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With the cost of health care continually on the rise here are some items to keep in mind when looking to purchase Health Insurance.


Are there different kinds of health insurance?

What should I consider when picking a plan?

What can I do if I become unemployed and want to keep my insurance?

What about Long Term Insurance is that right for me?

Are there different kinds of health insurance? ↑TOP↑
There are essentially two kinds of heath insurance -- Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.

1. Fee-for-Service.
These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.

2. Managed Care.
More than half of all Americans have some kind of managed-care plan. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.

What should I consider when picking a plan? ↑TOP↑
If your employer gives you a choice of plans or you need to purchase your own coverage, it is crucial that you understand your health insurance choices and pick the insurance that is best for you and your family.

Here are some questions you should ask yourself when choosing a health insurance plan:

How affordable is the cost of care?

What is the monthly premium I will have to pay?

Should I try to insure most of my medical expenses or just the large ones?

What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?

After I’ve met my deductible, what percentage of my medical expenses are reimbursed?

How much less am I reimbursed if I use doctors outside the insurance company’s network?

Does the insurance plan cover the services I am likely to use?

Are the doctors, hospitals, laboratories and other medical providers that I use in the insurance company’s network?

If I want to use a doctor outside the network, will the plan permit it?

How easily can I change primary-care physicians if I want to?

Do I need to get permission before I see a medical specialist? What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?

If I have a preexisting medical condition, will the plan cover it?

If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how will the plan treat it?

Are the prescription medicines that I use covered by the plan?

Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment? Does the plan cover the costs of delivering a baby?

What is the quality of the insurance plan I’m looking at?

How have independent government and non-government organizations rated the plan?

For example, the National Committee for Quality Assurance ( http://www.ncqa.org ) issues a Consumer Assessment of Health Plans (CAHPS) report for every medical plan and facility. What kind of accreditation has the plan received from groups such as NCQA or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ( http://www.jcaho.org )?

How many patient complaints were filed against the plan last year and how many were upheld by state regulatory agencies like the state insurance commission or the state medical licensing board? How many members drop out of the plan each year? State insurance departments keep track of “disenrollment rates.” Do the doctors, pharmacies and other services in the plans offer convenient times and locations? Does the plan pay for preventive health care such as diet and exercise advice, immunizations and health screenings? What do my friends and colleagues say about their experiences with the plan? What does my doctor say about his or her experience with the plan?

What can I do if I become unemployed and want to keep my insurance? ↑TOP↑

If you switch employers, you have the right to carry your group health insurance coverage with you to a new job for up to 18 months under the Congressional Budget Reconciliation Act (COBRA).

You must pay the full premium, but at group rates that are far cheaper than the individual rates you would pay for similar coverage. Health insurance under COBRA is available if you are in these situations:

1. You leave a company and become unemployed or self-employed for up to 18 months. You are a widow or widower or child of an employee who dies while working for the same company for three years or more.

2. You are the divorced spouse or child of an employee who has left the company he or she was employed at for at least three years.

3. You are the child of an employee who left a job and have not yet reached age 23.

NOTE: If you need COBRA benefits, you must fill out the appropriate forms from your employer’s benefits department within 60 days of leaving your job. If you do not act within that time, you may be denied coverage.

What about Long Term Insurance is that right for me? ↑TOP↑
The average cost for one year in a nursing home is $40,000, but can be close to $100,000 in some big cities. Round-the-clock care at home can be just as expensive. Medicare does not pay these bills beyond a short period of time after a hospital stay. Health insurance rarely pays any of the cost. Unless you have so little money that you will qualify for Medicaid, or so much money that you can pay the bills out of your own pocket, you should consider long-term care insurance.

Four key reasons to buy long-term care insurance

1. Preserve your assets for your family instead of spending the money on long-term care.

2. The odds are one-in-three that a man over 65 will need long-term care; for a woman over 65, the odds are one in two.

3. New rules make it hard to qualify for Medicaid.

4. Premiums may be partially tax-deductible.

Typical policy features

The best policies pay for care in a nursing home, assisted living facility or at home. Benefits are typically expressed in daily amounts, with a lifetime maximum. Some policies pay half as much per day for at-home care as for nursing home care. Others pay the same amount, or have a "pool of benefits" that can be tapped as needed.

Elgibility triggers

Make sure you know when benefits kick in. The policy should state the various conditions that must be met.

1. The inability to perform two or three specific "activities of daily living" without help.These include bathing, dressing, eating, toileting and "transferring" or being able to move from place to place or between bed and chair.

2. Cognitive impairment. Most policies cover stroke, Alzheimer’s and Parkinson's disease, but other forms of mental incapacity may be excluded.

3. Medical necessity, or certification by a doctor that long-term care is necessary.

4. Prior hospitalization. Some older policies require a hospital stay of at least three days before benefits can be paid. This requirement is very restrictive and should be avoided.

5. A benefit period that may range from two years to lifetime. You can keep premiums down by electing coverage for three to four years -- longer than the average nursing home stay -- instead of lifetime.

6. A waiting or "elimination" period. Premiums will be lower if you pay for an initial period of care yourself instead of electing first-day coverage.

7. Inflation protection is an important feature, especially if you are under 65 when you buy benefits that you may not use for 20 years or more. The best inflation provision compounds benefits at 5% a year.

8. Guaranteed renewable policies must be renewed by the insurance company, although premiums can go up if they are increased for an entire class of policyholders.

9. Waiver of premium, so that no further premiums are due once you start to receive benefits.

10. Third-party notification, so that a relative, friend or professional adviser will be notified if the policyholder forgets to pay a premium.

Optional features

1. Restoration of benefits. This feature ensures that maximum benefits are put back in place if you receive benefits for a time, then recover, and go for a specified period (typically six months) without benefits.

2. Nonforfeiture benefits return a portion of premiums or keep a lesser amount of insurance in force if you let the policy lapse. This provision, required by some states, adds to the cost of the policy.

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