Discount Plans vs. Health Insurance

January 29, 2009

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

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.

Discount Plans vs. 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.

The Long and Short on Short Term Health Insurance

January 24, 2009

Sometimes, short-term health insurance is just plain needed. If you
have just graduated from school, or left a job, or need to get your
own insurance on a temporary basis while you job hunt, this might
be the answer for you. This can also be very helpful while waiting
for your employer’s group health insurances waiting period to end.
Many employers require you be with the company at least 90 days
before you can even think about wanting insurance, and then it can
be the first of the next month before they kick in. If you can get
short-term coverage where you live these are good times to consider
this type of health insurance. As the name states, short-term
health insurance is health insurance that is top be used for the
short-term. For usually 30 days to 180 days though some plans will
offer coverage for up to 12 months. If you haven’t found what you
are looking for yet at the end of the period you can always renew,
if the company offers that possibility. You shouldn’t try to rely
on short-term health coverage for more than a year some companies
don’t allow renewal, and in fact, most don’t.

Usually you will receive many the same benefits as you would with a
regular health plan, the outline is very similar. It is just the
time you have on the plan that is different and what type of
procedures are most likely to come up that are mostly covered. You
will have the same limitations, freedoms, co-pays, and deductibles
as you would with any other private insurance. In most situations
you can pick out your own providers such as doctors, hospitals and
other medical professionals covered under your plan. You probably
won’t need a physical and your coverage will most likely start
immediately after receiving the first payment. You can also expect
previously existing conditions to probably not be covered. This
keeps the cost down and makes you look to more long-term policies
for your needs. The point of this policy is to protect from those
unexpected accidents, illnesses, and emergencies, not provide
routine care that would only be done once in a year and can come
out of pocket. The point of this plan is to be inexpensive and keep
you from the big money pinches.

Many short-term plans don’t offer some of the same benefits as
regular plans, this helps reduce its cost. They are more concerned
about what will be covered in the short-term basis then any normal
routine things that might come up during that period that you can
cover yourself. There is a good chance that you will not be covered
for regular check ups, pregnancy and childbirth costs, dental,
vision, or preventative exams. Your coverage will most be likely to
include illness and emergency care which would cost you the most
out of pocket. So you will definitely want to get a new plan
through work or privately as soon as you find one that suits your
needs and budget. Having a permanent health package is much more
suitable and economical. Short-term plans are meant to bridge you
through till you get a new plan that has long-term coverage.

Short-term health insurance is exempt from the Health Insurance
Portability and Accountability Act. In other words, you will not
qualify for COBRA if you only have this type of coverage at your
job and not a normal health care plan. As a result, most carriers
don’t have to guarantee to renew you when your time frame is over.
They also don’t have to waive pre-existing conditions, even when
other plans would. They only have to help out with those rare
occasions you might get sick or if there is an emergency. Let’s
face it; you won’t be likely to have too many emergencies in a
year, so the company is making a profit. It is much better and
economical to get a regular plan as soon as you can to avoid paying
out too much money in routine costs. You would not want to keep
this type of plan if your employer offers medical benefits. If,
and/or when, you leave this job you want to be able to qualify for
COBRA and have all the necessary benefits, instead of pay more for

The Long and Short on Short Term 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.

Interpreting Health Insurance Hieroglyphics

January 5, 2009

Trying to figure out everything that is on your insurance policy
can feel like trying to read a new language. Having an illness or
non-work related injury is devastating enough, trying to figure out
what is covered and what is not can be a whole other picnic.
Especially when prices on health care have raised so much. Even
though managed care can really save people some serious money, you
have to know what each term means and how it works in you specific
plan. If you have a group plan from your employer you are
definitely paying much less than if on your own, but do you really
know what that plan really says or what it offers? Some people are
better off and covered more for their own private plan once they
figure out the medical lingo.

The whole point of health insurance is to pay for the accumulating
cost of exams, diagnostics, and treatments of any particular issue
you may have. There are several coverage options when it comes to
what kind of health care plan you have or want. Try to pick a plan
that best meets you needs and budget, this will help you save
money. Also, don’t feel dumb if you have no clue what your agent
says. You can ask them what things mean if you don’t know. You are
better able to understand what you are covered for than be
surprised when you get the bill. It is better to know what is
available to you in health benefits on all fronts. Become familiar
with the types of plans available and know their specific
advantages and disadvantages so you can best determine what works
for you.


?Indemnity Policies (Traditional Fee-for-Service Insurance)
?Preferred Provider Organizations (PPOs)
?Health Maintenance Organizations (HMOs or Managed Care)
?Self-Insured Health Plans (Single Employer Self-Insured Plans)
?Multiple Employer Welfare Arrangements (MEWAs)


Assignment of Benefits: Your signed authorization to give your
doctor or hospital (medical provider) direct payment to them for
your medical treatment. This means you do not see the money and
don’t have to pay at the time of service more than your co-pay.

Business Day: Every day that insurance companies are open for
business, which excludes Saturday, Sunday, and state and federal
holidays. These tend to be from Monday to Friday from 8-9 AM to 4-5
PM their local time.

Calendar Day: Every day of the calendar month, which includes
Saturday, Sunday, and state and federal holidays. If something
happens on a Saturday, Sunday, or holiday you will be able to call
in a claim but it will not be recorded till the next business day.

Certificate of Coverage: The document you get that tells you that
you are a member of the group and hold a policy.

Certificate of Creditable Coverage: A written statement from your
previous insurance company and/or health plan stating the length of
time you were covered with them.

Claim: A notification to your insurance company that payment is due
under the policy provisions.

Co-payment – The portion of charges you pay to your provider for
covered health care services in addition to any deductible.

Coverage: The actual details of protection provided by an insurance

Denial: An insurance company’s decision to withhold a claim payment
or demand a preauthorization. A denial may be made because the
medical service is not covered, not medically necessary, or
experimental or investigational.

Deductible: A set amount of money paid by the insured for medical
costs before benefits kick in and pay.

Exclusions and/or Limitations: Conditions or circumstances spelled
out in an insurance policy that limit or exclude coverage benefits.
It is important to read all exclusion, limitation, and reduction
clauses in your health insurance policy or certificate of coverage
to determine which expenses are not covered.

Experimental and/or Investigational Medical Services: A drug,
device, procedure, treatment plan, or other therapy, which is
currently not within the accepted standards of medical care. These
items are more than likely not covered.

Grace Period: A specified period immediately following the premium
due date during which a payment can be made to continue a policy
without interruption. This applies only to Life and Health
policies. Check your policy to be sure that a grace period is
offered and how many days, if any, are allowed.

Independent Medical Review: A process where expert medical
professionals who have no relationship to your health insurance
company or health plan review specific medical decisions made by
the insurance company.

Medically Necessary: A drug, device, procedure, treatment, or other
therapy that is covered under your health insurance policy and that
your doctor, hospital, or provider has determined essential for
your medical well-being, specific illness, or underlying condition.

Policy: The written contract between an individual or group
policyholder and an insurance company. The policy outlines the
duties, obligations, and responsibilities of both the policyholder
and the insurance company. A policy may include any application,
endorsement, certificate, or any other document that can describe,
limit, or exclude coverage benefits under the policy.

Visit us for more information on Interpreting Health Insurance Hieroglyphics
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.