Pros and Cons of Supplemental Health Insurance

November 25, 2008



Supplemental insurance benefits, like cancer insurance or
heart/stroke insurance are paid directly to the insured, unless
otherwise required by Medicare supplemental insurance. Hospital and
major medical insurance benefits are paid directly to the provider,
which you would only have to pay small co-pay, if anything. But if
an emergency were to happen or you had a specific disease or
condition that was going to cost you out of pocket expenses,
investing in a supplemental plan is a good idea. As a policyholder,
you can use those benefits to help with your out-of-pocket expenses
or loss of income. Supplemental insurance products such as cancer
and accidental injury insurance are not a replacement for major
medical insurance. These types of policies help to cover expenses
that are not covered by major medical insurance and reduce the
money paid out by the insured. These policies can also paid for
lost income in the case of missing work.

Supplemental medical insurance only provides coverage after your
regular medical insurance has been exhausted. Supplemental medical
insurance is used to pick up where basic medical insurance leaves
off. You will have to hold a regular health plan to be able to use
the supplemental insurance. When this coverage is exhausted, your
supplemental medical coverage would begin paying. Supplemental
medical coverage is written in a separate policy, and does not
include coverage for basic doctor visits. Supplemental insurances
are definitely lifesavers for many people. The only downside is
that they can be expensive and useless if you never need them. You
have to pay for your regular medical coverage and now add an extra
policy or two and that can get pretty high. If you try to purchase
a policy after you have become ill or injured it won’t cover a
pre-existing condition, so you will pay out and not receive and
benefits for the condition you already have. The idea is that you
have to buy into a supplemental plan prior to the incident so they
can collect off of you being healthy. Here are some plans for
supplementing your health insurance that can be used at any age.

Cancer Insurance provides benefits to help cover costs for cancer
treatment and other related expenses associated with the disease.
Most policies provide direct-to-policyholder cash benefits for
daily hospitalization and intensive care unit confinement, as well
as for surgery, anesthesia, chemotherapy, radiation, and
preventative care. This is a good plan to have if you have a family
history of cancer, it could save your life and your wallet.

Critical Condition/Critical Illness Insurance is a policy designed
to provide you with a lump sum benefit to help pay out-of-pocket
expenses if you suffer a heart attack, stroke, have heart surgery,
cancer (except skin cancer) or several other conditions. It covers
illnesses and diseases that cause you to hospitalized for critical
condition and picks up where you regular benefits left off.

Disability Income Protection supplements lost income by paying a
monthly benefit to you if you become partially or totally disabled
due to a covered illness. This also provides a daily benefit for
in-patient hospitalization for a covered illness. This policy has a
reduction in benefits after age 65.

Hospital Emergency Recovery & Outpatient Insurance (Supplemental
Medical) provides benefits for treatment due to a covered illness
including daily benefits for in-patient hospitalization, intensive
care and recovery care following hospital confinement due to a
covered illness. It also provides a benefit for outpatient surgery
and emergency room treatment for each covered illness.

Some of the plans geared toward the elderly and retiring persons
are actually very smart to have. They can help pay for things that
Medicare won’t or can’t. They also offer assistance if you ever
need to be cared for at home, move to an assisted living home, or
need to go to a nursing home. These types of expenses can leave
other family members in debt after you are gone. Funeral and burial
are usually also covered. This gives many folks the ability to
leave their families something other than bills. Also with
assistance for medication there is more money to enjoy while you
are still around. Some age related supplemental insurances are:

Long Term Care Insurance can help cover the high cost of a variety
of long-term care options such as: assisted living facilities,
medical home care, custodial home care, adult day care, and if
necessary, nursing home care, up to specified policy limits.
Includes bed reservation benefit, respite and hospice care,
emergency response system, and caregiver training. For an
additional cost, you have the option of a valuable cost-of-living
adjustment option. Separate Nursing Home Care and Home Health Care
only policies also are available in most states. These will pay if
you or your spouse needs to go into a nursing care facility.

Medicare Supplement Insurance is for people 65 and over mostly.
These offer a wide range of standardized plans that supplement
expenses not covered by Medicare. This will help pay for doctors
visits and prescriptions that were only covered partially by
Medicare.

Find out more about Pros and Cons of Supplemental Health Insurance

DISCLAIMER: This information is for educational and informational
purposes only. The content is not intended to be a substitute for
professional advice. Always seek the advice of a licensed Insurance
Agent or Broker with any questions you may have regarding any
Insurance Matter.

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Tips on Finding Health Insurance Even with Pre-existing Medical Conditions

November 19, 2008



How much coverage you can get on a pre-existing condition varies
from state to state. For people getting insurance through their
job, it is illegal for them to not let you join the plan based on a
pre-existing condition. As long as you are an employee, you have
the same rights as all other employees to the group plan and rates.
The Health Insurance Portability and Accountability Act, also known
as HIPAA, also grants limited eligibility for continuous coverage
for employees who leave their employer, through COBRA laws. If
certain conditions are met, such a person can obtain health
insurance in the individual market on a guaranteed-issue basic like
every one else.

Most insurance companies consider pre-existing conditions as health
conditions that you already have gotten or are receiving treatment
for. Pregnancy, AIDS, high-blood pressure and stroke are all
considered pre-existing conditions. Each insurance carrier has
their own policies and procedures regarding pre-existing
conditions. Some have waiting periods while others totally won’t
cover certain conditions. Having a pre-existing condition obviously
puts you at a higher risk for compensation than people without
pre-existing conditions, but that doesn’t necessarily mean you
can’t get insurance.

HIPAA tells you the conditions under which a person who maintains
continuous insurance coverage is able to purchase individual
insurance on a guaranteed-issue basis. This is free of exclusions
for pre-existing health conditions after leaving an employer group
insurance plan. To qualify for guaranteed issue of non-group, or
individual insurance, a person must have 18 months of prior,
continuous coverage by group insurance. Second, if coverage on
COBRA was available the person must have used all the time he or
she had on that plan. In most states, this period of time is 18
months. Once COBRA coverage is no longer available, association and
individual health plans must cover pre-existing conditions.
Finally, the person must buy an insurance plan with in 63 days of
leaving the group plan to exercise this guaranteed eligibility.

In addition, every state has a mechanism for guaranteed-issue
insurance. If you are not eligible, then there are some other
insurance options. Twenty-eight states operate a “high-risk” pool.
Pool coverage is like group coverage and part of the cost is
subsidized by appropriations from state revenue. Other states offer
guaranteed-issue basic or standard insurance coverage. In order to
find out if your state has one of these opportunities, contact your
department of insurance. An easy way to find an insurance
department is on the Internet. Try the web site of National
Association of Insurance Commissioners (NAIC). In many states,
health maintenance organizations (HMOs) offer guaranteed-issue
insurance. HMOs are much more strict about whom you see but having
coverage of any kind is a need.

In 1996 the laws changed for those people with pre-existing
conditions. Now many people would not be forced to have no
coverage, they can opt for a plan that excludes the disability for
a brief time. The HIPAA (Health Insurance Portability and
Accountability Act of 1996) determined that there are certain
conditions health insurance carriers may and may not cover. HIPAA
defines a pre-existing condition as: “A condition (whether physical
or mental), regardless of the cause of the condition, for which
medical advice, diagnosis, care or treatment was recommended or
received within the 6 month period ending on the enrollment date.”

However, exclusions are generally limited in how long they can be
excluded: Regular on-time entrants may only endure an exclusion
period of 12 months following enrollment. Those who received
treatment for a condition 6 months before enrollment, such as you
were treated for melanoma on January 1, 2005: you can enroll up to
July 1, 2005 and still be eligible but you must wait until July
2006 for benefits to begin. Late entrants must endure a longer
exclusionary period of 18 months, but maintain the same eligibility
requirements for regular on-time entrants above. HMO’s may affix a
“waiting” period of 60-90 days if they have no pre-existing
exclusion policies.

DISCLAIMER: This information is for educational and informational
purposes only. The content is not intended to be a substitute for
professional advice. Always seek the advice of a licensed Insurance
Agent or Broker with any questions you may have regarding any
Insurance Matter.

Find out more Tips on Finding Health Insurance Even with Pre-existing Medical Conditions


Why Seniors Should Not Totally Depend on Medicare in the Golden Years

November 17, 2008



Seniors have a need for the health care system more often than
younger people. They need good comparative information on quality
of care in order to make the best health care decisions. Seniors
also need to understand how Medicare works and if it will benefit
them at all. Many seniors have found that getting a private plan is
actually cheaper or the same with many more benefits. So, before
deciding that Medicare is your only option, look into things
better. Many companies let seniors purchase policies that work with
Medicare, so the cost that is not Medicare covered can be submitted
and a portion of the cost returned to the senior. Seniors today are
faced with many challenges with the rise in health care expenses
and high priced drugs. The government’s benefits just aren’t
enough. Many people today are preparing for those years with many
other insurance options.

There are also supposedly two forms of Medicare now, not that they
both are available to all persons. Three years later after Congress
expanded health care options for seniors, they are just now getting
access to a private fee-for-service plan. But so far, Sterling Life
Insurance Co. of Bellingham, Washington, is the only company
offering seniors a private fee-for-service option. The company
started the plan in July and now it is available in all or parts of
25 states. This plan was supposed to be bettered designed, but
obviously is not available as it should be. The other option of
Medicare is the basic HMO. This service has all the same components
as any other HMO, except the deductible and co-payments are higher.
Many times, these plans are so high that many seniors can’t eat
healthy and have the medications they need.

What can you do to keep yourself away from these really poor
options? You can invest in a good plan at a young age and at
optimal health. Purchase privately so it is not limited to your
work with a specific company. Having a well-known private insurance
can benefit you in many ways. Many young people don’t think of what
will happen when they retire. They find health insurance a
money-sucking item instead of a necessity. As you get older and
have a family, you tend to realize the importance in having
insurance and usually carry a plan through an employer at a cheaper
group rate. Most people even when they are ready to retire don’t
think about what is next for benefits. You can get COBRA after
retirement for up to 18 months, maximum. Now you will have to get a
health insurance through a private carrier at a higher cost and
possibly less benefits than if you had purchased the plan at 30. So
it makes more sense to get the plan at a fixed rate when you are in
your prime than to wait till after you retire. If you wait too long
and get that higher cost plan, you may find out as you get older
and older and your health declines you can’t afford it or it
doesn’t cover some of the things you may need and Medicare won’t
help with either.

Another option for seniors and other people who want to prepare for
the future is Long-Term Health insurance. This will provide
assistance when and if the day comes that you or your spouse needs
assistance with everyday tasks that require a nurse or helper. This
can help ease the burden of paying for in-home support or care,
assisted living facilities, and nursing homes. It can also help
with funeral expenses and burial costs. This is a great investment
for any person who knows they either won’t qualify for medicare or
will have to lose everything to get that assistance. It is better
to invest at a younger age so the benefits can at their optimum
when you have to call on them. Plus, you would hate to lose
everything and have your children stuck with your nursing home
bills and death expenses. Most everyone wants to leave their family
a little something when it is their time to go. However, bills and
debts that remind them of sadness aren’t what most people have in
mind.

DISCLAIMER: This information is for educational and informational
purposes only. The content is not intended to be a substitute for
professional advice. Always seek the advice of a licensed Insurance
Agent or Broker with any questions you may have regarding any
Insurance Matter.

Find out more about Why Seniors Should Not Totally Depend on Medicare in the Golden Years


Medicaid Madness – The Latest in Eligibility Requirements

November 15, 2008



Medicaid is state regulated and funded health insurance that helps
low-income persons who can’t afford medical care pay for some
and/or all of their medical bills. If you qualify and don’t have
medical insurance, Medicaid can help you stay healthy and assist
you till you find other resources. Medicaid is available only to
people with limited income and has strict limitations. In order to
qualify, you must fall into a group of persons that meet specific
criteria. Medicaid pays money directly to your health care
providers. Depending on your state’s rules, you may also be asked
to pay a small part of the cost (co-payment) for some medical
services or prescription drugs. .

Many groups of people can be covered under Medicaid that will
qualify under their own group’s specific guideline. Some examples
of group’s requirements can include your age, whether you are
pregnant, disabled, blind, or aged or your income and resources.
Resources can be cash or any item that can be sold for a
substantial amount of money, or bank accounts, or property. Another
requirement is whether you are a U.S. citizen or a lawfully
admitted immigrant. The rules for counting your income and
resources vary from state to state and from group to group, so you
should check the requirements that pertain to where you are living.

In addition, for those persons living in a nursing home or at home
with disabilities, there are specific rule and guidelines to be
met. Your dependent child or children may be eligible for coverage
if they are U.S. citizens or a lawfully admitted immigrant, even if
you are not. Eligibility for children is based on the child’s
status, not the parent’s. Also, if someone else’s child lives with
you, the child may be eligible even if you are not because your
income and resources will not count for the child.

General eligibility requirements you must meet to obtain Medicaid
in your state may vary from other states, but they are pretty mush
based on the same criteria. You must meet the income, dependent,
resources, and other various requirements asked on the application
to qualify. People who qualify are individuals over 65, blind, and
disabled for social security disability purposes. Others are
families or single parents with children under 21 year old who
either don’t make enough money, don’t have health benefits at a
reasonable cost, or are on public assistance. Single and married
persons with a temporary disability, limited income, special
circumstance, or between the ages 59-64 also can meet the criteria.
If you need to seek drug or alcohol treatment, or are the victim of
domestic violence you are eligible for Medicaid during treatment
and possibly after the crisis is over. You can also qualify if you
are caring for a child or disabled person.

When applying for Medicaid your eligibility is determined by your
income and that can come from various sources. They compare the
income and to the size of the family to determine if they qualify.
Qualifying income is, and not limited to, earned wages, interest,
dividends, social security, veterans’ benefits, pensions, child
support, and spouse or partner’s income if living with them. Types
of payments that aren’t considered countable income are public
assistance, social security benefits, food stamps, low income home
energy assistance program benefits, foster care payments, certain
housing and utility subsidies, and weatherization payments. There
are income limits of course and they are strict, if you exceed them
by a penny you don’t qualify. The limits are different depending on
the amount of family members living in the home and requesting the
benefits.

You will have to have proof of your resources and family size to
determine if you have resource limits and are eligible. Different
groups of qualifiers will vary in what resources they can have.
Resource limits do not apply for those persons with children at
home and under the age of 21. Resources that are counted in
eligibility determination are cash, checking and/or saving
accounts, certificates, Christmas or vacation clubs, stocks and
bonds, some types of trust funds, life insurance, vehicles,
revocable burial funds, and non-resident property. Items that
cannot count against you when determining eligibility are your
home, burial space and marker, and one vehicle per household. If
you are a student and get federal grants and loans, those cannot be
counted either. Find out more about Medicaid Madness – The Latest in Eligibility Requirements

DISCLAIMER: This information is for educational and informational
purposes only. The content is not intended to be a substitute for
professional advice. Always seek the advice of a licensed Insurance
Agent or Broker with any questions you may have regarding any
Insurance Matter.


Defining Point of Service (POS) Health Insurance

November 3, 2008

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.

Find out more about Defining Point of Service Health Insurance

DISCLAIMER: This information is for educational and informational
purposes only. The content is not intended to be a substitute for
professional advice. Always seek the advice of a licensed Insurance
Agent or Broker with any questions you may have regarding any
Insurance Matter.