What kinds of health insurance are there?
There are essentially two kinds of heath insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.
These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
- Managed Care
More than half of all Americans have some kind of managed-care plan1. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.
The Patient Protection and Affordable Care Act (PPACA), signed into law in 2010, is predominantly focused on lowering the number of uninsured Americans and reducing the cost of health care in the United States.
How will health care reform affect you?
- Health care will be available and affordable for individuals with pre-existing conditions. Starting in 2014, cancellations and non-renewals based on chronic illness are illegal. This includes both adults and children.
- Preventative services, such as diabetes and blood pressure screenings, will be available at no cost.
- Children can remain on their parents’ plan until age 26.
- Small businesses will receive a tax credit to offset the burden of offering health care in comparison to larger companies that can afford employee benefits.
- An 80/20 rule will force insurance providers to spend at least 80 percent of premium dollars on medical treatment, rather than advertising and executive bonuses. If they do not meet this requirement, they must offer a rebate to customers.
- Lifetime and annual dollar limits on essential medical treatments will be phased out by 2014, which means that consumers will no longer be denied coverage once their medical expenses reach a certain dollar amount.
- The gap, or donut hole, in Medicare’s Part D prescription drug program will close in 2020, making drugs more affordable. Until then, seniors will receive savings on both brand-name and generic drugs.
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Vision insurance refers to a contract between a consumer and an insurance organization which provides vision care in return for a premium. In exchange for their premium payments, consumers usually receive eye examinations (given by doctors and clinics contracted with the insurance organization) and corrective eyewear. Exactly how much of the fees are covered varies according to the specifics of the plan.
Even if you have perfect vision, proper preventative eye care is an essential practice towards ensuring the health of your vision in the years to come . The most important step is receiving routine examinations from a qualified eye care professional. Individuals between the ages of 20 to 40 are recommended an exam every 5 years or so, provided no visual changes or injury has occurred. Individuals over the age of 40 should have an exam every 2 years or so.
Plan features and benefits will vary depending on the provider, but features typically discounted include:
- Eye examinations
- Surgical procedures - including Lasik procedures where available.
- Contact Lenses
- Non-prescription sunglasses
What is 'long-term care'?
Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed). These six actions are called Activities of Daily Living–sometimes referred to as ADLs. In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need “long-term care.”
Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.
Many people think that long-term care is provided exclusively in a nursing home. It can be, but it can also be provided in an adult day care center, an assisted living facility, or at home.
Assistance with ADLs, called “custodial care,” may be provided in the same place as (and therefore is sometimes confused with) “skilled care.” Skilled care means medical, nursing, or rehabilitative services, including help taking medicine, undergoing testing (e.g. blood pressure), or other similar services. This distinction is important because generally Medicare and most private health insurance pays only for skilled care–not custodial care.
What are the types of disability insurance?
There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):
- Short-Term Disability policies (STD) have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
- Long-Term Disability policies (LTD) have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.
- Non-cancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
- Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company. However, your insurer has the right to increase your premiums as long as it does so for all other policyholders in the same rating class as you.
- Additional purchase options
Your insurance company gives you the right to buy additional insurance at a later time for an additional cost.
- Coordination of benefits
The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
- Cost of living adjustment (COLA)
The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.
- Residual or partial disability rider
This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.
- Return of premium
This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.
- Waiver of premium provision
This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.
What is supplemental health insurance?
Health insurance goes a long way toward paying your medical expenses. Plus, it’s now required by law. However, even if you have a health insurance policy, you can still face out-of-pocket expenses like deductibles, co-pays and treatment. Supplemental health insurance can reduce that burden.
What are the benefits of supplemental health insurance?
Supplemental health insurance is not meant to replace primary health insurance. But, it can help pay some medical expenses once your primary policy has paid. These policies help cover expenses like the following:
- Outpatient services and hospital stays
- Critical illnesses and emergencies
- Private rooms and private duty nurses
- Deductibles and co-pays
- Unexpected childcare
Are your medical expenses too high? A supplemental health insurance policy may be a good addition to your healthcare coverage. Call us, and we can discuss this coverage in more detail to help you determine the best plan that will keep you in good health.