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

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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


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.


Self-Employed Should Make Health Insurance a Priority

October 17, 2008

Having enough and being able to afford health insurance, is one of
the most nagging concerns for those who run their own business.
Many small businesses don’t offer health benefits to employees if
they have less than 20. It is hard and expensive enough to work for
yourself, but having to pay high prices for health insurance can
make life much harder. If you work as a consultant, freelance
worker, and other self-employed individual you will be allowed to
deduct all of your health insurance premiums and bills off of your
taxes. It is especially valuable because it is an above the line
deduction for Adjusted Gross Income (AGI), so you can take
advantage of this deduction even if you do not you itemize your
deductions on your tax return. For those persons opening a small
business, even the cheapest plan can be too expensive to pay for.
Between the overhead and invested money to get your business off
the ground, and the fact that most businesses take years to turn a
gain, you can find your self making ends meet the first few years.
But your medical bills and premiums are deductible, too. So, get a
plan and have your taxes reduced at the end of the year, it will
save you money in the long run for sure.

How to find Self-Employed Health coverage at a price you can afford
doesn’t have to be a headache. When you leave your employer to
venture forth on your own take advantage of your COBRA rights. This
law allows you to keep your coverage for up to 18 months after
leaving at a higher rate. Most employees only pay about 28% of
their policy. This will be a shock to the system because your
employer will no longer be paying for part of your coverage so you
will be paying the whole bill yourself. So in essence, you will be
paying for a higher group rate verses the original group rate on
the job, but this will buy you some time in looking for a new plan.
COBRA will at least get you through in case you need time to look
at many policies and find one that works for you.

Lighten your financial burden before you hastily leave your current
job if you can. This will allow you to have money put aside and
have researched other health plans that you can go to right after
leaving. If you purchase your own policy before leaving your job
you will still qualify for COBRA but the rates will be lower and
something you are used to. Make sure you have paid up all your debt
so the money you have saved can be used to start your business and
pay your insurance when you leave. If you will be working from
home, save some money and designate that for your medical expenses.
Most independent contract work pays weekly so that money can be
used for bills and other things till you start to make more. If you
are going to need a lone to start your small business, make sure
you are in the green credit wise. This can up the loan amount, so
you have some extra to put aside for bills. That way you can use
the money saved from your job just for insurance.

Don’t let time slip by you and forget to find a new insurance
company if you are on COBRA. They will only cover you for 18 months
and an extra 63 days past that if you haven’t. At that point they
could up your rates and not include any previously existing
conditions and that will just make your premium higher. So, utilize
the time you have and get a cheaper plan that works for you as soon
as possible. Why shell out more money and then also forget that you
are going to be cut off. If you have a spouse or partner who works
outside the home go on their plan. They will be getting a group
rate from their employer. You might have to wait till the next
eligible entry day, but that should happen before the 18 months of
COBRA has run out. Have your partner ask his or her employer when
they would be able to add you to the policy. Find out more about
why Self-Employed Should Make Health Insurance a Priority

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.


How to Get a Group Health Insurance Rate as an Individual

October 13, 2008

 

Most individuals can get really good group rates through their
employers. As long as your place of business has more than 50
employees and actually offers a medical plan, you should get a
pretty good deal. The overall cost is based on how many of the
employees actually have the insurance plan. The more people who are
signed up, the cheaper the plan will be. Most people will choose
this over going with a private plan any day because it is so much
more cost friendly. That is one of the first things you should be
looking for when seeking a job, whether or not they offer insurance
benefits or not. At your interview ask to see their healthcare
providers plan and rates. If they will let you take it home. This
way you can see if the plan offers what you want and at a price you
can afford. There are some private insurance companies that have
reduced individual rates that are comparable to group ones.

When going with a private company make sure you shop around. Check
several companies and have a checklist of your definite needs and
requirements. Also know how much you are willing to pay. Plan ahead
for the future. Buying insurance at a younger age and better health
will get you that low cost deal you have been looking for. Take a
plan with a higher deductible if you can afford to pay out a few
hundred dollars here and there till it is met. This will save you
money on your monthly fee and won’t be a huge bill if you have an
emergency. Look for a HMO, PPO, or POS plan, they are cheaper than
traditional plans and tend to have very low co-pays. Don’t
over-insure your self, you don’t need anything more than normal
coverage. Most plans will pay if you get sick or injured after the
policy is bought.

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. Make sure you find out if you have a deductible and how
much it is. Most HMO’s don’t have one at all, and most basic PPOs
and POS only have a small one, usually $200 to $500 per year. 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. Usually this is because
the 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.

The best and most assured way to guarantee that you are getting the
best-reduced prices for health care benefits is to make sure you
work for a large company. The more employees there are, the cheaper
the cost out of your pocket. Find out how many employees a company
has and what the percentage is that have taken the company’s
insurance. Talk to the other employees and ask them if they like
the coverage and has it suited their needs. Also, ask them if there
have been any problems with it at all. Talking to the people who
have used the coverage that is being offered and what it has done
for or to them will let you know if this is the type of company you
want to work for. Think long term when job hunting, it isn’t just
about a paycheck. Sometimes a few dollars less per hour is better
to take if the insurance plan is a gem. You also need to think
about what will happen if you are ill and can’t be at work and how
to pay for these expenses. Look for a job that pays well and has
great medical coverage, you will be much better off in the future.
Not to mention you never know when you might get sick or injured
and need coverage for those expenses.  Find out more about
How to Get a Group Health Insurance Rate as an Individual

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.