"if you want health insurance, get some"
Nick Gillespie on ReasonTV with a solution to one significant element of the health insurance "crisis".
I've blogged about this quite a bit, but government makes health insurance artificially expensive in a number of ways. "Doctor", first do no harm!
Or as my new Despair.com coffee mug says about "Government: If you think the problems we create are bad, just wait until you see our solutions."
posted by Eric Schansberg @ 11:35 AM
9 Comments
9 Comments:
I have been a health insurance broker for over a decade and every day I read more and more "horror" stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer.
However, what most people fail to realize is that there are very few "loopholes" in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn't until they receive a "denial" letter from the insurance company that they take their policy out to really read through it.
The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan's coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible. For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don't realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that "benefits were denied."
Sure, we all complain about insurance companies, but we do know that they serve a "necessary evil." And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price. Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they "want" and the benefits they really "need." Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great "curb appeal," I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not!
In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month? Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn't the 80/20 plan still offer you adequate coverage? Don't you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn't it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?
Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.'s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred HSA can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional IRA Most HSA administrators now offer thousands of no load mutual funds to transfer your HSA funds into so you can potentially earn an even higher rate of interest.
In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or "ripped-off" by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, "I have to run my business, I don't have time to be sick! "I think I have gone to the doctor 2 times in the last 5 years" and "My insurance company keeps raising my rates and I don't even use my insurance!"
As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer. Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.
So what do you think happens almost 100% of the time when I ask these individuals "BASIC" questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let's see how many YOU can answer without looking at your policy:
1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-"Basic Blue")
2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)
3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)
4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)
5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any "per illness" maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)
6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, (N.A.S.E.) is known for endorsing schedule plans)
7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)
8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).
9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).
10. Do you have to pay a separate deductible or "access fee" for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health's "CoreMed" plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit "caps" or "access fees" for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit "caps" could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 "access fee" per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).
Now that you've read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn't answer all ten questions don't be discouraged. That doesn't mean that you are not a smart consumer. It may just mean that you dealt with a "bad" insurance agent. So how could you tell if you dealt with a "bad" insurance agent? Because a "great" insurance agent would have taken the time to help you really understand your insurance benefits. A "great" agent spends time asking YOU questions so s/he can understand your insurance needs. A "great" agent recommends health plans based on all four variables; wants, needs, risk and price. A "great" agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a "great" agent looks out for YOUR best interest and NOT the best interest of the insurance company.
So how do you know if you have a "great" agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a "great" agent. If you were able to answer the majority of questions, you may have a "good" agent. However, if you were only able to answer a few questions, chances are you have a "bad" agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.
Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don't be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don't feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the "fine print" in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.
If you can't understand something, or aren't quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification. Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been multiple class action lawsuits brought against these companies since 1995. So ask yourself, "Is this a company that I would trust to pay my health insurance claims?
Additionally, find out if your agent is a "captive" agent or an insurance "broker." "Captive" agents can only offer ONE insurance company's products." Independent" agents or insurance "brokers" can offer you a variety of different insurance plans from many different insurance companies. A "captive" agent may recommend a health plan that doesn't exactly meet your needs because that is the only plan s/he can sell. An "independent" agent or insurance "broker" can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.
Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use Ebay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make....your health insurance policy.
Lastly, if you have any concerns about an insurance company, contact your state's Department of Insurance BEFORE you buy your policy. Your state's Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn't being honest with you, your state's Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.
In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: "If it sounds too good to be true, it probably is!" and "If you only buy on price, you get what you pay for!"
TEN QUESTIONS YOU SHOULD ASK YOUR HEALTH INSURANCE AGENT
If you are a business owner, self-employed or an employee of a company that is not offering medical coverage though your employer, you may have to undertake the frustrating, daunting and time consuming task of purchasing health insurance on your own. If this is the case, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a price you can afford.
When you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and cost, before you spend your money. Although you may "want" a health plan that offers you 100% coverage and a $5 co-pay for prescription medications, you may not "need" this type of health plan if you are healthy, take no medications and do not have any significant health related "risk" factors. Since a 100% health plan may "cost" significantly more than a health plan with 80/20 coverage, it may not be in your best interest to pay higher monthly premiums for coverage that you are not likely to use.
In addition to weighing the aforementioned key variables, it is also critical that you understand the limitations of your coverage. The following is a list of 10 key questions that you should ask your insurance agent, BEFORE making a decision to purchase a health insurance policy.
1. What insurance company do you represent and are you a "captive" agent, "independent" agent or insurance "broker?" (e.g. A "captive" agent usually represents ONE insurance company and can usually only sell that company's insurance products. An "independent" agent or insurance "broker" usually represents many insurance carriers and can sell a variety of insurance products.)
2. What is the plan's calendar year deductible and would I have to pay a separate deductible for each family member if everyone in my family became ill at the same time? (e.g. The majority of health plans have a per person calendar year deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each calendar year, even if everyone in your family needed extensive medical care.)
3. What is the plan's coinsurance percentage and what dollar amount (stop loss) it this percentage based on? (e.g. A plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000. It is also important to note that some policies have NO stop loss.)
4. What is the plan's maximum out of pocket expenses per year? (e.g. This expense is a total of all deductibles plus all coinsurance percentages plus all applicable "access fees" or other fees.)
5. What is the plan's lifetime maximum benefit if I become seriously ill and does the plan have any "per illness" maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but the policy many stipulate that there is a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)
6. Is the plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g. Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. agents are known for selling schedule plans.)
7. Does the plan have unlimited doctor co-pays or is there a limited number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you can go to the doctor per year for a co-pay and, quite often, the limit is 2-4 visits.)
8. Does the plan offer prescription drug coverage and if it does what type of coverage? (e.g. Some plans offer prescription benefits right away, other plans will require you to pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no outpatient prescription drug co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications.)
9. Does the plan have any reduction in benefits for organ transplants and if so, what is the maximum the plan will pay out for an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you may be required to pay for anti-rejection medication out of pocket.)
10. Does the plan have any separate deductible or "access fee" for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health's "CoreMed" plan have a separate $750 hospital admission fee or "Access Fee" that you pay for the first 3 days of a hospital admission. "Access Fees" are in addition to your plan deductible. Also, many plans have benefit "caps" or "access fees" for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit "caps" could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 "access fee" per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000.)
Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don't be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. And, most importantly, read all of the "fine print" in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.
Lastly, if you have any concerns about an insurance company, contact your state's Department of Insurance BEFORE you buy your policy. Your state's Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn't being honest with you, your state's Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.
DON'T FALL VICTIM TO A HEALTH INSURANCE SCAM: TEN RED FLAGS TO WATCH FOR BEFORE YOU BUY
In today's fast paced world, business owners don't often have the time to thoroughly check out the companies they rely on to provide goods and services. In many cases, a determination of product/service quality can be made at the time goods are delivered or services are rendered. If goods or services do not meet expectations, there is often an immediate remedy available. For example, poor quality goods can be shipped back to the supplier and/or payment for services can be withheld until services are satisfactorily rendered.
Unfortunately, business owners do not always purchase items that are tangible items, in the sense that they can immediately determine the quality of the goods and/or services at the time of purchase. One example of such a purchase is health insurance. Since health insurance is not usually used immediately after purchase, the quality of care or the legitimacy of the policy may not even come into play until the business owner, or a family member, actually needs to have medical treatment. This is one of the primary reasons that many companies, often appearing legitimate, can get away with selling bogus health insurance coverage to unsuspecting business owners.
In most cases, fraudulent health insurance policies are sold to business owners by telemarketers or "agents" through bogus Associations and Unions. In that, the buyer must join a professional and/or trade association or become a union member to qualify for health insurance. In fact, in a study published by the U.S. General Accountability Office (GAO) in 2004, the GAO found that association schemes rankedat the top of the marketing methods followed by bogus health insurers. According to the report, "Employers and Individuals Are Vulnerable to Unauthorized or Bogus Entities Selling Coverage, between 2000 and 2002, the U.S. Department of Labor and state insurance regulators identified 144 unauthorized entities selling health insurance unlawfully. These entities defrauded 15,000 employers and more than 200,000 policyholders out of $252 million."
However, it is important to mention that many individual and group health insurance products are endorsed by reputable Associations, such as the AARP and the American Bar Association and, many reputable Unions, such as the AFL-CIO and the Teamsters. These organizations have long been recognized for bringing a common class of professionals or citizens together for other purposes that have very little to do with health insurance. Membership commonly includes a wide range of other benefits in addition to discounted health insurance. Typically, the organizations have a governing organization, a constitution and bylaws, a set of officers, voting rights, regular membership meetings and a professional code of conduct.
Unfortunately, most individuals do not find out that they were making hefty monthly payments or premiums to fraudulent Associations or Unions until they have a severe condition that requires medical treatment. Usually, it isn't until after they receive treatment that they receive notice from their medical provider that the claim that was submitted to the insurance company was denied and that all the medical charges that were incurred are now their responsibility.
Often, the scheme starts when business owners are contacted by telephone or approached by someone who claims to represent a certain, official sounding, Association or Union. The business owner is then informed that if s/he becomes a member of the Association or joins the Union, s/he could qualify for a low cost group or individual health insurance plan. Typically the Association or Union is promoted to represent self-employed individuals and small business owners. The low cost health insurance is usually presented as one of the many "perks" that the business owner can qualify for, in addition to many other "member" benefits, like discounts on other services, such as dental, eyeglasses, office supplies, hotels, rental cars, etc.
In many instances, these bogus companies involve licensed health insurance agents to sell their fraudulent health insurance products. Sometimes the "agents" know the products are fraudulent, other times, the "agent" also falls prey to the scheme. Often, the schemes prey upon consumers who have been previously declined insurance coverage or suffer from a pre-existing condition. Since these consumers have very limited options to purchase private health insurance coverage, the benefits of an Association or Union membership that offers health insurance coverage for a "membership fee" or "union due" is enticing. To the unsuspecting consumer that has a pre-existing medical condition or is paying high premiums for coverage, the "membership fee" or "union due" is a small price to pay for what they believe will be a quality health plan that provides "guaranteed" coverage with no "pre-existing condition exclusions" and no "waiting periods."
In many circumstances, the print materials that are left with the consumer are very well designed, however, the majority of the time, the language in the "health plan brochure," if there is one, is very unclear. The literature may name the entity that is authorized to act as the health plan administrator of the plan, but neglect to name the actual insurance company that is providing the health insurance coverage. Unfortunately, it is often difficult for the consumer to separate the illegitimate companies selling official sounding health plans from the legitimate ones. Typically fraudulent health plans have many commonalities.
Here are 10 "Red Flags" that may indicate health insurance fraud:
The "agent" is not a licensed insurance agent but an "enrollment" or "membership" coordinator.
The term "discount plan" is written in the product literature, but the term health plan, health insurance or policy is frequently used by the plan promoter. Discount plans often provide nothing more than a discount for medical services, such as prescription medications, eyeglasses, dental, etc. These plans are not designed to offer major medical health insurance coverage.
The official sounding "Association or Union" is one that you have never heard of before.
The plan is referred to as an ERISA plan. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that allows employers to set up employee benefit plans for employees and their dependents. ERISA plans are not subject to state regulation and are not regulated by the state insurance commissioner. ERISA plans are normally not sold as health insurance, but are instead, established by employers, unions or groups acting on behalf of employers. Therefore, unsuspecting buyers believe these plans actually offer health insurance coverage, when if fact, they do not.
The buyer is told that the "membership fee or union dues" includes the health insurance premium, but there is no mention of the word "premium" in any of the plan literature.
The plan offers "guaranteed" insurance coverage with no exclusions for "pre-existing conditions" and no "waiting periods."
The plan is significantly cheaper in price than other health insurance plans.
The term "reinsured" is used in regards to the plan. Reinsurance is something insurance companies buy to protect themselves against their own risks. It is insurance for insurance companies. Licensed insurers rarely have their agents mention any of their reinsurance arrangements during a sales presentation.
The Association or Union is comprised of members from all walks of life and/or requires its members to state that they belong to a certain trade, class or group of professionals that they have no affiliation with, for example, the Association or Union is said to be comprised of "Food and Beverage" workers, but "Florists" and "Machinists" are allowed to enroll as members.
If the Association or Union is said to have a special arrangement with a health insurance company, a plan administrator or another third party that has designed the plan using a legal "loophole" that allows members to purchase health insurance at a discounted rate or to purchase a individual or group health insurance policy.
So how can you protect yourself from falling victim to a fraudulent insurance scam? Make sure you contact your state's department of Insurance to determine if the health insurance company and the third-party administrator are licensed to do business in your state and make sure that the "agent" selling the plan is a "licensed health insurance agent." Additionally, make sure that health insurance company has been approved to sell the particular policy that is being offered. Since it may be difficult to tell if fraud is involved, always put off buying your health insurance policy until you have had the opportunity to perform your own due diligence.
SOCIALIZED MEDICINE: WOULD IT REALLY WORK FOR THE U.S.?
"Socialized Medicine" is primarily an ideology championed by the Democrats. However, contrary to popular belief, a nationalized health care system for all American's has never actually been on the agenda for President Elect Obama http://healthpolicyandmarket.blogspot.com/2008/03/detailed-analysis-of-barack-obamas.html
His agenda instead, has always been to assist those who are rendered uninsurable and or are in need of assistance in obtaining health care coverage due to low income.
Part of his plan is to expand the role of SCHIP and State Insurance Risk Pools so that those who are rendered "uninsurable" on the individual major medical market have guaranteed insurability through their respective State Risk Pools. Many states already have this option. However states such as Arizona and Florida do not. These states desperately need such Risk Pools. Unfortunately, until now they have not been able to receive enough Federal funding to expand this much needed role. States that do have risk pools are listed here: http://www.naschip.org/states_pools.htm
President Elect Obama wishes to provide more Federal funding to these existing risk pools to drive the premiums down, thereby making this option more affordable for those rendered uninsurable.
One of the reasons that a "nationalized" health care system has never been on Obama's agenda is most likely due to the terrible failure of such programs in countries such as Canada. A common example used to further the cause of "socialized medicine" in the United States is to point out how well it is working in Canada. However, those living in Canada know full well that their government run health care program is most certainly not working.
As a matter of fact, many Canadian citizens choose to hire high priced brokers to find them quality health care right here in the United States because of the terrible bureaucracy that controls all forms of health care in Canada. For more about what is really going on with the Canadian health care system please watch these short but very informative documentary videos:
http://www.freemarketcure.com/brainsurgery.php
http://www.freemarketcure.com/twowomen.php
http://www.freemarketcure.com/thelemon.php
The number of actual uninsured's in the US has been grossly inflated as well. For the real numbers watch: http://www.freemarketcure.com/uninsuredinamerica.php
The truth of the matter is we already have an enormous amount of entitlement programs available to those who find themselves unable to pay for their health care. Often times these entitlement programs are offered to those who are here legally and illegally as was the case in the State of Illinois: http://www.sbisvcs.com/healthinsuranceblog.htm
Most recently, the State of Hawaii tried to emulate the Medicaid Expansion programs that were enacted in Illinois. It took less than 7 months to render their program bankrupt: http://www.breitbart.com/article.php?id=D93SBEUG0&show_article=1
All things considered, the best way to offset the high cost of health care in the US is to adopt the initiatives set forth over a decade ago by Senator Bill Archer (R) of Texas. The Health Savings Account (commonly referred to as a "Medical IRA") is a unique option that maintains high quality health insurance coverage for the policy holder whilst also building a tax deductible, tax deferred interest bearing account for the insured to use for future medical expenses. Even if these expenses would not normally be covered by the policy holder's health insurance plan. For more about the "intelligent health insurance choice" (HSA qualified HDHP's) please click here: http://www.sbisvcs.com/HSA%20&%20HDHP.html
In the end consumer education and retention of existing Federal entitlement programs (via a legitimate needs assessment test) will go a long way towards not only maintaining our current health care system, but also towards keeping the bulk of our nations risk where it belongs namely, with the private health insurance sector. In light of the recent $7 Trillion "Bail Out" and many other failing corporations coming to the table with their hats in their hands (and their private jets on the tarmac) the last thing our government should do is start cutting more blind "bail out" checks in an effort to "reform" the U.S. health care system.
COBRA CONTINUATION: ARE THERE MORE AFFORDABLE INSURANCE OPTIONS?
A very attractive and significantly lower cost alternative to Cobra continuation coverage is an individual health insurance policy which can be purchased for one person or for an entire family on the open market. The reason that these types of policies are inherently cheaper is because you can design the plan to meet your personal budget.
The problem with Cobra continuation coverage is that you are continuing a health insurance plan that was designed and purchased by someone else. Specifically your former employer. The decisions made during that purchase were much different than the decision that a family must make when purchasing their own health insurance coverage without the help of their former employer (who used to pay a significant portion of the monthly premium as an employee benefit). Cobra continuation plans typically have very low calendar year deductibles (e.g. $250 or $500). The lower the deductible, the higher the premium. When you design your own individual health insurance policy you can raise the calendar year deductible and lower your premium drastically whilst retaining all of the "first dollar" benefits that are normally included with Cobra continuation coverage.
"First dollar" benefits are defined as "benefits you receive WITHOUT paying your calendar year deductible (e.g. outpatient doctor office visits, outpatient generic and brand name prescription drugs, outpatient preventative care or wellness coverage and accidental injuries). All of these "first dollar" benefits are covered WITHOUT paying your calendar year deductible first. Typically only a small "co pay" ($25 or $30) is required at the time of service. This being the case, it is much wiser to choose a high deductible plan (e.g. $2,500 per calendar year) with $5,000,000 major medical coverage per family member instead of paying twice the premium (or more) for Cobra continuation coverage. Doing so will protect each family member just as well as Cobra continuation coverage whilst also maintaining all of the aforementioned "first dollar" benefits found on most Cobra continuation plans.
A common misconception is that individual health insurance plans do not cover "pre-existing conditions". Whilst this can be the case with some carriers (e.g. Blue Cross Blue Shield.) There are many quality insurance carriers who actually cover controlled conditions such as Hypertension (High Blood Pressure) & Hyperlipidimia (High Cholesterol) from day one, including the medication one uses to control such conditions. This being the case, if you and your family are reasonably healthy people there is no reason to throw your money away by paying an inflated Cobra continuation premium. After all, isn't it better to pay a bit more IF you actually end up in the hospital, then pay twice the premium (or more) each and every month for fear that one day you will? For quality health insurance options for the insurable please visit: http://www.sbisvcs.com/Small%20Business%20Health%20Insurance.htm
What if you have tried to obtain individual health insurance coverage and have been declined for a pre existing condition more serious that the two aforementioned conditions? Are there still options to Cobra continuation coverage? Indeed there are. The options are threefold. They are as follows:
1.) State Insurance Risk Pool Coverage provided under HIPAA that provides seamless continuation of coverage after your Cobra continuation coverage expires, or if you have lost employer sponsored group coverage due to policy cancellation by your former employer. Pre existing conditions such as Diabetes & Cancer that would render one uninsurable on the individual major medical market would be covered from day one providing you have been insured for a minimum of 18 months with no lapse in coverage of more than 63 days. Not all states have insurance risk pools but many do. To find out which ones do visit: http://www.naschip.org/states_pools.htm
2.) Small Group Health Insurance which contains the all important "Guaranteed Insurability" clause. This option can be elected with a minimum of two people (often husband and wife) who work for the same corporation. Small Group coverage will also provide seamless continuation of coverage for those with pre-existing conditions such as Diabetes or Cancer providing the aforementioned 18 months of prior continuous coverage has been met. Must have corporate tax ID number and both "employees" must work 30 hours or more. These policies can be premium rated as high as 67% in states such as Illinois due to the severity of the medical history of one or more applicants. However, often times this rate increase is less than a Cobra continuation premium.
and
3.) "Defined Benefit" Health Insurance policies. These policies (recently advertised on the Fox news channel) are issued on an individual basis to anyone regardless of medical history. Whilst these policies offer limited benefits. They do offer an unlimited surgical benefit and up to $1,000 a day for hospital coverage up to 100 days. These policies are also HIPPA qualified. Meaning that they will also cover pre existing conditions such as Diabetes or Cancer from day one providing you have the same aforementioned proof of prior coverage of 18 months or more with no lapse in coverage of more than 63 days. To learn more visit: http://www.sbisvcs.com/guarantee_issue.htm
GUARANTEED ISSUE DEFINED BENEFIT INSURANCE FOR THE UNINSURABLE
I have been a multi state licensed health and life insurance broker for 13 years now. One of the biggest challenges I have had to deal with through the years has been trying to help the uninsurable. Unfortunately in most states if you have one of a host of "pre-existing" medical conditions you are labeled as uninsurable on an individual health insurance policy. In most states this uninsurable status lasts for many years and sometimes for life depending on the specific pre existing condition you have been diagnosed with. Some of the pre existing medical conditions that render an applicant uninsurable for ten years or more are:
Heart Attack
Stroke
Diabetes (insulin or sugar pill dependant)
Cancer (Infiltrating Ductal Carcinoma only, Carcinoma in situ ok after excision)
Lupus
Multiple Sclerosis
Muscular Dystrophy
Degenerative Arthritis
and a host of other pre existing conditions. In addition, there are applicants who have a combination of controlled pre existing conditions but because they have more than three "rateable conditions" they are labeled uninsurable. For example, with many carriers an applicant who has Hypertension & Hyperlipidimia but is also overweight falls under the "3 strikes your out" rule and is labeled uninsurable. Or an applicant may have two of the aforementioned controlled conditions and is not overweight but is a smoker and is then labeled uninsurable also. Or an applicant who has asthma but also smokes falls in to the same uninsurable category with many carriers.
This is just a small snippet of conditions or "combo conditions" that can render an applicant uninsurable. The question then becomes, what do I do now? Who will insure me against the catastrophic medical bills that I may face in the future? Who will help me pay for the medications I currently am taking to control the aforementioned conditions? For many years depending on the state you live in you only had two options. They are as follows:
1.) If you have a corporate tax i.d. number you can purchase a small group health insurance policy from most insurance carriers. With this scenario a minimum of two people (often husband & wife) who work for the same corporation can apply for a small group health insurance policy. After a period of time, or in some cases immediately (depending on how many months you have had prior health insurance coverage without a lapse) pre-existing conditions will be covered provided that they are a covered expense on the policy.
2.) Enroll in your states insurance risk pool (if your state is fortunate enough to have one). In our home state of Illinois the risk pool is called the Illinois Comprehensive Health Insurance Plan (ICHIP). ICHIP is a state health benefits program and not an insurance company. Persons must qualify for coverage but in most cases if the applicant is coming off an exhausted qualified COBRA continuation plan from a prior employer sponsored group, their pre existing conditions will be covered from day one (provided again that those conditions are a covered expense on the ICHIP policy). However, ICHIP (and all insurance risk pools) are by no means entitlement programs. They are far from free! Premiums charged are established by law at from 125%-150% above the average rates charged individuals for comparable major medical coverage by five or more of the largest insurance companies in the individual health insurance market in that state. Suffice it to say, the premiums are far from affordable for many people. The rates for a person 50 years of age living in Chicago can range from $554 monthly for a $5,200 deductible plan to $852 monthly for a $500 deductible plan. For those who do not have an insurance risk pool in their state (http://www.naschip.org/states_pools.htm) their options are then even more limited if they are labeled as uninsurable.
There is now another option. American Medical & Life Insurance Company of New York, New York is now offering Defined Benefit Health Insurance Policies to the uninsurable. There are only three restrictions to obtaining these quality Defined Benefit Health Insurance Policies. They are as follows:
1.) You may not be a Medicare recipient.
2.) You may not be receiving disability benefits.
3.) You may not be receiving workers' compensation benefits.
There are no other underwriting requirements. This means that regardless of your pre existing condition American Medical & Life insurance company will issue you a Defined Benefit Health Insurance policy.
What exactly is covered by their Defined Benefit Health Insurance policies? There are four different Defined Benefit Health Insurance Policies to choose from.
I will list the benefits covered on the best of the four different plan options. They are as follows:
All benefits are provided on a "first dollar" basis (no deductible or co pays required)
$1,000 per day covered for the first 100 days of hospital admission
$2,000 in additional coverage for the first day of hospital admission
$1,000 in additional coverage for the first 15 days of Intensive Care or Critical Care
Unlimited inpatient our outpatient Surgical Benefit provided on all plans
One Preventative Care Visit is covered per insured per calendar year with a $150 allowance for that visit
Up to 7 outpatient doctor office visits included with the with no co pay or deductible required
Mail order Generic & Brand name medications are discounted at up to 50%
Medically necessary diagnostic tests and x-rays performed in a doctor's office or outpatient facility (e.g. MRI, CAT Scan, EKG, Mammography) are covered up to $400 per visit with a 5 visit allowance per year
There is a 12 month waiting period for Pre Existing conditions. However, because the plan is HIPAA compliant this waiting period will be waived if you have a Certificate of Creditable coverage from another health insurance plan showing 18 months of prior coverage with no lapse of more than 63 days
$5,000 of Critical Illness coverage provided for Primary Insured & Spouse (optional on other 3 plans)
Nationwide P.P.O. network (www.multiplan.com)
Arguably these benefits rival the "first dollar" benefits provided on most major medical health insurance policies on the market today. The most attractive part about this kind of health insurance policy is that the premium required is well below half the premium required for the ICHIP state insurance risk pool. Also like the state insurance risk pool coverage these Defined Benefit Health Insurance policies are fully HIPAA compliant. This means that if you are coming off of an employer sponsored Cobra continuation plan and can produce a certificate of creditable coverage from this prior carrier showing 18 months of prior coverage with no lapse of more than 63 days your pre existing conditions will be covered from day one. If not, there is a 12 month waiting period for pre existing conditions.
Whilst a major medical health insurance policy is always the best way to insure oneself against the catastrophic medical bills one can experience throughout their lifetime, a Defined Benefit health insurance policy is most certainly a cost effective way to protect oneself if you are rendered uninsurable on the individual health insurance market.
Without a doubt, this is the finest Defined Benefit health insurance policy on the market today. Most especially since the majority of other offers to the uninsurable consist of discount P.P.O. network memberships that are by no means health insurance policies. We've all seen them advertised from company's like "Care Entree" or "Ameriplan" that offer "health coverage" (clever way to circumvent the words "health insurance") that will "cover" the entire family for $89 monthly!
This "coverage" is so inexpensive because it provides nothing more than a P.P.O. repricing discount. This in itself is not a bad thing. However without a Major Medical or Defined Benefit health insurance policy in place one can experience catastrophic medical bills with these types of "health coverage" plans. This is the case because the average P.P.O. discount on medical procedures performed within a P.P.O. network is between 25% & 40%. For a $100 doctor office visit, this is a good deal. However, if the medical bill is $500,000 that can leave the "covered" person with as much as $200,000 in out of pocket expenses!
For more information about Guarantee Issue Defined Benefit Health Insurance Plans and or Major Medical Health insurance plans please visit click here: http://www.sbisvcs.com/guarantee_issue.htm
Plans underwritten by American Medical & Life Insurance Company of New York, NY www.usamli.com
Available in all 50 states.
UNITED HEALTH CARE NOW OFFERS INSURANCE FOR HEALTH INSURANCE
United Health Care now offers the Continuity plan. The Continuity plan is a concept enacted by the CEO of United Health Care & it's subsidiary Golden Rule Insurance company. The concept is a brilliant one indeed because one of the greatest challenges to all health insurance brokers is the struggle to maintain "Guaranteed Insurability" for clients who have been diagnosed with a host of conditions such as Diabetes or Cancer. The onset of either one of these illnesses (and many more) will render one "uninsurable" on the individual major medical market. This can become a very serious problem if one looses their employer sponsored group coverage and can not either afford their State's risk pool coverage, or they do not live in a State that provides an Insurance Risk Pool. For states that do http://www.naschip.org/states_pools.htm
The Continuity plan resolves this problem by allowing insurable consumers to purchase any plan that United Health Care/Golden rule offers at only 20% of the normal required premium for that plan. Consumers can purchase this plan whilst they are covered by an employer sponsored group health insurance plan that offers them Guaranteed Insurability. Whilst the consumer is still insured by their employer sponsored group plan the United Health Care policy of their choice goes in to a "dormant" state. In other words, the policy remains in force as long as the insured pays only 20% of the required monthly premium for that product.
The moment that the consumer looses employer sponsored group coverage, or is faced with a hefty Cobra continuation premium. They can then elect to "awaken" the policy out of it's "dormant" state and the policy will then begin to cover them on a Guaranteed Insurability basis without the need for underwriting. This means that if a consumer were to develop a major medical condition that would render them uninsurable on the individual major medical market whilst the Continuity plan was in it's "dormant" state, their pre existing conditions would continue to be covered seamlessly from day one once the consumer elects to "awaken" their Continuity coverage. Once the policy is "awakened" the insured would now have to pay the entire monthly premium required to maintain that individual health insurance policy. But as anyone in the industry knows, individual policies often require a fraction of the premium that is required to maintain a Cobra continuation plan.
Once the insured has retained another employer sponsored group plan that provides Guaranteed Insurability (presumably by securing another employment position) then the policy goes back in to it's "dormant" state and the premium is subsequently reduced to only 20% or the required monthly premium. Essentially this concept allows any consumer to "float" in and out of employer sponsored group coverage whilst also maintaining the all important Guaranteed Insurability clause so valuable to those who have been rendered "uninsurable" on the individual major medical market. For more about this brilliant concept visit:
http://www.sbisvcs.com/united%20health%20care%20individual%20policy.html
We need single payer. If only to reduce the amount of health insurance spam on libertarian blogs. <grin>
LOL!
There's a balance in deleting-- and I considered deleting Mr. Tucker's dissertation, but it seemed like it had enough value-added.
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