You may be one of the many millions of Americans nearing the age of 65 wondering if you will survive Medicare enrollment. As someone who has worked intimately with the Medicare program for a number of years, let me encourage you to relax. Yes, there is a great deal of confusion surrounding the program, but an understanding of the basics will allow you to put awe aside and send confusion packing.
Just what is Medicare?
Medicare is the Federal retirement program initially signed into law in 1965. It is often referred to as Original Medicare because it was the first or “original” program and is managed by the Federal government. Original Medicare coverage is available anywhere in the United States to seniors age 65 or over, people with positive disabilities under 65, and to people of any age with End Stage Renal Disease (ESRD).
How do you enroll?
If you are receiving Social Security benefits, Railroad retirement, or civil service benefits, your enrollment into Medicare will be automatic. In this case, approximately three months prior to your sixty-fifth birthday you will receive your initial enrollment packet, which will include your red, white, and blue Medicare card. You will notice an emblem of an eagle emblazoned on the front of the card. Simply sign the card, maintain it in a respectable place, and you are ready to go.
If you are not receiving Social Security benefits at the time you turn 65, then you will need to start your enrollment into Medicare yourself through the Social Security Administration. The time to do this is during your seven month Initial Enrollment Period, which includes the three months before your sixty-fifth birthday, the month of your birthday, and the three months following the month of your birthday.
Do you have to accept Medicare?
No. Although Medicare is a right granted American citizens and eligible legal residents, you do not have to enroll in Medicare if you do not want to. However, Medicare Part A is available without premium to most beneficiaries because either they or their spouse paid Medicare taxes while working. Medicare Part B does require payment of a premium, and unless you decline Part B, the premium will be deducted automatically from your Social Security benefit check. If you are not receiving Social Security at the time of your enrollment, then the Social Security Administration will bill you for Share B on a quarterly basis.
According to the Medicare publication, Understanding Medicare Enrollment Periods, if you decline Medicare enrollment during the Initial Enrollment Period, then in most cases you may risk a surcharge of 10 percent of either or both Piece A and B premiums for each twelve month period that you could have had Share A and/or B but were unenrolled.
What is the Special Enrollment Period for Part B?
An important exception to this rule as it applies to Part B would be if you or your spouse is working, and you are covered under the employer’s group health plan. If that is the case, then you can decline Fraction B enrollment under the Special Enrollment Period until either the employment or the group health coverage ends. If you decide to defer Part B enrollment, then you have the eight months following the month of termination to sign up for Part B without penalty. If you have questions about your Medicare eligibility or how much you might owe or have to pay, you would need to contact the Social Security Administration at 1-800-772-1213.
What benefits does Medicare provide and what is Part A and B?
Original Medicare offers a comprehensive range of medical and hospital benefits, and it allows doctors a relatively free and unrestricted hand in diagnosis and treatment. In fact, Medicare never gives prior authorization for services. That means your doctor can provide you with medically necessary treatment without having to explore permission beforehand from the insurance company. In Original Medicare, you could never be denied coverage because neither you nor the doctor sought prior authorization. However, it would be up to your medical provider to file claims correctly to Medicare and to show that your services were medically necessary. For purposes of administration and billing, the federally managed Unusual Medicare program subdivides your insurance benefits into two categories, Part A and Part B. In a nutshell, Part A covers inpatient hospital, skilled nursing facility, home health, and hospice benefits. Part B covers doctor services, outpatient services, and medical equipment, prosthetics, orthotics, and medical supplies.
Here is an example to relieve note how this might work. Let’s say you go into the hospital for a knee replacement. Medicare Part A would help pay for services such as room, meals and special diets, nursing, anesthesia, and medical equipment and supplies you use an inpatient, Share B will benefit pay for all doctors services such as inpatient admission and discharge evaluations, consultations, surgical procedures, and follow-up care. If you should be discharged to a Skilled Nursing Facility, then Part A would help pay for all services—including doctor services–received during your stay.
What are Medicare’s out of pocket costs?
Unfortunately, Medicare does not pay one hundred percent. In Original Medicare, beneficiaries are responsible for the Part A and B deductibles and coinsurance. These two terms are often misunderstood, but they are easy to understand. Deductible is simply a fixed share of costs you pay before the insurance begins paying on claims. You pay the deductible only once for the time period to which it applies. In Part A, you pay the deductible once per benefit period and this covers a total of sixty days of inpatient care received within that particular benefit period. The term “relieve period” is used only in Part A and means a unit of time that begins when you are signed in as an inpatient. The benefit period ends when you have been released from a hospital or Skilled Nursing Facility, and you stay released for sixty consecutive days. So, from the time you are first signed in, you can be released and re-admitted numerous times, but the benefit period does not end until you have been released and stay out of the hospital or Skilled Nursing Facility for sixty days in row. It is possible to have more than one back period in a calendar year. Part B also has its own deductible, but the Allotment B deductible is paid only once during your current calendar year (January through December). This means, for example, that if you have a doctor visit, or other Part B services such as x-rays, physical therapy, or chiropractic, you pay the cost out of your have pocket until you pay out the amount of the deductible. After that, the insurance begins to pay on the claims.
Once you have met the deductible, you are responsible for the coinsurance. Coinsurance is a percentage of an amount the insurer sets for the payment of medical providers (doctors, hospitals, skilled nursing facilities, etc.). What a doctor or hospital charges Medicare is not necessarily what Medicare approves for payment, and what you pay is based on Medicare’s celebrated amounts and fee schedules, not on what a provider charges Medicare. For inpatient care, there is a daily coinsurance that would apply to days sixty-one through ninety of an inpatient finish within a benefit period. For Part B, your coinsurance is twenty percent of what Medicare approves for payment. In other words, Medicare Part B is an 80/20 split once you’ve met the deductible. Medicare Part A is not an 80/20 split. As mentioned above, you a pay a fixed deductible, and after that you pay a daily coinsurance for inpatient days sixty and beyond (up to 150) received within a aid period.
Here is an out of pocket cost example to help illustrate how this works. Keep in mind that deductibles and coinsurance amounts may change from year to year. If we use the year 2010 as an example, we find that the Part A deductible (covering up to 60 days of inpatient care) is $1100 per benefit period. The Daily coinsurance for days sixty through ninety is $275 per day. For Fraction A, Medicare establishes fixed coinsurance and deductible rates that apply to all Part A facilities in the United States. Part B is a little different. For 2010, the Part B deductible is $155 for the calendar year, which means January 1 to December 31. The Section B deductible always applies to the calendar year, and you only pay the deductible once per year. After you meet the deductible, you pay the twenty percent coinsurance as described above. It is not possible to give an exact dollar amount of the coinsurance because it depends on the approved amount for each individual service you receive. That, in turn, will vary depending on your location and the kind of provider from whom you receive service.
Up to this point, I’ve provided a basic guide to understanding Original Medicare. The out-of-pocket costs and cost sharing I’ve described are different when you consider the Advantage Plan option for receiving your Medicare benefits.
What are Medicare Advantage plans?
Up until 1997, Original Medicare was the only means of receiving Medicare benefits. However, according to Legislative Observe 22, the Balanced Budget Act of 1997 allowed private insurance companies to begin administering the Medicare benefits established by the Federal government through private, managed care plans. Today, these private plans are known as Advantage Plans. All Advantage Plans must provide coverage for the same, core benefits established by the Federal government, though they may provide them in a different way than in the fee for service based Original Medicare program. It is notable to be aware that they are not supplemental insurance, and if you elect to join a private concept, that company takes over the responsibility of managing all of your health care and handles all claims and billing. That means that the Advantage Plan becomes the single and only payer for all of your doctor and hospital charges, and that Original Medicare does not pay on your claims while you are a member of an Advantage Plan. Enrollment in an Advantage Notion also means that no other supplemental insurance you might have can pay on any of the charges billed during your membership in the view. This also means that you agree to pay all out of pocket costs established by the plan, such as copayments for doctor and hospital care, and any other charges for other services such as x-rays, ambulance, emergency room, and outpatient hospital facility visits.
While the Advantage plans must meet the level of coverage as determined by Original Medicare, how they do so and the costs involved may differ. For example, some Advantage Plans may set out-of-pocket maximums for services, which would limit the amount you would pay in a given year should you reach a catastrophic level of coverage. Plans generally set co-pay levels for doctor visits, but the co-pays will vary from concept to conception. Plans may choose to pay more some services than Original Medicare, such as for inpatient care, which would mean you would pay less in the private plan than in Fresh Medicare. Other plans might pay less for certain services than Unusual Medicare, such as for skilled nursing facility care, which would mean you would pay more for those services in the plan than in Original Medicare. Another feature of Advantage Plans is that they may add benefits not generally covered by Medicare, such as payment for eyeglasses, dental, and hearing aids. Some plans include coverage for gym memberships and exiguous, non-emergency transportation.
The term, “Advantage Plan,” does not really tell you very much about the nature of the plans, how they are structured, or how they work. To make this more concrete, any privately managed Medicare insurance plan is an Advantage Notion if it has been authorized by Medicare. The most common kinds of Advantage Plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee for service (PFFS) plans. There are some other kinds of private plans, such medical savings accounts (MSAs), but the HMO, PPO, and PFFS are probably the most commonly offered.
Which is best, Unique Medicare or an Advantage Plan?
That is a difficult question. The acknowledge depends on a number of factors, such as your occupy, specific medical needs and expectations for coverage and medical costs. Keep in mind that the variety and quality of plans varies immensely throughout the United States from insurance company to insurance company, and even plans offered by the same insurance company may vary in quality and care due to differences in how the plans are managed. Some people may really like their Advantage Plan because of good customer service, responsiveness to medical needs, quality of care, inclusion of drug coverage, and simplification of paperwork and billing. Generally speaking, people in better health with few medical needs tend to be more satisfied with their plans than people with chronic and severe conditions. However, some companies now offer special needs plans to cater to individuals with extreme conditions, and some special needs plans are specifically for beneficiaries enrolled in both Medicare and Medicaid. In order to have the best chance of success with a private plan, it is important that you do your research to be obvious that the plan will be able to meet your specific needs.
What is Medigap Insurance, and where does it fit into the Medicare Program?
Medigap insurance is Medicare supplemental insurance. Medigap policies are written by private insurance companies and work only with Original Medicare and are available for purchase in the private insurance market. Medigap policies cover the costs that Original Medicare doesn’t pay, such as the coinsurance and deductibles associated with Portion A and B services. Medigap insurance is very different from Advantage Plan insurance. Whereas Advantage Plans manage your Medicare benefits and are responsible for claims and billing, medigap policies have nothing to do with the management of your Medicare benefits and coverage. Their critical function is to only pay after Current Medicare in order to pick up some or all of the costs that Unique Medicare doesn’t pay. What the Medigap policy pays for and how worthy depends on the type of policy you purchase.
Although medigap policy offerings may change in July 2010, at this writing there are twelve medigap policies, and they are called after the letters of the alphabet, A through L. Each policy covers a slightly different set of benefits, and the policies are standardized, which means that each policy is the same regardless of the insurance company from whom you prefer. Thus, a medigap policy F is the exact same policy whether you consume it from Aetna, Blue Cross, Mutual of Omaha or any other insurer. It is important to be aware that Medicare has nothing to do with Medigap sales, premiums, or regulation. Medigap insurance is subject to the insurance laws of the state in which you reside, and all purchases must be made from the private insurance company selling polices. As such, all premiums are paid directly to the private insurance company and cannot be deducted from your Social Security benefits.
Medicare enrollment can give any prospective beneficiary a lot to think about, but the basics outlined in this article should help guide you through much of the initial confusion you may face concerning Medicare enrollment, Advantage plans and Medicare supplements. Remember, Original Medicare is the program managed by the Federal government. Advantage Plans are an alternate means of having your benefits managed through private insurance company, and medigap insurance is simply an optional supplementary policy that pays after Unusual Medicare to pick up some or all of the benefits that Medicare doesn’t cover. Remember, once enrolled in Original Medicare, you have comprehensive coverage anywhere in the United States and its territories. For more detailed information, call 1-800-MEDICARE (1-800-633-4227).
Health insurance is really beneficial for both the providers and their patients. Patients receive benefits by being able to go to a provider (a doctor, a hospital or an independent medical facility) and save money by paying only a miniature fraction of the bill or even receive services for free. As for providers, since patients would usually prefer to use their insurance cards, they will have more patients.
I worked for a health insurance company before and we were handling provider calls for their claims and verification of benefits for their patients. It really isn’t that easy for providers to get paid for the services they have rendered to a member patient. They have to verify themselves if the patient still has active insurance. Most providers would require a letter of authorization from the insurance company before rendering any service especially for HMOs.
But for patients who have a wider coverage like a PPO or private fee for service, providers usually call the insurance company themselves. Then, after rendering service to a member patient, they have to file a claim in order to obtain paid. If you’re asking how long it takes for a claim to be processed, based from the different health insurance companies I’ve had and worked with, the usual turnaround time is 30 days.
Recently, we’ve been to a doctor (who I shall not name or give a clue about for security purposes since there may be court cases related to this) to have a diagnostic check up. That doctor still remembered us even though we last came to the doctor’s office 4 years ago. We had a few small talks since there were no patients on queue at that time.
Before I had health insurance from my employer, I was a private patient of that doctor. It was way succor in 2004. Now that I have health insurance, I asked what insurance company the doctor is participating with. To our surprise, the doctor isn’t participating with any insurance and only accepts private patients. We were astounded when the doctor told us the reason why.
The doctor pointed towards a huge cabinet and showed us a pile of papers. All of those papers were unpaid insurance claims. The doctor told us that it’s actually worth hundreds of thousands of pesos or it may even have reached a million pesos or so. I stood up and the claim forms were as high as my pelvis. Unfortunately, the health insurance company closed probably due to bankruptcy and our doctor told us that it’s been more than a year now and the claims still aren’t paid.
Well, I can really understand how our doctor felt about medical insurance. Our doctor said, with conviction, “I won’t be participating with any health insurance company anymore.” To be handsome, there are really good insurance companies out there. They process claims on time and do pay per contract. But sometimes, we may be unlucky to be working with a abominable insurance company. Ask around for feedback about your health insurance regarding how they treat members and providers. This intention, you’ll have an concept how trustworthy your medical insurance is.
A blog of one’s own
Uninsured in the United States
Blogging is a relatively new technology that has helped shape how people communicate. With the help of the internet, minority groups have been able to gain public serve and attention from their blog posts. The internet has gained mass popularity in the previous 15 years growing at an exponential rate; it allows us to reach anyone anywhere at the speed of light. Blogging is important because the average person can now project their message to millions of people online almost instantly. Blogs have become a key tool for minority groups to get their opinion across without spending a lot of money. They have empowered and given a voice to, people without adequate health insurance, and will be able to help more people in the future if the trend of blogging continues.
More than 44.8 Million people in the United States do not have health insurance (Wattenberg). This causes a great deal of concern for the average person living in the United States. The question is whether or not health insurance is worth the amount of money they will have to spend or if they even have the money to spend on it. They then will inspect at the opportunity cost; this is what they will have to give up if they don’t buy health insurance. When struggling to construct this decision they often look at themselves as healthy and won’t need or can’t afford health insurance. Health insurance costs on average of $10,880 dollars per family, however most companies cover a large portion of,this cost, thus making it cost on average $2,713 per year (Appleby). These numbers are staggering for the average family in America who design only $48,201 per year.
The uninsured in the USA are a seemingly invisible group to political elite and law makers. The predicament with Universal healthcare is that it would, in theory, give everyone an equal opportunity at who gets what doctor. In other words there would be no “better” hospital to visit if you were wealthy or had some sort of influence. The documentary Sicko Michael Moore outlines what happens to people without health insurance in the USA, and it also largely covers what happens to people who have health insurance but their thought limits how much care they can receive. The documentary also includes what happens to people who live in countries who have universal healthcare. The documentary was an extreme bias towards Universal Healthcare, but it outlined many facts. The following quote comes from the Institute of Medicine, was featured in the movie Sicko, and indicates the severity of the US healthcare problem.
According to the Institute of Medicine, “lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage.” (“Insuring America’s Health: Principles and Recommendations”)
This is a scary number of people that die each year from the lack of financial means in the United States. With the institution of Universal Healthcare that number would be down to zero.
The scary facts about United States current healthcare system are that the United States Government is doing petite in the way of making this number go down. Hillary Clinton, one of the biggest supporters of Universal Healthcare, was bought out by the drug companies and doctors in the make of campaign money. She is the second highest recipient of money from the current healthcare system; thus causing a conundrum (Christensen). How can the government fix the current problem when the candidates themselves are in the pockets of the healthcare system and large drug manufacturers? Most concept it as a problem, but do not know the extent of the problem; the healthcare companies are spending more and more money hiring people to fight congress over healthcare plans. In fact, there are 2,084 lobbyist and only 535 members of congress (Mayor).
The uninsured are a large marginalized group in the United States that are not being represented by the government with adequate representation. The drug companies have the most to lose if the United States government adopts universal healthcare. They will lose the most because right now they are making their fortune off the current health insurance plan in the United States. They effect their money off not treating everyone and from their high premiums. The current Bush administration has been urged by the drug companies to not agree to a universal healthcare system. They offer payouts to high political figures such as George W. Bush himself. This money is just a fraction of the amount of money that these drug companies receive every year from American families.
The uninsured American has no arrangement to argue with the insurance or drug companies over how worthy their care will cost them. To put it simply, they can’t. The following is a quote from Kuro5hin.org which posted this argument about bargaining rights of the uninsured:
“An individual who needs medical care has no bargaining power whatsoever with a hospital. He can either agree to pay whatever he is charged, or he can die. There are no other choices. In some cases, the government will force him to accept medical care – if he is a minor child in a family that does not wish to regain him any for religious or financial reasons, or if he is considered not to be in possession of reason – but he will still be billed. Refusing medical care for a dangerous or fatal condition is something most people won’t do – and may, in fact, be considered evidence of insanity which takes away the patient’s good to refuse treatment at all. He can’t sprint out because the price seems unreasonable. In some cases negotiation is fruitful, but often it isn’t.”
This following scenario is a real situation that far too many Americans face who are uninsured. They have no way to pay off their bill so they can only choose to refuse care instead, often doing this to assist their families financially. Their bills often accumulate so high that if they chose to die, it would be better financially. So are we putting a price on human life?
Stunned by the cold shoulder that the U.S. Senate shows the uninsured, I looked into real life accounts of uninsured persons in the United States and their chilling stories. The following story touched me because it is of a hard working miner named Lenny who worked all his life in unforgiving conditions. He survived a mine fire which killed 91 of his co-workers. This didn’t stop Lenny from returning to work, because after all he had three kids and with his job great health care. Unfortunately for Lenny he had health care up until the mine he worked for laid everyone off. This left Lenny with serious health problems from working underground for twenty years. He would eventually need medical care; so he applied for a job that offered medical assistance, and the only catch was that it took 60 days to go into effect. The following comes from (Sered and Fernandopulle):
“The luck that had made Lenny one of the survivor’s of the 1972 mine fire had run out. Only 30 days after he began the job, he fell down onto the pavement in full cardiac arrest. Paramedics flew him to Spokane, Wash., to a cardiac unit. His recovery was far better than anyone expected, but he was saddled with enormous medical bills. A year later, he was sent to the hospital for angioplasty and eventually open-heart surgery. The doctors saved his life, but Lenny is still suffering acute headaches as a result of falling to the pavement when he experienced the initial cardiac arrest. The cardiologist sent him to an otolaryngologist, who then sent him to other specialists for treatments; none has eliminated his headaches.
The bill for his various surgeries, consultations, medications, and treatments is more than $140,000—it might as well be $1 billion in terms of Lenny ever being able to pay it. His sole income at this time is the $400/month pension he receives from the mining company.
The second ending to Lenny’s story is a bit different. Speaking with feeling about the first time he had to ask for public assistance, tears come into his eyes, which seems incongruous for a man who went back down into the mine as soon as the smoke from the deadly fire had cleared out. “We have worked all of our lives, even went to work sick,” Lenny says. And now, instead of the dignity of automatic access to care, he depends on the golden heart of the county indigent assistance program.”
Lenny’s case is not an isolated one by any means; many people are uninsured and share similar stories about how the flaws of the current healthcare system.
Recently the blogging phenomenon has allowed many people with internet access to be able to share their healthcare stories with the world. Many people who can’t afford insurance can’t afford the cost of high speed internet which is required in order to blog. However, many public libraries offer this service and this allows many to have a voice when they wouldn’t previously. Healthinsuranceblog.com offers many different facts about the benefits of healthcare and what could happen if you don’t have it. The blog does not give proper life accounts of people who are uninsured, but they help raise awareness of what it means to not have insurance. The blog brings up a good point about why Universal Healthcare in the United States is unlikely, we don’t have the money to provide healthcare for everyone. The government currently does not have the allocated funds to cover insurance for everyone. With a tax it might be able to afford healthcare, but currently there is not enough money. Over 55% of the uninsured don’t pay taxes (healthinsuranceblog) and there would have to be higher taxes for everyone while only some people benefit. Health Insurance Blog is a political blog that outlines what the upcoming presidential candidates support for health care.
Healthcare is often a matter of life and death for many. Without health insurance, the uninsured cannot afford routine doctors visits so if there is something wrong with them it is not detected until it’s too slow. Most of the illness that people derive can be easily treated with worthy care, but since most people fear the cost of a doctors or hospital visit they are left untreated.
Uninsured persons spend political candidates to abet procure their message to the public about how critical their situations are. On the website healthinsuranceblog.com the democratic author talked about how politicians are getting the public aware of what it is like to be uninsured:
“In the Democratic Party primaries of 1988, for example, candidate Michael Dukakis talked about a young single mother who had two jobs and still could not afford medical insurance for herself and her children. In 1992, Bill Clinton did the same, changing the story only slightly. This time it was the case of a woman with diabetes who could not salvage health insurance because of her chronic condition. And now, in the 2008 primaries, Hillary Rodham Clinton (whom I worked with on the White House Health Care Reform Task Force in 1993) describes a similar case. This time it is a single woman, with two daughters, who cannot pay her medical bills because her congenital heart defect makes it impossible for her to get medical insurance coverage. And Barack Obama describes similar cases, with the eloquence that characterizes all of his speeches. He frequently refers to his own mother, who had cancer and had to worry not only about her illness but about paying her medical bills.”
Healthcare cannot wait much longer. Americans are dying every day because they can’t afford to go to get a routine doctors visit or they can’t afford their medication. I looked at the earning of the CEO of GlaxoSmithKline which is one of the larger providers of health insurance, Jean-Pierre Garnier the CEO made $9.4 million dollars last year. How is it fair that many people in the United States are uninsured and can’t afford to fetch the help they need, and the CEO’s of the companies that are denying them affordable healthcare are making a large salary. When people have to work two jobs just to be able to afford to pay for their medications, why should insurance and drug companies continue to be making such a grand profit?
Internet savvy users who happen to be uninsured illustrate their hardships over the internet. Oftentimes, people without healthcare who have problems have a hard time expressing their feelings about their situations because they either can’t afford to use the internet or are too frustrated. The internet, along with blogs, has become a tool for people to voice their plan without the censor of mainstream media. Blogs are written by people who have a voice and without an agenda (for the most piece anyway; there are also corporate blogs).
Health care blogs are written by numerous people including, doctors, people without health insurance, and supporters of healthcare for everyone also known as universal healthcare. The commonwealthfund.org is an internet site that describes stories of people without healthcare and their hardships. The area is made for people to gain awareness of how bad it is to not have healthcare, and even trip down the stereotypes of people without health insurance. One stereotype I used to have is that people without health insurance are lazy, and or did not work hard enough to be able to afford it so it was be their fault for not having it. After looking at this site that gives minorities a deny, I learned that even college-educated men and woman have a hard time getting health care.
One profile on commonwealthfund.org was of a college graduate named Ryan who had to determine whether or not to pick up a job based on income or healthcare. He was a healthy young individual who did not think he would need healthcare so he decided to steal a job teaching which did not offer good benefits. Ryan fell down on his apartment stairs and hurt his knee, he now has very high hospital bills to pay off. He later had to prefer a job that paid less but offers health benefits. Ryan ended up getting care for his knee in Chili because they did not charge as much and offered equal or better service. The question I have to ask after reading Ryan’s story that he told was why should anyone have to choose between a career or a job that offers health benefits? What happened to what we were told as kids: “we can be anything we want to be? ” The truth is with our current plan many Americans are finding themselves working for adequate health service.
Blogs have become an favorable form of education for people who did not know about what is happening to the uninsured. With the recent popularity of blogs, many are using their voice to disprove common misconceptions about what is it like to not be fully covered by their insurance company when they need care. After reading all the Profiles of the uninsured on commonwealthfund.org I wanted to know more about how we could get their stories across to more people. The upcoming election for president has given the most power to the uninsured. The biggest problem that is being addressed besides the Iraq war is the topic of affordable healthcare for all. The fact is that healthcare is only affordable for the average American making under $50,000 for a family is one that is mostly covered by their employer. But with the economy falling without or little growth since 2001 has not made it accessible for runt companies to provide healthcare for their employees.
Small business owners are finding it increasingly difficult to afford the cost of healthcare for employees. Small businesses have to deal with high taxes by the government on their income (this number is usually around 35% but can very dwelling by state), this is a high number so the amount of funds left after paying for overhead is very little. The goal of small business it to expand and grow, but how can they afford to do that with all the costs they have? If healthcare cost less for business owners the economy would follow suit. It would grow, and I dare say we would be out of the recession that we are currently in. There is little in fabricate of growth in the United States compared to other developing nations.
Universal Healthcare to many Americans is not indispensable to them because they are already covered; however I am concerned about it because the United States is doing so poorly economically. Blogs have been significant in addressing the issue of how grand money in being spent by individuals every year. In 2003 1.3 trillion dollars was spent on healthcare by the American people. This is an alarming amount of money that is going to something that is under regulated as far as price goes. The drug companies and insurance companies are taking a large portion of all Americans income each year. Healthcare blogs have played a big role in getting the public’s attention at this issue. They often make issues aware to us that we may not have known about; blogs unlike mainstream media are not censored and do not have a corporate sponsor. Americans who do not have health insurance get their stories about their hardships on blogs or others write about them on their behalf.
I found a family member in my family who did not have health insurance. I learned last year she had a major operation on her back, and I often wondered how she was going to pay for it. I conducted an interview with her and what I found out was disturbing. I have to say I am slightly bias towards this because she is a family member; however it does not make the facts any less chilling.
My Aunt Lisa Herbert is a working class woman who did not finish high school or attend any formal schooling after she dropped out. She got pregnant at the young age of 15 and had her first child at the age of 16. Lisa had a tough life from her teenage years. She had a hard time raising a kid at her age; she went through multiple husbands and boyfriends who would promise to prefer care of her children but left her financially ruined. Lisa’s anecdote regarding medical insurance starts two years ago in 2006. From all aspects she had a hard life but she wanted to mild make something of herself, she got a job at a Dunkin Donuts as was promoted quickly to manager. She was enjoying for the first time in her life financial freedom even if it was small; she had the sense of independence. She went to work just as she has always done one day in the winter; she fell on the ice leading up to the Dunkin Donuts she worked at. She fractured one her vertebras, however not life threatening, neither were her injuries threatening enough to make her become a paraplegic. However she was still injured. Lisa could not walk or be mobile for over 6 months; now imagine this as she described to me, she was finally becoming financially independent and was proud to become a manager, then after one accident she landed in the hospital. She did not have worthy insurance; she had what Dunkin Donuts provided for her. She was “lucky” in the sense that because she did not have the financial means to sue them. Dunkin Donuts gave her the pay for the 6 months that she was not working. She took this as a gift, but from my point of view she could have got more out of them if she had money. Lisa then had to pay overwhelming medical bills (the precise amount was not disclosed) that mounted on her already oppressed position.
Lisa’s story is not an isolated one or even a rarity in the United States. Many workers who are working either retail or chain restaurants are not making it financially. The rising cost of healthcare that is not provided from the companies that they are working for is overwhelming and often times unaffordable. The blogging community is just starting to pick up issues of social injustice that is being done to marginalized groups such as the medically uninsured in the United States and giving them a voice. These groups should not be silenced because they do not have enough money to pay for proper care or routine visits.
I want to address one important say that the readers of this paper may be having; I have talked a lot about universal healthcare and how the uninsured need care as well. Many Americans that I have spoken to said that they don’t want inferior quality care if we decided to do universal healthcare. I have a personal story I want to share to clear up any confusion with the quality of nonprofit hospitals or hospitals that offer free care. When I was the age of 15 I had a severe flat foot problem, with health insurance that covered nearly 99% of all medical bills my parents had to pay over $3,000 out of pocket for treatment in order to get custom made orthotics for my feet and other care. They did not work. I ended up going to a hospital in Springfield Massachusetts that offered free orthopedic care to anyone under the age of 18; we did this only because all the “specialists” we visited did not help my condition. My doctor I had was the top orthopedic surgeon at the hospital and could rival any at a paying hospital. He suggested a new treatment for my feet without surgery and gave me free orthotics that actually helped. My family had the money to get nearly any doctor that would help me however this was the only doctor that knew what he was doing that we visited so far. He was still paid but by donations (he drove a 7 series BMW so he was getting paid a lot). I think that Americans that are opposing universal healthcare have a twisted view on what it means to not have insurance pay for their care. I want to address one more thing, I found out about this hospital from a healthcare blog (can’t remember which one) which had other patients writing about their care and how they were helped by this hospital.
Universal healthcare to many is something that we want and strive for in America; but the question we have to ask is can we afford it? A study was done on the National Center for Political Analysis website outlining what would happen if we adopted universal healthcare today. According to the set if we were to look at another universal healthcare plan such as Sweden’s, America would suffer far beyond what it is suffering today. Due to lower funding to hospitals through taxes instead of the healthcare providers, we would experience the following, a lag in new staff for hospitals, reduction in staff at hospitals and clinics, reduction in beds at hospitals to house patients, undertrained people taking on higher responsibilities such as surgery (Larson,1). This makes it hard for us to consider universal healthcare in America when there are so many negatives. However should the voices of the uninsured that are dying simply because they can’t afford their premiums be silenced?
Many of the uninsured living in America now are between the ages of 20-30, these by all means are young healthy individuals who feel like they will never need insurance until past the age of 30. They reflect, what are the odds of getting sick? They are classified by the insurance agencies as “young invincibles” these are the people who do not have the average $3,000 a year to spend on health insurance let alone if their employer even offers it. Jake Hollner is by all rights a young healthy individual who at the age of 24 is working for Home Depot and is an artist piece time. He missed the insurance that Home Depot offers as it is only offered once a year in a two week time frame. He thought to himself that he did not have the money to afford insurance (he was only making $6 an hour) so why bother? The money he would save from the insurance could be save to his medical bill if he had a onetime accident. He suffered from stomach ulcers since his undergraduate years in college, these ulcers objective starting coming back so he decided to bite the bullet and go to the doctors for help. He paid $200 for the visit and $73 for the prescription. This was his entire paycheck for the week but he was pretty upright? The ulcers did not go away after he took his medication; he had to do the unthinkable for an uninsured person, he went to the emergency room. He lost his gamble with not having insurance he ended up paying a fortune for his ulcer coverage because he was without health insurance. The steady costs were not disclosed. Jake before the doctor visit could barely afford rent and other living expenses including health insurance (Amsden, 1).
There are other stories such as Jake’s out there, where young people who are rarely sick do not have the coverage they need in case of an emergency. The healthcare providers commented on this blog which Jake’s story was on. They gave him a link to get affordable healthcare through them, the provider is Blue Cross Blue Shield. Even if there was “affordable” healthcare to many, how could someone like Jake who was only making $6 an hour be able to fix his other expenses? There is no cutting corners in his case, he has no money and is living on necessities.
With the institution of universal healthcare people such as Jake would not have to pay a lot to get coverage since he does not make a lot. Why is it that in America the better off richer class doesn’t want to help everyone else? Universal healthcare redistributes the wealth that we are not getting a piece of. When the majority of our wealth is going to the 1/10 of the top 1% in our country how can the rest of us afford to live? In theory, their money would benefit fund everyone else with healthcare from their taxes. Wouldn’t it be better to live in a community where everyone helps each other, and there is no one who has to choose between eating or taking their child to the doctor’s office?
Universal healthcare is a topic that cannot be ignored any longer. We have too many people living amongst us who simply cannot afford the absurd premiums that the insurance companies are charging. The people that are dying because they cannot afford regular doctors visits are real people who have families and people that rely on them. This is a change that will need to be addressed as our unusual president comes into office in the year.
Whole life insurance policies – those that are purchased for a lifetime of protection, as opposed to term life insurance which has a limited period of time until the policy matures, can be given as a deferred gift to a nonprofit agency or organization. Just exactly how to do this can be confusing to the average devoted donor. Read on to find out more about how to make a gift of life insurance:
When an individual purchases a life insurance polity – they normally have a value of how much they will pay out upon the death of the individual ($10,000, $50,000, etc.). A person then makes payments for a certain amount of time according to a schedule. When purchasing a policy, the individual assigns ownership of the policy to a nonprofit agency, instead of an individual, as well as making the organization beneficiary of the policy.
An individual may be able to get a tax deduction for the premium payments. In some cases the individual will need to make a donation in the amount of the scheduled payment to the nonprofit and the nonprofit organization. A tax consultant and/or attorney should be consulted to make sure that things are done properly according to the laws in your state.
This may seem like a lot of paperwork and details for both the individual and the nonprofit organization. But, in fact, this is one intention that individuals can make substantial gifts to a common charity, and the charity can benefit from a large donation. Additionally, since the ownership of the life insurance policy has been assigned to the organization from the onset – it becomes an asset of the organization. As an asset, it can help the organization build its financial health, be used to secure loans and grants, and help construct stability.
For the donor, he or she can aid the organization both during his or her lifetime, and after death. This is one way that individuals (including younger donors) can create broad gifts that can really obtain a huge difference and contribution for an organization.
The one disadvantage is to the nonprofit organization. The individual may choose to, or be unable to make the scheduled payments. In this case, the organization can take over the payments (since the organization is the owner) or find another donor to do so in order to maintain the policy, or the organization may be able to cash in the policy for whatever its current cash value is to access some cash from the arrangement.
Again, both the individual and the organization should consult a specialist to make sure that all the bases are covered, unless they have experience in dealing with donations of life insurance policies. Laws change and it is vital to earn sure that everything is done thoroughly and legally.
Is infant life insurance a boon, or a boondoggle? On the pro side are companies like Gerber Life and Globe Life Insurance that promote infant life insurance as a way of providing financial security to families and, eventually, to the insured children once they have grown. Critics complain that the investment benefits of infant life insurance are overstated. They suggest taking the money that would go into a life insurance policy and investing in something else. Who is right?
Actually, they both are. The question is: Which competing strategy fits a family’s financial goals and, unbiased as importantly, its investment aptitude?
The product at issue is whole life insurance. In addition to insuring the life of the child, a whole life policy builds cash value over time. Cash value is the amount the insurance company will surrender to the insured if the policy is cancelled. The accumulation of cash value is slow but steady.
Critics suggest that the money spent on whole life insurance would be better used investing in something else. They suggest using part of the whole life premiums to pay for a term life insurance policy with the same amount of coverage. That way, the life is still insured. Because term life covers a set number of years and does not build cash value, the premiums are much lower than they are for whole life. According to this strategy, the money saved on premiums should be invested in the stock market, Treasury bills, bonds, or an Individual Retirement Account (IRA). Over time, the critics say, the return on any of these investments will exceed the return from a whole life policy.
Individual investing has its own drawbacks, however. First and foremost, the plan is difficult to start, both logistically and emotionally. It requires at least twice as much paperwork to get started-one set of papers to initiate the term life insurance and another to set up whatever the investment is. The alternate investment requires a great deal thought and research, as well. Which stocks? Which mutual fund? Which bonds?
The emotional factor cannot be ignored, either. The beauty of whole life insurance is that the investment feature diverts attention from the life insurance feature. Parents of a newborn do not want to think about their child dying. With whole life insurance, the focus is on life-building a financial future-not death. Putting term life insurance into the mix strips away the emotional cushion. Parents are forced to confront the possibility of losing their child. Many people refuse to do so, and they end up doing nothing.
This is the problem with individual investing in general; inertia is difficult to overcome. Everyone should be saving and investing all the time, but they don’t-unless it is so easy to do so that they cannot resist. This is another appeal of whole life insurance. It offers an easy contrivance for parents to invest some money in their child’s future.
Those who have the emotional detachment to select out term life insurance on an infant and the financial aptitude to purchase their gain investments should avoid whole life insurance. But those who are turned off by the plan of insuring the life of their newborn and who lack the financial savvy to invest on their own should mediate it. Whole life insurance is better than no investment at all, which is what many people would have without it.
You may be one of the many millions of Americans nearing the age of 65 wondering if you will survive Medicare enrollment. As someone who has worked intimately with the Medicare program for a number of years, let me encourage you to relax. Yes, there is a immense deal of confusion surrounding the program, but an understanding of the basics will allow you to set anxiety aside and send confusion packing.
Just what is Medicare?
Medicare is the Federal retirement program initially signed into law in 1965. It is often referred to as Original Medicare because it was the first or “original” program and is managed by the Federal government. Original Medicare coverage is available anywhere in the United States to seniors age 65 or over, people with determined disabilities under 65, and to people of any age with End Stage Renal Disease (ESRD).
How do you enroll?
If you are receiving Social Security benefits, Railroad retirement, or civil service benefits, your enrollment into Medicare will be automatic. In this case, approximately three months prior to your sixty-fifth birthday you will receive your initial enrollment packet, which will include your red, white, and blue Medicare card. You will peer an emblem of an eagle emblazoned on the front of the card. Simply heed the card, keep it in a worthy place, and you are ready to go.
If you are not receiving Social Security benefits at the time you turn 65, then you will need to commence your enrollment into Medicare yourself through the Social Security Administration. The time to do this is during your seven month Initial Enrollment Period, which includes the three months before your sixty-fifth birthday, the month of your birthday, and the three months following the month of your birthday.
Do you have to accept Medicare?
No. Although Medicare is a fair granted American citizens and eligible legal residents, you do not have to enroll in Medicare if you do not want to. However, Medicare Part A is available without premium to most beneficiaries because either they or their spouse paid Medicare taxes while working. Medicare Share B does require payment of a premium, and unless you decline Portion B, the premium will be deducted automatically from your Social Security benefit check. If you are not receiving Social Security at the time of your enrollment, then the Social Security Administration will bill you for Part B on a quarterly basis.
According to the Medicare publication, Understanding Medicare Enrollment Periods, if you decline Medicare enrollment during the Initial Enrollment Period, then in most cases you may risk a surcharge of 10 percent of either or both Part A and B premiums for each twelve month period that you could have had Part A and/or B but were unenrolled.
What is the Special Enrollment Period for Portion B?
An primary exception to this rule as it applies to Part B would be if you or your spouse is working, and you are covered under the employer’s group health plan. If that is the case, then you can decline Fraction B enrollment under the Special Enrollment Period until either the employment or the group health coverage ends. If you decide to defer Fraction B enrollment, then you have the eight months following the month of termination to mark up for Part B without penalty. If you have questions about your Medicare eligibility or how much you might owe or have to pay, you would need to contact the Social Security Administration at 1-800-772-1213.
What benefits does Medicare provide and what is Part A and B?
Original Medicare offers a comprehensive range of medical and hospital benefits, and it allows doctors a relatively free and unrestricted hand in diagnosis and treatment. In fact, Medicare never gives prior authorization for services. That means your doctor can provide you with medically well-known treatment without having to seek permission beforehand from the insurance company. In Original Medicare, you could never be denied coverage because neither you nor the doctor sought prior authorization. However, it would be up to your medical provider to file claims correctly to Medicare and to show that your services were medically necessary. For purposes of administration and billing, the federally managed Novel Medicare program subdivides your insurance benefits into two categories, Part A and Part B. In a nutshell, Part A covers inpatient hospital, skilled nursing facility, home health, and hospice benefits. Part B covers doctor services, outpatient services, and medical equipment, prosthetics, orthotics, and medical supplies.
Here is an example to befriend show how this might work. Let’s say you go into the hospital for a knee replacement. Medicare Piece A would help pay for services such as room, meals and special diets, nursing, anesthesia, and medical equipment and supplies you use an inpatient, Part B will benefit pay for all doctors services such as inpatient admission and discharge evaluations, consultations, surgical procedures, and follow-up care. If you should be discharged to a Skilled Nursing Facility, then Fraction A would help pay for all services—including doctor services–received during your cease.
What are Medicare’s out of pocket costs?
Unfortunately, Medicare does not pay one hundred percent. In Fresh Medicare, beneficiaries are responsible for the Part A and B deductibles and coinsurance. These two terms are often misunderstood, but they are easy to understand. Deductible is simply a fixed fraction of costs you pay before the insurance begins paying on claims. You pay the deductible only once for the time period to which it applies. In Part A, you pay the deductible once per benefit period and this covers a total of sixty days of inpatient care received within that particular serve period. The term “benefit period” is used only in Part A and means a unit of time that begins when you are signed in as an inpatient. The benefit period ends when you have been released from a hospital or Skilled Nursing Facility, and you stay released for sixty consecutive days. So, from the time you are first signed in, you can be released and re-admitted numerous times, but the benefit period does not end until you have been released and stay out of the hospital or Skilled Nursing Facility for sixty days in row. It is possible to have more than one serve period in a calendar year. Part B also has its maintain deductible, but the Fragment B deductible is paid only once during your current calendar year (January through December). This means, for example, that if you have a doctor visit, or other Section B services such as x-rays, physical therapy, or chiropractic, you pay the cost out of your own pocket until you pay out the amount of the deductible. After that, the insurance begins to pay on the claims.
Once you have met the deductible, you are responsible for the coinsurance. Coinsurance is a percentage of an amount the insurer sets for the payment of medical providers (doctors, hospitals, skilled nursing facilities, etc.). What a doctor or hospital charges Medicare is not necessarily what Medicare approves for payment, and what you pay is based on Medicare’s approved amounts and fee schedules, not on what a provider charges Medicare. For inpatient care, there is a daily coinsurance that would apply to days sixty-one through ninety of an inpatient halt within a support period. For Part B, your coinsurance is twenty percent of what Medicare approves for payment. In other words, Medicare Part B is an 80/20 split once you’ve met the deductible. Medicare Piece A is not an 80/20 split. As mentioned above, you a pay a fixed deductible, and after that you pay a daily coinsurance for inpatient days sixty and beyond (up to 150) received within a benefit period.
Here is an out of pocket cost example to help illustrate how this works. Keep in mind that deductibles and coinsurance amounts may change from year to year. If we use the year 2010 as an example, we find that the Part A deductible (covering up to 60 days of inpatient care) is $1100 per aid period. The Daily coinsurance for days sixty through ninety is $275 per day. For Part A, Medicare establishes fixed coinsurance and deductible rates that apply to all Part A facilities in the United States. Part B is a little different. For 2010, the Portion B deductible is $155 for the calendar year, which means January 1 to December 31. The Part B deductible always applies to the calendar year, and you only pay the deductible once per year. After you meet the deductible, you pay the twenty percent coinsurance as described above. It is not possible to give an exact dollar amount of the coinsurance because it depends on the accepted amount for each individual service you receive. That, in turn, will vary depending on your location and the kind of provider from whom you receive service.
Up to this point, I’ve provided a basic guide to understanding Original Medicare. The out-of-pocket costs and cost sharing I’ve described are different when you consider the Advantage Plan option for receiving your Medicare benefits.
What are Medicare Advantage plans?
Up until 1997, Original Medicare was the only means of receiving Medicare benefits. However, according to Legislative Notice 22, the Balanced Budget Act of 1997 allowed private insurance companies to begin administering the Medicare benefits established by the Federal government through private, managed care plans. Today, these private plans are known as Advantage Plans. All Advantage Plans must provide coverage for the same, core benefits established by the Federal government, though they may provide them in a different way than in the fee for service based Original Medicare program. It is important to be aware that they are not supplemental insurance, and if you elect to join a private plan, that company takes over the responsibility of managing all of your health care and handles all claims and billing. That means that the Advantage Plan becomes the single and only payer for all of your doctor and hospital charges, and that Original Medicare does not pay on your claims while you are a member of an Advantage Plan. Enrollment in an Advantage Plan also means that no other supplemental insurance you might have can pay on any of the charges billed during your membership in the plan. This also means that you agree to pay all out of pocket costs established by the concept, such as copayments for doctor and hospital care, and any other charges for other services such as x-rays, ambulance, emergency room, and outpatient hospital facility visits.
While the Advantage plans must meet the level of coverage as definite by Original Medicare, how they do so and the costs involved may differ. For example, some Advantage Plans may set out-of-pocket maximums for services, which would limit the amount you would pay in a given year should you reach a catastrophic level of coverage. Plans generally site co-pay levels for doctor visits, but the co-pays will vary from thought to plan. Plans may choose to pay more some services than Original Medicare, such as for inpatient care, which would mean you would pay less in the private concept than in Original Medicare. Other plans might pay less for definite services than Original Medicare, such as for skilled nursing facility care, which would mean you would pay more for those services in the plan than in Original Medicare. Another feature of Advantage Plans is that they may add benefits not generally covered by Medicare, such as payment for eyeglasses, dental, and hearing aids. Some plans include coverage for gym memberships and minute, non-emergency transportation.
The term, “Advantage Plan,” does not really tell you very distinguished about the nature of the plans, how they are structured, or how they work. To make this more concrete, any privately managed Medicare insurance plan is an Advantage Belief if it has been authorized by Medicare. The most common kinds of Advantage Plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee for service (PFFS) plans. There are some other kinds of private plans, such medical savings accounts (MSAs), but the HMO, PPO, and PFFS are probably the most commonly offered.
Which is best, Original Medicare or an Advantage Plan?
That is a difficult quiz. The answer depends on a number of factors, such as your own, specific medical needs and expectations for coverage and medical costs. Retain in mind that the variety and quality of plans varies immensely throughout the United States from insurance company to insurance company, and even plans offered by the same insurance company may vary in quality and care due to differences in how the plans are managed. Some people may really like their Advantage Plan because of gracious customer service, responsiveness to medical needs, quality of care, inclusion of drug coverage, and simplification of paperwork and billing. Generally speaking, people in better health with few medical needs tend to be more satisfied with their plans than people with chronic and severe conditions. However, some companies now offer special needs plans to cater to individuals with extreme conditions, and some special needs plans are specifically for beneficiaries enrolled in both Medicare and Medicaid. In order to have the best chance of success with a private notion, it is vital that you do your research to be determined that the plan will be able to meet your specific needs.
What is Medigap Insurance, and where does it fit into the Medicare Program?
Medigap insurance is Medicare supplemental insurance. Medigap policies are written by private insurance companies and work only with New Medicare and are available for purchase in the private insurance market. Medigap policies cover the costs that Original Medicare doesn’t pay, such as the coinsurance and deductibles associated with Part A and B services. Medigap insurance is very different from Advantage Plan insurance. Whereas Advantage Plans manage your Medicare benefits and are responsible for claims and billing, medigap policies have nothing to do with the management of your Medicare benefits and coverage. Their principal function is to only pay after Original Medicare in order to grasp up some or all of the costs that Original Medicare doesn’t pay. What the Medigap policy pays for and how much depends on the type of policy you purchase.
Although medigap policy offerings may change in July 2010, at this writing there are twelve medigap policies, and they are called after the letters of the alphabet, A through L. Each policy covers a slightly different set of benefits, and the policies are standardized, which means that each policy is the same regardless of the insurance company from whom you purchase. Thus, a medigap policy F is the exact same policy whether you buy it from Aetna, Blue Cross, Mutual of Omaha or any other insurer. It is important to be aware that Medicare has nothing to do with Medigap sales, premiums, or regulation. Medigap insurance is subject to the insurance laws of the situation in which you reside, and all purchases must be made from the private insurance company selling polices. As such, all premiums are paid directly to the private insurance company and cannot be deducted from your Social Security benefits.
Medicare enrollment can give any prospective beneficiary a lot to think about, but the basics outlined in this article should help guide you through much of the initial confusion you may face concerning Medicare enrollment, Advantage plans and Medicare supplements. Remember, Original Medicare is the program managed by the Federal government. Advantage Plans are an alternate means of having your benefits managed through private insurance company, and medigap insurance is simply an optional supplementary policy that pays after Current Medicare to choose up some or all of the benefits that Medicare doesn’t cover. Remember, once enrolled in Current Medicare, you have comprehensive coverage anywhere in the United States and its territories. For more detailed information, call 1-800-MEDICARE (1-800-633-4227).
If one is not pregnant and would like to add on additional pregnancy insurance to his/her individual health insurance plan, then one should know few things such as the existence of individual health insurance policies which allow us some measure of pregnancy insurance in the form of a rider for an additional cost.
One should always know the options available before obtaining pregnancy insurance and health insurance. Specific amount of coverage can be variable and sometimes we may find ourselves without enough pregnancy insurance to completely screen the costs of a pregnancy.
The trouble with being pregnant and trying to fetch pregnancy insurance, unless one is getting it through job, is that many insurance companies treat pregnancy as a pre-existing condition and will not cover it after the fact. And if they do, they do so at elevated costs.
So how to get pregnancy coverage with health insurance
- Look out for different types of coverage your health plan provides for pregnancy. Eye at what type of maternity, anticipatory and well-baby care the plan provides.
- Avoid changing jobs if you are pregnant. If you switch to a new job during a pregnancy, there are chances that you may have to wait for a couple of months before you are eligible for coverage.
- Think about applying for Medicaid if you are not insured and satisfy the program’s low-income criteria
- Contact your situation insurance department for more info on how to cover your pregnancy and ask about different types of economical insurance plans offered by them
There are some types of pregnancy insurance that are not actually health insurance as they have charges which are lower than insurance costs and they also offer discounts on doctor’s visits and hospital care. If women cannot afford to or are not having pregnancy insurance, they may eye for options like making payment arrangements with doctors and hospitals.
However, it is recommended that one should get regular prenatal care; since women who do not get prenatal care could have complex labor problems and there could more chances of mortality risk for both child and the mother.
With the rising costs of health insurance these days, more and more companies are opting to either pay only a portion of these costs or forego offering health insurance at all. A growing number of companies that do offer health insurance to their employees choose a plan that leaves a yearly deductible of anywhere from $600 to $1200. What this means to the employee is that, on top of the co-pay expected for each doctor visit, the employee has to pay off this deductible before the real benefits kick in. This is where having a good health care discount plan could be useful when used in conjunction with your health insurance.
A discount health care concept is not the same as health insurance. What a plan like this offers is a group of medical professionals that agree to provide service to plan members at a discounted rate. An example of this discount would be paying $35 for a routine office visit as opposed to the $75 that most doctors charge. It might not seem like much of a savings but, over time, it adds up. As with any health plan, you should evaluate your family’s needs and shop around. There are several health care discount plans out there to resolve from and you want to choose the proper one for you.
Make sure that the health care discount plan you choose has providers in your area. This is very important. Not all areas are covered by all plans. There should be a provider list available online. If you can’t find a provider list online, call the customer service number provided and have them mail you one. Call the providers on the list to make sure they aloof participate in the discount plan. Never buy a plan without verifying that they have participating providers in your area.
Determine whether the discounts you receive will be worth the cost of the plan. Consider whether the cost of the plan will be more than the discounts you will receive. The plan provider should disclose a full list of discounts and benefits as well as a break-down of all the costs and fees interested with purchasing said plan.
Additionally, be sure to get a definite explanation of the payment rules from the plan provider. Find out if you are given the discount at the time of service or if you will have to pay in full and wait for reimbursement. Also, ask if the plan has rules for pre-authorization before hospital stays. It is crucial that you understand how your plan will work before you execute a decision to buy.
Health care discount plans are not a cure all for an uninsured/underinsured America, nor were they ever intended to be. They can, however, be a band-aid if properly utilized.