Your health is way too important to leave to chance. That’s why it’s critical that you have health insurance and that it is the right fit for you and your family. Unfortunately, millions of Americans do not know if their health insurance plan will cover their needs—or how to secure better coverage. Yes …there are LOTS of changes coming in health insurance… We are staying on top of the changes so we can better serve you. Let us sit down with you and help work out the plan that is best for you.
A good health insurance plan—one that covers every potential need—goes a long way toward providing peace of mind and helping avoid a financial burden that otherwise would saddle you and your family with payment of major medical expenses. Ideally, you should have a more comprehensive plan that provides coverage for hospital, surgical or routine medical expenses. But, at minimum, your health insurance policy should cover major medical expenses resulting from catastrophic illness or injury.
Many Americans secure health insurance through their employer; others are not so lucky. But even if you have a primary policy, be aware that group benefit plans do not always provide all the coverage for your needs. You may want supplemental insurance or a health savings account (HSA) to help fill the gaps.
For those purchasing their own primary or secondary health insurance policy, the options can seem confusing and expensive. So, how do you know if your health plan is a good fit for you? Here are some tips:
1. Evaluate your family’s needs. Consider your family’s lifestyle and medical history, and try to anticipate life-stage health events, such as braces for your pre-teen and glasses for your self. Wife turning 40? That means mammograms every year.
2. Prioritize those needs. For example, vision care may be a good benefit for your family, but not as essential as a prescription-drug plan. List your must-haves as well as your nice-to-haves.
3. Review plan options. For each plan you are considering, ask about key coverage provisions: Does the policy cover major medical expenses only? If your family needs preventive, dental and vision care, does the plan provide them? Does it include a prescription drug plan? Do any of these must-haves need to be purchased separately? Are your current doctors in the plan? Does a family member have a pre-existing condition and will the plan cover it?
4. Determine your costs. Premiums are not the only costs you should consider when looking at a health insurance plan. Take into account the expenses you may have to assume beyond paying the premium, such as deductibles, coinsurance and co-payments. Are there added costs for using an out-of-plan doctor or hospital? Consider increasing your deductible for a lower monthly premium.
5. Consider an HSA or FSA. An HSA provides two benefits: a tax write-off and a health coverage benefit. The health benefit provides coverage when you are sick or injured and the savings mechanism allows you to accumulate funds that you can use to pay for care for illnesses or injuries not covered by your insurance. An added benefit of an HSA is that both the cost of the health plan and your contributions are tax-deductible. Similarly, a Flexible Spending Account (FSA) allows you to set aside pre-tax dollars to cover medical expenses, which can help lower your taxes.
6. Know the differences of PPOs & HMOs. Individuals in a health maintenance organization (HMO) must choose a primary-care physician from a provider network. This physician is responsible for routine medical care and must refer you to specialists. HMOs typically provide no coverage for services from physicians outside the network. Meanwhile, individuals in preferred provider organizations (PPO) do not choose a primary care doctor and do not need referrals. They can obtain coverage from physicians outside the network but the PPO likely will reimburse less for the services. PPOs require deductibles and co-payments; HMOs don’t have deductibles but participants must pay co-payments. Again, be sure your family’s doctors are in the plan you select.
7. Get coverage today. Health insurance, much like life insurance, is usually less expensive for younger people. So, get your coverage now to secure a lower premium and be sure to maintain your coverage.
8. Use it. Use your insurance for preventive care and wellness to decrease your risk of needing more serious medical treatment. Schedule routine doctor visits and get the regular tests that physicians advise for your age and condition. Take advantage of the discounts offered by some plans for gyms and weight-loss programs. Seek help for smoking or alcohol abuse.
9. Don’t let it lapse. If you lose or leave your job, you may be eligible to take advantage of a COBRA plan. Even though you’ll be footing the whole bill for your health insurance, you’ll be getting the employer’s group rate and retaining coverage for 18 months. If you go without insurance for more than 60 days, it can be trickier and more expensive to purchase health insurance down the road.
10. Stay current. Coverage can be affected by life’s changes—if you get married or divorced, for example. And keep in mind that your children will not be covered by your plan indefinitely; generally dependent children lose coverage at 19 (or 22 if a full-time student).
With so many options and pitfalls to consider, talk with us today to ensure you are securing the most appropriate coverage for you and your family.
Call us today to see how we can make sure your health is covered and that you are in compliance with the new Health Care Reform Act.
Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed). These six actions are called Activities of Daily Living–sometimes referred to as ADLs. In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need “long-term care.”
Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.
Many people think that long-term care is provided exclusively in a nursing home. It can be, but it can also be provided in an adult day care center, an assisted living facility, or at home.
Assistance with ADLs, called “custodial care,” may be provided in the same place as (and therefore is sometimes confused with) “skilled care.” Skilled care means medical, nursing, or rehabilitative services, including help taking medicine, undergoing testing (e.g. blood pressure), or other similar services. This distinction is important because Medicare and most private health insurance pays only for skilled care–not custodial care.
What are the types of disability insurance?
There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):
Short-Term Disability policies (STD) have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
Long-Term Disability policies (LTD) have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.
Disability policies have two different protection features that are important to understand.
Non-cancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company. However, your insurer has theright to increase your premiums as long as it does so for all other policyholders in the same rating class as you.
In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:
Additional purchase options
Your insurance company gives you the right to buy additional insurance at a later time.
Coordination of benefits
The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
Cost of living adjustment (COLA)
The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.
Residual or partial disability rider
This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.
Return of premium
This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.
Waiver of premium provision
This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.