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Complete Health Care Resources

Affordable Healthcare: Can It Happen To You?

by: Irina

Let's face it - an apple a day is no longer an adequate
substitute for the professional healthcare services. And
after the doctor leaves, someone has to reach for a wallet.
Accept this undeniable fact of life and make necessary
arrangements BEFORE you get into a car accident, suffer
intolerable toothache, or become pregnant.

The cold reality of healthcare in this country is that you
do not have any legal right to it. There are no state or
federal laws mandating employer-paid or -subsidized health
benefits. So if you (or your spouse) have a complete and
reasonably priced health coverage through your employer -
BE GRATEFUL... and find some better use for your time than
reading this article. (I would still suggest saving it -
just in case...)

For those who keep on reading, health insurance is
available on an individual or group basis, but don't be
fooled by the terms! INDIVIDUAL insurance usually covers A
GROUP of people (entire family), and many GROUP health
plans will cover "a group" of ONE. In both cases you are
the only one paying (individually!) for the coverage. So,
what's the difference? From a consumer's point of view, the
big advantage of group health insurance plans over
individual is that they can't turn you down because of
health problems.

Of course, the ABILITY to get into a health insurance plan
is one thing. The AFFORDABILITY is quite another! Let's
begin with some basic terminology (or should we call it
deceptive lingo?) used in the health insurance industry.
Here are major plans with unique features to consider while
making your choice:

HMO - Health Maintenance Organizations
=============================================
The least expensive, but also the least flexible of all the
health insurance plans.
Advantage:
- Low co-payments, minimal paperwork, and coverage for
some preventive-care and health-improvement programs.
Disadvantages:
- You must choose a primary care physician, also known as
a PCP.
- HMO requires that you see only network doctors, or they
won't pay.
- You must get a referral from your PCP to see a
specialist.

POS - Point Of Service plans
=============================================
More flexible than HMOs, but they also require you to
select a PCP.
Advantages:
- You may visit a doctor outside the network and still
receive coverage; but substantially less than if you
stayed within your network.
- Offer more preventive care and well-being services, such
as workshops on smoking cessation and discounts to
health clubs.
Disadvantages:
- You must choose a PCP.
- If you don't receive permission from your PCP, you're
likely to wind up submitting the bills yourself and
receiving only a nominal reimbursement - if any.

PPO - Preferred Provider Organizations
=============================================
Give policyholders a financial incentive - reasonable co-
payments (also called co-pays) - to stay within the group's
network of practitioners.
Advantages:
- The standard co-payment is $10 for a routine office
visit during regular hours.
- You may go to any specialist without permission, as long
as the doctor participates in the network.
Disadvantages:
- If you see an out-of-network doctor, you may have to pay
the entire bill yourself, then submit it for
reimbursement.
- You may have to pay a deductible if you choose to go
outside the network, or pay the difference between what
network doctors charge vs. out-of-network doctor's
charge.

FFS - Fee-For-Service plans, also called Traditional
Indemnity
=============================================
Offers flexibility in exchange for higher out-of-pocket
expenses, more paperwork, and higher premiums.
Advantages:
- You may choose your own doctors and hospitals.
- You may visit any specialist without getting permission
from a primary care physician.
Disadvantages:
- There's a deductible (from $500 to $1,500) before the
insurance company starts paying claims, and then doctors
are reimbursed about 80 percent of the bill while you
pick up the remaining 20 percent.
- You may have to pay up front for medical services, then
submit the bill for reimbursement.
- FFS plans pay only for "reasonable and customary"
medical expenses. If your doctor charges more than the
average for your area, you will have to pay the
difference.

Depending on what you choose, you might end up with either
EXPENSIVE or VERY EXPENSIVE plan. Here are some practical
ways to reduce the high (and constantly rising!) cost of
health care if you are unemployed, self-employed or work
for an employer that doesn't offer health benefits:

- If you feel comfortable buying online, you can often save
on broker and agent fees. Sometimes, this will translate
into premium savings for policies purchased over the
Internet.

- If you can afford to do so, pay your premiums annually
rather than monthly or quarterly to avoid service fees and
to take advantage of prepayment discounts where available.

- Take advantage of the group buying power. Check out your
local chamber of commerce, trade and professional groups
and small and home business associations relevant to your
particular profession. Many of them offer access to
discounted health insurance. Here are some links:
National Association for the Self-Employed
http://www.nase.org/nase_benefits/health_benefits.asp
American Association of Home-Based Businesses
http://www.aahbb.org/benefits.htm
Home Office Association of America
http://www.hoaa.com/allbenefitsnew.htm
National Business Association
- Increase your deductible. This obviously depends on you
risk tolerance. The general rule of thumb is that by
increasing your deductible from $100 to $2,000 you can cut
your premium payment in half.

- Use new tax laws. The self-employed can write off 70% of
their health insurance premiums in 2002. This increases to
100% in 2003.

- Use Medical Savings Accounts or MSA. Under the Health
Insurance Portability and Accountability Act (HIPAA), self-
employed individuals are eligible for a medical savings
account. MSA works nicely in conjunction with higher
deductible health insurance policy to reduce premiums and
allow you to use pre-tax dollars to pay for your medical
expenses. Basically, you reduce your premium by increasing
deductible and use the savings to make fully tax-deductible
contributions to your MSA. You can contribute up to 65% of
the deductible each year into your MSA (75% for families).
The money goes into a tax-deferred account or trust and you
pay your medical expenses by drawing from the account.
Once you hit the deductible, of course, the insurance
policy kicks in.

All the above is helpful if you're able to get health
insurance in the first place. What if a pre-existing
condition disqualifies you from getting insurance at any
price? There are still some options to consider.

HIPAA may offer some protections. For more information
visit
http://www.hcfa.gov/medicaid/hipaa/content/hipsteps.asp



Copyright (C) by Irina 2003.
 

 

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