A dilemma people often face due to health insurance restrictions is in the choice of doctor. Most HMOs and EPOs do not pay for the cost of service or at least just pay a partial amount if the doctor consulted does not belong to the list of accredited doctors. What this means is that it limits the patient’s choice. However, this does not mean that the patient has no choice at all.
One of the best strategies for ensuring that you get the best health care possible while still managing to lower the costs through your health insurance policy is simply by researching the list of the HMO accredited doctors. Who knows your current primary doctor may even be accredited!
Another way is to go to the HMO accredited doctor/clinic for routine lab tests and checkups and to go to your own doctor for cases you think need special attention.
You can also visit your own doctor for a checkup and find out his initial diagnosis, then go to the HMO doctor for a second opinion (getting a second opinion is good practice!) then having all the other tests done care of the HMO. This way you only need to pay a consultation fee and still be at peace that you’re getting quality yet affordable care.
CHIPRA Big Help to Children’s Health
Earlier this month, President Obama signed the Children’s Health Insurance Program Reauthorization Act (CHIPRA). CHIPRA is meant to provide additional funding in order to renew the Children’s Health Insurance Program (CHIP), which provides low-cost insurance to children coming from families that do not qualify for Medicaid but cannot afford private health insurance. According to Health and Human Services Secretary Kathleen Sebelius, thanks to the signing of CHIPRA, 10 states will be able to share in the $100 million grant to “help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives.”
While rules and benefits vary for each state, basically those that qualify are all children up to age 19 whose families have incomes lower than $45,000 (even higher in some states). What many people do not realize though is that CHIP also cover pregnant women. This means that pregnant women can have the cost of lab tests, labor and delivery covered thru CHIP.
Tom Daschle announced as new nominee for Secretary of Health and Human Services.
We now know who the face behind the shaping of reforms to the health-care system will be – Tom Daschle.
President-elect Obama revealed in a new conference in Chicago on Thursday that former Senate majority leader Tom Daschle will be the new Health and Human Services Secretary and spearhead the health reform.
Tom Daschle is a good choice in terms of being well-versed in health policy and, of course, Senate procedure. However, some of his ideas regarding health care can prove to be very controversial, especially his idea of establishing a Federal Health Board, which will act like the Federal Reserve but in the field of health care. We’ll just have to see though if he will try to insert that in the future health care bill.
As for his commitment and zeal to provide health insurance to those who don’t have any coverage we can be sure that he cares very much. As he said, “Our growing costs are unsustainable and the plight of the uninsured is unconscionable.”
Being out of a job does not always mean having to do without health insurance as well. While waiting to be covered by Medicare you can avail of health insurance coverage under COBRA.
COBRA (Consolidated Omnibus Budget Reconciliation Act) is a way to provide continuation coverage to covered employees and their family after the employee…
- losses his/her job
- get reduced work hours
- dies
Instead of having no coverage, the employee has the option of getting coverage through COBRA. However, in most cases the employee ends up having to pay for the whole cost of the monthly premium. There is also a limited time for signing up for COBRA (usually max of 2 months from time insurance is lost) and the coverage only lasts for a limited time (18 to 36 months). The good thing is that while it is only for a limited time by the time coverage ends you will be covered through Medicaid.
Having adequate health insurance is very important but you should never forget that the prevention of health problems is of equal importance. As they say, an ounce of prevention is better than a pound of cure!
These days, health insurance is one of the buzz words with candidates going on and on about how they plan to make health insurance more affordable and accessible to the public. We don’t know for sure how their plans will pan out. What we do know though is that with the lifestyle that most Americans are now living, the fact that people will be needing their health insurance to cover health care costs is only a matter of when.
While we cannot prevent some illnesses, the sad thing is that many illnesses that plague people are very much preventable. It only takes a healthier lifestyle, starting with proper diet and exercise, to prevent a lot of health problems and even reverse some. In the end, I would rather never use my health insurance as long as I don’t get sick. How about you?
Limits and Exclusions
Child being given polio vaccine
When it comes to health insurance it is always of utmost importance not just to know the benefits but also the limits and exclusions.
Limits refer to the maximum amount an insurance company will pay to cover for health services of an individual. Most companies have a lifetime limit though some have an annual limit (usually job-based plans). What this means is that as soon as the limit is reached the insured person will no longer receive any of the benefits listed on the health insurance policy. There are also specific limits for some covered services, which sadly usually are the ones that incur a really large bill (i.e. chemotherapy, dialysis, etc.).
Exclusions, on the other hand, are services that are automatically not covered by the insurance policy. Some exclusions may be general, since the insurance policy is cheaper and does not cover a lot of things, or may be specific to an individual due to pre-existing conditions. Make sure you know the exclusions so that you can purchase a “rider” that will cover even your pre-existing condition, if available and/or allowed.
Shopping for Health Insurance
In health insurance, as in everything else, the best doesn’t always mean the most expensive. What is most important when choosing a health insurance policy is figuring out which best fits your needs, both health and financial needs.
So what can you do to make sure you get the best health insurance for you?
- The first thing you need to do is read the fine print. Find out exactly what each policy offers. Know the exact premium you need to pay, the benefits offered (and not offered), and exactly how much you need to pay before insurance coverage begins.
- Next find out exactly how much the services that are covered and how much you will need to pay after the deductible amount.
- You also need to find out how much you will need to pay for services that are NOT covered.
- Then do the math before answering the following questions. Will the insurance policy really save you money in case you get sick? By how much? And which one will give you more value?
Tax Breaks for Health Insurance Buyers
President Bush wants to give tax breaks to individuals who purchase their own health insurance.
The proposal was made by President Bush during his State of the Union address to Congress yesterday. Currently, employee-sponsored health insurance coverage is already tax deductibles but those that voluntarily purchase their own coverage do not get the same benefit.
The initiative, if passed, will not lower the cost of health care outright but will obviously make coverage more affordable for many. However, since even more people usually opt not to get health insurance coverage because they simply cannot afford the out-of-the pocket expense of having to pay for monthly premiums this will still leave millions without the ability to get covered. Still the several millions who will benefit from the initiative is still better than nothing.
According to President Bush he also wants Congress to pass the initiative within this year, which is also his last year in office.