Medicare is a governmental program which provides
medical insurance coverage for retired persons over
age 65 or for others who meet certain medical
conditions, such as having a disability.
Medicare was signed into legislation in 1965 as an
amendment to the Social Security program and is
administered by the Center for Medicare and Medicaid
Services (CMS) under the Department of Human Services.
Medicare provides medical insurance coverage for over
43 million Americans, many of whom would have no
medical insurance. While not perfect, the Medicare
program offers these millions of people relatively low
cost basic insurance, but not much in the way of
preventative care. For instance, Medicare does not pay
for an annual physical, vision care or dental care.
Medicare is paid for through payroll tax deductions
(FICA) equal to 2.9% of wages; the employee pays half
and the employer pays half.
There are four “parts” to Medicare: Part A is hospital
coverage, Part B is medical insurance, Part C is
supplemental coverage and Part D is prescription
insurance. Parts C and D are at an added cost and are
not required. Neither Part A nor B pays 100% of
medical costs; there is usually a premium, co-pay and
a deductible. Some low-income people quality for
Medicaid, which assists in paying part of or all of
the out-of-pocket costs.
Because more people are retiring and become eligible
for Medicare at a faster rate than people are paying
into the system, it has been predicted that the system
will run out of money by 2018. Health care costs have
risen dramatically, which adds to the financial woes
of Medicare and the system has bee plagued by fraud
over the years.
No one seems to have a viable solution to save this
system that saves many people throughout the country.
Advantages to Managed Care Plans
There are many different types of Health insurance plans out there. Picking the right one for yourself can be troublesome in the beginning, especially if you don’t know what you are looking for. You might have trouble deciding which one would be better for you.
Health insurance is divided into two large categories-indemnity and managed care plans. Indemnity plans, also commonly called reimbursement plans, will reimburse your medical expenses up to a certain limit. Under the Reimbursement plan, the insurer pays a percentage of the total charges, regardless of how much the charges are. With the indemnity plan, the insurer will pay a specified amount every day for a specified number of days. The amount reimbursed does not rely on the cost of medical care, but what you are reimbursed will never exceed your expenses.
The other popular type of health insurance plans is managed care plans. The three types of policies categorized as managed care plans are HMOs, POSs, and PPOs. This type of insurance is more popular than the indemnity plan, as they offer more flexibility. With these types of options you either pay a monthly fee no matter how many times you see a doctor, or pay a co-payment but no monthly fee. With managed care plans, you are given options of care. The plan you choose and the amount of money you wish to pay determines how big of a network of doctors and specialists you can see and still be covered under the plan. Some managed car plans (most often PPOs) offer sponsorship programs from a network of hospitals and medical services. You can often get this kind of plan through your employer.
Managed healthcare plans are better for the average person due to the fact that they are more cost effective. While indemnity plans may give you a lot more freedom in cost, you will have to use the healthcare provider that the insurer chooses. If you have a specific disability, this can present itself as a problem. In the long run, a managed care plan will save you money, especially if emergencies arise when you are out of town. These types of plans also are more flexible in policy. Before you purchase any kind of health insurance, be sure to research the many options available for you and your family to ensure you receive the best coverage possible for the lowest monthly premium or deductible.
Getting the Most Benefit From Your Policy
The key to getting the most benefit from your health
insurance policy is knowing your policy coverage.
Many people don’t actually read the policy for the
policy plan book; they may not be aware that the
policy may pay 100% of certain procedures, like annual
physicals, mammograms, flu shots or certain labs
The policy plan book will outline for you what
procedures are not subject to the deductible or co-pay
(your out-of-pocket expense).
Some insurance companies have shifted their emphasis
from health insurance to health improvement and
maintenance and will pay for the cost of gym
membership, nutritional counseling or plans to stop
If you were trying to lose weight and knew that you
could get these services at no cost, wouldn’t you take
advantage of them?
If you wanted to quit smoking, wouldn’t it be
beneficial to know that you could get the patch for
It is very wise to know what services are available to
you through your insurance company, and you will only
know if you take the time to read through your policy.
Health insurance is an expensive item; take advantage
of every aspect of it that you can, not only for
yourself but for the members of your family.
By taking full advantage of the free benefits of your
health insurance policy, you will be healthier and
possibly require fewer visits to your doctor.
Affordable Health Insurance for the Unemployed
Being unemployed can be a financial downside to say the least. You may be dependant on someone else to cover your daily expenses such as a place to live and food to eat. Health insurance is something that everyone needs and not enough people have available because of these other financial burdens. Any emergency such as a car accident or broken bone will require adequate medical assistance. What do you do when you don’t have insurance and can’t afford expensive medical bills? If you are unemployed, you need to find health insurance to prevent this from happening.
COBRA is a law in which many people could be eligible to remain on an employer’s health insurance plan even after they lose their employment. The most ideal person for this coverage is someone who is between jobs and is not in need of long-term help. It can last at least a year to those who qualify, but the premium amount is still an expense that some unemployed individuals may not be able to take care of with their lack of income. If you are able to pay the premium and are eligible, COBRA will also cover your spouse and children who are dependent on you for insurance. The best way to determine if you could receive health insurance is to contact your local employer’s benefits department and fill out the required forms.
You can also shop around for typical health insurance. Many free Internet services are proven reliable by the Better Business Bureau Online. By speaking with one of these insurance experts, you can get help finding the most affordable health insurance that will fit your specific needs. They know the rates of thousands of insurance companies and can fix you up with appropriate coverage for your specific needs. If you have a spouse or children, having health coverage is a necessity. Life is full of unexpected events and you cannot ensure that everyone will stay completely healthy until you have insurance again because accidents do happen. Finding an affordable coverage rate on your own can be a hassle. The experts at these companies are offering their assistance to you, often as a free service. Whether you need to find something short-term or for an extended period, they are qualified and dedicated to helping you.
If you find yourself unemployed at any time in your life, you are probably without health insurance. This can be a nightmare whether you have a family or not because medical expenses can put you into debt quickly. Luckily, there are ways of finding affordable coverage providers that can keep your health, as well as your finances, safe. A simple doctor visit can cost you significantly more money than it would with insurance. Do not let yourself become one of the many people who are unfortunately living life without proper insurance coverage.
Health Insurance When Living Abroad
You may not know this already, but when planning on traveling abroad you cannot take your local insurance with you. You will need to purchase an international insurance plan offered by a multinational insurance company. While they may be hard to track down, it is the best way to assure that in the event of an accident or illness you will be able to acquire medical attention if needed.
Many of these plans will cover you up to six months in another country. When you speak with the insurance company, be prepared to give an extensive list of information to them. This will range from health problems you’ve had in the past ten years, your hereditary conditions to substance abuse, and almost everything else-if it has anything to do with your health be prepared to disclose the information. If you are planning on traveling with more than one family member, then be prepared to give information for each family member as well.
Many times your basic coverage will include emergency treatment regardless of which facility it is administered. This is not the case with minor medical treatment. It is important to know whether you are buying an insurance plan that is an HMO or PPO. If you are under an HMO or health maintenance organization, then you will be limited to receiving care from only the providers who are in their network. You can retrieve a list of all the companies within your insurer’s network upon request. If you are under a PPO, or preferred provider organization, you will have the opportunity to pick the best facility you see fit, but your insurer will only cover a portion of the incurred cost.
If you plan on staying abroad for more than six months then you will need to look into what is called expatriate health insurance. Only larger companies supply this type of insurance, as it is much more extensive with the type of options that can be applied to each policy. The type of treatment options that are covered with expatriate health insurance are those that are labeled as specialty treatments, like chiropractic therapy and acupuncture. There are many options that can be applied to expatriate health insurance depending on your family’s needs and how long you plan on spending abroad.
There are many options for health insurance when you are traveling abroad. While many individuals never consider purchasing insurance when traveling to another country, this should be at the top of your list when planning for a trip. Health insurance should not be taken lightly. Be sure you understand every aspect of your policy before deciding with any one particular company.
Ways of Paying for Health Insurance
When it comes to health insurance, many people don’t exactly know everything that there is to know about the subject. That only stands to reason, it is not something that is easily understood because of its complexity. For instance, when you visit the doctor you may be asked to pay something that is called the “co-pay”, and other times you may not have to do anything at all depending on your plan. Let’s look at some of the ways that health insurance is paid for.
Often times, your employer will sponsor your insurance and you only have to pay what is known as a “co-pay” or co payment. The co-pay is a set amount that is determined by your insurance company when you receive covered services. This is a significantly smaller fee than you would be paying without the co-pay. Many companies offer this type of payment option because it is easier on the employee to pay this way.
You may consider opening what is known as a Healthcare Savings Account (HSA). This will assure that you always have a location in which to retrieve payments for various medical expenses. The HSA is a pre-tax savings account where a portion of your pre-tax income, determined by you, is deposited into an account automatically. Since this account comes from your paycheck pre-tax, that means it will lower your overall taxable income. This means you are saving money in terms of taxes and saving lots of money towards your overall health care costs.
For certain disabled individuals and those above the age of 65, Medicare is also another way to pay for health insurance. While they will not pay all of your healthcare expenses, they will pay for most of them. Medicare, however, doesn’t cover prescription drugs and nursing homes. It is important that you check the different types of restrictions that may apply. There are low-cost prescription discount cards that have been proven to save people who require costly medications on a regular basis over 50% of what they would have been paying without any health care.
Paying for health insurance doesn’t have to be complicated as long as you understand just what is going on in terms of where you stand with your plan. Discuss any questions you may have about the plan before committing to one. While one plan may be right for many people, it does not always mean that it will fit your specific needs.
Stay Legal! Avoiding Insurance Fraud
Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a $30 billion to over $100 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.
Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.
Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.
Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear – along with the money you have been paying in premiums.
The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember – it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.
What You Don’t Know Can Kill You: Health Insurance Limitations
Health insurance often requires a mountain of paperwork that has a lot of fine print. Unfortunately, this means that few people read their plans thoroughly nor do they fully understand what their plan covers or does not cover. Here are some common limitations in health insurance coverage that you should know.
Some of the most shocking health insurance limitations are found in the the fine print holes in the insurance policy. For instance, many people have found that their health insurance did not cover a routine or necessary medical procedure because they did not receive an authorization code prior to the procedure or the hospital did not correctly fill out the paperwork. Your medical claim can be denied simply because the hospital used odd codes for your treatment. While any claims denied by the insurance company can be disputed, this process is not only tedious, but time-consuming and draining, especially for someone who is already ill. There is also little success in winning disputed claims, which makes this option rather limiting.
Another surprising health insurance limitation happens more often than people realize. Imagine this situation: you are diagnosed with a medical condition and need an operation. You research surgeons and hospitals within your plan. You understand your plan’s coverage of hospital care. You have your operation and then you find a massive medical bill in the mail. Apparently your health insurance did not cover the anesthesiologist or other specialists that may have consulted in your operation. Thus, you have to pay these specialists for their services, even though you were under the impression that your plan would cover these costs associated with the surgery. Such a bill can be in the thousands of dollars, and there is little you can do to dispute the charges. The only way to avoid these charges is to make sure that you ask before the operation who will be involved and ensure that they are covered in your health insurance plans.
Other limitations are put on a number of treatments. For instance, you may need physical therapy or visits to a psychiatrist. Many health insurance plans will put a limit on the number of covered visits for such medical treatment. Without realizing it, you may surpass the maximum visits allowed by your health insurance and end up racking up huge bills.
Many people think that buying health insurance will cover them medically, but this is only correct to a point. When securing insurance, you should read through your health insurance package carefully, and when you are about to undergo any expensive medical procedure, be sure to consult your health insurance plan first.
What if I leave my job?
The Consolidated Omnibus Budget Reconciliation Act
(COBRA), a law created in 1986, gives workers (and
members of their family) who lose their health
insurance benefits the right continue their group
health insurance for a limited period of time under
circumstances such as voluntary or involuntary job
loss, reduction in hours, transition between jobs,
divorce, adoption and death.
Generally, the employee pays up to 102% of the premium
cost for the same policy; this is still usually less
expensive than buying an individual insurance policy.
There are three basic aspects for qualifying for
COBRA: the qualifying event, the insurance plan
coverage and the qualified person.
Each aspect is taken into consideration when applying
for COBRA and you must elect to either apply for COBRA
or waive your rights to COBRA within 14 days after a
You must also have been in the group insurance plan
during your employment to be eligible. Although there
are exceptions, generally you may continue to pay your
own premiums to keep COBRA coverage intact for up to
Companies who have fewer than 20 employees, State or
Federal employers or employee organizations may not
offer COBRA coverage.
Check with your health insurance administrator to see
if you may qualify. You may also have this information
readily available in your group health insurance
policy or in your company handbook.
Although it may be expensive, the cost of being able
to keep your group insurance coverage rate may be well
What Happens When I Retire?
Health insurance considerations weigh heavily on the
minds of people wanting to retire before Medicare
coverage kicks in at age 65. Many people put off
retirement simply because the cost of an individual
health insurance policy is too great on a limited
What options for health insurance do you have if you
choose to retire before age 65? Although they are not
required to, you may be able to get COBRA-like
coverage from your employer.
As an added retirement benefit, your employer may
allow you to pick up the premium on your policy;
although paying 100% of your premium may initially
appear to be an expensive option, purchasing an
individual policy apart from a group may be even more
costly and not provide you with the level of coverage
you previously had.
Some companies are offering basic high-deductible
insurance reasonably in the hopes that they will be
able to enroll you in Medicare Part C (supplemental
insurance) when you retire.
Another option is to budget and save money to cover
your anticipated medical costs for the time period
between retirement and age 65. If you are in very good
health, this may be a viable alternative for you.
Pre-planning for retirement is an important issue; the
earlier you start planning, the better. Realizing the
Medicare does not pay all of your medical expenses,
you should budget money for medical expenses even