Question of a Reader:
What are the things to bear in mind by senior people about health insurance?
Claire Redfield
Thank you for this question.
There are different plans for health insurance for seniors. One plan may differ from another. For example, many policies do not cover prescription drugs. But I think it would be better for you to consult an insurance agent to better study the preferred choice of long-term care insurance. Some policies offer fewer benefits for home care than those providing care in a long-term facility.
There is also a reimbursement policy which is cheaper and covers some, if not all, the out-of-pocket expenses up to a certain maximum limit. There is so-called an income policy, which is more expensive, that pays more benefits whether the services are rendered or not. The manner of the income spent is entirely depending on you.
It is advisable to check on the amount the home health care agencies, nursing homes and the assisted living facilities in your area are charging for their services before deciding on the benefit amount that you prefer. The amount of benefits that you are qualified for depends on the number of the daily living activities that you are capable of and better check if the policy states if it specifies clearly if you are unable to dress or feed yourself. Such benefits begin depending on the period you prefer when you purchase your policy. If you have a waiting period of ninety days and you only need a 3-day a week service, you have to wait for as much as seven months before such benefits may start. Policies containing the elimination period in calendar days may result in earlier benefits.
Inflation protection in a policy is vitally important. Having this kind of protection may usually increase the premium amount. However, it does not keep up with rising prices of cost of care as the benefits increases over time. The younger you are when you buy an insurance policy, the more it is significant to add such inflation protection.
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Question of a Reader:
My family and I are going out of the country. May I know what does the emergency health insurance cover?
Tom Sullivan
Thank you for this question.
When you are going on a vacation or long trips, you would hardly think that you will get injured or even get sick. You cannot avoid that; you need to get the best care possible while you are away from home.
If you already have a health insurance, you would want to check your insurance policy to see what kind of coverage is available while you are away from your own country. Better see if your regular health insurance offers no coverage; only 50% coverage is included for the medical expenses. It will also not cover you if you need to be evacuated back to your country.
The emergency health insurance covers the travel-related medical emergencies, regardless of your status as a businessperson, or a student coming home from school, or just a vacationer travelling even for a few days. You may be able buy insurance for the exact number of days that you will be going on vacation.
Whenever you buy an emergency insurance, make sure the policy covers any preexisting conditions that you may have. Be sure to include in the policy the emergency medical evacuation and even an emergency assistance phone number that you may call for assistance in finding a hospital or doctor if needed. You may also likely choose whether the policy may include other items like additional coverage for the baggage insurance, the trip cancellation insurance, and even the trip interruption insurance.
The most fortunate thing about emergency health insurance is that it doesn’t cost a lot. You may be able to get a cheap insurance rate by going to an insurance comparison website. While in the site, you just enter your travel information and your insurance needs, and quotes will be sent from class A insurance companies. Insurance professionals are even online to better get answers to all your possible questions.
Question of a Reader:
Will you please provide me some guiding factors in helping me choose a health insurance that is high risk?
Sam Smith
Thank you for this question.
High risk health insurance are self-funded, private health insurance plans that is set up by the state to help the high-risk individuals who meet the criteria set and do not have such access to group insurance. You may be able to apply for high-risk coverage through an insurance company or go directly with the state. Many choices of health plan options are laid out and you will be able to receive enrollment cards and other such information like any other health plan. These high-risk insurance plans normally set up a contract with a health insurance company or a third party administrator to handle all the paperwork and claims so that the enrollment card and other paperwork may not even show to be made by the high-risk pool. Once you are enrolled, you may be able to use your benefits like any other consumers of private insurance coverage.
Such coverage options look very much the same with the traditional individual health insurance offerings. Generally, it is a comprehensive major medical plan with a wide range of deductible options. The PPO plan is the most common risk option offered, although many states offer indemnity coverage to consumers. Most insurance also offer the coverage of prescription drugs, mental health, maternity, and substance abuse, among others. There are also excellent management programs on disease for enrollees showing that many people are catered due to chronic illnesses.
Like other individual policies, the high-risk policies contain such pre-existing condition waiting periods to prevent unfavorable selections. Such selection occurs when a person purchases a health insurance after he or she has a medical problem that requires the usage of such benefits.
High risk health insurance is also found online for the patients who are denied insurance coverage because of a very serious medical condition. By bringing together patients of the same condition and who requires high risk medical insurance, the coverage is offered at group rates by some states. Some states are also additionally compensated through the federal tax dollars. So to qualify for this coverage type, proof of denial by other insurers should be shown by the consumer.
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Question of a Reader:
What is the best health insurance plan for me?
Nancy Pallind
Thank you for this question.
Choosing among the best health insurance plans is not an easy task. There is actually a so-called best plan for all. It is entirely depending on the needs of each of us and every family. One plan is a best match for someone and not a best match for another person.
Bear in mind that some health insurance plans offer basic coverage to cover you just in case of an accident or a major illness like outpatient surgery coverage or primarily inpatient hospitalization, among others. These insurance plans have a much lower monthly premium payment than those plans with a more comprehensive coverage. These plans are appropriate for those people who have the sole purpose of using their insurance in the case of an accident or illness.
You may check in the short term coverage options just in case you are on and off jobs regularly. Otherwise if there are no prospects of getting coverage of a group health insurance through a possible employer, the importance of getting a health insurance plan through an individual and family will at the same time provide longer term coverage, increased benefits and stability.
Take into consideration the easy access to a specialist. This is especially vital in care coordination through a primary care physician in obtaining a referral before going to a specialist. If you like an easier access to specialists, a different type of plan may be considered.
If you have a health insurance plan with a high premium, normally the pay in co-payments and deductibles per the visit to the doctor is less. If the plan is with a low monthly premium payment, you will likely have a higher co-payment or deductible. If you foresee yourself going to the doctor or making use of your health insurance coverage frequently, maybe a higher deductible plan with a lower monthly premium is best for you.
The best way to choose the best health insurance plan in your area is to evaluate your one’s own needs. If you do not need medication, then you may not want to pay an extra amount for prescription coverage. Do not take the very first plan that is offered to you. Choose a plan that you really need. These different types of plans have different advantages and disadvantages that may or may not be beneficial to you. So be sure to research more to be able to get the right plan.
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Question of a Reader:
My wife is pregnant and we are wondering on how the pregnancy will be covered with health insurance. Thanks a lot.
Bud Dillingham
Thank you for this question.
It is much better to plan ahead to be able to make sure that your wife will be covered by a health insurance pregnancy. Try to get a health insurance before your wife gets pregnant. If you don’t have any insurance coverage for her at all, maybe you may get insured through a group plan. The new health plan that you are going to get does not have to be able to cover her pregnancy at once. You may be able to have her pregnancy covered maybe a couple of months after the offered coverage.
Research on the type of coverage her health plan has or even the prospective plan. Check on whether her plan will cover adoption, birth and pregnancy and the type of maternity, preventive and care for the baby the plan will provide. Potential employers should be asked if the health insurance offered will cover maternity. It is better for your wife to avoid going from one job to another if your wife is pregnant. It is possible to wait for a period of time for such maternity coverage if your wife begins a new job during her pregnancy.
It is best for your wife to apply for Medicaid if she is uninsured and the program’s requirements for the low-income should also be met. Get in touch with your state insurance department for further information on how to cover the pregnancy of your wife and inquire about other types of offered insurance plans that are low-cost.
A group health plan through present work or a professional group like the Catholic Charities or the Lutheran Social Service is best if one is personally uninsured and pregnant. Joining this kind of health plan is less expensive as compared with getting an individual insurance. They have available reduced cost prenatal services.
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Question of a Reader:
May I know some affordable alternatives of health insurances for individuals?
Bill Dawson
Thank you for this question.
You may be able to take advantage of available low cost alternatives of the traditional health insurance for individuals.
The individual’s cost of insurance will be lessened by joining the HMO. They are much cheaper than buying the traditional insurance policies. In having an HMO, you are limited in the doctor’s usage, and other physicians and specialists and hospitals that are approved by the organization. If you do not prefer to have limited choices of HMO, you have the option to choose the traditional health insurance for individuals. Just research some more and you will be able to get lower rates. If saving money and cutting cost is the priority, get the HMO as it is cheaper.
There is what is called a Preferred Provider Organization or the PPO. It is just like an HMO wherein it is usually lesser in price as compared with the traditional health insurance for individuals. As compared with the HMO, more choices are offered with the PPO but it is much more expensive. In choosing between the HMO and PPO, needs should be considered and the amount that will be saved in using either a PPO or a regular health insurance. If the cost of the insurance is the priority, you will be able to save more in using the PPO instead of getting the traditional.
You may also choose the traditional plan and pay fewer amounts as compared with other people if you do some more extensive research on insurance plans. You may compare quotes with the different insurance companies; maybe at least three quotes is enough. You may be able to get lower quotes if you have many choices of quotes to choose from. So, the more insurance companies you get from the quotes, the bigger the chances of obtaining the best rates on health insurance for individuals.
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Question of a Reader:
If you use a health insurance claim form, how does it work? Why is a health insurance claim denied sometimes?
Christine Heart
Thank you for this question.
A health insurance claim is a bill for the health care services that the provider for the health care refers to the insurance company for payment. Once you see a doctor, the claim for your insurance commences. Your insurance company will only pay the benefits that are covered by your policy. Better make sure that research should be done first to avoid any disputes or misunderstandings upon settlement with the doctor or when you buy medicines at the store. Ask your insurance representative anything that needs clarification. Policy should be read thoroughly so that the coverage may be studied well. This is vitally important especially when a treatment is needed and is not included in the policy.
After the payment, the doctor will send the bill to the insurance claims processing center. This processing center will gather all the important information from your doctor like the information sheet of the patient, health insurance claim forms and the documentation of the proper services. These claim forms is compared with the stated insurer’s benefits to check if the policy covers such services. If it meets the requirements, the insurance company will send the payment for such remaining balance. If it does not, you will have to pay the balance left after your co-pay.
The process is easy as most claims processes are very smooth, but there will also be some denied claims of health insurance. Such claims happen because the plan does not cover the actual procedure, or the medication or supply or the insurance company decides that it is unnecessary or experimental. You may even turn the denial of the claims to acceptance by calling the insurance company before the doctor’s visit and even reviewing carefully your policy.
So every time you go to a new physician, you just need to fill out long forms with all the insurance information, and then give out your insurance card to the receptionist.
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Question of a Reader:
Why do I prefer my high deductible health insurance plan over the traditional health plan?
David Turner
Thank you for this question.
It is advisable to get a health insurance while you are in good health. The consumers of health insurances will benefit by taking care of one’s body. Routine check up with the doctor and following their advice together with regular exercise will lessen the costs of health care in the future. By doing so, seeking medical care will be less frequent. With a high deductible health plan, better make sure that your deductibles will be the cause that you will lose any money in the future.
Now, let us compare the traditional plan with high deductible health insurance plan. The traditional plan actually has an individual deductible and an individual out-of-pocket limit amount of money. In addition, it is a copay-driven plan. In comparison, the high deductible plan has a higher deductible and also a higher out of pocket maximum amount. After all the deductible is met, a corresponding percentage amount of out of pocket is paid up to the maximum out of pocket amount. There are no copays and everything counts towards the deductible. This means that if you already meet the deductible, you have to pay the full cost of everything out of pocket including the prescriptions.
From a mathematical point of view, others will choose the traditional plan if they do not have plenty of money to pay the full costs of the visits to the doctor and the prescriptions. If you have small children, this kind of plan is not advisable for you. A high deductible plan is appealing to someone who uses the benefits minimally.
With a commitment to stay healthy, you really need health insurance coverage to bear the unexpected and unavoidable emergency situations.
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Question of a Reader:
My daughter will start college anytime soon. Her college is offering student health insurance. Is it okay to obtain that kind of services? What are the other precautions that should be taken into consideration?
Manny Hart
Thank you for this question.
Always be careful in signing up for a student health insurance through the school of your daughter. Some health policies for the students have low deductibles but with very low coverage limits. Remember that these policies may be dangerous to your finances in the long run—uncovered expenses may multiply and generate if your daughter eventually will encounter a major illness or accident.
It is better to have an insurance policy with a big limit on its maximum coverage. In addition, you may be able to maintain your daughter within the policy of the whole family up to age 25, on the condition that she is a full time student till that age. Some states even raised the age to 30 years old. Find out more about the rules beforehand from your insurance company. Research also whether the hospitals and doctors within her area are included as part of the network providers, or how much is the amount she has to pay if she gets a specialist out of the network.
You may raise the deductible so that the premium may be lower, which is a good deal for young healthy people like your daughter and other students like her who have just a few regular medical bills. They primarily need health insurance to cover much of the unexpected, bigger expenses like if ever, a major illness or accident. A policy with high deductible and high coverage limits will be able to do the best task of giving coverage at such an affordable price.
If your child is living in a dormitory, it is much easier. These children are covered by the homeowners insurance of the parents; better ask your insurance agent or insurance company if there are such limitations.
Ask also some information about discounts of auto insurance from your agent. If your daughter’s college is about 150 miles away from home and does not bring the family car with her, your premium on auto insurance may go down up to 30%. She will still be covered while she is home during school breaks.
Question of a Reader:
Is health insurance for students necessary?
Sue Choe
Thank you for this question.
Looking for a very affordable health insurance for students is such a valuable task. Just a lone major injury will cause medical bills to pile up and paralyze a person for many years even after such a major mishap happened long time ago. Most of the time, getting an insurance that will cater to the health of the students is important so that the students will have the medical attention they really deserve.
The student will really benefit from a medical insurance that they have since it gives out various advantages and benefits with complete coverage. The health insurance for students will lessen the worries on their health care. In each state, there are different instructions that need to be followed thus if you intend to get a specific health insurance plan, you should have an idea of the kind of policy that is possibly considered.
Even if one state differs from another in terms of health insurance plans, all the states are obliged in providing coverage for a healthy child physicals, and for a minimum healthy baby, the immunizations and emergency services that the child may need in the future. If you already have a health insurance policy for your children, your child may no longer qualify for the coverage of the state, even if it is under your group insurance or another insurance plan that you possess.
Possible research may be done if your children may not yet be available for state coverage. More often than not, it is easier and more affordable if you get an insurance policy covering your entire family. But you may prefer to get an individual policy if you have only one child.
The most common areas covered by the student benefit are: a visit to the doctor’s office, care of an ambulance, prescription services whether outpatient and inpatient (with certain limitations), hospitalization, even intensive care in other hospitals, laboratory services, surgical procedures done in the outpatient department, among others.
So as a student, your child has several options; the best option is to have your child be covered by an insurance policy. Most plans will have coverage for your child in the condition that the child is attending school and is actively enrolled.
Both students and the children require them to have health insurance coverage. It is important to find the right plan for your child and it will be very tedious indeed although it is not an impossible process.
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