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Archive for the ‘Medical Insurance’ Category

Medical insurance can be complicated enough – for seniors, it seems the
picture is often more confusing. Most seniors don’t work and many are in ill
health or have special medical needs. And many seniors rely on government funded
assistant living facilities – an estimated 1 million seniors live in around
30,000 assisted living facilities throughout the country.

Most seniors qualify for either Medicare or Medicaid, depending on their income
and situation. Medicare is available to those who are at least 65 years old, and
have legally lived in the US for at least 5 years before applying. Medigap
insurance is supplemental health insurance taken out by some seniors as a way of
supplementing their Medicare insurance.

Medicaid is funded by the government and administered by individual states under
their department of insurance. Qualification for Medicaid also depends on an
individual’s assets, income and type of residence. Medicaid will usually cover
most or all of the costs of nursing home admission and the accompanying care
that is necessary.

Some seniors, because of a particularly low income or a specific disability, may
also qualify for Supplemental Security Income (SSI) a program administered by
the Social Security Administration. This program offers several benefits
including providing monthly supplemental payments, food stamps and assistance
with hospital visits and drug costs.

If you don’t qualify for Medicaid, what is known as long term care insurance can
be purchased for long term stays in nursing homes or assisted living facilities.
If you are shopping for long term insurance, you should consider what other
benefits are covered under the plan, the costs of premiums and whether the
policy covers pre-existing conditions.

Seniors may also find themselves using the services of Health Maintenance
Organizations (HMOs) HMOs generally accept Medicare payment and offer lower cost
deductibles or co-payments. They also put an emphasis on preventative medicine
as well as the actual treatment, and many provide eye care, dental services and
emergency care when necessary.

One would be hard pressed to impart actual figures relating to the medical malpractice insurance rates since there is a host of variables which apparently influence the cost of such insurance. It is adequate to say that the outlay has exceeded any expectations from the medical profession. Unfortunately, there appears to be no leveling out of these rates at this time.

The common medical practitioner who is initially purchasing their malpractice insurance is questionably shocked to discover their premiums recurrently rising. This increase in rates is not restricted to any one medical discipline but rather it is a reflection upon the medical industry as a whole. Between the bizarre jury monetary awards and the intensified legal defense costs the medical malpractice insurance market has been forced to repeatedly adjust the medical rates accordingly.

It has been many years now since the physicians have experienced a stable rate in their malpractice insurance and it is likely that they will not see this desperately needed leveling within the near future. Concern has been naturally expressed regarding the incorrigible adverse patient outcomes which symbolize the underlying factor for determining the physicians expected rates. The likelihood is eminent that such adverse reactions to these medical outcomes will ultimately result in legal actions is the major cause of these increased rates.

When a claim is initially submitted there are numerous cost influences which have a propensity to shape the final outcome. These factors stretch from the nature of the grievance, the complete extent from which the provided caretaker is able to be legally defended as well as the compliance of the doctor himself to participate in his own defense. In our society today the irregularity of jury awarded claims has driven settlement costs sky-high and the attitude towards the doctor’s proficiency fosters a legal environment where the liability insurance companies and the policyholder’s would prefer to merely settle the cases out of court.

Probably everyone in Dallas Fort Worth knows someone who had a major illness or accident that wasn’t totally paid for by their company’s group health insurance plan. Group health insurance rates have climbed abut twelve to fifteen percent per year, and employers have had to raise deductibles and coinsurance to reduce the expense.

The result is that today, employees in Dallas Fort Worth with group health insurance have two to three times as much financial risk from a major medical accident or illness claim as they did a decade ago. An employee with a family working for a company with group health insurance is often exposed to over $10,000 in major medical expense risk, and there appears to be no end in site to rate increases and deductible increases. And today in Dallas as in the rest of the country, medical expenses are the highest reason for personal bankruptcy.

With that as a backdrop, Colonial Voluntary Insurance introduced in Texas in August a new medical gap plan that takes the “bite” out of major medical expense risks. What medical gap plans, or medical insurance gap plans do is pay the employee cash to cover major medical insurance claims. Thus the employee has the money to cover their medical bills, and the employer has an employee who is more productive and not as stressed.

The Colonial medical gap plan is very affordable, and has a number of options that allow the employee to reduce much or all of their group medical insurance plan’s out of pocket risks. Like most of Colonial’s products, the new medical insurance gap plan is a group product that is offered by the employer, and the employee can purchase voluntarily and have deducted from their pay check.

Dallas area employers can also purchase and pay for the Colonial Life and Accident medical insurance gap plan for their employees. In fact, by combining Colonial’s medical gap plan with a high deductible group health plan, we have found that employers can lower their employee’s medical out of pocket expense risk at a lower cost than if they purchased a group health health insurance plan with a lower deductible.

Colonial even offers a version of the new medical gap plan that is compatible with health savings account group health insurance plans as well as traditional copay group health insurance plans.

Medical gap plans offer Dallas area employers another way to offer their employees more benefits and save money.

California is one of the largest health insurance markets in the United States as many companies offer medical insurance plans in the state. In order to offer insurance in the state, a company must have a license from the state of California. This is a highly regulated process in order to ensure that insurance carriers have substantial assets and the necessary infrastructure to offer health insurance. General insurance companies like Aetna, New York Life, Prudential charge higher premiums. These general carriers do not have any specialized delivery mechanisms and usually third parties administer their plans. Specialized insurance giants like Blue Cross and Blue Shield are able to keep costs down with local delivery infrastructure and therefore offer lower premiums to the consumers. Health Maintenance Organizations (HMO) such as Kaiser and HealthNet maintain premiums even lower than the specialists and therefore, have developed a giant share of the market. HMO organizations manage to have such low premiums as they intervene in the health care delivery process as well. In some cases, for instance where carriers run their own delivery centers in California, as Kaiser does, it becomes quite possible to offer such inexpensive rates.

Medical insurance has multiple components and can be underwritten by specialized providers. Dental and vision insurance plans are some examples of this specialized underwriting. The terms of these plans vary widely as do their underwriting guidelines. Therefore, consumers have to be careful about the kind of plan they choose. There are also specialized carriers offering packages that specifically cover disability.

For those who cannot afford health coverage but are eligible for medical aid, the State of California provides a state government driven program. The state of California runs its own facilities to deliver medical benefits to medical recipients.

Health insurance is a cheap kind of contradiction in terms. Premiums for medical insurance, whose health continues to grow and many people can not afford it. There are ways to lower the cost of your health care and this article will explain some ways.

First – Take care of your health, eat some healthy food like fruit and salad. Most companies lower premiums if the client is healthy. If you do not smoke then, drink alcohol, you can get a lower rate. If your weight is normal, then the bands you can expect a reduction.

Second – Increase your deductible to get low-priced rates. The majority companies now obtain deductibles as high as twenty-five thousand dollars and premiums are very low. This choice is better than no coverage. If you can not afford to get health insurance then consider getting a policy with a high deductible.

Third – Shop online. Many people believe that submitting a health insurance company is the same as others. The fact is that many businesses seek more customers and lower interest rates in hopes of getting more business. I recommend using a service that provides estimates of several quotes from reputable companies so you can compare. I have seen quotes ranging from hundreds of dollars. So the lesson is that you should do the trick.

Cheap medical insurance quotes are available if you change your habits; increase the deductible, and shopping. In today, world can not afford not to go around. To get medical insurance with low price is not impossible.

If you recall, we explained that there are two broad categories of health insurance policies: disability and medical expense. Thus far we have covered disability. Now we’ll take a look at basic medical expense insurance.

Basic medical expense policies provide for medical expenses that result from accidents and sickness. This is a loose term that refers to various medical, hospital and surgical benefits.

The broad category of medical expense coverage provides a wide range of benefits for hospital, surgical and medical care. Other benefits may apply as well, such as private nurses, convalescent care, and more.

Policies may be written as such that they may be limited to only one or two types of coverage like hospital or miscellaneous medical costs or surgical expenses. These are known as basic plans.

Other, more broadly written, policies may cover all expenses resulting from accident or illness using some specific exceptions.

Medical plans include fee-for-service wherein doctors and other providers receive a payment that does not exceed their billed charge for service provided.

Prepaid plans provide medical or hospital benefits in the form of service rather than dollars. Many things need to be considered when selecting a medical expense plan such as:

Specified coverage versus comprehensive care. In other words does the plan feature only specific benefits or is the coverage comprehensive?

Any provider versus a limited number of providers. Are you required to choose from a specific list of providers?

National versus regional operation. Is the plan limited to a specific geographical region or operate nationwide?

Insured versus subscribers. Are participants considered insureds (the person who receives the benefit) or subscribers (the person who is paying the premium)?

We are going to take a look at the limited coverage for hospital, medical and surgical expenses. Discussing this separately first, will help you to understand how the components are combined in major medical and comprehensive policies.

The broad definition of basic medical expense insurance in most states includes hospital, medical and surgical expenses. The purpose of this type of insurance is to cover a broad range of medical, hospital and surgical expenses as well as separate categories of medical expenses.

Let’s explore individual versus group coverage.

No matter how a policy is written, narrowly or broadly, medical expense insurance is designed to reimburse for the cost of care whether it results from injury or illness.

Both individual and group policies are available to consumers. Normally individual policies are more costly along with having limited benefits but generally speaking, both types cover the same medical services.

Hospital expense benefits provide for expenses incurred during

hospitalization. Indemnities usually fall under two broad groups:

* Room and board – including nursing care and special dietary requirements

* Miscellaneous medical expenses – including x-rays, lab work, medications, medical supplies and operating and special treatment rooms

In some cases, benefits might be included for certain surgeries and related costs like pain killers given during a hospital stay.

Room and board benefits may be paid based on indemnity or reimbursement depending upon the particular policy. When paid on an indemnity basis, the insurer pays a specified rate per day that has been pre-determined and is laid out in a schedule within the policy.

The schedule will spell out the details of the benefit coverage as it pertains to length of stay. Once the length of stay has been exhausted, no more benefits are available. These are sometimes called dollar amount plans and typically the number of days is from 90 up to 365.

More commonly used is a reimbursement basis, also known as an expenses-incurred basis. With this type of coverage the policy will pay in one of two ways – the actual charges for a semi-private room or a percentage of the actual charges. There are no specific dollar amounts but a maximum number of days will still be specified.