under Workers Compensation or similar laws. Now read that last sentence again.
COULD HAVE BEEN COVERED!?
That is correct. Most self employed people and even some small business owners do not carry Workers Comp on themselves.
There are designed insurance plans that will cover you on and off the job — 24-hours a day, if you are not required by law to have Workers Compensation coverage.
2. ARE YOU WRITING IT OFF?
Independent contractors (1099's), home based business owners, professionals and other self employed people generally are not taking advantages of the tax laws available to them.
Many people who are paying 100% of their own costs are eligible to deduct their monthly insurance payments. Just that alone can reduce your net out-of-pocket costs of a proper plan by as much as 40%. Ask your accounting professional if you are eligible and/or check out the IRS website for more information.
3. INTERNAL LIMITSAll true insurance plans use some form of internal controls to determine how much they will pay out for a particular procedure or service. There are two basic methods.
-Scheduled Benefits
Many plans, some of which are specifically marketed to self employed and independent people, have a clear schedule of what they will pay per doctor office visit, hospital stay, or even limits on what they will pay for testing per 24-hr. period. This structure is usually associated with "Indemnity Plans". If you are presented with one of these plans, be sure to see the schedule of benefits, in writing. It is important that you understand these type of limits up front because once you reach them the company will not pay anything over that amount.
-Usual and Customary
"Usual and Customary" refers to the rate of pay out for a doctor office visit, procedure or hospital stay that is based on what the majority of physicians and facilities charge for that particular service in that particular geographical or comparable area. "Usual and Customary" charges represent the highest level of coverage on most major medical plans.
4.YOU HAVE THE ABILITY TO SHOP!
If you are reading this you, are probably shopping for a health plan. Every day people shop, for everything from groceries to a new home. During the shopping process, generally, the value, price, personal needs and general marketplace gets evaluated by the buyer. With this in mind, it is very disconcerting that most people never ask what a test, procedure or even doctor visit will cost. In this ever-changing health insurance market, it will become increasingly important for these questions to be asked of our medical professionals. Asking price will help you get the most out of your plan and reduce your out-of-pocket expenses.
5. NETWORKS AND DISCOUNTS
Almost all insurance plans and benefit programs work with medical networks to access discounted rates. In broad strokes, networks consist of medical professionals and facilities who agree, by contract, to charge discounted rates for services rendered. In many cases the network is one of the defining attributes of your program. Discounts can vary from 10% to 60% or more. Medical network discounts vary, but to ensure you minimize your out-of-pocket expenses, it is imperative that you preview the network's list of physicians and facilities before committing. This is not only to ensure that your local doctors and hospitals are in the network, but also to see what your options would be if you were to need a specialist.
Ask your agent what network you are in, ask if it is local or national and then determine if it meets your own individual needs.