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Affordable Healthcare: Can It Happen To You?

Affordable Healthcare: Can It Happen To You?

By Irina

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The author grants permission to publish this article, in

its entirety, electronically or in print, as long as the

bylines are included. A courtesy copy of your publication

(or, at least, an e-mail notification) sent to

irbonness@ureach.com will be appreciated.

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Let's face it - an apple a day is no longer an adequate

substitute for the professional healthcare services. And

after the doctor leaves, someone has to reach for a wallet.

Accept this undeniable fact of life and make necessary

arrangements BEFORE you get into a car accident, suffer

intolerable toothache, or become pregnant.

The cold reality of healthcare in this country is that you

do not have any legal right to it. There are no state or

federal laws mandating employer-paid or -subsidized health

benefits. So if you (or your spouse) have a complete and

reasonably priced health coverage through your employer -

BE GRATEFUL... and find some better use for your time than

reading this article. (I would still suggest saving it -

just in case...)

For those who keep on reading, health insurance is

available on an individual or group basis, but don't be

fooled by the terms! INDIVIDUAL insurance usually covers A

GROUP of people (entire family), and many GROUP health

plans will cover "a group" of ONE. In both cases you are

the only one paying (individually!) for the coverage. So,

what's the difference? From a consumer's point of view, the

big advantage of group health insurance plans over

individual is that they can't turn you down because of

health problems.

Of course, the ABILITY to get into a health insurance plan

is one thing. The AFFORDABILITY is quite another! Let's

begin with some basic terminology (or should we call it

deceptive lingo?) used in the health insurance industry.

Here are major plans with unique features to consider while

making your choice:

HMO - Health Maintenance Organizations

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The least expensive, but also the least flexible of all the

health insurance plans.

Advantage:

- Low co-payments, minimal paperwork, and coverage for

some preventive-care and health-improvement programs.

Disadvantages:

- You must choose a primary care physician, also known as

a PCP.

- HMO requires that you see only network doctors, or they

won't pay.

- You must get a referral from your PCP to see a

specialist.

POS - Point Of Service plans

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More flexible than HMOs, but they also require you to

select a PCP.

Advantages:

- You may visit a doctor outside the network and still

receive coverage; but substantially less than if you

stayed within your network.

- Offer more preventive care and well-being services, such

as workshops on smoking cessation and discounts to

health clubs.

Disadvantages:

- You must choose a PCP.

- If you don't receive permission from your PCP, you're

likely to wind up submitting the bills yourself and

receiving only a nominal reimbursement - if any.

PPO - Preferred Provider Organizations

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Give policyholders a financial incentive - reasonable co-

payments (also called co-pays) - to stay within the group's

network of practitioners.

Advantages:

- The standard co-payment is $10 for a routine office

visit during regular hours.

- You may go to any specialist without permission, as long

as the doctor participates in the network.

Disadvantages:

- If you see an out-of-network doctor, you may have to pay

the entire bill yourself, then submit it for

reimbursement.

- You may have to pay a deductible if you choose to go

outside the network, or pay the difference between what

network doctors charge vs. out-of-network doctor's

charge.

FFS - Fee-For-Service plans, also called Traditional

Indemnity

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Offers flexibility in exchange for higher out-of-pocket

expenses, more paperwork, and higher premiums.

Advantages:

- You may choose your own doctors and hospitals.

- You may visit any specialist without getting permission

from a primary care physician.

Disadvantages:

- There's a deductible (from $500 to $1,500) before the

insurance company starts paying claims, and then doctors

are reimbursed about 80 percent of the bill while you

pick up the remaining 20 percent.

- You may have to pay up front for medical services, then

submit the bill for reimbursement.

- FFS plans pay only for "reasonable and customary"

medical expenses. If your doctor charges more than the

average for your area, you will have to pay the

difference.

Depending on what you choose, you might end up with either

EXPENSIVE or VERY EXPENSIVE plan. Here are some practical

ways to reduce the high (and constantly rising!) cost of

health care if you are unemployed, self-employed or work

for an employer that doesn't offer health benefits:

- If you feel comfortable buying online, you can often save

on broker and agent fees. Sometimes, this will translate

into premium savings for policies purchased over the

Internet.

- If you can afford to do so, pay your premiums annually

rather than monthly or quarterly to avoid service fees and

to take advantage of prepayment discounts where available.

- Take advantage of the group buying power. Check out your

local chamber of commerce, trade and professional groups

and small and home business associations relevant to your

particular profession. Many of them offer access to

discounted health insurance. Here are some links:

National Association for the Self-Employed

http://www.nase.org/nase_benefits/health_benefits.asp

American Association of Home-Based Businesses

http://www.aahbb.org/benefits.htm

Home Office Association of America

http://www.hoaa.com/allbenefitsnew.htm

National Business Association

http://www.nationalbusiness.org/NBAWEB/Directory/Internal_Pages/Member_Benefits/Health.htm

- Increase your deductible. This obviously depends on you

risk tolerance. The general rule of thumb is that by

increasing your deductible from $100 to $2,000 you can cut

your premium payment in half.

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- Use new tax laws. The self-employed can write off 70% of

their health insurance premiums in 2002. This increases to

100% in 2003.

- Use Medical Savings Accounts or MSA. Under the Health

Insurance Portability and Accountability Act (HIPAA), self-

employed individuals are eligible for a medical savings

account. MSA works nicely in conjunction with higher

deductible health insurance policy to reduce premiums and

allow you to use pre-tax dollars to pay for your medical

expenses. Basically, you reduce your premium by increasing

deductible and use the savings to make fully tax-deductible

contributions to your MSA. You can contribute up to 65% of

the deductible each year into your MSA (75% for families).

The money goes into a tax-deferred account or trust and you

pay your medical expenses by drawing from the account.

Once you hit the deductible, of course, the insurance

policy kicks in.

All the above is helpful if you're able to get health

insurance in the first place. What if a pre-existing

condition disqualifies you from getting insurance at any

price? There are still some options to consider.

HIPAA may offer some protections. For more information

visit

http://www.hcfa.gov/medicaid/hipaa/content/hipsteps.asp

State-funded high-risk health insurance plans, also known

as Risk Pools, are an important safety net for individuals

denied health insurance because of a medical condition.

They're available only in 29 states though. For more

information on risk pools in your state, contact your state

health insurance department, the national association

"Communicating for Agriculture and the Self-Employed"

(1-800-432-3276) or visit

http://www.selfemployedcountry.org

Last but not least, consider possible NON-INSURANCE

solutions to minimize your out-of-pocket healthcare

expenses. Through the various Healthcare Savings Programs

you can access the same networks of healthcare providers

(for the same negotiated rates!) that large insurance

companies use. No long-term commitment is required on your

part and the service is available for a modest monthly fee

that is only a fraction of a health insurance premium. To

make them even more attractive, these programs accept all

pre-existing conditions. For example and details see

http://www.careentree.com/310559

Finding adequate healthcare coverage might seem

overwhelmingly elusive like hitting a moving target, but

learning the basics and knowing where to start can make the

process less painful and even save you money. No matter

which (if any) of my suggestions you decide to follow,

please eat at least one apple a day! Not for the alleged

ability of the fruit to keep a doctor away - just because

it tastes good!

Copyright (C) by Irina 2003.

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About the Author:

Irina runs home-based business helping people save on

healthcare and create steady stream of residual income

working from home

http://www.megaone.com/hbb/savemoney/

mailto:imakemoney@freeautobot.com

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About the Author

Irina runs home-based business helping people save on

healthcare and create steady stream of residual income

working from home

http://www.megaone.com/hbb/savemoney/

mailto:imakemoney@freeautobot.com