6/27/2011 1:16 PM ET|
7 costly health insurance mistakes
Before you pick a policy, carefully evaluate what you need as well as how much risk you can afford to take. Also, keep your eyes open for potentially nasty surprises.
Poring over the fine print of health insurance plans to choose a policy is nobody's idea of fun, but you're better off spending some painstaking time researching before you buy than nursing a nasty financial headache later.
The "quality" of a health plan often depends on your needs and how much financial risk you can bear.
"One size doesn't fit all," says Martin Rosen, co-founder and executive vice president of Health Advocate, which helps employers and individual clients navigate the health care system. "You really need to assess what you need."
Whether you're choosing among group health plans offered by your employer or shopping for individual health insurance coverage, there are seven scenarios to avoid.
1. Your doctor isn't in the network
You'll pay more to use health care providers who aren't in your health plan's network, so check to see if the doctors and other professionals you want are included.
A plan that tightly restricts you to a local network might be sufficient if you need care only in your area, but it won't benefit a kid away at college or meet all your needs if you spend a lot of time on the road, says Pete Villemain, the president of Employee Benefit Services, which manages employer benefits plans.
Make sure any specialists you need are also covered by the plan, Rosen says. Don't assume a specialist is in the network just because your primary care doctor gave you the name.
2. You pay huge insurance premiums to save a few bucks on the co-pay
"The mistake I see individuals make so many times is they focus so much on getting a low co-pay and they fail to look at how much extra premium they pay for it," says Villemain.
He suggests evaluating how you'll use your plan and comparing the costs accordingly. If you go to the doctor only a couple of times a year, is it worth hundreds of dollars extra on the premium just to get a lower co-pay?
3. The drugs you take aren't covered
Some states require individual plans to offer prescription drug coverage, but in other states, many individual health insurance plans don't cover drugs, says benefits consultant Michael Goodheim of Farsighted Strategies in Seattle.
If the plan provides prescription-drug coverage, check to see if your medications are included on its formulary, which lists the preferred drugs for coverage, Goodheim says. Expect to pay more if you take a drug that is not listed.
Rosen suggests checking whether the plan provides discounts if you mail-order prescription drugs in bulk. For instance, you might be able to pay less per month for a 90-day supply through mail order than for three 30-day supplies at the pharmacy counter.
4. You're overinsured
In addition to comprehensive health plans, many employers offer supplemental insurance policies, such as cancer or critical illness insurance, that pay a lump sum of cash after diagnosis. Such policies can provide valuable protection, but they might be unnecessary if you already have broad coverage under your medical insurance and short-term and long-term disability insurance, Goodheim says.
If you're footing at least a portion of the premium bill, why pay for coverage you don't need?
5. You can't afford your share of the medical bills
Low premiums are an attractive feature of high-deductible health plans, but make sure you're prepared to pay all the out-of-pocket medical expenses, Goodheim says.
Besides the deductible, check the maximum out-of-pocket expenses you pay. After you pay the deductible, many plans pay only a portion, such as 70%, of covered medical expenses. Your 30% share is called co-insurance, which you must fork over until you reach the cap on out-of-pocket expenses.
"Those dollars can really add up," Goodheim says.
6. You're expecting, but your policy doesn't cover maternity care
Most employer-sponsored plans cover maternity and prenatal care, thanks to the federal Pregnancy Discrimination Act of 1978 and the Health Insurance Portability and Accountability Act of 1996, as well as many state health insurance mandates for group coverage. Some states also require individual health insurance plans to include maternity coverage, but in states where there is no such mandate, many individual health plans pay only a small portion of the costs or don't cover maternity at all. Even if the plan includes maternity coverage, read the fine print to know exactly what is covered and whether there's a monetary cap.
Starting in 2014, individual and small-group plans sold through state health insurance exchanges must include pregnancy and newborn care, along with other essential benefits.
7. You don't check your health plan for changes
Scrutinize group health plan offerings from employers each year during open enrollment, Rosen says. Don't assume the plan is still the same. Coverage levels, costs and networks could change from one year to the next, even if the plan is offered by the same insurer.
"If you're not sure about something and it raises a flag in your mind, then check it out," Rosen says.
This article was reported by Barbara Marquand for Insure.com.
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These days health insurance has become big business filled with loop holes, for profit.. Nothing is really straight forward. There is a real problem with health insurance. It reminds me of auto insurance, its cheaper for people to duck tape fender broken vehicles then to go through the insurance company.
Health insurance has become a racket, I've been working in the medical field for nearly 40 years and I have realized the corruption taking place is a sad state of affairs. We had a chance to reform health insurance, but that would have been lost funds for medical insurance companies. Medical insurance is for profit, if they claim non profit status, well then that's yet one more loop hole filling their pocket full of lies.
We finally could not afford healthcare any longer.
My husband is self employed (no health benefits available to him). I work at a job that cheats me out of 5 minutes a day so they don't have to consider me a "full time" employee, so no health benefits available.
When our health insurance that we had (through BC/BS) got upto more than $850 per month. (at a $5000 deductible) ..that was it (That's more than my mortgage payment). We had to cancel it and take our chances. It would have only gone higher as we get older. God only knows what the premium would be now, For now, we have been lucky and not had anything big happen. If it does, I guess the county owns my house. What ever happened to "Obamacare" ????? Didn't he want everyone Wasn't everyone to have coverage??
I agree that the article is totally useless information. Most companies hold mini-seminars explaining every aspect of the policies they're presenting. Nowadays you'd be lucky to get a choice of two! As for drug coverage....there's always WalMart with it's $4 generic drugs ($10 for 90 days). I've visited my doctor with WM's list and told him to pick one that matches what he wants to prescribe me!! If you have to have the real thing, be sure to investigate the drug company's hardship policy - you may qualify for a much more reasonably priced subsidy!! Yes I am aware of the claim that some generics aren't as "potent" but this information is easily accessible and your doctor can calculate a higher dose that will give you the equivalent of the name brand's dosage. We're all stuck with having the premiums deducted from the paycheck - you just have to figure out how to maximize or rather, downsize, the additional costs of actually having to use the insurance.
I have never and would never try to scam an insurance company but I have yet to find the insurance company that would not scam a client. They are as good at it as any lawyer or politician in this country and that is saying something. They call it " The Nature of The Beast".
It's a matter of who can scam the most from whom. They take your money as long as you are willing to give it but when it's time to pay, whoooooooo, that is not covered. They all get their training from the same place. You are stupid, I am smart, there fore I deserve everything I can beat you out of. It is really very simple.
Really? The present administration is on the side of the insurers? Really? Why don't you go back and check to see where the insurance lobbyists put all their money into. The solution is never as simple as one party or entity is to blame, everyone has their share but no one wants to accept responsibility for their part. Let's see, Dr's overcharging for unneeded tests, filing claims that are filled with errors. Insurance companies witholding payments for proper claims, unjustified premium increases for Dr's malpractice, and patient premiums. Finally the lawyers, who complete the circle chasing cases to see which one can pay off like a winning lotto ticket. So make sure you hold any party responsible for screwing up the system, not just the ones that you were given talking points about.
Insurance Companies are LOW LIFE, They have all the statistics, your sex, age group, cost of medical services, etc. and the probability of you developing serious medical conditions. Your premiums, are based on, those statistics and the probabilities that the company will have more money coming in, than they pay out in claims. In addition, people who really need health insurance either can't afford it, or they are refused coverage, based on things like family medical history, credit history, pre-conditions.etc, If a person has insurance through their employer, & looses their job, they either loose their insurance, or pay COBRA $700 or more a month to keep their insurance. How can a person who has lost their job, pay that kind of money for insurance..
Insurance Companies are like a Gambling Casino, The Odds are ALWAYS SET, in favor of the House, the House takes in more than they pay out, & even cheating is figured into their odds. The problem is that Insurance Companies stack the deck. If you happen to have a claim, their adjusters attempt to find reasons not to pay, to delay payments, and/or refuse to pay for certain test, services & medications prescribed by the doctor. When they pay. they only pay a percentage of the doctor, and hospital bill. You pay the remaining cost, or take out a second policy to help pay for things the first policy doesn't cover. These tactics force many people to do with-out needed medical services, or If they can, hire a lawyer to fight the insurance company. Even when they file a suit, the insurance companies have their own lawyers,that can tie up the case for years.. They hope people will either die, drop the suit, or will accept a low ball offer.
Nicholas, honestly you are about as ignorant as they come. 3/4 of the federal budget is spent on welfare programs??? Please educate yourself so you dont' make such a fool of yourself. It's very easy to find out where the majority of the federal budget goes. Programs for low income people are a very tiny, tiny portion of the budget. Your other statement about privatizing the health care industry, umm let me let you in on a big secret..... it already is. Private hospitals, private insurance companies all making billions in profits because guess what people have to have health coverage, it's not a want its a need so they can charge whatever and deny whomever they choose. Why do you think we in the US pay the most per person for health care that is getting worse and worse. You cannot have for profit health care, it is as simple as that.
With respect to your comments about Obamacare, I am noting this. Starting in 2014, in theory, insurance rates should go down instead of up. This should be due to the reason that there will be (again in theory) virtually universal insurance coverage, increasing the numbers of insured to pay into health insurance. Prior to that, uninsured would go to emergency rooms for care, which the hospitals (by law) were required to take in, but a per ermergency room visit is far costlier than a regular doctor's visit, and since uninsured did not pay for these emergency room visits the remaining people who had health insurance saw their premiums jacked up to cover uninsured health care costs in these emergency rooms. The principle in having universal health insurance is a sound one, as again, if the formerly uninsured (who must have health insurance in 2014) had access to a regular doctor instead of an emergency room, costs to insurers overall would drastically drop.
But on the other side of the coin, starting in 2014, health insurers are required to take in high risk preexisting cases such as people who have kidney failure, etc. The costs to the health insurers for these high risk cases will be horrendous, and by law, the insurers must spread the cost of these high risk cases throughout their subscriber base. I personally have Diabetes (no fault of my own, I got it throught Agent Orange exposure when I was in the Military in Vietnam which is by the way covered by the VA) and are considered high risk for private health insurance purposes. Currently, if I wanted to get any high risk private health insurance coverage, I would have to be unisured for six months and then enroll in a high risk health insurance pool where I would get subsidized premiums. After 2014 that will not be the case, for the high risk pool program will disappear, and I can then apply to any private insurance company to get coverage under Obamacare. Unfortunately, people like me will drive up the costs of private health insurance, but with the looming cuts on the horizon at the VA, I may have no chioce but to enroll in a private plan.
My personal opinion about the health insurance and health care system in the USA, is that it has been operated at a for profit greed based system for a number of years now. The health insurance company CEO's get their massive pay packages to deny needed care for their subscribers, in order to maximize their profits, the malpractice lawyers get their 40 percent cut on multimillion dollar malpractice awards, and the hospital chain administrators get their 7 figure salaries managing the whole system while doctors (residents) put in 30 hour days making 50 k a year, and nurses even being paid less. Nowhere else where you will find this but the good old USA, which due to this has a general quality of care equalling it to a country like Turkey.
In my work as an engineer, I have travelled the world, and have seen other healthcare scenarios providing more bang for the buck, as compared to the USA. For example, Japan whose people have an average life expectancy of 83 years with a per capita healfh care cost of about $ 3000.00 a year, versus the United States where the average life expectancy being 78 with about an $ 8000.00 per capita per year health care cost. Even our neighbor to the north, Canada has a life expectancy of about 80 with about a $ 5000.00 per capita per year cost. And Canada has socialized mediciine, where, except in Medicare, the USA does not.
Unfortunately dealing with health insurance primarily comes down to patient education. By this I mean the patient needs to know what their benefits are. I deal with insurance companies all day/every day as a patient accounts rep in a provider's office. If you call a carrier their job is to give you the least amount of information that's going to get you off the phone. If you haven't received an explanation of benefits (EOB) that explains how the claim was processed, demand one. Most patient's I talk to do not know what their deductible is or if they have a copay or coinsurance or even what they are.
The guy who complained the UHC wouldn't pay after his wife's car accident, UHC is medical insurance, not car insurance. They will not pay, he said that his car insurance and the other car insurance paid more than UHC did......that's what they are supposed to do!!!!!.
Unless you, the patient or subscriber, are willing to educate yourselves and find out what your benefits are then don't complain. It's like any contract, how many really read the insurance contract and ask questions before signing it, or just complain later and wonder why they are getting screwed by the insurance company. I really get tired of trying to help (educate) these people after the fact.
Group insurance coverage is determined by the company buying the coverage for the group, if there is a problem go to your human resources and complain. If you have individual coverage problems, find the agent who sold you the coverage. Granted, there is a very serious need for health reforms, but let's start with educating ourselves and trying some self help.
hi nicholas- i don't think she'd make that much in canada- the government would cover her and her kid's medical bills but not give her a cushy income. maybe some retraining? but really in your country or mine there's always going to be people who try beat the system, but i think it would be really hard to live on welfare here. i think the idea is to get you over the hump so you're not on the street until you're working again. pumping out babies just doesn't pay. i just wish you could worry about your education and not medical costs. people should be able to work low paying jobs if that's all they can get and still have basic medical care. the insurance companies just aren't allowed to stick it to you here and they still seem to make lots of money.
on a reality scale our dollar is on par with yours and even with $60.000 that mother would be bringing her 5 kids up in a life of poverty and of course- no health care.. at least every child has the right to decent health care. all the best, nicholas, glen
Getting a real quote online is very costly. They quote you a low number at the beginning, but it is not until your application is processed that you get a real quote on the cost. They want you to pay the first month premium to get a real quote. At 300 - 500 per quote and a 30 day processing time how can you really get a real quote and know what you are going to wind up paying. Then they issue a policy that excludes every condition that you told them that you had in the past 5 years.
They should only be allowed to give you a quote based on the average of what they currently charge their exisiting policy holders in your age group.
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