Saturday, January 30, 2010

YouTube - Health Care Reform: 450,000 Doctors Can't Be Wrong

YouTube - Health Care Reform: 450,000 Doctors Can't Be Wrong

Friday, January 29, 2010

Spending more money on your health care than needed

Do you know your policy's health insurance benefits, deductibles, out-of-pocket limits and co payments? If you think you have an idea but somewhat unsure, then you may be spending more money on your health care coverage than what's actually needed.

Who manages your checking account? The bank, you, or both? The same analogy applies to your health care costs and benefits. Your health insurance is a partnership between you, the medical providers and the insurance company. If you are not involved in the equation, you could underminine yourself by paying a co payment that is not required, spending more than the out-of-pocket maximum expense, or exceeding the annual deductible.

Keep your medical expenditures intact.

An annual deducitble is a specific amount of money paid on as you go basis (doctor office visits) or in one lump sum (hospitalization), before the insurance company participates in the cost of your health care expenses. The carrier only becomes aware of the medical expenditures incurred when you file a claim against your annual deductible. Be sure to include your receipts and keep a copy for yourself. Be aware there are some medical benefits, whereby the annual deductible is not required for immediate access to the benefit.

Once you have met your deductible, then you are eligible to cost share with the insurance carrier for approved medical expenses. Assuming, you have an 80/20 policy, 80% of the costs will be paid by the insurance company and the remaining or 20% will be paid by you. Hence, for example, on a medical bill of $100, your share will be $20.

The cost-share or the 20% from the example given above has a maxium dollar amount or an out-of-pocket limit. Let's assume it is $2500. When your 20% equals $2,500, the good news is that the carrier becomes 100% responsible for the covered medical expenses up to the policy's lifetime maximum, if any. Be aware that co payments and deductibles are usaully not considered an out-of-pocket expense.

To summarize, the steps are, 1) meet your annual deductible, 2)cost-share up to the out-of-pocket limit, and 3) once you have met the prior steps in order of sequence, the insurance carrier covers 100% of the eligible medical expenses up to the applicable policy maximum.

Most insurance companies provide their membership access to online resource tools to assist their memberhsip with information about their health insurance benefits, claims or topics of interest. This is a superb way to manage your coverage or become aware instanteously of the claims made against your benefits by providers and the amounts paid or denied by the carrier.

Information is power. Be familiar with your annual deductible, out-of-pocket and benefits co payments and their applicabilty; particularly, to assure you're in balance with your share of the financial responsibilty.

Tuesday, January 26, 2010

Massachusetts vote spoke with fork tongues

Massachusetts voters may have spoken in wanting less government as most political analysts reported. But, let me play the devils advocate and extrapolate on one subject matter, health care coverage and government intervention.

It appears that Massachusetts resident's vote spoke with 'fork tongues'. Massachusetts enacted legislation in 2006, under then Governor Romney (R) that mandated Massachusetts residents to have universal health care coverage through an individual mandate. Individuals unable to afford the premiums are provided a government subsidy to obtain coverage; resulting in 98% of its residents as insured.

A recent Kaiser report findings indicates that Massachusetts residents are content with the passage of universal health care mandate even though premiums are higher. Understandably, the mandate requires acceptance of all pre-existing medical conditions; consequently, raising the insurance carrier's exposure to increase medical claims and premiums.

The same intervention applies to workers that receive employer provided health care coverage. Employer provided health care plans takes into consideration the groups claims experience versus an individual health plan where the monthly cost imposed is the sum of one versus the sum of all. We pay for each others medical history-good or bad. The federal government mandates through the passage of HIPPA not to discriminate and accept pre-exisitng medical conditions such as newborns born with birth defects or pregnant women, requirement of employer premium participation, and the right to the continuation of our employer sponsored coverage after we loose our jobs or a divorce or another qualifiable life event.

In health care, there are inequalities and government involvement is appropriate. If not, we the people, couldn't afford to pay or obtain health care coverage if we could.