Posted on Thu, May 28, 2009
When you are trying to find the most affordable medical insurance, you need to understand some basic insurance terms so you know you are comparing apples to apples and coming up with accurate answers. Several terms are very commonly used in medical insurance policies that can reduce the confusion and make it much easier to choose the best coverage and most affordable health coverage available.
- Benefit - the amount the insurance company pays when the insured suffers a loss
- Benefit period – the benefit period is the amount of time involved in an individual claim. In the case of hospitalization, for example, the benefit period begins the first day of the hospital stay and ends when the patient is released from the facility. The benefit period will often extend for up to 60 days after release from a hospital or other qualified facility, counting any return to the facility as part of the original claim.
- Cafeteria Plan – a plan that offers a choice between two or more benefits or a choice between a benefit or cash
- Claim – a request by an individual or their provider to the insurance company to pay benefits for a loss
- COBRA - a federal law that allows employees to continue their insurance coverage, through self-pay, after it would normally terminate for up to 18, 24, 29 or 36 months. (COBRA insurance is generally expensive and not an affordable health coverage option for most people.)
- Co- Payment – a small charge the insured pays at the time medical service is received. Co-payments do not count toward deductible or out of pocket maximums.
- Deductible – the amount of covered expenses the insured must pay out of pocket before the insurance company pays. Choosing higher deductibles can help with affordable medical insurance premiums.
- Flexible Spending Accounts: special accounts typically funded by an employee’s salary reduction to help pay certain expenses not covered by the employer’s group health plan or insurance contract. The advantage of these accounts is that after-tax dollars are converted to before-tax dollars, thereby reducing the actual cost of expenses.
- Grace Period: time period that follows the premium due date when the coverage and policy remain in force.
- Health Maintenance Organization (HMO): a medical organization providing a wide range of widespread health care services for a specified group of enrollees for a fixed, pre-paid premium.
- Managed Care: coordination of financing and delivery of health care services to produce quality yet affordable health care coverage. Managed care puts limits on the use of services and the charges of providers.
- Out-of-Network Care: medical services obtained by managed care plan members from non-contracted health care providers. In many plans, such care will not be reimbursed unless the insured obtains previous authorization
- Out-of-Pocket Maximum: maximum dollar amount an insured is required to pay under a plan.
- Preferred Provider Organization (PPO): managed care arrangement consisting of a group of hospitals, physicians and other providers contracted with an insurer, employer or other group to provide health care services to covered persons in exchange for prompt payment and higher patient numbers.
While there are many other terms used throughout the medical insurance field, these are some of the ones you can expect to find. Understanding these and other common insurance terms will help you determine the most affordable medical insurance for your individual needs.
Posted on Wed, May 27, 2009
Is affordable health coverage possible in the United States? While many ideas are being shared and argued over in the name of health care reform, it can be next to impossible for the average person to know what the best options for affordable medical insurance are. One idea is to create a publicly funded insurance pool to help provide affordable health coverage to the uninsured. Other people are in favor of the opposite approach – market based policies.
What are Market-Based Policies?
Market-based medical insurance policies look to the private sector for insurance coverage rather than the government. Supporters of market-based policies believe they are the only way to give the consumer control and choice, as well as fostering competition to keep costs down and quality high.
Why are Market-Based Policies Better than Publicly Funded Health Care Policies?
Market-based policies are more cost effective for the government – and therefore the taxpayers- than publicly funded healthcare. According to the Kaiser Commission on Medicaid and the Uninsured, January 2005, if every uninsured individual was covered by a government program such as Medicaid, the cost to the federal and state governments is approximately $2000 each. If, however, low-income and modest-income Americans could purchase their own health insurance by utilizing a $1000 tax credit, the federal government would save 50% of that money. With over 45 million uninsured Americans, that savings would be substantial indeed.
Market-based insurance would not only be more affordable medical coverage, it would also provide consumers with more choice. Because savings come from a tax credit, the option to choose insurance companies, policies and doctors is left to the person who purchases the insurance, not a group of politicians. Health insurance needs vary widely from one individual to the next and having the ability to choose the options that work best for an individual’s circumstances is fundamental to quality health care.
Several different market-based solutions could help low and modest-income individuals and families find affordable health plans. Tax credits, tax deductions, health savings accounts and high-risk pools are all market-based options to make affordable medical insurance a reality for uninsured people who are working, but cannot afford medical insurance.
Tax credits allow people to keep more of their income on a monthly basis in their pay so the can purchase coverage. Because tax credits enable people to make their own choices of providers, plans and doctors, they are considered to be a preferred market-based solution for affordable health coverage. Tax credits enable working people to pay for their own health insurance without having to fall back on Medicare or other government health programs. Because a tax credit would cost only half the amount of Medicare per individual, the burden on all taxpayers is also reduced, saving everyone money.
Private health insurance can be affordable health coverage for every working American. By working with market-based solutions, health care reform can be a workable solution to the millions of Americans living in fear of a medical crisis because they have no medical insurance.
Posted on Tue, May 26, 2009
Trying to maintain affordable healthcare costs can be frustrating. With employers cutting medical insurance premium costs by raising employees’ deductibles, co-pays and out-of-pocket spending limits, it becomes even more important to find ways to save money on medical costs wherever possible. You can take some steps to keep affordable medical insurance costs affordable and still get quality healthcare.
It may seem obvious, but your medical insurance costs will be lower if you take care of your health. Maintain a healthy weight, exercise, don’t smoke and get an appropriate amount of sleep at night in order to keep your body as healthy as possible. You may get lower premiums by being a non-smoker or other healthy lifestyle choices.
Understand your benefits. If you don’t have a clear understanding of what is covered and what you are responsible to pay for yourself, you may miss out on ways to save money outlined in the benefits manual.
If your plan requires you use healthcare providers within a certain network, do all you can to stay within that network. When you are seeing colleagues of your network provider, make sure they too are in the network. If you are having surgery or other team-based procedures done, find out if all the team members participate in your network. When you choose providers outside your network, you can wind up paying as much as 50% more for those services than you pay would for an in-network provider.
Negotiate! If you must see a doctor or other healthcare professional from outside your network, talk to them and ask if they will reduce their fee. Prepare yourself by talking with your insurance company’s customer service department first and find out what they pay a network physician for the service you need. Use that figure to negotiate with the out-of-network doctor. Many times, you can also get a discount rate if you can pay cash at the time of the service. It can be worth hundreds or even thousands of dollars to shop around a bit and negotiate a rate before having a procedure done.
Use a Flexible Spending Account, if you have one. Many employers offer Flexible Spending Accounts or Medical Spending Accounts that allow employees to set aside pretax earnings to be used for reimbursement of qualified medical expenses not otherwise covered by insurance. It is possible to save several hundred dollars a year by taking full advantage of a Flexible Spending Account. You can also save money at tax time by keeping track of your out-of-pocket medical expenses and they add up to more than 7.5% of your adjusted gross income.
If you are able to set aside a “self-insurance” fund and you are in good health, you may be able to switch to emergency only medical insurance. Emergency medical insurance carries a high deductible. With a substantial deductible, you would use your own money to pay for things like doctor visits and prescription costs, as well as minor medical procedures and rely on your insurance in the case of larger, unexpected medical expenses. By carrying a very large deductible, your premium costs are significantly lowered, saving you money and providing you with more affordable health coverage.
You can save money on your medical insurance and keep affordable healthcare a reality but understanding your policy, utilizing employee benefits and making wise lifestyle choices.
Posted on Tue, May 26, 2009
BestHealthcareRates.com agrees with most Americans that the health care reform must include affordable health coverage for everyone. One option for affordable medical insurance, introduced in a resolution by 28 U.S. Senators, is a publicly funded health insurance option. Medical insurance has become more and more expensive and access to health care is difficult for many people.
Affordable health insurance for every U.S. citizen is a top priority for politicians in Washington. While there is much disagreement over the best way to provide affordable health coverage, one idea offered by over 25% of our U.S. Senators is a federally-backed health insurance pool for people who cannot afford private insurance.
Those who back a federally- funded public medical insurance plan insist it will provide consumers with more choice and perhaps better quality of health care as well. By providing a publicly funded health insurance, private insurance companies would be forced to compete for customers by providing excellent benefits, high quality care and affordable medical coverage to stay in the game.
Sen. Bob Casey, one of the sponsors of the resolution had this to say regarding health care reform and the proposed resolution, “Improving our health care system to increase quality and improving affordability is the ultimate and long-neglected goal. A public option can help this effort by increasing competition in the market and maintaining patient choice.”
The sponsors of the resolution believe a public medical insurance plan option is necessary to offer the most possible choices for Americans. Private health insurance companies would be pushed into keeping their rates competitive with the public health option. In the highly-regulated insurance industry, health insurers have to publish the amounts that they pay in claims per dollar premium collected. This is called the loss ratio. Standardizing the loss ratio for all insurers would help control rates, which would be a step toward keeping health insurance costs in check. The net effect would be a stabilization in healthcare costs and broader coverage nationwide; widespread health insurance coverage would ultimately result in lower healthcare expenses for all.
With a public pool of funds for health care, a new option is created for the 46+ million Americans who are currently living with no medical insurance coverage.
“While the President and Congress attempt to find a workable solution to health care reform, 28 U.S. Senators sponsor a resolution to create a publicly funded health insurance option. BestHealthcareRates.com supports helping people find affordable health coverage now, regardless of political decisions made in Washington, D.C.,” said Tom Carolan, Director of Client Services for BestHealthcareRates.com.
Posted on Fri, May 22, 2009
The struggle for affordable health care is faced by millions of American families. As medical costs continue to rise, affordable medical insurance becomes more difficult to find. Without affordable health coverage, families run a much higher risk of a small health problem turning into a nightmare, with both medical and financial consequences.
Families and individuals can still find affordable medical insurance and it may be more important now than ever before. The President and Congress are both announcing plans for a health care reform bill to be put to a vote in July 09. People who are without insurance after a reform plan is instituted will find themselves subject to a new policy with a new set of rules. No one knows yet what that policy might include, so it makes sense to do your research now and make your own decisions about affordable health care.
The only sure way to compare medical insurance plans is to look at the premium amounts, benefits, co-pays and deductibles and find the combination of numbers that fits your needs and your budget.
Of course, you need a premium amount you can afford or you will wind up being unable to keep the policy in effect. The premium amount is the ongoing fee you pay in exchange for the benefits you receive.
Benefits, the money the insurance company pays when a claim is approved, vary widely between policies and companies. Some policies only pay for hospital stays and emergency care. Others pay for routine doctor visits and preventative care as well. Some plans will accept clients with pre-existing medical conditions and others will not. A medical insurance policy may include prescription drugs or you pay need separate coverage for medications.
You may need to pay a co-pay with your insurance. A co-pay is the money you must pay yourself at the time a medical service is received. The co-pay amount will vary between different types of services. You may pay a $10 co-pay for an office visit, but pay $40 for an emergency room visit. Generally, the higher your co-pay, the lower your premium will be.
Deductibles are another expense involved with affordable health care. The deductible is the dollar amount of covered medical services you need to pay yourself before the insurance company begins to kick in on the bills. The deductible you choose will have a significant effect on how affordable health coverage will be for yourself or your family. The higher your deductible, the lower your premium cost will be. It is important to understand the terms of your deductible. With some medical insurance, the deductible amount must be met for each member of the family. Other policies just have one deductible amount for the policy, no matter how many family members are included.
Affordable health insurance isn’t always easy to find, but by being able to choose your deductible and perhaps the co-pay amounts you are responsible for, you may be able to affect the premium amount you pay, leaving you with an affordable health coverage plan that provides quality care at a reasonable cost.
Posted on Wed, May 20, 2009
As graduates across the country are preparing for new adventures and responsibilities, the importance of affordable health insurance coverage is becoming a reality. In a new poll released by UnitedHealth Group, Inc, over 2/3 of young adults in the US know they need affordable health insurance, but over half of them say they don’t have the information they need to choose the right type of coverage to meet their needs.
1,000 young adults were polled and 67% of them haven’t made any plans for health insurance. While these 18 – 21 year olds know they need medical insurance coverage, they aren’t clear about the coverage they have through their parents and don’t even know when that coverage will end.
Young adults are in the largest and fastest growing group of the 46 million uninsured people in the US. This alarmingly large group of Americans, along with the 25 million underinsured, is facing incredible risk by not having appropriate coverage in the case of a medical need.
When you need affordable medical insurance and you cannot get coverage through your employer, it can be confusing how to even begin the process of finding health coverage on your own.
Determine your insurance needs: Before you can find the most affordable health insurance plan, you need to understand how insurance policies work. When it comes to cost, there are two things to understand -the deductible and the co-pay. Nearly all insurance plans have both a deductible and co-pay you are responsible to pay.
The deductible is the amount of medical expenses you have to pay out of pocket before your insurance coverage kicks in. The co-pay is the portion of each individual charge you must pay, in addition to the insurance company’s portion. For example, if you have a $500 deductible, you are responsible to pay the first $500 of medical expenses per year, before your insurance company pays anything. With the co-pay, you must pay a percentage of each charge, often at the time of your service.
To help keep your health insurance affordable, you have options how you pay these expenses. If you are in reasonably good health, choose a lower deductible and higher co-payment. If however, you go to the doctor fairly often, you pay be better off with lower co-payments, but a higher deductible. Once your annual deductible is reached, you will have less expense through out the year. For the most affordable health insurance premium, choose both higher deductibles and higher co-payments. This will at least spread your costs out over a length of time.
You can compare rates and plans for medical insurance online. This way you can look at several different types of policies from different companies and take your time deciding the best option for your medical insurance needs.
It is very important for young adults to have a good understanding of the type of insurance they need. With the large number of health insurance companies, as well as the variety in policies and coverage, the only way to find the most affordable health care coverage is to do some research and compare your options. Most importantly, however, is to avoid going with non health insurance at all so you don’t wind up with huge expenses you cannot afford to pay.
Posted on Tue, May 12, 2009
More boys than girls are born every year in the U.S. But any lead in health men start with, vanishes with the first dirty diaper. From infancy to old age, women are simply healthier than men. Out of the 15 leading causes of death, U.S. men lead women in all of them except Alzheimer’s disease, which many men don’t live long enough to develop.
Although the gender gap is closing, men still die five years earlier than their wives, on average. While the reasons are partly biological, men’s approach to their health plays a role too, experts say. “Men put their health last,” says Demetrius Porche, DNS, RN, editor in chief of the American Journal of Men’s Health. “Most men’s thinking is, if they can live up to their roles in society, then they’re healthy.”
Men go the doctor less than women, and are more likely to have a serious condition when they do go, research shows. “As long as they’re working and feeling productive, most men aren’t considering the risks to their health,” says Porche.
But even if you’re feeling healthy, a little planning can help you stay that way. The top threats to men’s health aren’t secrets: they’re known, common, and often preventable. Experts were consulted to bring you this list of the top health threats to men, and how to avoid them.
Cardiovascular Disease: The Leading Men’s Health Threat They call it atherosclerosis, meaning “hardening of the arteries.” But it could as easily be from the Latin for “a man’s worst enemy.”
“Heart disease and stroke are the first and second leading causes of death worldwide, in both men and women,” says Darwin Labarthe, MD, MPH, PhD, director of the division for heart disease and stroke prevention at the Centers for Disease Control and Prevention. “It’s a huge global public health problem, and in the U.S. we have some of the highest rates.”
In cardiovascular disease, cholesterol plaques gradually block the arteries in the heart and brain. If a plaque becomes unstable, a blood clot forms, blocking the artery and causing a heart attack or stroke.
One in five men and women will die from cardiovascular disease, according to Labarthe. For unclear reasons, though, men’s arteries develop atherosclerosis earlier than women’s. “Men’s average age for death from cardiovascular disease is under 65,” he says; women catch up about six years later.
Even in adolescence, girls’ arteries look healthier than boys’. Experts believe women’s naturally higher levels of good cholesterol (HDL) are partly responsible. Men have to work harder to reduce their risk for heart disease and stroke:
- Get your cholesterol checked, beginning at age 25 and every five years.
- Control your blood pressure and cholesterol, if they’re high.
- If you smoke, stop.
- Increase your physical activity level to 30 minutes per day, most days of the week.
- Eat more fruits and vegetables and less saturated or trans fats.
“There’s a saying that ‘children should know their grandparents,’” says Labarthe. “This is fatal or disabling condition that causes lost family time and working time. But a large number of these events are preventable.”
Lung Cancer: Still a Health Threat to Men Lung cancer is a terrible disease: ugly, aggressive, and almost always metastatic. Lung cancer spreads early, usually before it grows large enough to cause symptoms or even show up on an X-ray. By the time it’s found, lung cancer is often advanced and difficult to cure. Less than half of men are alive a year later. So… are you still smoking ? Tobacco smoke causes 90% of all lung cancers. Thanks to falling smoking rates in the U.S., fewer men than ever are dying of lung cancer. But lung cancer is still the leading cancer killer in men: more than enough to fill the Superdome every year. No effective screening test for lung cancer is available, although a major study is going on to learn if CT scans of the chests of high-risk people can catch cancer early enough to improve survival. Quitting smoking at any age reduces the risk for lung cancer and of course reduces the cost of medical insurance. Few preventive measures are as effective — or as challenging — as stopping smoking. But new tools are available that work to help men quit. Your doctor can tell you more.
Prostate Cancer: A Leading Cancer for Men Prostate cancer is the most common cancer in men other than skin cancer . Close to 200,000 men will develop prostate cancer this year in the U.S. But while one in six men will be diagnosed with prostate cancer in his lifetime, only one in 35 will die from it. “Many prostate cancers are slow-growing and unlikely to spread, while others are aggressive,” says Djenaba Joseph, MD, medical officer for cancer prevention at the CDC. “The problem is, we don’t have effective tests for identifying which cancers are more dangerous.” Screening for prostate cancer requires a digital rectal exam (the infamous gloved finger) and a blood test for prostate specific antigen (PSA). But in fact, “Screening has never definitively been shown to reduce the chances of dying from prostate cancer,” according to Joseph. That’s because screening finds many cancers that would never be fatal, even if undetected. Testing then leads to aggressive treatment of relatively harmless cancers, which causes problems like incontinence. Should you get screened for prostate cancer? Some experts say yes, but “the best solution is to see your doctor regularly and talk about your overall risk,” says Joseph. “All men should understand the risks and benefits of each approach, whichever you choose.”
Depression and Suicide: Men Are at Risk Depression isn’t just a bad mood, a rough patch, or the blues. It’s an emotional disturbance that affects your whole body and overall health. In effect, depression proves the mind-body connection. Brain chemicals and stress hormones are out of balance. Sleep, appetite, and energy level are disturbed. Research even suggests men with depression are more likely to develop heart disease. Experts previously thought depression affected far more women than men. But that may just be men’s tendency to hide depressed feelings, or express them in ways different than women’s. “Instead of showing sadness or crying, men get angry or aggressive,” says Porche. “They feel it’s not OK for them to say, ‘I’m depressed,’ so they cope in other ways, like drinking too much.” Men are also less likely to seek help for depression. The results can be tragic. Women attempt suicide more often, but men are more successful at completing it. Suicide is the eighth leading cause of death among all men; for young men it’s higher. Most men and women respond well to depression treatment with medications , therapy, or both. If you think you might be depressed, reach out to your doctor or someone close to you, and seek help.
Diabetes: The Silent Health Threat for Men Diabetes usually begins silently, without symptoms. Over years, blood sugar levels creep higher, eventually spilling into the urine. The resulting frequent urination and thirst are what finally bring many men to the doctor. The high sugar of diabetes is anything but sweet. Excess glucose acts like a slow poison on blood vessels and nerves everywhere in the body. Heart attacks, strokes, blindness, kidney failure, and amputations are the fallout for thousands of men. Boys born in 2000 have an alarming one-in-three chance of developing diabetes in their lifetimes. Overweight and obesity are likely feeding the diabetes epidemic. “The combination of diabetes and obesity may be erasing some of the reductions in heart disease risk we’ve had over the last few decades,” warns Labarthe. Exercise, combined with a healthy diet, can prevent type 2 diabetes . Moderate weight loss — for those who are overweight — and 30 minutes a day of physical activity reduced the chance of diabetes by more than 50% in men at high risk in one major study.
ED: A Common Health Problem in Men Erectile dysfunction may not be life threatening, but it’s still signals an important health problem. Two-thirds of men older than 70 and up to 39% of 40-year-old men have problems with erectile dysfunction. Men with ED report less enjoyment in life and are more likely to be depressed. Erectile dysfunction is most often caused by atherosclerosis — the same process that causes heart attacks and strokes. In fact, having ED frequently means that blood vessels throughout the body are in less-than-perfect health. Doctors consider erectile dysfunction an early warning sign for cardiovascular disease. You’ve probably heard more about the numerous effective treatments for ED than you ever cared to just by watching the evening news. Treatments make a fulfilling love life possible despite ED, but they don’t cure the condition. If you have erectile dysfunction, see your doctor, and ask if more than your love life is at risk.