This is an archive of every release we’ve done on a single page.

Understanding The Medicare Donut Hole

What is the Medicare “Doughnut Hole”? How is the Medicare Part D Doughnut Hole broken down in terms of dollars and cents? How will the Doughnut Hole effect me? If I receive a Low Income Subsidy from Medicare (i.e. extra help) how will the Doughnut Hole affect me? Will I hit the Doughnut Hole? When will I hit the Doughnut Hole? When will the average Medicare enrollee hit the coverage gap called the Doughnut Hole? Do I still have to pay my monthly Medicare Part D premiums while I am in the Doughnut Hole? What expenditures count towards the $2850 level that puts me into the Doughnut Hole? What is the reason that the government created a Doughnut Hole in the Medicare prescription plan? Will the Doughnut Hole be the same in 2015? How many people will hit the Doughnut Hole in 2015? What are out-of-pocket (OOP) expenditures? What expenditures do not count towards my out-of-pocket expenditures? What is the catastrophic coverage point? What other issues are there with the Medicare Part D program that may affect me? How can I avoid the Doughnut Hole?       What is the Medicare “Doughnut Hole”? The Medicare Doughnut Hole is the gap in the 2014 Medicare Plan D coverage between $2850 and $4550 in prescription drug spending. (Please see below for an important note on how your prescription drug spending costs are calculated.) During this gap in coverage, you’ll pay 47.5% of the plan’s cost for covered brand-name prescription drugs and 72% of the price for generic drugs. In 2014, this is a gap in coverage of $1700 that you must...

Double dose, Half Cost

Chicagoan Jonathan Winans, 75, is curtailing costs in this time of high gas and food prices, in part, by zeroing in on prescription costs. The retired Dominick’s deli manager has high blood sugar, high cholesterol, arthritis and a heart condition. He’s on a dozen medications, and his wife, Elaine, 76, is on the medication Plaquenil for her arthritis. “I have my doctor write prescriptions for pills at twice the dose and prescribe half a pill,” he said. Then Winans cuts the pills in half with a pill cutter. “Prescriptions last twice as long with just a little more cost,” he said. With the couple only having Medicare Part D prescription drug coverage, costs are a heavy burden, he said. That’s especially true when the “doughnut hole” kicks in for him in the last four or five months of the year, he added. Under Medicare Part D prescription drug coverage, Medicare will pay a percent of drug coverage, minus the deductible, up to a total drug cost of $3,700. After that, seniors have to foot the bill for the costs until they’ve spent $4,950 out-of-pocket and coverage resumes.   The Winans’ other cost-cutting ways: • • “I’ve learned to cut back on gas by ‘stacking’ errands and routing them to put on the least miles,” he said. “I’ll sit down and draw a little map and say, ‘Well, I’ll go to here to here to here.’ I’ll do all [the errands] on a Saturday or a Sunday so that I can get as many trips out of the way as possible with the least amount of mileage.” • • The couple also...

Texas Medicare Supplement Options

For those who are soon turning age 65, you are likely to be researching your options for Medicare health care coverage. In doing so, you will find that there are two primary options for obtaining this important health insurance. One option is to go with the Original Medicare. Here, you will be able to receive Medicare Part A and Medicare Part B. With Medicare Part A, various hospitalization services are covered, including certain inpatient procedures. Part B of Medicare covers doctors’ services, as well as some hospital outpatient services, and other miscellaneous care. The other option for receiving Medicare coverage, Medicare Advantage, is also referred to as Medicare Part C. With this Medicare option, you have numerous choices of health care plans. Many of these are set up in a similar manner to an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) where enrollees need to choose their providers and health care facilities from a network. The tradeoff, however, is that there are typically many more services that are covered in comparison to Original Medicare, such as dental and vision care. The premiums that are charged for Medicare Part C may also be less. Filling in the Gaps That Medicare Leaves Behind For those who choose Medicare Advantage, there are several items covered about health and wellness. And, while there may be some out-of-pocket charges, these will typically differ from one plan to another. Those who opt for Original Medicare (Medicare Parts A and B), however, will usually run into a fair amount of out-of-pocket costs. This is especially the case if the enrollee encounters many doctor visits...

Types of Medicare Advantage Plans

There are several different types of Medicare Advantage plans.   HMO (Health Maintenance Organizations) HMOs account for the largest share (64%) of Medicare Advantage enrollment and have been available under Medicare for several years. HMOs are the most tightly managed plans and utilize a defined network of providers that beneficiaries generally must use to receive care (with some exceptions, such as emergency care).  If you get health care outside the plan’s network, you may have to pay the full cost. Do I need to choose a primary care doctor?  In most cases, yes. Do I have to get a referral to see a specialist?  In most cases, you need a referral.  Certain services, like yearly screening mammograms, don’t require a referral.   PPO (Preferred Provider Organizations) PPOs also utilize provider networks. However, with PPOs, patients can choose to obtain care outside the network for a higher cost-share amount. Do you need to choose a primary care doctor?  No. Do you have to get a referral to see a specialist? No.  If you see a Plan specialists cost will usually be lower.   PFFS (Private Fee-for-Service Plans) PFFS plans are more flexible than HMOs and PPOs because they are not required to establish provider networks. Patients can see “any willing Medicare-approved provider” if the provider accepts the plan’s terms and conditions.  However, some PFFS Plans now have a network. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan’s terms, but you may pay more. Do I need to choose a primary care doctor?  No. Do I have to get a referral to see a...

The Difference Between MA and MAPD Plans

The Difference Between MA and MAPD Plans     Most (but not all) Medicare Advantage plans include prescription drug coverage. Plans that combine medical coverage AND prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans. It is important to understand the difference between MA-only and MAPD plans.   MA-only plans Replace Original Medicare Administered by private insurance companies approved by Medicare Offer medical coverage only (do not cover prescription medications) Patients can add prescription drug coverage by enrolling in a stand-alone prescription drug plan (PDP) MAPD‏ plans Replace Original Medicare Administered by private insurance companies approved by Medicare Offer combined medical and prescription drug coverage in one comprehensive...

2017 Medicare And You Handbook

Welcome to Medicare & You 2017. Since the health care law was passed more than 6 years ago, we’ve seen a transformation in this nation’s health care. We’ve covered 20 million more Americans, while providing higher-quality care at reduced costs. And now, the Quality Payment Program, the result of a bipartisan bill passed last year, builds on these improvements. This program helps make sure Medicare doctors are rewarded for providing improved care to you, instead of being paid based on the number of services they...

2016 Medicare Drug Price Comparison Tool

Use Medicare Help’s updated for 2016 Drug Finder Tool. It Helps you find the cheapest prices for all your prescription drugs by comparing all the plan prices for your drugs in your coverage area and provide you with more accurate cost estimates and coverage...

5 Tips to Choosing the Best Medicare Plan

With the open registration season for Medicare plans having started on the 15th of October, the time to choose a new 2016 Medicare Advantage or Medicare Part D plan is now. The registration is only open until the 7th of December, so time is most certainly of the essence. To help you make the best healthcare choices possible, here are five tips that will make your experience much easier. 1.) Get to know the MedicareHelp.org’s website Medicare.gov is a powerful tool, and it can help you find the best deals for your particular medical needs. However, it can also be very confusing, with a host of different buttons, options, and menus. Medicare Help’s platform keeps it simple, where you can see all your available plans and your costs on one screen.  And we provide the same information that Medicare.gov offers.  MedicareHelp.org could be useful in your search for the cheapest healthcare. 2.) Know your drugs There are many factors that could affect your payment with regard to your drugs. Their dosages, particular restrictions surrounding them (such as requiring prior authorization or step-up therapy), co-payments (flat payments that could drastically increase the cost of your plan), or a myriad of other factors could all change your plan. Make sure you know everything about your drug(s) before attempting to choose a 2016 Medicare Part D plan. The different combinations of drugs, dosages, pharmacies, regions, and more all affect the cost outcome. Finding the right 2016 Medicare Advantage or Part D plan for you personal health combination accurately could save you hundreds of dollars. 3.) Look at the quality ratings Each plan has a unique rating,...

2016 Medicare and You

We’re excited that 2015 marked the 50th anniversary of President Lyndon B. Johnson signing into law the Medicare program. Medicare has been protecting the health and well-being of American families and saving lives for five decades. Over the years, Medicare has grown and today provides quality health coverage for more than 50 million Americans. But we’re not stopping there. Every day, we’re working to make Medicare even stronger to offer you better care and to keep you healthy. Having Medicare provides peace of mind, but it’s also important that you’re getting the most out of your coverage. Use this handbook as a resource to help...

2016 Plan Directory

This directory contains information for Medicare Advantage, demonstration, PACE, and cost organizations that have an active contract with CMS at the time of the directory’s publication. These data have been extracted from the Health Plan Management System (HPMS), maintained by the Center for Drug and Health Plan Choice/Medicare Drug Benefit and C & D Data Group/Division of Plan Data (CPC/MDBG/DPD). This directory will be updated on a monthly basis. The plan directory contact data is maintained by each organization in HPMS. If an organization needs to update its contact data, the plan user should use the following navigation path in HPMS: HPMS Homepage > Contract Management > Contract Management > Select a Contract Number > Contact Data > Plan Directory Contact for Public Website. The enrollment number displayed in this directory has been pulled from the “Monthly Enrollment by Contract” file posted on the CMS public website. This enrollment number represents the number of enrollees for which the contract received payment for the month. As asterisk in place of the enrollment number indicates that the count is less than 10. Pilot contracts are excluded from this...

2016 Medicare Enrollment

All types of insurance are complicated to figure out, and Medicare is no less so.  There are certain things that may be useful to know if you are thinking of applying for Medicare next year, or if you would like to make changes from an already existing plan.  Medicare plans are often altered, with the costs, coverage, pharmacies and providers changing almost constantly.  Therefore, this is the period where you can re-evaluate whether a particular plan is good for you or not. Open Enrollment Period From the 15th of October to the 7th of December the Medicare Open Enrollment Period will be running.  It runs at the end of every year. During this time you can make changes to your Medicare plan, or, if you do not already have a plan, you can sign up for Medicare.  Usually, information for next year’s plans is released in October, giving you time to decide whether you would prefer a switch or not.  If you apply for Medicare in this period you will be covered from the first of January next year. During the Open Enrollment Period you can: Change your plan from an Original Medicare plan to a 2016 Advantage plan, or vice versa. Get drug coverage by signing up for a 2016 Part D plan. Get a new Part D plan if you are unhappy with the one you have now, or if circumstances have changed and you need to make adjustments in your plan. Definitions of Key Terms Original Medicare:  Original Medicare is a health insurance program funded and managed by the federal government.  If you are eligible and you get Medicare...

2015 Medicare Drug Price Comparison Tool

Use Medicare Help’s new Drug Finder Tool. It Helps you find the cheapest prices for all your prescription drugs by comparing all the plan prices for your drugs in your coverage area.

Medicare Advantage (Part C) Plans

About 6 to 12 months before most Americans turn 65, they are bombarded with junk mail offers for different Medicare-related insurance products such as Medicare supplements, Part D prescription drug plans, Medicare Advantage plans, annuities, and life insurance policies. It is no wonder that most consumers that are Medicare eligible are confused about the choices. It almost seems like some companies want you to feel that way. In this article, we will explain in layman’s terms exactly what a Medicare Advantage plan is, how it works, what they usually cost, and then, you can decide for yourself if they are right for you. What is the difference between a Medicare Supplement and Medicare Advantage Plan? • A Medicare supplemental insurance policy is a standalone health insurance policy that is purchased by seniors to cover some of the costs not picked up by traditional Medicare, the most significant cost being the 20% of Part B expenses not covered by Medicare. Also referred to as a Medigap policy, one of the most popular benefits is that you can use this kind of policy with any Medicare provider. You do not have to worry about networks or unexpected out-of-pocket costs. If you need prescription drug coverage, you would need to pick up a separate Part D drug plan, since Medigap policies do not cover outpatient prescription drugs. • A Medicare advantage plan also referred to as Part C, is a health plan that includes outpatient prescription drug coverage, also called Part D. Advantage plans have special times during the year when you can sign up called “Enrollment Periods.” If you fail to...

Humana Walmart RX Plans

Humana and Walmart teamed up back in 2010 to offer one of the most price competitive drug plans in the history of the Part-D drug program, and they have been going strong ever since. One of the reasons why their partnership is so successful is using a Walmart or Sam’s Club pharmacy to fill your prescriptions will get you the lowest cost possible for your prescription drugs versus going to any other pharmacy. Another reason for the success of the program is the four dollar generic prescription drug program that they have been pioneering for the last several years. Last but certainly not least, the cost of the drug plan is so low that pretty much any senior looking for a drug card can afford it, especially if they are only taking generic or low-cost brand drugs. For 2015, the premium for the  Humana Walmart RX plan is only $15.60 per month, with a co-pay as low as one dollar after the deductible is met if you fill your prescription at Walmart-branded pharmacies. What’s amazing is that some drugs can come at absolutely no cost to the consumer if they use mail order, after the deductible is met. The plan covers over 1,500 generic prescription drugs, which happens to be quite more than some of their competitors. The deductible this year for this drug card is $320, and this is for all tiers of drugs. It includes your tier 1 cheap generic medications as well.          ...

Seniors Cope With Drug Plan ‘Donut Hole’

Michigan seniors have been hit with the full cost of brand name drugs, thanks to new legislation. Effective this year, the law eliminated Medicare’s Part D prescription drug plans offering coverage during the gap period, dubbed the “donut hole.” People such as Janet Clapper, 72, of Battle Creek are finding out some of their brand-name drugs covered in 2006 are not covered this year. She said she reached the gap period around March or April and has had to dip into her savings for the about $700 a month cost of her multiple prescriptions. “I saved my money because I knew I’d need it when I got old, but now the government’s taken it all,” she said. Seniors eligible for Medicare in 2006 selected from a list of competitive Part D plans offered by private insurance companies to cover the cost of prescriptions. The sign-up period generally is Nov. 15 to Dec. 31 for coverage without penalty beginning the following year. But many seniors were shocked last year to discover coverage stopped when the total cost reached $2,251. Most seniors taking expensive, brand-name drugs ended up paying thousands of dollars out-of-pocket for prescriptions mid-year. The donut-hole coverage gap lasted until the total cost hit $5,100; then emergency coverage kicked in, bringing the cost down to just a few dollars for each drug. Some plans in 2006 offered coverage during the donut hole for a higher premium cost. This year, that’s not even an option. “Regardless of anything, I would have had to pay full price for all them drugs,” Clapper said. “That was the new law.” In Michigan, there...

AARP Medicare Advantage Complete Plan

As someone who is reviewing Medicare plan options either for yourself or for a loved one, I can almost a guarantee that you have heard of the AARP brand before, if you are not already deeply familiar with the organization. AARP is a consumer organization whose goal is to help seniors of every walk of life. They are not actually an insurance company. If you are interested in health insurance, the AARP branded medical insurance plans are actually underwritten by Aetna insurance company. In the case of Medicare supplements and/or Medicare advantage policies, they are underwritten by United HealthCare  insurance company. The AARP Medicare complete plan is a type of Medicare advantage policy, and not a Medicare supplement. Medicare advantage also goes by the name of Part C, which is a combination of traditional Medicare benefits and a private insurance policy merged together to provide an all-in-one plan for seniors. Depending on where you live, this Medicare advantage policy might be branded as Secure Horizons instead of AARP, something you should be aware of in case you think they are totally different companies. This happens to be a very popular Medicare advantage plans option for seniors this year because the premiums are starting at zero dollars. Even if this policy does not charge you a monthly plan premium, you’re still responsible for paying your Part B premium to traditional Medicare. A number of other factors are making this a very successful plan for this enrollment period. First of all, there is no medical plan deductible that needs to be satisfied before services are covered. Secondly, you can use in and...

Medicaid vs Medicare

Is there a difference between Medicaid and Medicare? This a question that many consumers become easily confused about, and it’s absolutely understandable to get the two programs mixed up. Medicare is the Federal health insurance program for seniors who are primarily over the age of 65, and those under 65 who have certain disabilities, such as kidney disease and require dialysis. Medicaid on the other hand is a state run program (which financial assistance from the Federal Government) that provides medical care to many different types of Americans such as:       The Undeserved       Children       Pregnant Women       Those with serious health conditions What do the two programs cost? Medicare Part A (Hospital Coverage) is primarily funded by payroll taxes. If you have     not earned enough credits to receive Part A at no cost (rare), you can “buy into” Medicare Part A. Part B (Physician Services) – Most Medicare beneficiaries pay about $147/month in 2013. Part D (Outpatient Drug Coverage) – This is optional coverage with rates averaging $40/month for a drug plan. Medicaid For most consumers, Medicaid will come at no cost, although there are “share of cost” programs, dependent on income, where an insured may be responsible to a small cost for medical services. What do they cover? Medicare Part A – Hospital Expenses Part B – Physician Charges and Outpatient Medical Expenses Part D – Prescription Drugs with plans like this Transamerica MedicareRx Medicaid Medicaid covers a lot more medical services than does Medicare. Though each state determines what they will cover with their own Medicaid program, a few of the benefits that are routinely...

10 Highest Rated Medicare Advantage Plans For 2014

The providers listed below offer consistently high rated Medicare Advantage plans. CMS developed these 2014 Medicare Advantage Ratings in advance of the annual enrollment period. Each of the evaluated plans are rated and then scored on a 5 star scale. These plans receive a high performing score as a result of there performance on the Overall Part C measures. There was no change in the number of Medicare Advantage plans receiving five star rating in 2014. Plans ranking in the four or higher categories have increased from 26% in 2013 to 35% in 2014 The CMS main focus on evaluating each of these plans is based on five domains: Outcome: measures focus on improvements to a beneficiary’s health as a result of the care that is provided. Intermediate outcomes: Intermediate outcome help move patients closer to the “outcome” as defined above. Controlling Blood Pressure is an example of an intermediate outcome where the outcome would be better health status for beneficiaries with hypertension. Patient experience: Patient experience measures represent beneficiaries’ perspectives about the care they have received. Access: Access measures reflect issues that may create barriers to receiving needed care. Plan Makes Timely Decisions about Appeals is an example of an access measure. Process: Process measures the method by which health care is provided. Provider Name Plan Name State Rating Kaiser Permanente Kaiser Permanente Advantage Inland Empire California Group Health Cooperative Group Health Coop Clear Care Basic Washington Gundersen Health Plan, Inc. Gundersen Senior Preferred WI,IA Cigna-HealthSpring Cigna-HealthSpring Advantage (HMO) Florida Providence Health Plans Providence Medicare OR, WA Medical Associates Health Plan Medical Associates Basic Plan (Cost) Iowa Dean...

2014 HumanaChoice PPO Medicare Advantage Plan Details

HumanaChoice PPO® is a Medicare Advantage Preferred Provider Organization (PPO) which offers additional benefits to your original Medicare. HumanaChoice® gives you the freedom to choose which hospitals, specialists, and doctors you would like to use. No referral is required and you do not need to select a primary care physician (PCP). You can also go to providers outside of the network but you reduce your costs when you use the large list of in network providers. Some plans offer Prescription drug coverage better or equal to the requirement for a Medicare Part D Plan (depending on your region). HumanaChoice PPO® offers worldwide coverage for emergency care. And features an affordable monthly plan premium for most plans. Coverage for annual screening are also offered at no additional charge. Here are some examples of coverage of three plans offered by HumanaChoice® that show your in network benefits. You can browse the Medicare Advantage HumanaChoice PPO R-5826-005 complete plan details here. Humana Plan Details 2014 HumanaChoice R5415-056 (Regional PPO) 2014 HumanaChoice R5826-063 (Regional PPO) 2014 HumanaChoice R5826-005 (Regional PPO) Plan Type Medicare Advantage Plan Preferred Provider Organization(PPO) Medicare Advantage Plan Preferred Provider Organization(PPO) Medicare Advantage Plan Preferred Provider Organization(PPO) Rx Coverage Annual Premium C+D $540 $0.00 $1104.00 Annual Drug Deductible $0.00 No Prescription Drug Coverage $0.00 State Available Florida Virginia Florida Doctors and Hospitals HumanaChoice, PPO H5415-056 HumanaChoice, PPO R5826-063 HumanaChoice, PPO R5826-005 Annual Medical Deductible $0.00 $0.00 $0.00 Health Plan Premium $3.70 $0.00 $55.00 Maximum Out-of-Pocket $3000 $3400 $5700 Doctor Access Option to see physicians in- or out- of the plan’s network. No referrals required. You pay more for out-of-network services....

2014 Medicare Plan Changes for Open Enrollment on Oct.15.

Medicare recipients who want to enroll or change their Medicare health care and Part-D coverage for 2014 will be able to this week from Oct. 15 to Dec. 7. Beginning the 15th seniors can now change any type of Medicare coverage you choose but changes don’t take effect Jan. 1, 2014.  But now is the best time to review your needs.  Reviewing your options earlier rather than later will provide you a better position if you need to make changes. If you are already enrolled your plan will provide you information about plan changes each fall for the new year. You should review your needs and compare next year’s plan for a possible change in your monthly deductibles, premiums and co-payments. Medicare Supplement providers can also change your prescription drugs coverage by changing tiers or dropped medications from the list of drugs ( formulary). Seniors should check that your plan will continue to offer equivalent medication coverage on your medications and will continue to work with your pharmacy. If you are displeased with your plan or upcoming changes, you can make changes to your coverage during this open enrollment. If you are pleased with your current Medicare plan, consider looking at other or new Medicare choices in your area that may exceed your individual needs for the new year. Questions to Ask. Have you changed the medications you take? Are your medications still covered on your current plan in 2014? Have you been diagnosed with a new medical diseases or conditions? Has your health care provider situation has changed? Are your plan premiums, co-pays or deductibles increasing? Have you...

UHC’s Care Improvement Plus for Special Needs Plans

The Care Improvement Plus program was founded in 1977 by UnitedHealthCare. They offer health care to millions of residents on Medicare and Medicaid. The Medicare part pays for the medical, hospital, healthcare services and prescription medications.  This is for people that are aged 65 and up or for particular disabled conditions. Medicaid is for helping individuals that have a low income. Being a CMS contractor, they must provide services for the requirements of their clients. They are a quality improvement organization and operate as a non profit business. Care Improvement Plus has a reputation for being a unique Medicare Advantage special needs plan. This is to help with special benefits for beneficiaries using Medicare that have special conditions like heart failure or diabetes. The plan for UHC is to continue including additional offerings for people with full Medicaid and or a Low income subsidy. There is also a plan that works with just Medicare alone. They also have a pharmacy provider and prescription medication network. The plan years always begin on January 1st. In order to qualify for the program, you must have the required Medicare Parts A and B. The hours to contact them by telephone are 8am to 8pm 7 days a week. The states that Care Improvement Plus serves are: • Arkansas • Georgia • Illinois • Indiana • Iowa • Maryland • Missouri • New Mexico • New York • South Carolina • Wisconsin • Texas Members of Care Improvement Plus has a special needs plan for those that are chronically ill, and qualify for this plan. The qualifications of this plan are: • Diabetes • End- stage renal disease • Chronic obstructive cardio...

Top 10 Medicare Health Plans in the US

In addition to offering individual and family health insurance plans,  Health Insurance carriers also sell private health insurance plans to seniors and those eligible for Medicare. These products are called Medicare Advantage, Medigap or Medicare Supplemental Insurance, and Medicare Part D prescription drug cards. If you are looking at a company that is offering one of these products, keep in mind they are contracted with Medicare to offer this kind of insurance policy to you. In the case of Medicare Advantage or Part C of Medicare and Part D drug plans, the insurance provider receives a subsidy for Medicare for these kinds of plans in exchange for providing services to their insured members. As a Medicare beneficiary if you would like to lower your out-of-pocket costs for medical and prescription drug related expenses, you should consider supplementing original Medicare with a supplement and a drug plan. Since these kinds of Medicare supplemental insurance plans are sold to private for-profit insurance carriers, you will want to compare Medigap plans being offered to you side-by-side so that you can make an educated decision about which plan is best for you. Below we have listed some top rated Medicare health insurance plans.  The NCQA (National Committee for Quality Assurance) along with US News created a ranking of the top Medicare supplement health plans available in the US.  The plans are ranked according to best customer satisfaction, claims handling, medical treatment, communication, disease prevention, and quality of specialists. Top 10 Medicare Health Plans for Seniors Kaiser Foundation Health Plan of Colorado (Rank 89.0) Fallon Community Health Plan (Rank 88.8) Geisinger Health Plan  (Rank 88.1) Tufts Associated (Rank 88.0)...

What is the difference between Medicaid and Medicare?

Many individuals and families are living without health insurance in America, which has led to the popularity of Medicaid and Medicare. When it comes to Medicaid vs Medicare, some people looking for health care assistance fail to realize the difference between the two programs. Although both programs are federally funded, they are typically available to two separate groups of people. Medicaid is a state-run health insurance program available to eligible low-income people, seniors, people with specific disabilities and families with dependent children. The specific eligibility requirements for Medicaid vary per state, but the general requirements are based on financial need. The specific services offered under the Medicaid program are also determined at the state level. The federal government has established a list of services that all states must offer to Medicaid recipients. Some of the mandatory services offered under the Medicaid program include inpatient and outpatient hospital care, physician and midwife services, prenatal services, pediatric care, x-rays and laboratory testing and vaccines for kids. Optional services offered in some states include chiropractic, dental, private duty and physical therapy services. Understanding the Four Parts of Medicare Medicare is a health insurance program funded by the federal government that is available to people over age 65, younger individuals with certain disabilities and individuals diagnosed with End-Stage Renal Disease. Medicare has four parts – Part A, Part B, Part C and Part D. Each part has its own features. Most individuals meeting eligibility requirements receive Part A at no cost. Those who do not qualify for free coverage can purchase Part A. Individuals electing to receive the other three Medicare parts must pay a...

What is Life Insurance?

Life insurance is a contract between you the policy holder and the insurance contractor. This is an agreement whereby the insurance policy holder agrees to pay a specific life insurance rate, and in return, in the event of his death, the policy’s premium would be paid out to his beneficiary(s). Why You Need it? Life insurance is an investment in your family’s future and the most secure way to ensure their financial security in the event of your death. If you die, your family will lose your income and be forced to pay the monthly expenses out of a much smaller pool of money. Life insurance can help cover some or all of this lost income, plus the costs of the funeral, depending on the policy that you choose. Types of Life Insurance There are two general types of life insurance to choose from; temporary and permanent, each of which has subcategories with differing policy features. Temporary – Temporary life insurance, also known as term life insurance, is a life insurance policy where the policyholder pays a specified premium in return for a guaranteed payout if he dies during that time. Depending on the policy, once the time period is up, there may be the opportunity to renew. Permanent – This is life insurance that remains in place until the policy matures or the policy holder cancels the coverage. The only way the insurer can discontinue its insurance coverage to you is if there is evidence of fraud on your life insurance application. Permanent life insurance holders can usually have early access to their benefits in the cash value by...

Importance of an Online Life Insurance Quote

Considering investing in a life insurance policy, or even if you are updating an existing plan? It is important that you get a life insurance quote. This handy online tool will ensure that you get the insurance coverage that you need. This means not being underinsured, which could potentially leave your family struggling for money; but also not being over insured, as this is extra money spent in premiums that could be better spent on other things. Before life insurance quotes became available online, prospective clients had to deal directly with the insurance agents who calculated the amount of life insurance needed based on the company’s unique and often complicated formula. Depending on which life insurance company you dealt with there would be different information required. The online life insurance quotes uses the most common factors in the person’s expenditures, income, and savings into the calculation. All you have to do is input the values into the correct box and the computer does all the calculations for you so you can compare life insurance quotes. In a few short seconds you will know just how much life insurance you need. The life insurance quotes can include a variety of items such as mortgage payments, household expenses, children’s education, funeral costs, and other miscellaneous expenses. Income will include your salary, pension and government assistance. Getting a quote helps you anticipate the amount of life insurance coverage you need before you speak with insurance companies. This will give you an edge when discussing your life insurance policy needs and premium rates. No longer will your insurer be able to con you...

Compare Public And Private Health Insurance

Health insurance in the United States is predominantly privatized, with almost 60% of Americans getting their insurance through a private health insurance company. The remaining Americans are either going uninsured or using public health insurance programs.  Not everyone who can’t afford sufficient private health insurance will qualify for public health insurance; in fact, most won’t. This means that the majority of Americans are under-insured or not insured at all. Below is a more in-depth look into how both the private and public health insurance systems work. Private Health Insurance Health insurance in the United States is, for the most part, owned and operated by private companies. While there are many types of private health insurance plans, they can all be grouped into 3 larger categories: Fee-For-Service (Traditional Private Health Insurance); Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs). Fee-For-Service is private health insurance that requires you to pay monthly premiums to your insurance company, which will cover most of your health costs. You will then be required to pay extra for certain services. Health Maintenance Organizations (HMOs) are prepaid health plans. You pay monthly premiums, but unlike fee-for-service you must receive your health care directly from their facilities.  You can get an HMO Insurance Quote here. Preferred Provider Organizations (PPOs) are health insurance where you pay a monthly premium, along with a small co payment when you visit the doctor. This type of plan limits the doctors and medical facilities you can use. Public Health Insurance Publicly funded health insurance is available to senior citizens and low-income individuals and families, if they meet certain requirements. The primary vehicles for...

Health Insurance Quotes Online

Millions of Americans are under-insured and the worst thing is that they don’t even know it. Getting an online health insurance quote is the best way to prevent this. It will tell you just how much health insurance you and your family really need so that you aren’t left paying a medical bill you thought was covered. There are currently about 25 million under insured individuals in the US, according to The Commonwealth Fund, a health research and policy organization based in New York. Don’t let yourself be one of them. Before health insurance quotes became available online, prospective clients had to deal directly with the insurance agents who calculated the amount of health insurance needed based on the company’s unique and often complicated formula. This is the real benefit of a online health insurance quote; it can be accessed for free and right from your home computer. Instead of spending hours on the phone answering tons of questions for your insurance company, you can instead quickly fill in the form online and within minutes have the best individual health insurance coverage that you need. The online health insurance quote will require you to answer a variety of different questions and as long as your values are accurate, you will get a precise coverage amount. To speed along this process, it is helpful to have some basic health information about you and your family ready to go. Be ready to answer questions such as: • How much do you currently pay for health insurance? • What are your out-of-pocket medical expenses? • How often do you visit the doctor?...

Humana Medicare Health Plans

Humana is one of the biggest health insurance providers in the country providing one of the largest health care networks. Nearly 10 million people are enrolled in Humana in America including 5 million Medicare policy holders. Humana offers a wide range of additions to Medicare so you can find a plan that fits your lifestyle, your coverage needs, and your pocketbook. Humana is “A” rated by A.M Best and has been in business for over 50 years. Humana offers there types of coverage for Medicare beneficiaries Medicare Supplements, Medicare Advantage plans as well as Medicare Part D prescription drug plans. Humana offers health insurance services in all 50 U.S. states, D.C., and Puerto Rico. Humana Medicare Supplement Since all Medicare supplement plans are standardized, which means every plan generally offers the same coverages across the board.  What you want to do is check if Humana has a competitive rates for the Medigap plan you find most favorable. Also double check the prior two years renewal rate increase history for Humana in your area. Remember that Humana Medicare supplements do not have any network restrictions (except Medicare Select Plans or Choice Plans).  With Humana you don’t have to worry about if your doctor accepts the plan or if it’s good in another state when you travel.  Humana offers Medicare Supplemental plans A, B, C, G, K, L, N and a high deductible version of Plan F. Humana Medicare Advantage When shopping for a Humana Medicare Advantage plan keep this tip in mind. Like Part D drug plans Medicare Advantage plans pricing and availability is based on which county you live...

AARP Medigap Plans – Medicare Supplement

AARP Medicare Supplement insurance (also called Medigap) is meant to help people with some health care costs that Medicare Part A and Part B do not cover, such as deductibles, co-payment and coinsurance; it also covers further services, such as health care, when one takes a trip outside the United States. AARP (American Association of Retired Persons) is a nonprofit organization that assists people aged 50 and more with enhancing their lives’ quality, by promoting adequate and reasonably priced medical care. It is the largest organization for people over 50 in the United States and has agencies in all states. What is Medicare? Medicare is the medical insurance for people aged 65 and over, for people under 65 with particular disabilities and for all those with ESRD (End-Stage Renal Disease). Each part of Medicare covers certain services: – Part A – hospital insurance – Part B – medical insurance – Part D – medical prescription drug coverage   What is AARP Medicare Supplement and what does it Cover? Medigap is private health insurance that supplements the “gaps” in Medicare Part A and Part B. When you have both Medigap and Original Medicare, each will pay its share for covered medical treatment costs. Every such supplement policy follows state and Federal laws designed to protect the insured party and, no matter where you buy it from, it provides the same basic benefits. However, not all types of the AARP Medicare Supplement insurance policies may be available in every state. What you must know when you buy the AARP Medicare Supplement. – You must have both Part A and B Medicare. – You can...

Humana Enhanced PDP for Seniors on Medicare

The Humana Enhanced PDP (Prescription Drug Plan) is made available to Seniors over the age of 65 and anyone on Medicare due to a disability.  This is a premier Medicare part D plan offered by Humana Medicare.  This plan is for seniors who need more then basic drug coverage offered by Medicare but not a whole comprehensive plan.  This Enhanced PDP offers a zero deductible and affordable premiums.  Humana is a stand-alone prescription drug plan with a Medicare contract. Humana offers several different drug plans (part D) for all your needs.  Including Humana-Walmart Prescription Rx Plan, and Humana Complete.   If you are looking for prescription drug coverage plus additional health coverage Humana Medicare Advantage plans might offer the coverage you need.  They offer Humana Gold Plus Advantage (HMO), Humana Gold Choice Advantage (PFFS), and  HumanaChoice (PPO). Frequently asked questions about the Enhanced drug plan. Does it come with a deductible? No. There is non deductible with this drug card. How much is the premium? The monthly premium for the Humana Enhanced PDP averages to around $40 a month for Medicare beneficiaries. Are my drugs covered? We have attached the Humana Enhanced Forumlary below. What will my copay’s be with this drug plan? Below we have summarized the benefits of the Humana Enhanced PDP. You will simply look up in the forumlary. which tier your medication falls under and will see what your share of cost is. Summary of Benefits Medigap Comparisons for the Humana Enhanced PDP Prescription Drug Plan 2012 Annual Deductible $0 Out-of-Pocket Maximum None Prescription Drug Deductible $0 deductible on all drugs except Tier 1: Preferred Generic Drugs. Retail Pharmacy for Prescription Drugs: Preferred Generic :After...

Humana Walmart Prescription Rx Plan – Part D

Humana and Walmart have teamed up to offer seniors a Humana Walmart-Preferred Rx Plan (PDP) with the lowest premium for a Medicare Part-D prescription drug card in the country.  The premium is only $18.50 a month.  Humana and Walmart can provide momentous savings on your prescription medicine costs.  This plan is available to most Medicare beneficiaries, including seniors and people with disabilities.  Humana is a stand-alone prescription drug plan with a Medicare contract. Other pharmacies are available in network. “One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.” This drug card makes a GREAT addition to an affordable Medicare Supplemental Insurance Policy.  Remember if you already have a Medicare Advantage plan, then it will probably already have your Part-D benefits included! This drug plan covers more than 1500 generic drugs, it was designed with you -the senior in mind, to save you money. You will pay the lowest out-of-pocket when you fill your medications at a Walmart or Sam’s Club store. There is a $320 Annual deductible for all drug tiers. Tier 1 preferred generic medications are only one dollar co-pay for thirty-day supply at Walmart or Sam’s Club. Incredible as it...

Mutual of Omaha – Medicare Supplemental Plans for Seniors

If you have been researching your options for Medicare, you are going to realize that the answers are not as straightforward as you might have hoped. On the contrary, you will learn that even though the government is providing you with a service, you will still have to do some choices. United of Omaha is part of the Mutual of Omaha Companies and was founded in 1926, with a diversified portfolio of life insurance, fixed annuities and other insurance products including Medicare Supplements. Policies are a part of a long history with the reputation of providing quality products since Medicare began in 1966. Original Medicare, the service program provided by the government, is not setup to cover all healthcare costs. You will find that some costs, such as deductibles and co-pays, are not covered with the program. This would cause many seniors in financial trouble. That’s why there are Medicare supplemental insurance plans to fill the gap. These plans are often referred to as Medigap programs. If you are ready to start discovering the unknown Medigap programs, there are some things you will need to be aware of. The best time for you to obtain a extra plan is during the open enrollment period, lasting six months from the first day of the month in which you turn 65 or older and enrolls in Medicare Part A and B. During this point applications will not be subject to underwriting, the insurance company cannot reject any position they sell, and do not have a waiting period for coverage to begin, or charge more for a policy based on past or current health condition. Content...

Preferred Care Partners-Top Florida Medicare Health Plan for Seniors

Preferred Care Partners health insurance offers comprehensive Florida Medicare Advantage plans that include drug coverage to people who are eligible for Medicare. It is a health plan available to all Florida Medicare beneficiaries. You must have Part A and Part B to enroll and the benefits offered vary by plan. There are times of the year that you can sign up for this program but you need to speak with Preferred Care Partners for more information. If you decide to leave this program, a letter will be sent to you confirming you had creditable coverage. This is important to have so that you’re next health plan will pick up right where the old one stopped. At Preferred Care Partners, we give you the information that you need to decide which plan you want to go with. If you have a chronic illness related to diabetes, we offer a Preferred Care Partners Preferred Special Care Plan. There is an Preferred Medical Plan that is right for you. At Preferred Care Partners insurance, they offer other Medigap plans as well. They offer doctor’s visit and prescription drugs with affordable premiums. PCP was established in 1972 and has the largest individual Medicare Health Plan membership on the west coast in FL and offers quality service to all of its...

Calls On Congress To Stop Medicare Doctor Cuts

The American Medical Association (AMA) is now airing television ads calling on Congress to stop Medicare physician payment cuts to seniors. The ad, titled the Faces of Health Care, depicts seniors who will be hurt by looming Medicare cuts and the physicians who care for them. “This television ad is part of our campaign to get Congress to stop Medicare physician cuts that will harm seniors,” said AMA Board Chair Cecil Wilson, MD. “We are raising awareness of the severity of the problem.” Next year, Medicare will cut payments to physicians by 10 percent. Over nine years the cuts swell to about 40 percent, while practice costs increase 20 percent. Only congressional action can stop the cuts, and avert an access to care crisis for seniors who rely on Medicare. “Sixty percent of physicians tell the AMA that next year’s Medicare cut will force them to limit the number of new Medicare patients they can treat,” said Dr. Wilson. “As the baby boomers begin to age into Medicare in just three short years, we’re concerned that the cuts will mean that there simply won’t be enough doctors able to care for all the new Medicare patients.” The AMA is encouraging seniors and their loved ones to contact their members of Congress to tell them we need action to stop Medicare cuts to physicians now. Americans can contact their members of Congress through the AMA’s Patient Action Network Web site or at (888) 464-6200. The AMA also published print ads earlier this month in Capitol Hill papers. The print ads call on Congress to stop next year’s Medicare physician payment...

Florida Medicare Advantage Plans from Freedom Health

Freedom Health, which was founded in 2004, is a Tampa, Florida-based health insurance business that’s operated and owned by a group of physicians. The organization administers Medicare and Medicaid benefits throughout many Florida counties. It aims at providing members with affordable health coverage which is designed to upgrade their quality of health care and cut down on out-of-pocket costs. The organization works closely with a network of local health insurance brokerages and agents and also has offices in Casselberry, Fort Myers, Ocala, Spring Hill, and Vero Beach. Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid. In the Medicare Advantage Prescription Drug Plans, you have to use prescription drugs that have been placed on an approved list. The policy can be part of your Part B or D premium, cover medication through the coverage gap, and sometimes offers reduced co-payments for mail-order and generic drugs. However, you need to be aware that if your Medicare Advantage plan offers coverage for prescription drugs and you then enroll in a standalone drug plan, you may be removed from the Medicare...

Consumer Protections Sorely Lacking in Medicare

Consumer Protections Sorely Lacking for Older and Disabled Americans Enrolled in Medicare Private Drug Plans, Consumer Group Testifies Legislation Needed To Ensure that Both CMS and Private Drug Plans Fulfill Congress’ Intent to Provide Meaningful Protections for People in Plans Older and disabled Americans enrolled in Medicare private drug plans lack consumer protections needed to guarantee access to prescription drugs at affordable prices, the Medicare Rights Center testified today at a hearing of the U.S. House of Representatives Committee on Ways and Means Subcommittee on Health. Problems continue to plague the Medicare drug benefit program eighteen months after it took effect, testified the Medicare Rights Center, a national consumer service group. Enrollees in the Medicare drug benefit, available only through private drug plans, are still having difficulty securing – and maintaining – enrollment in an appropriate Medicare private drug plan, accessing affordable medicines through the low-income subsidy known as “Extra Help,” and getting needed medicine through Medicare private drug plans. “Congress must ensure that people with Medicare have due process protections that govern decisions made by the Centers for Medicare and Medicaid Services and Medicare private drug plans,” said Robert M. Hayes, an attorney and president of the Medicare Rights Center. “It’s common sense, basic fairness and a requirement of constitutional law.” Several consumer issues beleaguering the Medicare drug benefit program were highlighted in testimony provided by Paul Precht, deputy policy director at the Medicare Rights Center, including: rampant computer system problems among Medicare, private drug plans and Social Security that cause problems with plan enrollment, plan premiums and low-income status; people with the right to disenroll from Medicare...

Medigap Plans from Gerber Life Insurance

Gerber life started out as a life insurance company building a sterling reputation over a 156 year history. Now they are on their way to dominating the Medicare supplemental insurance market. Gerber life sells Medicare supplements which are also called Medigap plans a senior citizens health insurance option to cover the costs not covered by Original Medicare Parts A and B. Currently Gerber has the Plan A, Plan B, Plan F and Plan G available to Medicare beneficiaries. Remember these are Medigap plans, so there are no networks, you can use any Dr. or medical provider in the country that accepts original Medicare and assignments and you will not have to worry about a Dr. list. All of these Medicare supplement plans offered through Gerber life will cover your major out-of-pocket costs, those being the part a and part B deductibles and other costs associated risk receiving treatment from a Medicare contracted provider such as outpatient lab testing, outpatient surgeries and Dr. visits. An interesting fact about Gerber life Medicare supplements is that they are actually underwritten by Mutual of Omaha. So if you call the 800 number for Gerber Medicare Supplement quotes, they will answer the phone as Gerber but you are in fact common to Mutual of Omaha’s call...

Medicare Private Health Plan Monitoring Project

This past April, the Medicare Rights Center launched the Medicare Private Health Plan Monitoring Project to learn about the experiences of people with Medicare enrolled in these plans. In the past two months, we have received story after story from people with Medicare, their family members and friends, counselors and caseworkers about the problems they have encountered dealing with these plans. The insurance industry is reaping billions of dollars in over-payments from Medicare. Hoping to keep that gravy train rolling, the industry touts the extra benefits and better coverage in private plans. But it won’t brag about the higher cost sharing some plans charge for chemotherapy and other medicines compared to Part B under Original Medicare. It won’t boast about the Florida couple whose plan told them it would cover surgery in their local hospital but then denied payment claiming the hospital is not in the plan’s network and so they must pay for the surgery themselves. The insurance industry insists that private plans are especially beneficial for low-income people with Medicare. But it keeps quiet about the people with Medicare and Medicaid who enroll in these plans with the promise of extra benefits and end up being charged co-payments they did not have to pay under Original Medicare. The insurance industry argues that private plans offer consumer choice and empowerment. But it leaves out the abusive marketing tactics sales agents use to get people to enroll. There are stories about agents claiming to represent Medicare, aggressively pushing plans on people with Medicare in their homes and workplaces, forging signatures, leaving out crucial information about costs and restrictions, lying...

Social Security Checks Will Stop Increasing As Medicare Premiums Rise

Older Americans in Medicare’s Part D prescription drug program are more likely to pay at least $300 a month for medicines than those on other plans, a study published Tuesday by the journal Health Affairs has found. Experts consider the poll of more than 16,000 seniors, performed by the Kaiser Family Foundation, the Commonwealth Fund, and the Tufts-New England Medical Center, the closest thing yet to a “report card” on Part D. The study found that 8 percent of seniors in the government’s Medicare plans spent $300 or more out-of-pocket for drugs, compared with 5 percent for both those covered by the Veterans Affairs Department, which negotiates prices for drugs it covers, and those covered by workplace insurance. Medicare recipients were also more likely to delay or forgo filling prescriptions because of the expense, with one in five enrollees saying they had put off or even skipped getting some medications because of Medicare Part D’s high costs. Part of the reason so many beneficiaries are having difficulty paying for their medications is that many low-income seniors apparently do not know that they can get additional government subsidies to lower their costs, the survey indicated. Congressional Democrats, who have proposed expanding the number of seniors eligible for such subsidies by cutting over payments to private Medicare Advantage plans, seized on the findings as evidence that the benefit is not working well for those who need it most: seniors who have several chronic illnesses and must take a number of medications. Insurance Companies Targeting Early Retirees According to a recent report by The Wall Street Journal, health insurance companies are targeting...

AMA Television Ad Calls On Congress To Stop Medicare Doctor Cuts

Part D beneficiaries need more coverage Senior beneficiaries enrolled in a Medicare Part D prescription drug plan still lag behind the coverage afforded seniors covered by employer plans or under a veterans’ health plan, according to a report in the journal Health Affairs. The report, which surveyed some 16,000 senior citizens, states that while more senior citizens have drug coverage than before due to the Medicare Part D program, more of those participating seniors are paying greater out-of-pocket expenses, especially when contrasted with their counterparts who received drug benefits through the Veterans Administration (VA) and employer-provided coverage programs. According to the report, 26 percent of the responding Part D beneficiaries spent at least $100 each month for prescription drugs. The report stated that another 8 percent reported spending at least $300 each month for prescription drugs, which is less than those without Part D coverage, but still more than those beneficiaries under a VA or employer-provided coverage program. Only 8.5 percent of senior citizens in 2006 did not have prescription drug coverage, whereas 33 percent of senior citizens were without such coverage in 2005, according to the report. Despite the Medicare Part D program’s low-income subsidy (LIS) allowances, only 53 percent of Medicare Part D beneficiaries who were surveyed knew about the program, and only 52 percent of the non-participating senior citizens who were surveyed had knowledge of...

Take a look at the Humana Gold Plus HMO plan for Seniors

Humana Gold Plus® is a Medicare Advantage Health Maintenance Organization (HMO) plan with a wide range of coverage for seniors. Humana has contracted with Medicare to provide you with services that are not covered by your Medicare Part A and Part B benefits under original Medicare. Most Medicare Advantage Humana Gold Plus HMO Plans offer prescription drug coverage. With Gold Plus HMO Plans your out-of-pocket costs are reduced and more predictable than with the majority of other plans. You may enroll in Gold Plus HMO plan only during specific times of the year. You can compare this to Humana’s Gold Choice PFFs, Humana’s Part D Drug Plans, HumanaChoice PPO and Humana Enhanced PDP. Below is an example of one of the many plans offered by Humana. Summary Plan Type Humana Gold Plus H1951-013 (HMO) Office Visit for Primary Doctor $10 copay for each primary care doctor visit for Medicare-covered benefits. Office Visit for Specialist $10 to $25 copay for each specialist visit for Medicare-covered benefits. Doctor Choice Plan Doctor Only Annual Deductible None Out-of-Pocket Maximum $4,900 Prescription Drug Coverage Yes Physical Exams $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Hospital Services Coverage Emergency Room $65 copay for Medicare-covered emergency room visits. $25,000 plan coverage limit for emergency services outside the U.S. every year. Ambulance Services $200 copay for Florida Medicare-covered ambulance benefits. Outpatient Lab/X-Ray $0 to $25 copay for Medicare-covered lab services. $0 to $50 copay for Medicare-covered diagnostic procedures and tests. $10 to $50 copay for Medicare-covered X-rays. Outpatient Surgery $250 copay for each Medicare-covered ambulatory surgical center visit. $0 to $250...

Humana Choice PPO Plan Details

HumanaChoice PPO® is a Medicare Advantage Preferred Provider Organization (PPO) which offers additional benefits beyond original Medicare.  Humana offers a wide array of products and services in addition to your original Medicare plan.  HumanaChoice PPO® has a formed choice of hospitals, specialists and doctors for you to choose. No referral is required. You can also go to providers outside of the network but you reduce your costs when you use the in network providers.  Some plans offer Prescription drug coverage better or equal to the requirement for a Medicare Part D Plan (not available in all regions).  HumanaChoice PPO®  offers worldwide coverage for emergency care.  And features an affordable monthly plan premium for most plans.  Coverage for annual screening are also offered at no additional charge.  Below is a example of coverage of three plans offered by Humana that show in network benefits. HumanaChoice, PPO H5415-056 HumanaChoice, PPO R5826-018 HumanaChoice, PPO R5826-005 Plan Type Medicare Advantage Plan Preferred Provider Organization(PPO) Medicare Advantage Plan Preferred Provider Organization(PPO) Medicare Advantage Plan Preferred Provider Organization(PPO) Rx Coverage Annual Premium $468.00 $0.00 $960.00 Annual Drug Deductible $0.00 No Prescription Drug Coverage $0.00 Doctors and Hospitals HumanaChoice, PPO H5415-056 HumanaChoice, PPO R5826-018 HumanaChoice, PPO R5826-005 Annual Medical Deductible $0.00 $0.00 $0.00 Annual Plan Deductible N/A N/A N/A Maximum Medical Out-of-Pocket $5,000.00 $4,000.00 $4,750.00 Hospital Deductible (Per Benefit Period) $0.00 $0.00 $0.00 Doctor Access Option to see physicians in- or out- of the plan’s network. No referrals required. You pay more for out-of-network services. Option to see physicians in- or out- of the plan’s network. No referrals required. You pay more for out-of-network services. Option to...

Consumers Deceived By Medicare Private Health Plans Are Free To Leave Plans

CMS Has Yet to Notify Americans with Medicare of New Dis-enrollment Right New York, NY — People in private Medicare health plans can dis-enroll from their plans if they signed up after receiving misleading information, according to the Centers on Medicare and Medicaid Services (CMS). To date, neither CMS nor the insurance companies that operate Medicare private health plans have informed people enrolled in these plans that they can leave if they were duped into signing up. CMS has received thousands of consumer complaints about unscrupulous and aggressive sales tactics and seven companies have suspended marketing of their private fee-for-service plans. “We applaud CMS for acknowledging the fraudulent marketing activities of private plans, but our concern now is righting the wrong,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group. “While CMS informed their own hotline operators that Americans with Medicare have the right to leave plans they were tricked into joining, most consumers remain in the dark about their right to change their Medicare coverage. What good is a new dis-enrollment period, if no one knows about it or how it works?” The new right is known as the “exceptional circumstance special enrollment period” (SEP). Under CMS rules, most plan members are locked into their plans after March 31 for the rest of the year. More than 8 million people with Medicare are enrolled in Medicare private health plans this year. The Medicare Rights Center requested details from CMS on how the SEP works because no official guidance about required time frames or other specifics has been released, other than a one-paragraph...

End the doughnut hole

Part D beneficiaries need more coverage Somerset County senior citizens who thought they were getting help with the doughnut hole provision of Medicare Part D prescription drug coverage with the new Somerset County Drug Discount Card received bad news from Tuesday’s county commissioners’ meeting. None of their purchases with the new NACo card made during their doughnut hole will count towards getting them out of the hole. The doughnut hole is a gap in Part D coverage when people go from paying a co-payment for their prescriptions to paying for the entire cost. Somerset County commissioners worked to get the National Association of Counties prescription drug card for people who don’t have insurance or who have only some insurance. The cards, available without cost to residents or to the county taxpayers, enable people to save 20 percent on medications. They are to be commended for doing that; the fault is not theirs. Congress should have passed Part D without a doughnut hole. Instead, Congress sided with the drug companies and shifted the cost to senior citizens. As Part D’s threshold for resuming coverage goes up each year, more and more senior citizens will be unable to pay for all their medications. A report by the Center for Economics and Policy Research states if the drug benefit had been administered through the existing Medicare system, rather than through private insurers, the doughnut hole would be considerably smaller at no additional cost to the government. If Medicare had been allowed to bargain directly with pharmaceutical companies, such as the Veterans Administration does, the savings would have been more substantial. Congress needs...

Insurance Companies Targeting Early Retirees

Alliance for Retired Americans Older Americans in Medicare’s Part D prescription drug program are more likely to pay at least $300 a month for medicines than those on other plans, a study published Tuesday by the journal Health Affairs has found. Experts consider the poll of more than 16,000 seniors, performed by the Kaiser Family Foundation, the Commonwealth Fund, and the Tufts-New England Medical Center, the closest thing yet to a “report card” on Part D. The study found that 8 percent of seniors in the government’s Medicare plans spent $300 or more out-of-pocket for drugs, compared with 5 percent for both those covered by the Veterans Affairs Department, which negotiates prices for drugs it covers, and those covered by workplace insurance. Medicare recipients were also more likely to delay or forgo filling prescriptions because of the expense, with one in five enrollees saying they had put off or even skipped getting some medications because of Part D’s high costs. Part of the reason so many beneficiaries are having difficulty paying for their medications is that many low-income seniors apparently do not know that they can get additional government subsidies to lower their costs, the survey indicated. Congressional Democrats, who have proposed expanding the number of seniors eligible for such subsidies by cutting over-payments to private Medicare Advantage plans, seized on the findings as evidence that the benefit is not working well for those who need it most: seniors who have several chronic illnesses and must take a number of medications. According to a recent report by The Wall Street Journal, health insurance companies are targeting those who are...

Part D and People Who Are “Medically Needy”

Warning: this Alert may cause headaches. Those readers who have ever roamed the Serbonian Bog[1] that is Medicaid will feel right at home. THE MEDICAID BOG The so-called Medically Needy – Medicare beneficiaries whose Medicaid eligibility depends on meeting a spend-down (or share of cost) each month or quarter – are faced with difficult challenges just using their Medicaid, since, in most states, they must prove to the state that they have incurred a certain amount in medical bills before their Medicaid becomes effective. These same individuals face even greater complications resulting from their participation in Medicare Part D’s low income subsidy (LIS). One contributing factor to these complications is that the government’s share of payment for prescription medications, which are obtained at little or no cost to the individual under LIS, does not count toward meeting the medically needy spend-down, the condition that qualifies a beneficiary for full Medicaid coverage. In other words, having LIS often results in an individual losing their Medicaid coverage. EXAMPLE: ONE CLIENT’S WANDERING IN THE BOG Medicaid in 2005. Our client, Ms. H. had high drug costs prior to the implementation of Medicare Part D. Although her income was above her state’s limit for “regular” Medicaid, when her drug costs were taken into account, her income dropped to the state’s medically needy income level and Medicaid picked up her health care costs beyond those expenses needed to qualify. In addition to coverage for any drugs beyond those needed to qualify, she got coverage for some or all of Medicare’s cost-sharing as well as for services offered by her state Medicaid program that are...

Colorado seniors face soaring price of drug plans

Nancy Wittebort is 77, takes six medications each day and didn’t want to “tolerate” the hours-long hassle of figuring out which prescription-drug plan would get her the best deal. The letter informing her that the monthly cost of her plan was going up about 60 percent Jan. 1 left her no choice. “I thought that was too much of a jump,” said Wittebort, one of more than a half-million Coloradans receiving Medicare benefits. Wittebort’s monthly premium would have rocketed to $43.30 — up from $26.40 last year and $18.40 three years ago, when prescription-drug plans became an option for Medicare recipients. The Highlands Ranch woman dumped her insurance company and switched to one with a lower premium and a higher deductible before the Dec. 31 deadline, hoping the trade-off is worth it. Many senior citizens — the ones who read warnings about increased premiums — began calling Medicare counseling centers weeks ago in an end-of-the-year scramble to switch drug plans. Now, counselors expect another round of calls from irate and confused seniors as Social Security checks hit mailboxes and seniors realize deductions for drug plans are higher than they expected. The monthly cost for prescription-drug plans has doubled and in some cases quadrupled since January 2006, when the program started. The 10 most popular plans across the country went up drastically this year, some by 70 percent and others by 200 percent. “This is something that will catch the eye of policymakers,” said Lindsey Spindle, vice president of Avalere Health, a health-care information company in Washington, D.C. “I think there are years when those kinds of cost increases are...

Term Life Explained | Life Insurance 101

Term life insurance is life insurance coverage provided for a fixed term agreed upon by the insurance company and policy holder. With this type of life insurance policy, the policy holder pays a set premium for the coverage, and if the person happens to die during this time their beneficiaries will receive a full payout of the agreed upon death benefits. After that term has ended so does the coverage. Term life insurance is the most popular type of life insurance for a number of reasons. First is that it’s a cheap alternative to permanent or whole life insurance.  Term insurance uses the same mortality tables for determining your premium as permanent life insurance, and a death benefit which is always income tax free, but the insurance company saves money because the term life insurance plans often expire without a payout. Permanent plans, on the other hand, always have a payout, eventually, and as such have a higher premium in order to cover these additional costs. Another perceived advantage of term life insurance is its flexibility and convenience. You choose the amount of time that you want life insurance coverage and can even choose as little as a year. Under term policies you have the option to renew or discontinue your life insurance according to your changing coverage needs. There is one potential drawback of term insurance and that is the unpredictability of the insurance market. When your term is up and you want to renew, or perhaps change companies, you run the risk of having to pay a new, higher rate than before with potentially different conditions on...

Prescription for Medicare Part D

Attention seniors — and those who love them. Medicare Part D — the prescription drug program — is back again. From Nov. 15 through Dec. 31, there is a new “open enrollment” period for 2008 Part D coverage. So, here’s a reminder of how Medicare Part D works, along with a quick lesson in how to use the Medicare.gov “PlanFinder” tool to choose the plan that’s best for you. Medicare Part D is the federal government program started in 2006 to make sure that all seniors can get access to prescription drugs through a national insurance program, provided by private insurers. Since it is an insurance program, every senior must sign up, even if he is not currently taking prescription drugs, unless he is covered by a “creditable” plan such as a workplace health insurance program or corporate retiree plan. Many seniors take no prescription drugs. Still, they need to sign up for the least expensive monthly plan, or face steep penalties when they do sign up in the future as they start taking necessary medications. Last year, Washington created the standards for what must be covered in Part D, but it allowed private insurance companies to compete on the structure of their plans as well as the prices and co-payments they would charge. The result was a complicated challenge of comparing many variables, including the inexplicable “doughnut hole” that eliminates coverage after a certain level, then reinstates it after the “catastrophic” level of costs is reached. To make choices even more confusing, Washington also subsidizes Medicare “HMOs” to include prescription drugs in their coverage. So, seniors could choose...

Medicare Drug Coverage is Costing Seniors More

Premiums for the top 10 prescription plans are up an average of 16% from last year, a new study finds — a hardship for many people. As if escalating prices for food and gas weren’t enough of a worry, most seniors in Medicare’s prescription-drug program are paying considerably higher monthly premiums for coverage this year, according to a study to be released today. Those in the 10 largest plans — which account for nearly three-fourths of seniors signed up for drug coverage — are paying an average of $26.39 a month, or 16% more than last year, according to the analysis by Avalere Health, an information company serving the healthcare industry. The rise is modest in dollar terms, and some of the top plans actually lowered their premiums for 2008. But on average, the percentage increase for the drug plan is greater than the change in Medicare’s Part B premium for outpatient care, which rose only 3% in 2008. “A 16% increase is significant in and of itself, because premiums are rising rapidly at a time when Medicare beneficiaries are finding it harder to afford it,” said Dan Mendelson, president of Avalere. “These are individuals on a fixed income who are facing rapidly rising prices elsewhere in the economy.” Indeed, he added, premiums for many seniors appear to be going up faster than the cost of coverage for commercial insurance plans that serve workers and their families. Data from Mercer, a benefits consulting firm, show that drug-benefit costs rose a little more than 9% last year for large employers. Both kinds of coverage are delivered by private insurers, but...

Rising Medicare Premiums Will Hit Retirees Hard

Medicare premiums might soon start crushing retiree spending power. I estimate that many a long-lived couple might need to reduce their retirement spending on non-medical consumption by 13 percent to 26 percent to avoid sharp declines in purchasing power as they get older. This is not an alarmist fantasy. My estimates come from projecting historical cost rates into the 30-year retirement of a couple retiring this year. Here are the facts: Since 1965, the year Medicare was created, the consumer price index has risen at a 4.5 percent annual rate ~ but the Medicare premium has inflated at an 8.4 percent rate over the same period. Worse, the gap appears to be growing. Between 2000 and 2008, the monthly Medicare premium grew from $45.40 to $96.40. That’s a 9.9 percent annual rate of increase. During the same eight-year period, the consumer price index rose at only 2.8 percent a year. So Medicare costs are now rising 7 percentage points a year faster than the general inflation rate. You can understand what this means for real people by considering the future of an imaginary couple, Mr. and Mrs. Retirenow. They both turned 65 in January. They have $10,000 in cash, $300,000 in IRA investments, and they own their $200,000 home in Texas, free and clear. He collects $1,200 a month in Social Security, slightly above average. She collects $600 a month in spousal benefits. Neither has a pension, but they think they can get along pretty well on $21,600 in Social Security benefits and $15,000 from their IRA accounts, a total of $36,600 a year. They feel pretty safe about...

Understand how Medicare Part D works

Medicare Part D is a subsidized prescription drug program backed by the US Federal government that provides anyone on Medicare access to medications at reduced rates.  The premium for a Part D drug plan averages to about $15-$35 a month. If you don’t sign up for a drug card when you first become eligible, and decide later on to enroll into one, you are assessed a 1% penalty for every month you didn’t have the plan in effect going back to your date of eligibility.  All Medicare Part D plans must have the basic benefits required by Medicare, since it is regulated by the government. How much does Part D cost? Depending on the plan you may or may not have a drug deductible to meet which can be as high as $320/year. The higher the plan d premium, the less chance you will have a deductible to meet. Most Part D plans cover drugs based on a 4 or 5 tier system. You pay a co-pay or coinsurance for your medication depending on which level or tier it falls under. You pay your set out-of-pocket expense for each drug you take until you and your plan together, are out-of-pocket $2930 for the year for your medications. At which time you’ve entered what’s called the “Coverage Gap” or “Donut Hole”. Once your Part D plan and you come out-of-pocket $2930 for the year excluding premiums for your medications then you’ll get a 50% discount on brand drugs that are covered by the plan. For generic drugs that are covered by Part D you will be responsible for 86%. The good news...

Save on health care costs with a Florida Medicare Supplemental Policy

As a beneficiary with an Original Medicare parts A and B, you have a health insurance program that covers many of the costs to maintain your health care, however there are significant costs that are not covered.   Medicare does not cover things like co-payments, coinsurance or deductibles these are called gaps, this is why medicare supplements are often referred to as “Medigap plans”. Medigap plans are a type of individual health insurance plans that you purchase from private insurance carriers for a premium. When shopping or comparing Medicare supplement plans in Florida, the only thing you need to be concerned with is the rate and rate renewal history of the company you happen to be looking at. There are a couple reasons for this:  Medicare supplement plans are standardized, meaning that if you are looking at a Plan F from UnitedHealthCare/Blue Cross/Gerber, be rest assured the benefits are all the same and they all have to pay the claims in the same manner. Medigap plans don’t have networks unless you were looking at a Medicare Select plan. So as long as the provider accepts Medicare it does not matter which supplement company you are with  you can use any Medicare provider you choose. A Medicare Select plan is a Medicare supplement policy that is the same as any Plan D-F-G-N, the difference is in return for a reduced premium you would have a select network of hospitals you would need to use. The savings on a Medicare Select plan is usually around 20% dependent on the company. You may be thinking that Medicare will cover the bulk of your medical expenses,...

Medicare Racketeers

The Medicare bill defeated in the Senate would have improved coverage for mental health and preventive services and helped pay medical and drug costs for more people with Medicare living on fixed incomes. The administration objected to these improvements, which were paid for with a modest cut to some of the excessive subsidies Medicare pays to insurance companies. Administration officials opposed this reduction in subsidies, they claim, because it would result in reduced benefits for people with Medicare enrolled in private health plans offered by these companies. Translation: No one gets better Medicare benefits unless our pals in the insurance industry get a cut off the top. It’s as if the Medicare program had been taken over by Mafia goons. Numerous independent, nonpartisan studies have shown it cost taxpayers substantially more–about $1,000 a head, according to one study–to provide coverage through a Medicare private health plan instead of through Original Medicare. Just this week, the Government Accountability Office reported that, in 2005, insurance companies pocketed as profit $1.14 billion in subsidies that the companies had told Medicare would go toward medical benefits. Last night, 39 Republican senators joined President Bush in opposing HR. 6331, the Medicare Improvements for Patients and Providers Act. As a result, the benefit improvements in HR. 6331 will not take effect, and on July 1, doctors will get a 10 percent payment cut, a disaster for both patients and doctors that the bill would have averted. None of the senators’ excuses for this vote hold water: The bill was a partisan exercise. Not so. The bill passed 355 to 59, a veto-proof majority, in the...

How The Medicare Doughnut Hole Is Making American Seniors Sick

In 2003, Congress passed The Medicare Prescription Drug, Improvement and Modernization Act into law. The crafting and passing of this bill was highly influenced by lobbyists from both the pharmaceutical and insurance industries. These groups made sure their coffers would be filled with taxpayers’ money without providing any substantial benefit to American seniors. It was not until the Bill was passed that many started to see the pitfalls of the Medicare Prescription Drug Plan. Also known as Medicare Part D, the Medicare Prescription Drug Plan started providing prescription drug coverage benefits to Medicare-eligible beneficiaries in 2006. One of the most surprising elements of the drug plan for many seniors was the gap in coverage known as the Medicare Doughnut Hole. In 2007, the gap in coverage starts once an individual has spent $2,400 on their prescription drugs for the year. Individuals receive no further benefit from the Medicare Prescription Drug Plan until they spend another $3051.25 and make it to the $5451.25 annual expenditure mark. An estimated 7 million Medicare Prescription Drug Plan beneficiaries will hit the coverage gap in 2007. Hitting the doughnut hole can have very serious health consequences for seniors. In fact, it can even potentially result in death. Shockingly, a 2006 study published in the New England Journal of Medicine called, “Unintended Consequences of Caps on Medicare Drug Benefits,” found that drug plans with a cap on drug coverage (as is the case with the doughnut hole in the Medicare Drug Plan) have an annual death rate that is 22% higher than plans that do not limit drug benefits. This study also found that individuals...

Compare Medicare Advantage Plans

A Florida Medicare Advantage plan or Part C as it is called by Medicare is a health insurance policy sold through private insurance carriers such as UnitedHealthCare, BCBSFL , Aetna and Humana that covers or significantly reduces the medical costs not covered by Original Medicare. They combine your Part A. Part B and usually medicare Part D benefits in an all in one plan. Med Advantage plans are subsidized by the government through your tax dollars many of them are low premium such as 25 or $50 a month, in fact the most popular Medicare Advantage policies don’t even charge the insured a monthly premium. Most seniors citizens will find that the Medicare Advantage plans that are available in their County will come in two flavors, PPO or HMO. There are other types of Medicare Advantage policies such as private fee-for-service, special-needs plans which we discussed in another article. Both have their pro’s and con’s and it’s going to be entirely dependent on your personal situation on which one will make the most sense for you. HMO Medicare health plans typically have lower out-of-pocket expenses then PPO Medicare health plans since you’re not covered out of network accept for emergency room visits. There are some HMO health plans that have about half the out-of-pocket cost of the PPO plans. So if you check out the provider network before signing up and you happen to be happy with the providers, you will be able to use them and the HMO Medicare health policy might make perfect sense for you. PPO medicare health plans have a higher out-of-pocket costs than the HMO version because...

Gold Choice Medicare Advantage PFFS Plan from Humana

The Humana Gold Choice Medicare Advantage plan is a private fee-for-service (PFFS) plan.  That means, strictly speaking there isn’t a provider network with this kind of plan. However, since there is no network, your provider chooses at the point of service whether to accept this Medicare PFFS plan or not.  A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan.  The network providers (that is, providers who have signed contracts with Humana) have already agreed to see members of our plan. If your provider is not one of Humana’s network providers, then the provider is not required to agree to accept the plan’s terms and conditions, of payment, they may choose not to provide health care services to you, except in emergencies. If this happens, you will need to find another provider that will accept our terms and conditions of payment.  Humana has also included Part D prescription drug coverage into this plan. Plan Benefits Outpatient Mental Health Care $30 copayment for each Medicare-covered individual therapy visit $30 copayment for each Medicare-covered group therapy visit $30 copayment for each Medicare-covered therapy visit with a psychiatrist 20% of the cost for Medicare-covered partial hospitalization program services Outpatient Services/Surgery 20% of the cost for each Medicare-covered ambulatory surgical center visit 20% to 25% of the cost for each Medicare-covered outpatient hospital facility visit Ambulance Services $150 copayment for Medicare-covered ambulance benefits. Emergency Care $65 copayment for Medicare-covered emergency room visits $25,000 plan coverage limit for emergency services outside the U.S. every year. Outpatient Rehabilitation Services There may be limits on physical therapy, occupational therapy, and speech and language pathology services If so, there may be exceptions to these limits. $30 copayment [or 25% of the...

Optimum HealthCare Medicare Advantage

Optimum Healthcare is one of the nations most popular providers of Medicare health plans. The health maintenance organization (HMO) is based in Tampa, and was established in 2004.  It’s operated by a group of physicians and offers policies to the residents of more than two dozen Florida counties. They offer four different Medicare health plans depending on where you live. There’s also a company office located in Spring Hill. Optimum Health Care Medicare Advantage plans offer more benefits than the original Medicare and include those with Part B premium reductions, prescription drug plans, and special needs plans (SNP), which are designed for those with chronic conditions. All of the plans come with zero deductibles and offer benefits such as dental, vision, and hearing coverage as well as fitness programs. Plans with premium reductions for Part B include the Optimum Gold Rewards Plan (POS HMO), Diamond Rewards (POS HMO SNP), and Diamond Rewards COPD (POS HMO SNP). The part D prescription drug coverage plans provide both medical and drug insurance which can help you save on health care on cost. These include the Optimum Platinum Plan (POS HMO), the Gold Rewards Plan (POS HMO), Diamond Rewards (POS HMO SNP), Diamond Rewards COPD (POS HMO SNP), and the Emerald Partial and Full plan. To be eligible for the Diamond Rewards plan you need to be diagnosed with cardio vascular disease, diabetes mellitus, or chronic heart failure. To be eligible for the Diamond Rewards COPD plan you need to be diagnosed with COPD (chronic obstructive pulmonary disease). For the Emerald Plan you need to be eligible for both Medicare and Medicaid benefits (dual eligible). The special needs plans are for those with specific chronic diseases. All...

Hitting the Medicare Doughnut Hole Can Be Deadly For Some Seniors

In 2007, an estimated 7 million Medicare Prescription Drug Plan beneficiaries will hit the coverage gap, called the doughnut hole. Hitting the doughnut hole can have very serious health consequences for seniors. In fact, it can even potentially result in death. Shockingly, a 2006 study published in the New England Journal of Medicine called, “Unintended Consequences of Caps on Medicare Drug Benefits”,” found that drug plans with a cap on drug coverage (as is the case with the doughnut hole in the Medicare Drug Plan) have an annual death rate that is 22% higher than plans that do not limit drug benefits. This study also found that individuals whose benefits were capped were less likely to adhere to their long-term prescription drug therapies once they reached the coverage cap. This non-adherence to drug therapies led to significant increases in hospitalizations and emergency room visits. A new, free report called “Medicare Doughnut Hole Facts and Secrets” reveals to seniors exactly what the doughnut hole is and how it can affect them. This report also explains to seniors how they can continue to obtain their medications afford ably once they have hit the doughnut hole. By showing seniors where and how to obtain affordable medications while in the doughnut hole, this report will help seniors to avoid the adverse, and potentially very serious, health consequences of falling into the Medicare doughnut hole. With hundreds of thousands of seniors having already hit the doughnut hole this year, and with millions of seniors about to hit the doughnut hole in the next couple of months, it is critical to get this report into...

Cruise Travel Insurance

You might decide to go on a cruise vacation because it is suppose to be fun and carefree, and you won’t be bogged down with planning the whole vacation.  Sadly, anyone that cruises regularly or reads the news headlines knows that cruise vacations can quickly go bad.  If you’re planning on spending your vacation on a cruise line,  consider purchasing cruise insurance before you go.  Cruise insurance is similar to regular travel insurance; however, changes are made to the policy to reflect situations that may occur during a cruise. Not all insurance policies are the same, so it is important to thoroughly discuss what is covered under the policy before purchasing cruise insurance.  Here are a few tips for selecting the right cruise travel insurance. Look into Multi-Trip or Annual Travel Insurance: If you travel often, it may be cheaper to find a policy that will cover more than one trip. You may be able to pay for the insurance annually and it is usually more cost-effective to go this route if you travel more than once per year. It is important to make sure that there are no limitations in the policy, as some policies do not cover cruise holidays. Discover What Limitations There Are: Not all insurers will cover adventurous or water sports activities. If you enjoy white water rafting or other extreme sporting activities, make sure those items are covered in the policy. Some insurers will not cover injuries that occur from activities like this, whilst others will charge an extra premium if you want coverage for extreme sporting activities. Luggage and Personal Belongings: Although some...

7 Reasons You Need Travel Insurance

Traveling should be a fun experience and travel insurance helps to make sure that you do not incur unexpected burdens while away from home. Lets face it, nobody wants to encounter any complications while traveling. This is where travel insurance might come in handy. Several types of travel insurance is available to help you, including flight insurance, trip cancellation and trip interruption insurance, health insurance, baggage insurance and no-refund insurance. But deciding whether this additional premium is necessary may be a tough choice. However, if something should go wrong, your trip and your composure could be ruined. Here are some reasons why you need travel insurance. With the loss or theft of money, property and or travel documents, getting everything organized is a feat. Travel insurance protection offers a single point of contact to help you get back on track, with little cost to you. If you or your travel partners should fall ill or have an accident where you are forced to fore-go the trip, or the travel provider goes out of business, you are could be left in a helpless situation. Besides missing your vacation, you could end up losing the costs of your trip or incur hefty cancellation fees. Your destination has been hit by natural disaster, political unrest or medical outbreak, forcing you to cancel. A cancellation, even if it’s not under your control, may cost you. Traveling internationally will likely require checking your baggage. If your bags are lost or delayed, you could lose your packed valuables, or fork out cash for any essentials needed in the interim. Most major airlines offer a low payout...

AARP Medicare Complete Medigap Plans

About AARP Medicare Complete, Its Benefits, and the Enrollment Period. For decades, AARP, a government-sponsored health insurance plan for senior citizens has been guaranteeing maximum benefits for the elderly, and this is why many people opt for the AARP Medicare Complete program. What is there to know about this policy? AARP Medicare Complete (Part C) is run by the federal government and underwritten by the United Healthcare , but administered through a non-governmental body (insurance companies), and thus there may be potential greater benefits.  Medicare Advantage Plan is a Medicare Plan Part D (medical prescription drug coverage or AARP Medicare Rx Plan ) and in order to qualify for it, the insured party must have Medicare Parts A (hospital insurance) and B (medical insurance). This program usually has networks of doctors and hospitals that belong to the plan, and you are required to see them. There are four types of AARP Medicare Complete plans to compare from: HMO (Health Maintenance Organization) plan typically requires that you select a Primary Care Physician and you receive services from a network of local doctors and hospitals, except for the emergency room and renal dialysis service. Some of the plans also cover Part D and extended preventative assistance. Out-of-pocket costs are usually lower than with POS and PPO (which will be detailed below). The POS (Point-of-Service) plan is rather similar to the HMO plan, but it is more flexible, offering the possibility to visit doctors and hospitals outside the network for certain services. PPO (Preferred Provider Organization) allows you to choose any doctor or hospital both inside and outside the network for all...

Medicare Part D Drug Plans with Humana

Humana Insurance offers a Medicare Prescription Drug Plan that it contracts through the Federal government. This PDP Summary of Benefits chart shows you a few features of the Humana Complete Medicare plan. To obtain a complete list of benefits please contact Humana Complete (PDP) and ask for the “Evidence of Coverage”. Humana Complete is Humana’s most comprehensive Medicare Part D prescription drug plan to date. The monthly premium for Florida Medicare beneficiaries clocks in at around $100 a month. You can join Medicare Part D plan if you have or are eligible for Medicare Part A and/or enrolled in Medicare Part B and live in a provided area. There is no deductible for drugs on this Part D drug card. Another available plan to get your prescription drug coverage is a AARP’s Medicare Complete Medigap or AARP Medicare Rx Plans that includes prescription drug coverage. You can use this guide to compare coverage and then make and informed choice. Humana Complete Medicare PDP Summary of Benefits Plan Type PDP Annual Deductible $0 Out-of-Pocket Maximum None Prescription Drug Coverage Yes Prescription Drug Deductible None Retail Pharmacy for Prescription Drugs Preferred Generic You pay the following until total yearly drug costs reach $2,930: – $6 copay for a one-month (30-day) supply of drugs in this tier from a preferred pharmacy; – $18 copay for a three-month (90-day) supply of drugs in this tier from a preferred pharmacy. Non-Preferred Generic You pay the following until total yearly drug costs reach $2,930: – $39 copay for a one-month (30-day) supply of drugs in this tier from a preferred pharmacy; – $117 copay for a three-month (90-day) supply...

What is Whole Life Insurance?

Whole life Insurance, or permanent life insurance, is a life insurance policy that remains in force for the insured’s whole life and requires yearly premiums to be paid into the policy. Whole life insurance gives the policy holder a guaranteed death benefit with a cash value that builds up with a percentage of the yearly premiums paid, plus interest. But because whole life insurance has a guaranteed death benefit that is paid out to each policy holder eventually, they need to charge a higher premium to ensure that the insurance company continues to make a profit. Whole life insurance companies can charge as much as 30% overcharge which translates into pure profit for the company, but policy holders have the peace of mind knowing that their monthly payments are being accrued in part for a hefty death benefit in the end. Types of Whole Life Insurance In the United States there are five types of whole life insurance policies which will vary by rate and benefits. These include non-participating, participating, indeterminate premium, economic limited pay, and single premium. Each of these is explained below.  Non-Participating Non- participating is a whole life insurance policy that has the death benefits, premiums and cash surrender values all determined at the initial signing of the contract. This means that once you lock into the contract nothing can be altered for the life of the agreement. The benefit, or potential drawback of this agreement, is that insurance rates cannot be raised, even if market prices are going up. But at the same time if the market lowers the insurer is stuck paying the higher...

Travel Insurance Protection Against the Unexpected

A vacation can take a long time to save for, but can be ruined in just a second if you don’t have travel insurance. Below are just some of the reasons why buying travel insurance is a must! You can never predict what is going to happen when you are abroad. Unknown territory, unknown customs; you need to expect the unexpected and prepare for all possibilities. The best way to do this is to buy travel insurance. Having travel cover will not only give you the peace of mind of knowing that you are financially protected should any sort of situation arise, it will also ensure that you get where you need to be. Travel insurance protects you in the event of any cancellations or trip delays. Often times the kind of plane or train ticket that you purchase is non-refundable. Yet you purchase it, regardless, trying to save some money and not foreseeing any disruptions. Well, if the airline cancels the flight, or you miss your connection, this could potentially mean that you are out of this money and not where you need to be. When you buy travel insurance you will be protected from situations just like this. Your insurance company will make sure you get to where you need to go and cover all of the associated costs. Accidents are another important reason to buy travel insurance. No one can predict when they will be injured. Perhaps you fall and twist your ankle; you get bit by a snake, or you have an allergic reaction to a new food. You obviously need treatment that can’t be...

5 Quick Reasons To Get Travel Insurance

The benefits of travel insurance far outweigh the one and only drawback: money. While most people are already trying to minimize their vacation expenses, the money you might save is not worth the risks to which you are exposing yourself. Below are a few of the benefits of travel insurance that will show you why travel insurance is a must! 1. You Travel Worry-Free While most people don’t end up needing to use their travel insurance, it definitely gives you peace of mind. With travel insurance, you have the knowledge that if something should go wrong, (i.e. you lose your luggage, have an accident etc.) you won’t be responsible for finding the money to put it right, at a time when you are already stressed out. 2. Medical Coverage If you happen to have an accident or medical emergency while on your trip, the last thing that you want to have to think about is where to get the money to pay for medical attention or hospitalization. Travel insurance covers the cost of emergency medical assistance and treatment. And if wherever you are doesn’t have the treatment you need, your travel insurance covers the cost of medical evacuation in which you are transported to the nearest hospital that can treat you (even if it’s in another country). Once you are finished treatment, your travel insurance also covers the cost of returning you to your home. 3. Personal Belongings And Baggage Protection Given that thousands of bags are lost every single day on national flights alone, it is safe to say that when you travel, there is a good chance...

5 Quick Tips When Buying Travel Insurance

When choosing your travel insurance policy considerations to be made include policy coverage, deductibles and price. To ensure you get the best of all three we have listed some travel insurance tips below. Don’t Buy From Your Airline Airlines and travel agents are notoriously more expensive for travel insurance plans than private insurance companies. So while you are likely tempted to get travel insurance when you book your trip; hold off and get online travel insurance quotes. This will find you a cheaper insurance rate with minimal effort. Shop Around Compare travel insurance quotes online for a quick and easy way to save money. All you do is give your information to several different travel insurance websites and compare policies to find the cheapest and best travel insurance. This will save you the headache of having to deal with customer service reps, and you will have your travel quote within minutes. Consider Annual or Multi-Trip Policies If you travel out of country it is likely worthwhile purchasing an annual or multi-trip travel insurance policy. This will not only save you money, but also the time and hassle associated with securing travel insurance for every trip that you take. Do, however, make sure to get travel insurance that covers you for a variety of different types of travel, so that you don’t find yourself lacking coverage when you go to make a claim. Consider Family or Group Travel Insurance Family or group travel insurance is a great way to reduce costs while not sacrificing coverage. If you are traveling with 5-10 people or more you could qualify for significant insurance...

Key Coverages of Travel Insurance

Travel insurance is a necessary item to include in your travel budget. This precautionary tool will protect your financial investment in your vacation, give you medical coverage while out of the country, as well as protect you in any unexpected bumps that can happen along the way. Below is a breakdown of what a typical travel insurance package will contain. 1. Cancellation and Interruption Coverage This portion of your travel insurance ensures that you are reimbursed, or compensated if you cancel your trip, your airline or tour guide cancels your trip, or if your trip has been interrupted. An interruption means that a flight gets delayed; or there is an unexpected layover, or some other legitimate disruption that means you are late for where you need to go. 2. Emergency Medical Coverage Almost all regular health care coverage here in the US stops once you cross the border. This means that unless you purchase travel insurance you will be forced to pay out of your own pocket any medical expenses incurred while abroad. While this may not seem like that big of a risk or expense, accidents do happen. And while other countries have cheaper healthcare than the US, that is only in comparison because it is still by no means cheap. Having travel insurance will keep you from having to pay for this unexpected emergency medical attention you may need. 3. Lost, Stolen or Damaged Baggage Coverage Everyday thousands of bags are mishandled by airlines across the US, and while most of this luggage is eventually reunited with its owner (albeit battered and beaten up on occasion), sometimes...

Top Ten Life Insurance Tips

Life insurance is a much needed financial safety net in a world with so many unknowns. You spend your life working and saving to provide a comfortable life for your family and yet all of that can be taken away in an instance if you don’t protect your investments with life insurance. If you have already decided to purchase life insurance; good for you! Here are the top 10 life insurance tips to help ensure that your life insurance policy gives you all that you need without charging you a ridiculously high premium. 1. Check out What Coverage You Already Have If you are employed by a company with 50 employees or more you likely have some type of life insurance, even if relatively minor, that you are entitled to. Find out exactly how much that coverage is and then simply take out a private policy covering the difference. This will help save you $. 2. Make Sure You Buy Enough Life Insurance Coverage When purchasing life insurance make sure you get enough to maintain your family’s quality of living. Most experts recommend purchasing between 5 and 10 times your annual salary. To get an accurate idea of what your coverage should be you can also total your annual expenses and debts, taking into consideration significant future expenses such as funeral expenses, education or weddings. 3. Shop Around Never take the first quote that you are given by a life insurance company. Take your time and review your options. There is almost always a company out there with a lower premium. Consider online life insurance companies for even lower...

Chateau Marmont Los Angeles

From the time they first opened their doors in 1929, the Chateau Marmont has been known as one of the most romantic hotels in Los Angeles. An ideal spot for a wedding celebration for dozens or a romantic dinner for two, the hotel has sixty-three elegantly furnished rooms, bungalows, and cottages. Such stars as Clark Gable and Carole Lombard had private rendezvous there. Errol Flynn was a frequent guest, as was Paul Newman. Marilyn Monroe loved to check in for the luxurious rest and relaxation the hotel is known for as well as for her romantic interludes with the rich and famous men she dated. More recently, such stars as Johnny Depp, Winona Ryder, Ellen DeGeneres and Leonardo DiCaprio have been found at the romantic Bar Marmont, one of the hottest spots frequented by famous Hollywood stars. Anyone who is anyone is familiar with the glamorous reputation of this romantic hotel atop Los Angeles. The simplicity of billowing white curtains offers both elegance and privacy. There is no hotel in Los Angeles with more romantic history or lush surroundings. Assuring guests of a romantic getaway, Château Marmont is a perfect honeymoon destination. With all of Los Angeles twinkling below, these rooms and cottages offer everything one could wish for in the area of comfort and beauty. For example, the heated outdoor pool surrounded by lush gardens is only steps away from most rooms. Travelers Insurance Quotes Individual And Family Health Insurance Quote Life Insurance Quote Small Business Health Insurance Quote Medicare Supplement Insurance Quote Other amenities include 42” flat screen televisions, DVD players and DVD library, professional audiovisual equipment,...

Enrolling in Medicare Advantage and Prescription Drug Plans

Are you turning 65 in the next year? It’s time to consider your Medicaid options. Here are the facts: At age 65, you are automatically enrolled in Medicare Part A, hospitalization coverage, which is free, and Part B, which covers lab fees, physician’s fees and medical equipment. There’s a premium for Part B. If you want additional benefits, though, you will need to specifically opt into a Medicare Advantage plan (part C), and or a prescription drug plan (Part D). Medicare Advantage In addition to the basic Medicare benefits, Medicare Advantage plans may also provide additional benefits, such as dental, vision, expanded hospitalization benefits, or more focused care for those with special medical needs, such as diabetics. Premiums vary, depending on your plan and location. You can’t be turned down for Medicare Advantage, but you may have to pay extra if you don’t sign up when you’re first eligible. Note: Don’t get Medicare supplemental coverage if you already have a Part C plan. You don’t need both kinds of coverage – just one or the other. Some things to keep in mind: You can only enroll during your open enrollment period, during certain times of the year. Once you enroll, you stay in the plan for a year. Different plans cover different procedures and treatments. Look at their list of exclusions, or check with the plan before getting a treatment or service. Managed care plans typically come with a list of authorized providers. If you have a preferred physician or other care provider, consult your plan network to ensure your preferred provider is a member of the network. You...

Retirement Planning

Many employers are implementing 401(k) matching programs again. In recent years, matching was greatly reduced or eliminated in most businesses. While many are reinstating their matching programs, there are many who still have not started yet. In addition to this, some employers are matching at a lower percentage rate. Research shows that about 75 percent of employers that stopped matching have restored their plans. From this group, about 75 percent have implemented matching plans at the same rate they used before. Less than 5 percent increased their rate. Almost 25 percent lowered their percentage rate. It’s apparent that many employers want to reinstate their plans only when they can afford to do so. Since their ability to reinstate is dependent upon the economy, it’s difficult to predict when that will happen for each individual company. It’s no surprise that defined contribution plans that lack matching offers have a considerably lower rate of participation than plans that offer matching. This is likely the root of the many problems employers will face in the future when their older employees retire without saving enough money in an efficient and timely manner. Research shows recent workforce statistics suggesting that approximately 40 percent of working Americans are 55 or older. This is a significant increase from the statistics gathered 20 years ago. When this recent statistic is considered from a financial point of view, it shows that older workers are likely to be less engaged in their work and are more expensive in general. Many of them may be staying at their jobs because they have to do so in order to collect retirement...

Finances and Retirement Planning

Since the economic status of the nation is still shaky, both the young and old generations of America worry about retirement and financial prospects. Research shows that about 90 percent of people feel confident with their own financial decisions. Approximately 50 percent of Generation Y members aren’t sure where to begin with retirement planning. However, about 30 percent of Generation X members are unsure of how to go about planning for retirement. This research shows a nationwide need for comprehensive and continuous education about finances and retirement planning, which is necessary to properly prepare the public. If individuals receive proper education, they’ll be able to have the tools and guidance necessary for building a sound strategy that will contribute to a secure financial future. It’s important to have financial security from the time adulthood begins in order to survive rough economic times. However, it’s also crucial to be financially secure when the economic stability is good. In order to see Americans in every life stage feel a sense of financial control, research and findings must be made known on national agendas regarding how private and public sectors can help with this issue. To make the importance of these findings more apparent, it’s important to consider what the people of both generations are saying about their opinions. The same research showed that about 80 percent of Generation X members think the economy is going in the wrong direction. Almost 50 percent of Generation X members feel that they’re not financially secure. This figure represents the highest percentage of all groups surveyed. It’s also interesting to note that about 55 percent...

4 Good Reasons to Write an Ethical Will

In today’s world, most people are aware of the importance of a will. This document expresses a person’s wishes regarding personal property and money. Living wills have also gained popularity. They are used for expressing a person’s wishes if he or she becomes unable to make decisions for medical treatment and life-sustaining measures. However, there is another important type of will to add to the priority list: An ethical will. This type of will is not a legal document. It is a letter or informal document expressing personal values, hopes, future dreams, life experiences and blessings. The letter is shared with family members or friends while the creator is still alive. Although this idea may not sound as important at first thought, consider the following reasons to create one: It provides a way to impart wisdom. Most people find the task of writing a memoir too extensive. Editing, publishing and paying all the necessary bills associated with such a project requires plenty of time and money. An ethical will is a simple and inexpensive way to convey such important ideas. To reach a larger audience, the will can be shared at a special party, a family gathering or any other occasion. It is a very healthy exercise. Writing about life may have a positive health impact for some people. When individuals have the chance to explore their capabilities, desires and memories, they have a way to relieve stress or cope with life’s problems. Some people may even find that this positive task helps them sleep better. It draws a moral road map. Past reflections are not the only element...

Key Phrases that Expose a Home Repair Scam Artist

Home improvement scams are on the rise. Unfortunately, they are not confined to a particular season. However, the months that bring warmer weather are the most common times fraudsters make their attempts. There are also many honest contractors out there who are out of work. To distinguish which ones are operating scams, watch for some specific phrases. “I was just in the neighborhood.” Any encounter that starts with this phrase may be a scam. If this is the case, the handyman’s clothing will usually indicate he is ready to work immediately. In a friendly manner, he will usually explain that he noticed a problem with the driveway, roof, chimney or windows. He may have a partner with him. If there is a vehicle parked outside, check the license plates. Many scam artists have out-of-state plates. They usually do nothing more than collect payment, coat the roof with motor oil and leave. There is also another form of scam connected to this phrase. When two men show up and one tries to distract the homeowner, the other will enter the home and burglarize it. An honest local contractor knows to simply ask if there is any work that needs to be done. “I will need a large cash deposit or the total payment upfront.” An honest contractor will have the necessary credit lines to obtain materials, which means he will collect payment when the job is done. In addition to this, an honest contractor will show visible and tangible proof of improvements and costs. However, extremely large jobs may require a deposit. A deposit should never be more than 35...

The Advantages and Disadvantages of Private Health Insurance

Most Americans have private health insurance. This is a big monthly expense and one that many would prefer to do without. But what are the advantages and disadvantages of a country using this type of health care system? Read below to find out. Advantages: 1. You Choose Your Doctor In the private healthcare system you often have more flexibility in choosing a doctor as well as medical facility. For patients that want the same doctor all the time, this can be a very important advantage of this type of system. 2. Shorter Wait Times If you are having a surgery that is necessary but not life threatening, there are often long wait times. In a private health insurance system the patient will often have shorter wait times because the medical facility is less busy. And even if there are a lot of people waiting, you can often by pass the line by paying a little bit extra for faster medical attention. 3. Improved Facilities Unfortunately, because the public system is funded with government money it does not have access to as much funds as the private sector one do. This means that public hospitals and health care facilities are often overcrowded, and lacking certain comfort amenities. Private health care facilities, on the other hand, are usually well maintained, with private wards, private bathrooms, phones, TVs, and better tasting food. Disadvantages: 1. Private Health Insurance Costs More than Public Health Insurance While the US government might be saving a marginal amount of money by having a private healthcare system instead of a public one; there is no doubt that American...

Top Ten Health Insurance Tips

Health insurance is a monthly expense that most Americans would rather do without. Unfortunately this is not a luxury that you can afford to spare. Below are our top ten health insurance tips, about why you need it and how to get good coverage that fits into your budget! 1. Don’t Go Without Insurance There are too many Americans (about 15% of the population) that simply do not have health insurance coverage. Do not let yourself be one of them. All it takes is one unforeseen illness and all the money you thought you had saved will be gone; and in its place, a large medical bill that could leave you in a pile of debt. 2. Consider Your Deductible Your health insurance deductible is a great way to save money on your health insurance premium, but it also leaves you with more financial responsibility in the event of an illness or health insurance need. Unless you have the deductible set aside in a savings account, it is best to keep the deductible low and pay the slightly higher premium. 3. Use Employer Health Insurance If you are looking to save money on your health insurance costs, check to see whether your company offers employee health coverage. These insurance plans are less money because they are group plans and can often be discounted from your check. 4. Don’t Skip On Coverage Even if you have to pay a bit more for your health insurance than you would like, it is better to pay it and get the coverage that you need, rather than go under-insured. Under-insured individuals routinely end...

3 Quick Tips to Picking Your Health Care Insurance

Health insurance costs are on the rise, which makes it all the more difficult to find an affordable health insurance plan that doesn’t sacrifice coverage. To make this process a bit easier, we have listed 3 steps to follow that will help you find the right health insurance coverage. Step 1: Prioritize What Coverage Aspects Are Most Important No policy has everything, so inevitably you will need to decide what health services you want and need and those that you can live without. Questions to ask yourself: 1. Do I have a condition that requires ongoing medical attention? 2. Do I need to consult specialists? 3. Do I get a lot of dental work done? These are important questions that will help you figure out what health care coverage is most important. Step 2: Choose Between Managed Care or Fee-for-Service After deciding what services are essential to your health insurance plan, you will need to decide what type of care you want to receive. The level and type of attention that you require will play a big part in the cost of your health insurance policy. For example, if choosing your health care provider is very important to you, then a fee-for-service plan might be the way to go. Unlike the managed care plans that assign you a doctor, the fee-for-service health plan gives you the flexibility to change doctors and health care facilities. The fee-for-service health insurance premium covers you for 80% of your healthcare costs and then you are responsible for the remaining 20%. If you choose managed care, then there won’t be a lot of out-of-pocket...

AARP Medicare Rx Plan

The American Association of Retired Persons (AARP) is an organization that provides prescription drugs to the beneficiaries of Medicare at low costs. This Medicare approved organization has designed three drug plans that cover almost all brand name prescription drugs or its generic brand included in Medicare Part D. Around 60,000 pharmacies participate in the AARP Medicare Rx Plan to provide expensive prescription drugs at a reduced rate. The 3 prescription drug plans provided by AARP are AARP Medicare Rx Plus a Enhanced Plan and a Saver plan. Each of these plans includes one or more of co-payment tiers. Tier 1 includes generic drugs and has the lowest co-pay; Tier 2 has preferred brand name prescription drugs with medium co-pay; the higher co-pay Tier 3 includes non-preferred drugs; and the highest co-pay comes in the Specialty Tier. The three AARP drug plans cover the drugs that are also covered by Medicare Part D. AARP Medicare Rx Plan has mid-priced premiums, flat and simple co-pays with no deductibles. AARP Medicare Rx Plan – Enhanced has an additional bonus drug list that includes drugs not covered by Medicare Part D. This plan offers Tier 1 generic drug coverage with flat and simple co-pays and no deductibles. The only plan that has annual deductible is AARP Medicare Rx Plan – Saver. However, this plan includes the lower monthly premiums and co-pays. Other benefits of the AARP plans include discount mail order prescription services, additional assistance for low income beneficiaries, discounts on prescriptions approved by FDA, etc. The organization also offers other discount programs like discounts on vision programs, fitness programs, dental insurance and...

What is Medigap Coverage?

The Original Medicare Plan which includes Part A and Part B is not sufficient to cover all your medical needs. It leaves out certain gaps that require you to pay out of your pockets in the form of deductibles, co-pays, and co-insurance. Medigap policies are designed to fill in these gaps; that is, to cover the expenses that the Original Medicare Plan does not pay. Medigap policies are offered by private health insurance companies approved by Medicare. With the Original Medicare Plan and Medigap, you can rest assured of financing your medical needs in old age. Medigap policies are not stand-alone services. They work only with the Original Medicare Plan; you need to be enrolled in Part A and Part B of Medicare. And, it requires each person in the family to have separate Medigap policies since it is a one person per policy coverage. Medigap policies automatically get cancelled if you enroll in a Medicare Advantage Plan which is Part C of Medicare. Medigap policies are also known as Medicare Supplement policies and they are regulated by federal and state laws. There are twelve different plans identified by letters A through L. These policies are standardized plans that have the same basic benefits across providers. For example, Plan A of two different insurance companies must offer the same standard basic services. They can include additional services, but the common benefits cannot be different. Each of the twelve plans covers a specific medical service. More benefits are included in Plans A through J. The monthly premiums are high for these plans but the out of pocket expenses are considerably...

What is Hospice?

Hospice care is provided to persons suffering from terminal diseases. It could be the last stages of cancer, kidney disease or other fatal illness. Such patients require constant care administered by medical professionals. This could be the cause of great financial burden for most families. Medicare Part A services include hospice care to provide relief to the patients and their family members. Inpatient and at-home hospice care is provided by the Medicare-approved hospice. Hospice care requires the individual to possess certain qualifying criteria. Medicare Part A eligibility is a must for the seniors who require hospice care. Certification from a physician stating that the individual is terminally ill and has a life expectancy of six months or less is also needed to avail this service. The patient must sign an acknowledgment stating that what he/she wants is hospice care and not the regular Medicare services; they will not be getting any treatment coverage in such cases; for example, a cancer patient cannot get chemotherapy and hospice care covered simultaneously. Medicare Part A hospice care covers equipment and supplies required for hospice care, doctor and nurses, hospice professionals in hospitals and in home, physical and occupational therapies, speech-language pathology, medical social services, counseling services, pain and symptom management outpatient drugs, inpatient care, and other services approved by Medicare. There is also the acute short-term and respite care, and homemaker and home health aide services. You can discontinue hospice care and go back to the standard Medicare services at any time. If you want to return to hospice care after a while, you will need re-certification from the doctor. However, if...

Medicare Fraud

Medical care is a very expensive concern for a majority of people and that is why they resort to health benefit programs like Medicare that promise a tension free retired life by financially supporting your medical needs. But, this very tool that is supposed to be your lifeguard in old age could be the gunman if you fall victim to Medicare fraud. It has happened to many and it may happen to you also. The U.S. government has lost billions of dollars through the abuse of the Medicare system. Unscrupulous individuals who are into committing Medicare fraud bill Medicare for services that were not provided or received. These individuals can either be the real policy holders who practice dishonesty in dealing with Medicare or doctors or providers who take unnecessary advantage of the patient’s Medicare plan. It can also be a person who steals another person’s Medicare card to avail medical services offered by Medicare. Different types of Medicare fraud occur every year in the U.S. Some commonly reported cases include billing Medicare or a private insurance provider for services that you never received or for services or equipment that are different from what you received, using the Medicare card to avail the benefits for someone else, billing for home medical equipment even after it has been returned, etc. Whatever be the type of Medicare fraud, the burden is always on the honest members as they have to pay more premiums to compensate the losses to the federal government. And, even if someone else uses your Medicare card to get medical care or supplies, the charge will always be...

How to Enroll in Medicare

Medicare enrollment is a simple process if you know the program very well. If you receive Social Security checks or pension from the federal government, joining the Medicare plan is automatically started in the month you turn 65. You will be getting the Part A and Part B coverage. The Medicare card will be sent to you three months in advance of your 65th birthday. It is also possible to decline the Part B plan if you require only the Part A coverage. If the persons or their spouses have paid the Medicare taxes for 40 or more quarters while in employment, they too are eligible for automatic enrollment in the Medicare plan when they are 65 years of age. They do not have to pay monthly premiums for Part A. However, Part B is a fee based service and all enrollees have to pay premiums which are deducted from their Social Security checks. When you turn 65 and qualify the Medicare eligibility criteria, if you do not receive Social Security benefits or federal pension, and if you have not paid the Medicare taxes for a minimum of 40 quarters, you will have to apply for Medicare Part A coverage and pay monthly premiums. You have to initiate the enrollment process three months prior to your 65th birthday so that you start to receive the benefits from the age of 65 onwards. Applying for Medicare enrollment usually has three steps: determining your eligibility, collecting medical history, and selecting the most appropriate Medicare plan. Once you have verified you eligibility for applying for Medicare benefits, the next step is to...

Medicare Out of Pocket Expenses

Prescription drugs are the most expensive items in a senior citizen’s medical needs. Even though Medicare Part D offers coverage for prescription medicines, it is not a hundred percent payment for costly medicines. Several out-of-pocket expenses are part of the Medicare Part D plan. Since Part D does not cover all the prescription drugs, these expenses have to borne by the policy holders. Other Medicare expenses relating to Part D include annual deductibles and drug cost co-payments. Most of the Part D plans have an annual deductible of $250 and a 25% co-payment. This 25% co-payment is applicable until the enrollees have reached $2250 limit in drug expenditure. Up to this limit, the out-of-pocket expenses are $750. But, once the beneficiaries cross the $2250 limit, the enrollees will be paying hundred percent of the drug cost which can be very expensive for people with limited income or resources. This coverage gap that defines the range of drug expenditure is often called the Doughnut hole. Because of this factor, it is observed that a number of senior citizens have not enrolled in the Part D plan. This will eventually lead to a rise in the premiums of the existing policy holders. However, not all purchases are considered as out-of-pocket expenses. The following instances do not come under the out-of-pocket expenses criteria: purchase of drugs that are not covered by the chosen plan, purchase of prescription drugs during travels from a pharmacy outside the plan area or network, using other medical insurance plans that the individual holds to buy prescription drugs, and purchase of medicines from other countries. In all these...

Medicare Lacks Long Term Coverage

Medicare is touted as the best option for medical care in old age. Unfortunately, it does nothing in terms of long term care. Medicare long term coverage is not realized as this is a very costly affair for the federal government. The maximum number of days that Medicare can take care of medical care is 100 days’ stay in hospitals or nursing homes as inpatients under the Medicare Part A plan. Even in this case, only the first twenty days are fully covered by Medicare; the remaining eighty days’ payments are made on a co-payment basis. All expenses beyond this limit are borne by the individual. Long term care insurance becomes a necessity for majority of people aged 65 or over. It is estimated that the average visit in a long term care facility is about 2 ½ years or 900 days. And, Medicare cannot pay for such a long term with the limited premiums. Individuals are encouraged to find alternative insurance plans that cover long term care in medical facilities or at home. The eligibility criteria for long term care insurance state that the person must be unable to complete any two of the six “activities of daily living”: eating, bathing, continence, dressing, toileting, and transferring (such as from a bed). Other categories of people eligible for long term care insurance include those with Alzheimer’s disease or cognitive impairment. People with a doctor’s approval that they need additional care for at least ninety days are also eligible for this insurance. Long term care insurance provides you the flexibility to choose the type of medical care you prefer to...

Medicaid Eligibility Requirements

Poverty alone cannot ensure you that you are eligible for receiving Medicaid benefits. About 60% of poor Americans are not covered by Medicaid just because they do not qualify the criteria for eligibility to get Medicaid services. Therefore, it is essential to know what the different aspects of Medicaid eligibility are and who can apply for Medicaid benefits. Medicaid is a federal and state government joint venture to provide medical insurance coverage to the people belonging to the low income and resources group.  Even though Medicaid is a federal and state government funded initiative, the rule regarding eligibility and the range of coverage differ considerably for each state. However, some common criteria are applicable in all cases. The most important factor in deciding the eligibility for Medicaid is income and resources. The income threshold may be different for the various states of the country. The calculation of one’s resources also has slight variations from state to state. Usually, the factors that are considered while assessing the resources are bank accounts, real estate property like land and house, and other assets and items which will make cash if sold. The State Medical Assistance office may help you to assess your eligibility for Medicaid plan. If you receive Supplemental Security Income from the Social Security Administration, you could be eligible for Medicaid depending on your state’s rule. Other factors that affect the eligibility for Medicaid are age, residency, citizenship or legal status, pregnancy, and family size. Low-income families with children, children under 19 (in some states 21), pregnant women and the child born when the mother is on Medicaid, single parents,...

The Advantages & Disadvantages of PPOs

Preferred Provider Organizations (PPO’s) are Managed Care Organization (MCO) that contract with a network of doctors, hospitals, and other health care providers. This agreement allows treatment at a reduced cost.  In other words, Preferred Provider Organizations offer discounts to visit health care providers, within their provider’s network. Two most important characteristics of PPOs are: The first important characteristic of PPO is that it allows its plan members to visit any doctor or hospital without referrals from the members’ Primary Care Physicians (PCP). In other words, it is just opposite to another popular type of managed care plan, HMO (Health Maintenance Organization), which needs referrals from a PCP. Another appealing characteristic is the flexibility to visit or choose doctors and hospitals outside the network. But it also has some limitations—visits outside the network are not fully covered as visits within the network; thus require higher payments from patients. Despite of above mentioned facts, both these characteristics (no need to referrals and flexibility to choose outside the network) are very appealing to many employees. So, if you wish to avail any of these appealing characteristics, then it’s worth your time to consider PPO as a part of your health benefit package. In sum, PPO’s are virtually having all the advantages of managed care health insurance and fee-for-service health insurance. The only disadvantage is that you must have to pay full rate for physicians and hospitals outside the network. So if you agree to pay for your choice, then PPO’s are the best option for you. Points To Be Considered: Checking and evaluating the network of doctors. When evaluating a Preferred Provider...

What is Medicaid?

Medicaid is meant for people with limited income and resources, including children and disabled. It is a joint federal and state government funded initiative to support the medical needs of the impoverished. However, poverty is not the only eligibility criteria for receiving Medicaid benefits. The factors that determine a person’s eligibility for Medicaid include pregnancy, disability, age, blindness, income, resources, and U.S. citizenship. Applicants for Medicaid for the aged, blind, and disabled should meet the eligibility requirements set for each category; aged people must be 65 or above; blind and disabled must meet the definition of blind and disabled given by the Social Security Administration. Similarly, children must be under the age of 19. The resources that are considered for eligibility are bank accounts, land or house, and other sale-able assets or items. An evaluation of the circumstances and income is performed by the State Medical Assistance office. If there is an increase in the beneficiary’s income, it has to be reported to the authorities to effect eligibility changes; any failure in this will affect future eligibility. The rules regarding income and resource eligibility can differ from state to state and the Medicaid programs also will vary accordingly. Medicaid has more extensive coverage than Medicare, especially in the case of nursing home care. It is also considered as the best long term care insurance plan for the low income group. The only limitation is that the number of facilities that come under the Medicaid program is less. The cost of medical services under the Medicaid program is shared by the federal and state governments; while the federal government pays...

Managing The Cost of Health Insurance

The spiraling cost of health care is a matter of widespread concern. But there is huge concern for people without the proper health insurance coverage and health care insurance should not be neglected.  The right approach to this problem is to find ways of managing it through appropriate health insurance.  Within the vast insurance industry the right health insurance is obtainable of nearly for everybody. In some countries health coverage is provided by the government that has very agreeable welfare programs for its citizens. However, in the United States health care is borne by the citizens themselves. The insurance sector has grown in recent years in number and the quality of service that they provide. There are multiple providers to pick from that some shopping and research is a must so that you can make an educated decision on your needs. QOOQe is a great website to research and find the right insurance for you.  And more people now then ever use the Internet to shop for the right insurance policy and are able to research their policy making them well informed. A quick survey of health insurance shows that there are three main types. They are individual, group and family. Within these types of insurance the benefits can vary greatly.  Your age, habits,  and type of employment will be taken into consideration when assessing you insurance cost.  Insurance providers review these factors in deciding to accept an application and to help determine the cost of your premiums. There are various options for paying the premium. They can be typically paid bimonthly, monthly or yearly, and with some cases...

Choosing a Medigap Policy

Now that you’re on Medicare, all your health insurance worries are over, right? You think you’ll never have to make a decision about health insurance again, or be concerned about how to pay premiums for coverage, or pay exorbitant fees for services? Think again. There are gaps left by traditional Medicare – you could end up paying thousands out of your own pocket if you don’t have a supplemental insurance policy, also known as a “Medigap” policy. Let’s take a look at what Medicare covers, and more importantly, what it doesn’t cover. Medicare is a Federally provided health insurance program for American citizens over the age of sixty-five or citizens with certain disabilities. It’s a “fee for service” arrangement, which simply means you may go to any health care provider: doctor, lab, hospital, etc., that accepts Medicare, pay your deductible and your share of cost, and Medicare pays its share of cost. There are two parts to Medicare: Part A and Part B. Part A covers the “hospital-type” expenses: inpatient care in a hospital or skilled nursing facility, home health care and hospice. There are certain limits, such as it covers only the first 60 days in the hospital, and you pay a deductible and a co-payment. Part A is generally premium-free, and almost everyone qualifies for Part A. Part B is the “medical-expenses” portion: doctors, ambulance, X-rays, kidney dialysis, outpatient therapy, emergency care, artificial limbs, medical supplies, neck braces, etc. There is an annual deductible for Part B, and it is optional. Premiums vary each year, and are typically deducted by your Social Security check. Because not all...

Away at College Do You Change Their Health Insurance Coverage?

Children, especially teen-agers, are indestructible, right?  Nothing is bad ever going to happen to them.  No injuries, no illnesses, nothing requiring doctor visits or, (gasp!) hospitalization.  Just ask them, they’ll tell you. As parents and adults, we know better.  And now that the little darlings are away at college, you need to think about their health insurance coverage. Should you change it? Consider carefully before you do. Generally, a parent’s health insurance policy will cover dependents as long as they’re a full-time student, up to certain age limitations, usually 19 to 25.  The operative phrase here is full-time student – if they’re not carrying a full academic load, the insurance company can drop their coverage sooner. And even if they are carrying a full-time student load, insurance companies can cease to cover them when they’ve reached the plan’s maximum dependent age, typically 23 to 25. If you, as a parent, are continuing to be financial responsible for your child, there are some alternatives to consider.  And the best time to take a look at this issue is before you’re forced to make a decision by the insurance company.  You’ll have four basic choices when it comes to health insurance coverage: 1. Continuing coverage under your policy. 2. COBRA 3. An individual health insurance plan 4. Short term health insurance 5. High Risk Pool Continuing coverage under your policy – Remember, this option is only available up to certain age limitations, and if your child is a full-time student. Assuming that your coverage is part of a group health insurance plan from an employer, or if you’re self-employed, this choice...

Cancer Expense Coverage

Are you at risk of developing cancer? The American Cancer Society says that women have a 1 in 3 lifetime risk of developing some form of cancer; men have a 1 in 2 risk.  A family history of cancer or a smoking habit can increase those risks. Is your basic health insurance coverage enough? Cancer expense insurance is a relatively new type of coverage offered by some insurance companies – it’s designed to give you supplemental coverage, typically in the form of cash payments direct to you, in the event you’re diagnosed with certain types of cancers.  Is it worth the additional cost? Let’s take a look. Your basic medical insurance coverage may not be enough, if you’re stricken with a catastrophic illness such as cancer.  Most medical insurance plans have deductibles and co-payments, for everything from prescription drugs to hospital and doctor’s fees, to lab tests and nursing care.  As the costs of treatment for illnesses such as cancer continue to skyrocket, health insurance carriers are forcing insureds to pay more of the costs out of their own pocket.  Your plan may have an out-of-pocket expense maximum, but if it has no upper limit, you could be under-insured.  For example, say you have a PPO plan with a $1,000.00 deductible and a 20% out-of pocket co-payment.  If you’re diagnosed with leukemia, and put on chemotherapy, you’re total cost of treatment may be in excess of $100,000.00  If your insurance company pays only 80%, your out-of-pocket cost could be more than $20,000.00.  Do you have the resources to pay for that yourself? If not, cancer expense insurance is something...

Unproven Medical Treatments Effect Elderly

Unproven and untested medical treatments are a 20 billion dollar a year business. “Miracle cures” are announced weekly, if not daily. Internet marketers trumpet the benefits of their latest creation, while infomercials on late night television persuade, cajole and outright misrepresent the assertions of whatever product they’re promoting. Who is all this marketing aimed at? Why does it work so well? And most importantly, is it dangerous to your health? According to a House Subcommittee report on Health and Long-Term care, more than 60% of people who try unproven treatment are above the age 65, and they spend billions on useless treatments. It’s been estimated that just about 80 percent of retired people have at least one chronic health problem; their distress and infirmities can lead to depression and despondency, making them targets for scam artists and those selling the latest craze in health care. But the elderly aren’t the only ones purchasing these products: from weight loss to hair replacement gimmicks to vitamin supplements, younger people as well are opening their checkbooks and spending big bucks on these remedies. It’s enough to drive the FDA (Food and Drug Administration) crazy, since they’re the agency that regulates such activity. Trying unproven or untested treatments can not only be a waste of time and money, it can also be dangerous. The danger lies in two areas: direct health hazard or indirect health hazard. Direct health hazards are just that – the product can actually cause some action or reaction that endangers the health of the person using that product. For example, back in the early 1990′s, the herb Chaparral was...

Early Retirement – Health Insurance

Well, you’ve finally reached the big day. You’re employer is throwing you a big retirement party, and then you’re going to go fishing every day. Or play bingo. Or travel. Retirement is supposed to be a joyful occasion – the start of the rest of your life. All too often, it brings its own set of problems and concerns, not the least of which is health insurance. Early retirement in particular, before age 65, when you become eligible for Medicare, can present some interesting challenges in the area of health insurance coverage. It’s a fact of life: as we age, things start to go wrong with our health. Just at the time in life when you’ll probably need more insurance benefits, you’ll find the options are limited. Some things you need to consider before making the decision for early retirement: If your employer offers retirement benefits for health insurance, are you sure the company will be around for a long period of time? What if they go out of business and don’t pay your health insurance premiums? What if your employer doesn’t offer retiree health insurance? What if you can’t afford to pay the premiums for an individual plan? Early retirees have four choices when it comes to health insurance: Use your employer-paid health insurance Purchase an individual health insurance policy Continue coverage under COBRA Go without health insurance coverage Use your employer-paid health insurance – The first thing you need to find out is if your employer offers this benefit. Is it part of your benefits package? And if it is, check out the coverage very carefully; many...

Children’s Health Insurance Options

There are over 7 million children in the United States who do not have health insurance. Whether dual income families, or single parents, many families just cannot afford private health insurance, and their children’s health suffers because of it. Families in this situation usually seek medical care only in an emergency, and do not get the preventative care that healthy American children require. If you, or someone you know, cannot afford health insurance, there are many social service agencies at both the federal and state level that may be able to assist you. The federal government sponsors a Medicaid program, co-funded with each state, to offer medical care and assistance to individuals within the region, Usually children, pregnant women, disabled citizens, blind citizens and those over the age of 65 are eligible for Medicaid. A state’s Department of Public Aid, or a similar department, run the Medicaid program, so check with Public Aid to determine if you or your child is eligible for support. An insurance program specific to children was organized in 1997 when Congress enacted the CHIP, Children’s Health Insurance Program, to help reduce the number of uninsured children in the U.S. Congress ruled that each state had a three-year grace period to organize their state’s CHIP, known as a State Children’s Health Insurance Program (SCHIP), and at this time, each state has a SCHIP, or similar program, in place. Though each SCHIP has it’s own rules regarding eligibility, the main qualifications are: child is not eligible for Medicaid; child under the age of 19 (20 in some states); and family makes no more than 200% of...

What is Small Business Health Insurance?

Unfortunately, small businesses in the United States bear the weight of heavy expenses when it comes to health insurance for their small company. It is possible and fairly easy for small businesses in the U.S. to obtain health insurance for their employees, but it can be very costly. Insurance companies often penalize small businesses, with higher premiums, because they (small companies) are unable to spread the risk among a large number of employees. Usually, insurance carriers categorize small businesses as companies with 2-50 employees, though each insurance plan is different and the range may extend to as many as 250 employees. There are several options for small business health insurance from the local level all the way up to a national level. The first is group insurance purchased directly from the insurance company.  Group insurance quotes may be obtained by an insurance broker or via the Internet. You’ll need only a small amount of information about your employees to get started, including their full name, date of birth and home zip code. If you find that small business insurance is just too costly, there are several alternatives. The best place to begin is with your local chamber of commerce or trade association/union. Some of these groups form purchasing pools to obtain affordable small business health insurance for businesses in their region. If your local resources don’t offer what you are looking for, the next step is your state insurance department. It is their job to have information regarding purchasing pools, either in your local area or statewide, which may be able to offer less expensive options for small businesses....

What is Maternity Health Insurance Coverage?

Most people assume that an expensive health insurance issue, such as maternity coverage, is automatically included on health insurance policies. You may be surprised to find that pregnancy/maternity expenses are not covered on all insurance policies, and in fact, can be a costly additional premium, or not available at all via many insurance companies. How do you protect yourself, or your partner, if she is pregnant or thinking about becoming pregnant? First, find out if your current health insurance includes maternity coverage. Most group plans through employers and organizations (churches, trade associations, chambers of commerce) do include this item, as a service to the participants. If it does include maternity expenses, you’re in the clear. If you currently do not have insurance, or your insurance does not carry the maternity option, and you plan to start a family in the near future – you need get organized. As stated above, not all insurance companies offer the pregnancy option, and if they do it may be pricey and may include a waiting period of 3 months to one year before conception. So if possible, plan ahead before you become pregnant and are without insurance. If you are already pregnant and do not have insurance, you are at an extreme disadvantage. You will probably have a very hard time finding an insurance company who will insure you, or may insure you, but will exclude any maternity costs. But, you do have a few options. Because employers’ healthcare plans usually include maternity coverage, you may want to find a job with a decent insurance plan, just so you have some type of...

Self Employed Health Insurance

It may require a little work and research on your part, but people who are self-employed/sole proprietors can obtain health insurance. There are two routes to take when seeking self employed health insurance: individual health insurance directly from the insurance company or group health insurance, usually through a chamber of commerce or trade association. In general, group health insurance is less expensive to obtain, so be sure to check with any local trade group or chamber of commerce you are associated with before making any inquires about individual insurance. The only drawback with group insurance is that since the plan has already been established, you have no choice as to the plan options that are available. Make sure that the existing plan will suit your needs before joining the group. The second route, individual insurance, is usually more costly and will require more research before a plan can be established. There are many policies available with different types of coverage and different budgets from insurance companies. They may be researched via the Internet, an insurance broker or by calling the insurance company directly. Although it may seem difficult to obtain self-employed health insurance, there is a light at the end of the tunnel. If your business does well and you end up hiring at least one (full-time) employee, and you incorporate your business, you can acquire group health insurance for your new firm. Check thoroughly with each insurance company to determine the number of employees they consider to be a “small business” before committing to anything. If you are looking for self employed health insurance, you might want to...

What is Funeral Insurance?

Funeral insurance is insurance intended to cover the cost of funeral expenses. It usually has a low face value, normally less than $10,000. The value of the policy is determined by the anticipated total funeral expenses at the time of death, although some final expenses, such as cemetery property, can be prepaid and would not need to included in the policy. Some insurance agents base a policy on average expenses. Others, especially those representing funeral homes, will list funeral details, casket choice, cemetery expenses, etc. and give a more accurate face value. Some sellers apply the proceeds of the policy to the final expense. Others guarantee that the price of the funeral will not exceed the insurance benefit. Guaranteed policies may cost more, so you should compare the cost and the benefits carefully. In addition, you should get detailed documentation of what is included in the guarantee and what is not. Some funeral policies increase in value over the years while some do not. This is an important feature of the policy, and you would usually find that a policy which increases is more likely to allow for inflation. In Washington State, by regulation, insurance companies are not allowed to collect more in premiums than the face value of the funeral insurance policy. This has resulted in some complicated insurance provisions, especially in the early years of the policy. While they are based on sound business practice they can be confusing, so be sure you understand them. As with all business transactions, you need to know who is selling the insurance. Is the agent affiliated with an insurance company,...

Health Insurance Alternatives for the Elderly

It’s estimated that one in eight Americans is age 65 or older, comprising about 12% of the population. According to the CDC (Centers for Disease Control) by the year 2050, that figure is expected to increase to 20% of the overall population. As baby boomers age, health insurance alternatives become an increasing concern. As it stands now, your health insurance alternatives when you reach age 65 are largely determined by your income, assets and budget. The less you have of all three, the fewer your options. Let’s look at what’s available. Medicare – This is the government-administered health insurance program for people 65 and older, some younger people with disabilities and people with end-stage Renal Disease (ESRD). Approximately 40 million people are currently enrolled in Medicare. Basic Medicare is a traditional fee-for-services program, which simply means you can go to any health care provider that accepts Medicare. You pay deductible and your share of cost, and Medicare pays the rest. There are two parts to Medicare: Part A and Part B. Part A is the “hospital insurance” portion that pays for things like inpatient hospital care, skilled nursing facility and home health care and hospice, within certain limits. Part B is the “medical insurance” portion that pays for X-Rays, prescription drugs, doctors, ambulance and the like. Medicaid – is the jointly funded federal and state program that fills in some of the gaps under Medicare. Each state administers its own Medicaid program, setting its own guidelines for who is eligible as well as individual co-payments and deductibles. Because each state is responsible for its own eligibility criteria, there are...

What to Look for in an Individual Health Insurance Plan

Maybe you’ve finally taken the plunge and started your own business. Maybe you’ve changed jobs, and your new employer doesn’t offer health insurance coverage. Whatever your situation, you suddenly find yourself shopping for an individual health insurance policy to replace your group coverage. This process is all new for you. What can you expect? First and foremost, expect “sticker stock” at the price comparison. Your previous employer may have deducted your health insurance premiums from your paycheck, so you hardly felt the pain of the price of your insurance. That will all change when you start comparing individual prices. While costs vary widely from company to company, as well as state to state, expect a sharp increase in price from a group plan to an individual. Doubling, tripling or even quadrupling your premium is not unheard of, in fact, it’s pretty common. A bigger concern is that there is no guarantee that you can find a new insurance company willing to take you on. Under group policies, there is generally little or no medical underwriting, and insurance companies must either issue coverage for the whole group, or decline to cover the whole group; they can’t “cherry pick” the individuals within the group they don’t want to cover. Under an individual plan, however, much stricter underwriting guidelines are followed, and insurance companies are free to decline coverage for you or your family if they feel the risk is too great. Translation: if you or a family member has health problems, even something fairly common such as high blood pressure or diabetes, you can expect to be declined for individual coverage,...

Long-Term Care – Are You Covered?

The National Council on Aging conducted a survey that concluded “more Americans worry about paying for long-term care than paying for retirement”, but the study also found that 70 percent of those surveyed flunked a quiz about the basic facts of long-term care. Almost half of those surveyed said they had done little or no long-term care planning. As America ages, long-term care becomes a critical issue. The assumption that a close relative (daughter, son, etc.) will provide care may not be a valid one. Pressures of jobs, work-related issues such as travel, lifestyle changes and impact on the caregiver; all can make caring for a family member impractical or undesirable. As a consumer, you can’t rely on Medicare, Medicare supplements or basic health insurance plans to pick up the cost of long-term care. Long term care provides to the needs of people with disabilities or chronic illnesses. If you develop Alzheimer’s, have a stroke or advanced diabetes, for example, you may need assistance with every-day tasks such as bathing, dressing, eating and toileting (moving on or off the toilet). Long-term care insurance helps compensate for some of these services, depending on the coverage you choose, in a variety of settings: from your own home to a skilled nursing facility or an assisted living facility. In most cases, health insurance plans through your employer won’t cover long-term care costs. Neither does Medicare in any significant way, although it will pay for some short term professional care. Medicaid, the federal/state program for people on limited incomes and having minimal assets, will pay for long-term care, but you must use up...

HIPAA: What is it and what it means to you?

No, it’s not some new software from Bill Gates, or a video game your kids shouldn’t be watching: HIPAA stands for Health Insurance Portability and Accountability Act of 1996, and it’s actually a very important piece of legislation. If you’ve ever changed jobs (and who hasn’t?), you know that health insurance benefits don’t follow you from one employer to another. Your new employer might have a health insurance plan comparable to your old coverage, but if you have “pre-existing conditions”, your new employer’s health insurance company won’t be happy about covering you. Pre-existing conditions are just that: medical conditions that existed prior to your obtaining coverage with that company. Maybe you’ve got a heart problem, high blood pressure, diabetes or rheumatoid arthritis. In an effort to hold down cost, your new insurance company would refuse to cover any treatment associated with your “pre-existing” medical condition, which meant that you would be forced to pay costs out of pocket. Not just the normal out-of-pocket expenses like co-pays for doctor visits and prescription drugs, but every phase of treatment: MRI’s and hospital stays and open-heart surgery and dialysis. You get the idea. No health insurance coverage for those types of procedures and you could be bankrupt in short order. HIPAA changed all that, by imposing limits on health insurance companies who seek to exclude pre-existing conditions. For example, if you’ve had “creditable” insurance coverage for one year, with no lapse for 63 days or more, your new insurance company can’t use your previous conditions to decline coverage or limit your benefits. They must cover you as soon as you’re eligible for...

High-Limit Accident Insurance

A serious and fatal mishap can happen to anyone, anywhere, and at any time (especially in this fast moving world around us full of uncertainties). According to the National Safety Council’s Accident Facts 1994 Edition, accidents are the leading cause of death for people under the age of 37—the fifth leading cause of death for persons of all ages. These accidents can come in any form—imaginable and sometimes even unimaginable. During a morning shower you could slip and suffer one of the 12,600 fatal falls that occur each year, surprisingly half of them occur at home. You are back to your home on an overcrowded freeway, and suddenly smashed with the vehicle ahead, again you’re one of 44,000 annual traffic fatalities. Need Despite of thousands of efforts, cares, and ultra-modern facilities to save us from all these most unwanted events; these occur. Most of us would like to believe that accident is something that happened to other people—neither to us nor to any of our family members. But as a cruel fact accidents take lives of thousands of ordinary people like me and you, each year; most of who probably think and do the same things as we do. No one can adequately prepare for the loss that a fatal accident can bring to us and we know nothing can compensate the loss of life. This is perhaps the only blank space, which can not be filled, even with the best possible alternative available. But for sure you can prepare for the potential financial strain that you may face at this situation. Sending your children to college, once a...

What is HMO Health Insurance?

An HMO (Health Maintenance Organization) is one of many managed healthcare systems available to Americans to provide health insurance in case of illness or accident. HMO’s are one of the two most popular healthcare systems available in the United States, along with its cousin, the PPO (Preferred Provider Organization). Participants enrolled in HMO’s pay a fixed monthly fee for their healthcare, which is considered a pre-payment to healthcare to the provider. In return, the participant receives medical services including doctor visits, hospitalization and surgery for no other cost, except a nominal co-payment (usually less than $50). Each HMO has a network of doctors who participate in the system. When first enrolling in the system, all HMO participants choose a PCP, a primary care physician, from the HMO network who will serve as a caretaker for the enrollee’s future medical needs. The primary care physician (also known as a primary care provider) is the first line of defense, and the first person to call, in the time of medical need (except an emergency). The PCP gives referrals for specialized care and recommends further medical treatment when necessary. Though the low cost of participating in HMO health insurance is the obvious advantage, there are disadvantages that must be weighed before choosing this type of managed healthcare. Although most HMO’s have an extensive network of doctors and hospitals, not all physicians participate in HMO’s. Participants within an HMO must visit only those doctors within the system, or the provider is likely to deny a health claim. The enrollee’s primary care physician must refer the enrollee to a different doctor for any treatment...

What is Group Health Insurance?

Group health insurance is exactly what it says it is, a insurance policy covering a group of people. Usually a business opens a group plan to offer coverage to its employees, however, group health insurance is not always limited to companies and many different groups can obtain group health insurance. Many times, trade associations, church/religious, special interest groups, clubs/organizations and chambers of commerce groups create health care plans for their participating members. The advantage of having a group health insurance plan definitely exceed the disadvantages: After the initial set-up cost, group plans are generally cheaper because the insurance companies profit from having more people on their plans, even at a lower cost to the participants. Many employers cover part or all of the insurance premiums. Because an insurance company agrees to insure all employees/participants under a group policy, there are no physical exams or health history questionnaires to complete. A limiting of choices is the major drawback to group health policies. New enrollees to an already established group plan have no voice as to what type of policy, (HMO or PPO) would serve their purpose, or what amount of premium, deductible and maximum lifetime coverage would fit the participant’s budget. Most Americans participate in a group health insurance policy, through their work or other organization. Of course, before enrolling with any insurance group, be sure to research the policy to determine if it is right for you and your family.   If you are a small business or looking for group health insurance quote, you may want to try some instant online quotes from...

What is a PPO?

A PPO (Preferred Provider Organization) is a managed healthcare system popular throughout the United States. Similar to its cousin the HMO, Health Maintenance Organization, PPO’s provide a high level of healthcare, as well as a variety of medical facilities available to all participants. Unlike the HMO however, a PPO is actually a group of doctors and hospitals that work under one umbrella (called the PPO), to provide medical services at a discount to the PPO participants. By granting discounts to the participants via an insurance company, the insurance companies are able to entice people to join the PPO by offering financial incentives. These incentives may include: greater discounts for medical services performed by in-system doctors; lower deductibles and lower co-payments. Also different from traditional HMO’s is that PPO users pay for services at the time of the visit and are reimbursed some of the cost by the health care provider at a later time (though many PPO doctors prefer to invoice the healthcare provider directly). The percentage of reimbursement depends on the healthcare policy, a previously established rate agreement, and whether the doctor/hospital is within the PPO network. Unlike the HMO systems, PPO participants may utilize any doctor they wish, and are not required to select a primary care physician (PCP), and do not require authorization from that PCP before the enrollee seeks medical assistance for any ailment or malady. However, PPO enrollees are urged to select doctors within the PPO system, by way of higher reimbursement and lower co-payments. The disadvantage of a PPO healthcare system is the out-of-pocket expense to the enrollee. Because a percentage of each...

What is COBRA Health Insurance?

COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985, is a statute that guarantees employees and their families continued insurance coverage for a specified amount of time after termination of group health insurance coverage with the company. In layman’s terms, to be covered by COBRA means that after a person has lost his/her job, or experienced another qualifying event, the company’s group health insurance will continue to be offered to the employee and family until they can obtain alternative health insurance or until the COBRA benefits expire. Though most people associate COBRA benefits with loss of a job, there are several qualifying events the make a person/family eligible for COBRA: termination from job (as long as it is not “gross misconduct”); voluntary resignation from a job or reduction of hours ensure an employee and family 18 months of COBRA coverage. * The COBRA coverage may be extended to the spouse and dependent children of an employee for 36 months in case of: divorce/legal separation; employee becomes entitled to Medicare; death of employee or loss of dependent child status (available to child only). COBRA health insurance coverage is advantageous for several reasons, the most obvious, of course, is that a family can continue to have health insurance, even if the employee has lost his/her eligibility for the company health insurance. Many families also use the COBRA coverage to continue health insurance coverage if they have been, or will be, denied new health insurance coverage due to a pre-existing condition of one or several family members. The only overwhelming drawback to COBRA is the cost. Like individual and small business...

What is Student Health Insurance?

Student Health Insurance is an individual health insurance product available to full time college students. Many universities and colleges offer their students a group health insurance policy through the school. Each university policy is different, so check with each prospective university to answer any specific student health insurance questions. If your prospective university does not offer a plan, or the college’s plan does not satisfy your needs, student insurance may also be obtained through traditional health insurance companies. Obviously, it is important to have health insurance in case of accident or illness, no matter what age or stage in life, and students are no exception. Many different student plans are available directly through insurance companies, the Internet or your insurance agent. Though there are hundreds of available student insurance policies, and each one has its own unique set of eligibility requirements, most require the below listed qualifications in order to meet eligibility: Participant must be a full-time undergraduate student -OR- Participant must be a full-time graduate student(Check the specific policy for number of hours considered full-time) Why would a student need a student policy instead of an individual health insurance plan? There are many benefits to a student policy, the most apparent being cost. Most student policies have lower premiums and reasonable deductibles for students who have limited resources. (What student do you know who doesn’t have limited resources?) Also, most student health insurance policies purchased through traditional insurance companies travel with the student if they change schools, eliminated the unnecessary chore of reapplying for heath insurance if education plans change. Students may wish to obtain their own health...

Senior Citizen Health Insurance Options

In the USA, senior citizens over the age of 65 are offered medical care by your state and federal government’s Medicare Health Insurance program. All basic medical costs are covered from doctor’s visits to hospitalization. It is the early retiree that may have a problem with insurance. At the age of 65, in the United States, residents are eligible for Medicare and are automatically enrolled if already receiving Social Security. Though Medicare provides adequate medical coverage for many people, it does not cover all co-payments, pharmacy expenses etc. Seniors have the option to purchase extra insurance through the government, called Medigap. Medigap offers 10 different levels of supplementary insurance in groups called Medigap A – Medigap J, each level offering higher coverage for an additional expense. If you are not yet 65 and have retired or plan to retire soon, you should plan ahead. Many seniors, who are not yet eligible, have a challenging time obtaining reliable health care insurance, or may find private insurance too expensive to bear. If you must retire before you are eligible for Medicare, there are several options to consider. Some employers offer their company’s group healthcare plan to retirees. Though this is not the norm, larger companies or corporations involved with unions, may offer this option to retirees as an ongoing benefit, and is generally the least expensive healthcare alternative until Medicare kicks in. To find out if your company’s healthcare plan is available after retirement, contact your Human Resources Department. A second option, but much more costly than your current insurance, is to opt for COBRA benefits once you have left your...

If your health care plan won’t cover a procedure

You’ve just had an expensive medical procedure, and your health care plan won’t cover it. You probably have some options to resolve the dispute. The best defensive against having a health care plan from denying a claim is being informed before you have the procedure. This includes reading your plan description to determine if the procedure is covered, calling your benefits administrator to ask any questions, and communicating with your health care provider about exactly what procedures you will undergo. There are several reasons a health care plan will not cover a procedure. Here are a few of the most common: Failing to get a pre-certification for non-emergency surgery. Most insurance companies require physicians to obtain a pre-certification before the surgery and will send you a letter stating that the surgery has been approved. Be sure to have a copy of the letter before the surgery. If you must have emergency surgery, make sure to let your health care plan know as soon as possible. Make sure a family member or friend has a copy of your insurance card and is willing to call your health care provider and your plan’s benefits administrator. Pre-existing conditions. If you have an individual policy or had a lapse in coverage between group health care plans, some conditions you were treated for in the past may not be covered for a designated period of time. When you change health insurance plans, be sure to ask if any of your conditions will be considered pre-existing and the length of time the conditions will not be covered by your plan. Treatment for a condition related...

What to ask before you have surgery

When your doctor says you need an operation, there are a hundred details you must address before you can be sidelined for awhile to undergo the procedure and recover. As you get ready for surgery, make sure you have all the bases covered with your insurance company. Knowing what your financial responsibilities will be can help ensure you won’t have any surprises afterwards. The following steps will help you be prepared: Read your benefits plan or visit with your human resources department as soon as you know you need surgery. Learn the answers to the following: What are your deductibles or co-payments for my particular surgery? If you are admitted to the hospital, what does your insurance cover? If you want a private room, who will responsible for the cost difference between it and a semi-private room? Is a pre-certification required? Most insurance companies require physicians to obtain a pre-certification before the surgery and will send you a letter stating that the surgery has been approved. Be sure to have a copy of the letter before the surgery. Your insurance company may refuse to pay non-emergency surgical expenses if no pre-certification was obtained. If you have a health care plan that requires you to use a network of physicians, will you be covered if your doctor uses an out-of-network anesthesiologist? Surgeons usually choose these specialists, so it’s important to know if you will be covered if an out-of-network physician is caring for you. How does the insurance company handle longer hospital stays if there are complications? If you are having outpatient surgery, is the surgical facility in your insurance...

The Advantages & Disadvantages of HMOs

HMOs are nothing but Health Maintenance Organizations. In case of traditional health insurance, you can choose any physician you wish, and you can also decide which health service to obtain, but in case of HMOs, you have to choose a Primary Care Physician (PCP) from a list of doctors that your health plan has contracted with to provide services. This doctor will be your primary contact for all health services. He or she will manage your care by coordinating the services you should receive on your behalf. So here, your choice is restricted to the providers list. In simple words, an HMO is an organization that arrange hospitals and doctors into a organization.  Members pay a set per-person fee, giving them access to the HMO’s services. Unlike traditional health insurance or PPOs (the second most popular managed care system), HMOs require participants to pick a Primary Care Physician (PCP), who performs necessary health check ups and allows all visits to medical specialists. It is evident that these HMOs are one of the two most popular forms of managed care networks. According to American Association of Health Plans during their last count, there were 89 million Americans enrolled in HMOs in July. In other words, more than 30% of all insured people are enrolled in HMOs. Under these plans you pay a fixed amount for all of your medical care. You must use the HMOs doctors and facilities and all specialized care must be approved by your PCP. Advantages and Disadvantages: In case of HMOs, this arrangement helps lower general costs, it can still be disliked with some patients. For...

How to lower your price of prescription drugs

Consumers have noticed the skyrocketing cost of prescription drugs for some time, and there seems to be no end in sight. Even if your health care plan covers prescribed medication, co-payments that were $5 or $10 just a few years ago may have increased to $20 or $30 to cover the higher costs. Some new medications may cost hundreds of dollars just for a month’s supply. By communicating with your physician and taking advantage of all your health care plan offers, you can help stem the rising tide of medication costs. Here are some tips to help: Does your health care plan offer a mail-order prescription service? Although not as convenient as your corner drugstore, mail order can offer steep discounts. Most mail-order services provide online ordering, which can be relatively simple. However, there can be up to a week a delay in getting your medication, so mail order is probably not your best bet if the doctor is prescribing antibiotics for a sinus infection or any condition that needs treatment immediately. For daily medications, mail order can be convenient when you plan ahead for the shipping time. If your physician is writing a new prescription, ask for two: one for a one-month supply and one for a longer supply. You can fill the one-month prescription at your retail pharmacy, so you’ll have your medication right away, and send the longer-period one to the mail-order pharmacy. If you aren’t sure mail-order service is for you, start with a prescription for a three-month supply or less. It can be difficult sometimes for a retail pharmacy to obtain access to refills...

Cobra — Insurance when you lose your job

You may have lost your job, but you may be eligible to keep your health insurance coverage. The Consolidated Omnibus Reconciliation Act (COBRA) allows many employees to continue their coverage after losing their jobs for up to 18 months. If your company has 20 employees or more, you probably qualify to continue health insurance coverage under COBRA. Depending on the state in which you work, you may also qualify for continuing coverage if your company has fewer than 20 employees. COBRA covers employees who quit, retire or are terminated for anything but “gross misconduct.” Eighteen months of COBRA coverage is available to the employee, and often to the employee’s spouse and dependent children. The coverage is also generally available to spouses and dependent children in the event of the employee’s divorce or death for up to three years. You’re covered – that’s the good news. The bad news is that COBRA coverage can be expensive. In addition to the portion of insurance premiums that have been regularly deducted from their pay, employees on COBRA are required to pay their employer’s portion of the health care coverage and an administration fee up to 2 percent. For many families, that can mean hundreds of dollars every month. So, how do you determine if it is worth it to pay those costly COBRA premiums? The following questions may help determine what is right for you: How fast are you starting a new job? Workers are given 60 days to elect if they want COBRA coverage, and during those two months are still covered by their former employer’s health care plan. If the...

Choosing a Health Insurance Coverage Plan

Choosing a health insurance coverage plan can be a confusing and time consuming process.  Coverage and quotes can differ from company to company, but there are many great health insurance policies available to Americans, you just have to look carefully to find them. The first point to consider when evaluating health insurance coverage policies is the type of coverage you and your family require.  There are two levels of coverage: basic and major (or catastrophic) coverage.  Generally speaking, it isn’t the run-of-the-mill doctor bills that could eat up your life savings, but a serious accident or illness that could financially ruin a family.  Therefore, most insurance agents recommend that you make sure your health insurance policy incorporates both basic and major coverage.  Basic healthcare insurance covers normal doctor’s expenses, basic hospital and basic surgical expenses.  Catastrophic insurance includes the previously listed items, plus a myriad of other services including (but not limited to): services of nurses; anesthesiologists; surgeons; ambulance fees; lab fees; radiology fees; x-rays; blood/plasma; oxygen; drugs; home care; therapy and much more.  When considering health insurance coverage, one should also think about what type of managed healthcare system they prefer; HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization).  Most insurance companies offer HMO’s and PPO’s on both group and individual insurance policies.  For more information on HMO’s and PPO’s, see the related articles “What is an HMO?” and “What is a PPO?” on the Ask Mr. Health Insurance website.  The second most important issue regarding a health insurance coverage policy is cost.  Premiums and deductibles will determine the level of coverage you can afford, and depending...

Medicare HMOs

Medicare beneficiaries may elect to join an HMO as an alternative to traditional fee-for-service Medicare. Medicare HMOs contract with the Centers for Medicare & Medicaid to provide the full range of Medicare-covered services to Medicare beneficiaries for a fixed monthly fee from the government. Generally you have coverage for care only from providers who are part of the HMO network. The only exceptions are for emergency services, which you may receive anywhere in the United States and urgently needed services, which you may receive while temporarily away from your HMO’s service area. Therefore, if you spend part of the year (more than 90 days) outside the HMO’s service plan area, joining an HMO may not be in your best interest. When you first enroll in an HMO, you will be asked to select a primary care physician from the HMO’s list of doctors. A primary care doctor is responsible for managing all of your medical care, including referrals to a specialist like a cardiologist or gastroenterologist, when your doctor thinks you need it. Some HMOs offer a Point of Service (POS) option for an additional cost. Under the POS option, you will be allowed to see providers outside the network, and the HMO usually pays 70 or 80% of the cost. Some HMOs also offer coverage for services that Original Medicare doesn’t provide, including prescription drugs, routine physical exams, eyeglasses and hearing aids. However, there has been an upward direction in costs for Medicare HMO subscribers. This has finally reached heavily competitive areas such as New York City in recent years. The result is that more HMOs charge premiums,...

Create a strict budget through 6 prudent tips to prevent debt

Debts are frightening for many people. The main problem is you don’t realize the seriousness of debts while accumulating debt. You face the problems when you want to pay your debts off. Well, it’s definitely possible to escape the excessive amount of debt. You might be wondering. “how?” A proper budget is all you need to prevent debt troubles. 6 Tips to craft an effective budget plan 1.      Assess your actual situation: First of all, you must know your limits. This is the most important knowledge which you must have. You must keep your income in mind. Get all of the income sources listed and it’ll become easier for you to start your budget planning.  2.      Plan for your monthly expenses: There must be some mandatory things like groceries, medicines, car insurance and clothing which you can’t afford to miss each month. Create a list of those things. Plan how much you need and purchase accordingly. This will fulfill your essential needs and save your hard earned bucks.  3.      Be easy with your credit cards: Credit cards are very functional, only when they are used properly and within limitations. Don’t forget your credit cards charge interest rates. If you go on a spending spree with your credit cards, then it’ll become impossible for you to prevent debts.  4.      Avoid unnecessary purchases: Be sure about your needs. Having money doesn’t mean you must buy whatever catches your fancy. If you really want your budget plan to work for you, then it’s necessary for you to restrict yourself. Debt prevention is possible only when you can stick to your budget plan....

What is Long Term Care Insurance?

Thanks to the miracle of modern medicine, Americans are living longer then ever before. And because of lifestyle trends in healthy eating, exercise and regular medical check-ups, the 65 and over population has expanded many times over. Along with the great medical advances, comes a new set of problems. Due to cultural changes in the U.S., such as the increase in divorce rate, increase in the number single parent families and the decline of the nuclear family, many elderly people find themselves aging without the luxury of having a family to take care of them, or the means to afford a professional caregiver. As many families are finding out, professional health care, in its many forms, can be costly. A nursing home or daily in-home care can eat up a life savings in a matter of a few short months. In order to supplement the expense of future long-term care, long-term care insurance has been developed for people to plan ahead for a healthy financial future for themselves and their families. Though each plan is different, long-term care insurance generally refers to coverage for someone who may require “custodial care”, not daily medical attention or hospitalization (which would be covered by health insurance or Medicare). Alzheimer’s patients, the disabled or elderly who require daily monitoring, usually fall under the “custodial care” category and can be covered by long-term care insurance. The treatments covered by long term care insurance usually include four general types of care: in home care; adult day care; assisted living and nursing home living. Each type of care is expensive and can quickly consume a family’s...

How to save money when buying health care Insurance.

With the surge in the medical costs in the US and the large number of people who are drowning under a crushing burden of medical bills, getting a health insurance policy has become a necessity, especially for the middle-class income families. As Obama passed the health care reform act, this requires everyone to carry minimum health insurance coverage so that they don’t fall in a financial stress if they fall ill. However, still there are many who waver from the thought of getting health insurance as they think that they won’t be able to bear the premiums. Are you aware there are ways in which you can save money on your health insurance policies? Raise your credit score: Many insurers will check your credit score. A person who hasn’t been good at managing there personal finances and debt obligations is considered a higher risk. If you have a poor credit score, you can be subject to a higher rate on your health insurance policy. You could receive cheaper health insurance rates by first repairing your credit score if it is damaged. Take care of your health: As you probably know rates on most insurance policy’s is determined according to the risk that the insuree poses to be. The more you’re likely to file a claim, the higher your insurance premiums will be. You should take good care of your health so that the insurer knows that you’re not much likely to fall seriously ill and file a claim. This will reduce your insurance premiums. Quit smoking: Are you a smoker? If so chances are pretty high that you will...

Car insurance: Affordable Auto Insurance Premiums

Many people may not have the questioning mind when they find a cheaper deal. Obviously affordable auto insurance premiums are regularly available on the market from various insurers. There could be many good reasons behind undercutting competitors. Essentially companies will have to offer better rates when they are keen to take a larger share in the market. Most consumers are usually reluctant to move away from a provider they are comfortable with. In fact, there may not even be a good reason for sticking with a particular firm other than being used to it. Regularly we see examples of companies starting an aggressive campaign. This usually follows a significant change in the way they do or think about business. It is possible that the new approach may come with serious job, cost and service cuts. Recently this has been the way for many companies due to the availability of the internet in providing services and quotes. Some companies used the technology better than others and let the customers complete most of the forms online. It is only fair to offer cheaper rates to customers as a result of these cost savings. That is why many companies can offer cheap car insurance quotes to online applicants. Probably most people may not realize, but motorists remain with an insurer a few years after they sign up. Many smart companies look at the returns from a new policyholder within this period. So it would be alright to offer a lower rate to attract the business even it means that they lose money for the first year. They will make it up pretty...

Are you covered? The top 10 treatments that your health insurance may not pay for.

Think that your every health care need is covered by your insurance plan? It may not be so. Taking the time to read all the material associated with your health care package may keep you from being surprised later. Here are the top 10 treatments that your health insurance plan may not cover: Maternity expenses. Pre-natal and delivery expenses may not be covered in all plans. If you are planning on having a child, be sure to check your current health care plan to find out what it will pay for. If your company offers several choices for health care, you may need to switch to a plan that covers these expenses. Eye doctors. Routine visits for an eye exam, even if you go to an ophthalmologist, typically are not covered unless you have a medical condition, such as glaucoma. Low-cost vision insurance can help pay for eye exam costs, glasses and contact lenses. Surgery to improve eyesight is generally not covered by health care insurance. Treatment for drug addiction or alcoholism. If treatment is included in your plan, what is covered can vary greatly. Some plans will cover in-patient treatment but not out-patient programs. Nursing home or home health care. With shorter hospital stays a goal in saving health care costs, even patients too young to retire may require a stay in a long-term facility or home health care. Find out what your plan will cover and for how long. Cosmetic surgery. You most likely are on your own if a facelift or liposuction is in order. Treatment for weight loss. Prescription medication, surgery, dietitians and exercise trainers...

The right way to Buy a good Annuity

You can buy an annuity a little at a time, or in a single payment.  That’s one of the reasons annuities can be appealing:  You can choose a flexible premium annuity that lets you invest on a schedule that works for you, or you can buy a single premium annuity with a lump sum purchase. Having lots of choices can make investing seem somewhat like a jigsaw puzzle.  But all that variety can work in your favor, too, especially if it gives you flexibility in how you buy. That’s because finding the money to invest or deciding how to invest it are big issues for most people. For example, you might be able to commit a small amount each month to build your personal retirement savings, but not thousands of dollars at a time.  Or you might get a $5,000 bonus or an inheritance and want to put it to work right away. Single Premium Annuity Generally a single premium annuity requires a minimum investment, often $5,000, but impose no ceiling, or upper limit, on the amount of the purchase. That’s one reason people who inherit a sum of money or receive a lump sum payment see these annuities as a logical choice. A single premium annuity can be used to buy either immediate annuities or deferred annuities, based on whether you want to start taking the income right away or at some point in the future. A Little at a Time The other way to buy an annuity is by making contributions either on a regular schedule or one that suits your changing financial situation. After an initial...

Term Life insurance

Term life insurance is a type of coverage that is temporary, as it covers only a preset amount of time usually a year or less.  After the preset coverage expires the insuree must obtain addition coverage or go without coverage. Because many people would prefer longer term health insurance, but are unable to afford the higher premiums, many term policies offer a conversion privilege, after a certain time, to exchange to a more permanent policy of Whole Life or Universal Life.   This way a person can obtain cheaper insurance then be able to convert to a lifetime policy once the insuree is financially able.  The cost of term insurance are downright cheap for young (less the 50) healthy people when compared to whole life, universal life and variable universal life coverage. How Does Annual Renewable Life Insurance work? A term life insurance premium is usually paid at a fixed rate for one year of coverage or annual renewable term (ART).  The policy is only guaranteed to cover the year paid for.  Where as permanent insurance offers coverage for the life of the insured as long as the premiums are current.   Term Life Insurance is more affordable to receive coverage because a shorter term means a lower likelihood of a healthy persons demise in that short period of time.  But as the policy holder gets older or the cost to insure you increase your short term premiums can increase as well.  A big disadvantage of ART if you develop a terminal illness within the term and need to renew the insurance company could consider you uninsurable.  This is the reason...

Student Loan Consolidation

Many students and former students have more than one student loan debt. Many students have multiple loans through one lender, or multiple lenders. When you choose to consolidate your student loan debt, you can reduce your monthly payment. With student loan debt consolidation you may also lower the amount of the payments you have to make every month. The benefits of student loan debt consolidation are simple. First of all student loan debt consolidation can help you reduce your monthly payments through extended student loan terms or through interest rate deductions. Keep in mind that the longer it takes you to pay off your student loan debt, the more interest you will pay. Most lenders will allow your to repay your loan before the end of the repayment period. If you do that, you can save a significant amount of money in interest!  Check the website QOOQe for more...

Financial Planning for Singles

Money & The Single Parent Some days you may feel alone, but you aren’t. There are literally millions more single parents like you. According to the 2010 Census, 16.4 percent of American households have just one parent. There are 12.9 million single-parent households run by women and 4.39 million run by men. That’s not exactly comforting information, but it’s evidence that there are other people like you–probably just down the street. Still, we realize that your situation is unique. You may be divorced, separated or widowed, or you simply may have chosen not to marry. You may be just starting out in life or you may be well on your way to retirement. You may have lots of financial resources or you may have few, if any. The circumstances differ widely, but you all have one thing in common: You have yourself to rely on financially. It’s not always easy–sometimes it can be pretty hard–especially if you’ve been recently widowed or divorced. The first piece of advice we’ll offer is to give yourself time to get past the tidal wave of emotions you may be feeling now like grief, shock, sadness, anger, guilt, denial and depression. You may be feeling none of these emotions, but it’s likely that you’re feeling some. Be very cautious about making dramatic financial decisions in the heat of the moment. Give time a chance to work in your favor. This is not to say you should ignore necessary decisions. Keep paying your bills and be sure your insurance policies are up to date. If you haven’t done so already, you’ll also want to close...

Examples of some basic financial concepts

This section of our site addresses techniques using Charitable Tools and Discount Tools designed to reduce the taxable estate. Most of these tools can be quite expensive, costing thousands of dollars to implement and more to maintain on an annual basis. As a result, these tools should only be used when asset transfers are substantial. One goal of estate planning is to reduce or eliminate estate taxes. On this QOOQe page we open our toolbox for some basic but useful estate savings techniques as well as some personal comments. Death Tax Repeal? Not Exactly! The much heralded death tax repeal has come with its own form of resurrection. The bill signed by President Bush phases in the benefits over a ten year period, is repealed in 2010 and then is restored in 2011 in order to comply with a 1974 deficit spending budget restriction. For the remainder of 2001, single taxpayers will not owe federal death taxes if their taxable estate is $675,000 or less. This amount, known as the applicable exclusion amount or the exemption equivalent amount, will grow to $1,000,000 in 2002 and to $3.5 million by 2009. If you are married and have titled your property correctly, you will not owe federal death taxes unless your combined estates exceed twice the totals in the following table. The gift tax exclusion remains at $1,000,000 starting in 2002 and is not repealed. Year Deathtime Transfer Exemption Highest Estate & Gift Tax Rate 2001 $ 675,000 55% 2002 $ 1,000,000 50% 2003 $ 1,000,000 49% 2004 $ 1,500,000 48% 2005 $ 1,500,000 47% 2006 $ 2,000,000 46% 2007 $...

What is Healthcare Reimbursement Accounts?

Healthcare Reimbursement Accounts (HRAs) can be a great way to pay for medical expenses not covered by your health care plan. The pre-tax deduction taken out of your paycheck can also help reduce your tax burden. Participants in HRAs determine how much their out-of-pocket medical expenses will be for the coming year, and then the employer deducts an amount from their pay before taxes. For example, if you believe your expenses will be $1,200 over the calendar year, and you are paid twice monthly, your employer will deduct an addition $50 from your pay every pay period. One of the benefits of an HRA is that large health care co-payments or deductibles may be withdrawn from your pay over time. In other words, if you your have a $1,000 co-payment for a hospital stay in February, some HRAs will reimburse you immediately, even though your monthly HRA deduction is only $100 per month for the calendar year. HRAs differ in their reimbursement policies, so check with your benefits administrator to learn more about yours. The keys to making an HRA work for you is understanding what your particular health care plan covers and accurately predicting how much you will need to have deducted from your pay to cover out-of-pocket medical expenses during the upcoming calendar year. The Internal Revenue Service code states that any unused HRA funds are forfeited, so accurate planning is vital. Here are some tips about how to estimate your future medical costs: Look at last year’s medical expenditures to determine the ones that are likely to repeated, like prescription drug co-payments or annual visits to...

Benefits From a Flexible Spending Account

Flexible spending accounts (FSA), or, cafeteria plans, offer employees a menu of services they pay on a pre-tax basis. Authorized under Section 125 of the Internal Revenue Code, cafeteria plans allow employees to set aside money throughout the year to use toward medical or dependent care expenses not covered by health insurance benefits, including co-payments and deductibles. By setting aside money during the year for medical or dependent care services before taxes, employees are able to reduce their taxable income, which increases their take-home pay. Taxes are not paid on claims paid to employee from the account either. When you sign up for a flexible spending account, it is important to know that the money deducted from your pay throughout the year must be used or they will lose it. Therefore, deducting too little is better than too much. A cafeteria plan is not a savings account – the funds do not build up year after year. The federal government allows two types of spending accounts. One is for medical reimbursement and the other is for dependent care spending, whether it’s for child care or care for an elderly family member. The IRS does not set limits on the amount of medical and dental expenses that can be reimbursed by a spending account, buy your plan may establish annual maximums. Be sure to check to find out what yours are. When filing income taxes, you must complete the IRS Form 2441 if you participate in a dependent-care spending account. Dependent-care contributions are reported in Box 10 of the W-2 forms. Sometimes your flexible spending account administrator will provide a...

Tiering – Will you be willing to pay more for your doctor?

As the cost of health insurance premiums continue rise sharply, employers and health care plans are looking to the consumer to shoulder more of the cost of their health care. One recent study found that health insurance premiums increased on the average of 21 percent. With no end in sight, alternative concepts of controlling health care costs are being considered by health care plans and employers alike. Many of these concepts fall under an industry term called “consumer-drive health care.” The theory is the more you, the consumer, are aware of the cost of your health care, the more prudent you’ll be in using your benefits. One method being implemented in some parts of the country is called “tiering.” Consumers who have Preferred Provider Organizations (PPO) as part of their health care plan already choose whether they will use in-network providers or more costly out-of-network providers. As far as the consumer is concerned, tiering is similar, just a little more complicated. With a health care plan that includes tiering, your health care providers would be divided into several groups, such as low, medium and high, based on the fees they charge for services. In some organizations, the health care providers could set their own prices, allowing them to choose their tiers, as opposed to current PPOs, where providers have negotiated with an employer to provide fees at a lower price. Under a tiering system, you can choose a low-tier provider, which would require you to pay nothing or a small co-payment for services. If you choose a medium or high tier provider, you would be required to pay more...

Improve Comparison Of Medicare Prescription Drug Plans

Rep. Stark Proposes Changes To Improve Comparison Of Medicare Prescription Drug Plans House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) at a hearing on Thursday said that he might push for measures this summer that would increase oversight of Medicare prescription drug plans, CQ HealthBeat reports. Provisions of the measure could include giving state insurance regulators the authority to oversee insurers that market the plans and requiring public disclosure of enforcement action taken against drug plans that violate Medicare regulations. The proposal also could include a provision that would mandate coverage of benzodiazepines, which are used to tranquilize nursing home patients, among other uses. The measure also might require the same open enrollment periods for stand-alone Medicare prescription drug plans and plans sold under the Medicare Advantage program. In addition, legislation could include a provision that would require Medicare drug plans to cover six therapeutic drug categories. Comments Stark at the hearing said, “I hope this … will lay the groundwork for improvements to Part D that may be included in the Medicare sections of forthcoming health legislation we hope to move this summer,” which also would reduce Medicare payments to some providers to fund children’s health care. Stark said his goal is to make it easier to compare Medicare prescription drug plans, but “he didn’t specify whether he will seek to do so in the legislation,” CQ HealthBeat reports. He added, “I hope we can at least talk about standardizing Part D products so beneficiaries are better able to compare the 50 or more plans available in their communities” (Reichard, CQ HealthBeat, 6/21). Stark said, “In...

Medicare changes impact suppliers

Biotech drugmaker Amgen Inc. is among the companies that could see profits trimmed by a Congressional spending bill aimed at streamlining the Medicare program. On Friday Senate Finance Committee Chairman Max Baucus released a $20 billion bill that outlines Medicare spending through 2010. Roughly 44 million seniors U.S. receive health coverage through the program. To avoid cutting payments to physicians who treat seniors, Baucus would shave government payments for dialysis drugs, home oxygen equipment and other health services. Wall Street analysts debated Monday which proposals would eventually become law, with Lehman Brothers analyst Tony Clapsis advising investors that “provisions that are ‘non-controversial’ or raise a lot of money are the most likely.” One of the most significant proposals for investors would lower government spending on Amgen’s anemia drug Epogen, a $2.5 billion product used exclusively in kidney dialysis centers. Lawmakers have warned that Medicare’s current payment policy encourages doctors to overprescribe the drug to receive more government reimbursement. The Baucus bill would change that by lumping the costs of the drug into payments for all other dialysis-related services. Dialysis center operators like Fresenius Medical Care AG and El Segundo, Calif.-based Davita Inc. would cut down on their use of Epogen to increase profits, Citigroup analyst Paul Heldman wrote in a note Monday. While the new payment system wouldn’t take effect until 2011, Heldman states it could reduce Epogen usage by 20 percent, lowering Thousand Oaks, Calif.-based Amgen’s earnings per share to $5.16 from $5.88. Dialysis centers would fare better under the proposal, receiving bonus payments for meeting certain service requirements proposed by the new bill. Germany’s Fresenius is the...

Medicare Advantage Plan Payments Are Exacerbating Problems

CBO Director Discusses Health Care Spending Growth, Says Medicare Advantage Plan Payments Are Exacerbating Problems Congressional Budget Office Director Peter Orszag on Thursday at a hearing of the Senate Budget Committee said that federal spending on Medicare and Medicaid would increase from about 4.5% to about 20% of U.S. gross domestic product by 2050, CongressDaily reports. At the hearing, the first in a series on health care costs, Orszag said, “Rising health care costs and their consequences for federal health insurance programs constitute the nation’s central fiscal challenge” (Posner, CongressDaily, 6/21). He added, “The rate at which health care costs grow relative to income is the most important determinant of the long-term fiscal balance; it exerts a significantly larger influence on the budget over the long term than other commonly cited factors, such as the aging of the population” (Reichard, CQ HealthBeat, 6/21). According to Orszag, efforts to limit federal health care spending “over the long term will be very difficult without addressing the underlying forces that are also causing private costs for health care to rise.” Orszag attributed increased health care spending in part to new medical treatments, which “introduce new categories of spending” and in some cases “are being given broadly to patients” who “could do just as well with less-expensive care” (CongressDaily, 6/21). Asked about the effects of Medicare Advantage on federal health care spending, Orszag said that, “if over the next couple of years the rate of growth that we have experienced recently in Medicare Advantage were to continue, I think the result would be a fundamental change in the nature of the Medicare system...

Medicare CMS Launches Online Tool

The open enrollment period for the Medicare prescription drug benefit begins on Thursday, and CMS has established a new online tool to help with the comparison of plans, the Wall Street Journal reports. The tool, which appears on the Medicare.gov Web site, allows users to enter the list of medications that Medicare beneficiaries currently take to determine the amount that each prescription drug plan charges for premiums, copayments and deductibles. In addition, the tool allows users to compare Medicare prescription drug plans based on customer service and other areas. The tool also allows users to compare Medicare Advantage plans based on overall quality, disease management, access to physicians and other areas. The tool is part of Medicare Path Finder, which also appears on the Web site and allows users to compare prescription drug plans based on out-of-pocket costs and pharmacy networks. The Web site also includes a tool that addresses the so-called “doughnut hole” coverage gap in the Medicare prescription drug benefit. Acting CMS Administrator Kerry Weems said of the new tool, “This is really moving into consumer-driven health...

Newspapers Address Medicare Advantage, Prescription Drug Plans

Preserve Seniors’ Access To Care Funding: Recurring Medicare drug benefit financing problems create an opportunity for voters to “demand an adult discussion from political candidates about how they might fix this pivotal health program — what it might cost, what sacrifices might be demanded of taxpayers and recipients,” Los Angeles Times personal finance columnist Kathy Kristof writes. Changes to the program that have been suggested include raising the age at which people qualify for benefits, eliminating private Medicare Advantage plans, cutting wasteful spending, giving beneficiaries vouchers to make them more aware of the costs of treatment, raising taxes and increasing premiums (Kristof, Los Angeles Times, 6/24). Medicare Advantage: Lawmakers are starting to take action to address beneficiaries’ complaints about Medicare Advantage and Medicare prescription drug plans, the Raleigh News & Observer reports. The House Ways and Means Health Subcommittee last week heard testimony concerning problems beneficiaries are having in obtaining answers, help or changes for Medicare Advantage plans. In addition, an alliance of insurance companies last week said it would stop marketing private fee-for-service MA plans to individuals, and the House Energy and Commerce Oversight and Investigations Subcommittee has scheduled a hearing for Tuesday on Medicare plans and how they are carried out. Brian Webb of the National Association of Insurance Commissioners said, “If we had just had a new Medicare Part D (prescription) plan and a new private fee-for-service plan, there would have been a lot of complaints,” adding, “When on top of that, you take control away from the state, people can’t get their issues taken care of. And (Medicare) is not equipped to handle this” (Goldsmith,...

Feds launching new push for patients to take their pills

WASHINGTON, D.C. (AP) – Consider it the other drug problem: Millions of people don’t take their medicine correctly – or quit taking it altogether – and the consequences can be deadly. On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week. It calls the problem a national crisis costing billions of dollars. Some tips to help patients take their medicines correctly, from the not-for-profit National Council on Patient Information and Education: Before leaving the doctor’s office with a new prescription, ask detailed questions including: How and when do I take this? When do I quit? What food, drink, other medicines or activities should I avoid while using this medicine? What is it supposed to do? How do I know if it’s working? What are its possible side effects? What do I do if have those? Bring to each doctor’s appointment a complete list of all prescription and nonprescription medicines you take, so the doctor can check if a planned new drug will interact badly with an existing one. If you use one pharmacy exclusively, the pharmacist can print out a prescription list for you. If you have problems understanding the instructions that come with the medicine, ask the pharmacist for help. There may be a simpler brochure, large-print instructions or translations into languages than English. Patients who forget doses could try setting up pill boxes at the beginning of each week with morning, noon and night doses in separate compartments. Technology including “talking” pill boxes that sound an alarm when...

New prescription drug coverage in the federal Medicare insurance plan for the elderly

CHICAGO (Reuters) – New prescription drug coverage in the federal Medicare insurance plan for the elderly drove a boost in use of pricey brand-name drugs such as statins and ulcer medications, an analysis released on Tuesday said. Medicare, available to 43 million elderly and disabled Americans, began to pay for prescription drugs in 2006, the biggest shift in its four-decade history. As a result, more than half of the Medicare population now gets drug coverage through a private plan run by companies such as Humana Inc. or UnitedHealth Group. The so-called Medicare Part D program boosted sales of cholesterol-lowering statins by 7 percent, and ulcer- and heartburn-treating proton pump inhibitors by 5 percent, the report by pharmaceutical industry consultancy IMS Health said. These first few years of Medicare Part D will be “golden years for enrollees and branded pharmaceutical companies alike,” the report said. Drugmakers strongly backed the 2003 law creating the drug program and are turning out to be, as expected, big financial winners. Private health insurers that largely run the plans were supposed to keep a lid on costs, but spent the first year focusing on enrolling patients, one report author said. “The first year was about enrollment. To be very blunt, the second year will be about making money,” for the plans, Michel Denarie, senior principal at IMS said. The report forecast “bumps in the road,” for both enrollees and drugmakers going forward, as insurers clamp down on brand-drug usage and force more costs onto patients. About 486 million prescriptions, or 15 percent of all retail prescriptions filled in 2006, came from Part D beneficiaries. These...

Medicaid in New York

The Medicaid program was established by the Federal Government to assist the states in providing health care for low-income people. Individual states design their own programs to meet the needs of their citizens. Therefore, viewers of this Web page on Medicaid should consider all information as strictly related to New York State. Medicaid is means-tested, and the income-and resources-eligibility figures for the various programs are listed in the schedule on the following segment. In New York State the Medicaid program is financed 50% by the Federal Government, 25% by New York State and 25% by New York City. Medicaid is administered by the states and, in the case of New York State, the NYS Department of Health is the state agency responsible for regulations and guidelines. New York City (Human Resources Administration) and, in the counties outside NYC, the County Department of Social Services, directly administers the programs, including eligibility determination. Medicaid assists an individual of any age with very low income, but my counseling and, therefore, this Web site, is directed to Medicare beneficiaries (65 years and over or recipients of Social Security Disability Pensions). Over the years I have also counseled a small number of persons who were certified as disabled but were not Medicare-eligible for various reasons. Medicaid coverage in New York State is available to U. S. citizens, qualified aliens who entered the country prior to August 22, 1996 and qualified aliens who entered the country on or after August 22, 1996 after 5 years of residency. This five years of residency qualification has been overturned by a June 2001 New York Court of Appeals...

Medicare Covered Services Schedule

Medicare-covered services are in the main, not paid 100% by Medicare, although there are a number of exceptions. The following schedule of categories of benefits illustrates the gaps, and you are referred to Publication No. CMS-10050, “Medicare & You 2004”, for the full details of all Each “benefit period” begins with the first day at the hospital or skilled nursing facility, and ends after the patient has been out of that facility for 60 consecutive days (including date of discharge). **The exceptions are some hospital outpatient services and certain other outpatient services, for which the patient pays a fixed co-payment amount, which may vary, according to the service. Refer to Publication No. CMS-0218, “Your Guide to the Outpatient Prospective System” for details of the new payment procedure. Year 2004                                   Medicare Benefits   Part A   Uncovered Gaps   Hospital       First 60 days in benefit period*:                        $876 Next 30 days 61-90 (continuous confinement):   $219 each day   Days 91-150 charged against lifetime aggregate reserve of 60 days:                                                               $438 each day   After Day 90, if lifetime reserve days have been used:                      100%     Skilled Nursing Facility       First 20 days in full:   Nothing   Next 80 days (continuous confinement)      $109.50 each day         Part B – Medical       Medicare pays 80% of approved charges after a deductible of:   First $100 per calendar year   Therefore, patient’s risk is:     **20% of approved amount   The above chart clearly indicates the potential financial liability for the Medicare Beneficiary who...

Medigap Schedule Showing Benefits Not Covered By Medicare

A useful tool for understanding Medigap coverage is the following schedule that shows various gaps in Medicare coverage filled by Medigap Plans A, B and C. If there is interest in gaps in coverage such as prescription drugs and 100% of Part B excess charges benefit they are included in detail below the heading “Extra Benefits Not Covered By Medicare.” The National Association of Insurance Commissioners deserve credit for their help in designing insurance policies that perfectly cover the cost gaps in Medicare services, as well as completely covering some of the services not met under Medicare. Furthermore, since the plans are standardized (same ten plans in all states, except Minnesota, Massachusetts and Wisconsin), and use the same Medicare language, the insurance decisions of the consumers have been made easier, with one “caveat” — prescription drugs. In New York State Plan J is the only one not offered to individual Medicare beneficiaries. It is sold by one insurance company, which offers this plan and others through groups (membership organizations). Medicare Year 2004            Plans Deductibles and Co-Insurance (Patients’ Responsibility)   A    B    C Part A-Hospital Insurance No Yes Yes Deductible-$876 for the first 60 days (per benefit period)   Yes Yes Yes Co-payments — $219 a day for the 61st-90th each benefit period and Yes Yes Yes   $438 a day for each lifetime reserve day (60 days) after the 90th day (Medigap’s 365 lifetime days covers days 91-150 after reserve days are used up, and beyond day 150 of a hospital stay) No No Yes Skilled Nursing Facility co-payment — $105.00 a day for the...

Why Individual Health Insurance Is Becoming Popular

Individual health insurance (also called “non-group” health insurance) is generally purchased by those, who are not eligible for employer-sponsored plans. The individual health insurance market acts as a vital source of protection to millions of Americans, who do not have access to employer-sponsored health coverage. While it acts as a protective shield to individuals, this also suffers from the two most common criticisms. First, it is prohibitively expensive. Secondly, it is only available to the healthiest Americans. Undoubtedly, these issues are important. While many still rely on anecdotes and hypothetical examples, data are now becoming available, which demonstrate the affordability of individual coverage and the reasons, why individual health insurance is becoming popular. A recent survey of three insurance companies (eHealthInsurance, HIAA and Center forStudying Health System Change) actively marketing individual medical policies shows that a large majority of people, who lack employer-sponsored health insurance, can easily obtain affordable coverage from an individual policy. The study by the Health Insurance Association of America (HIAA) found that, even in states that allow insurers to consider the applicants’ health, nearly nine out of every 10 properly completed applications for individual health insurance result in an offer of coverage. Seventy one percent of completed applications for an individual policy resulted in an offer of full coverage at standard rates, while an additional 22 percent received offers of insurance with limits on the coverage, or at higher than standard premiums, or both. Because of health reasons, fewer than 12 percent of all completed applications submitted to the companies surveyed were declined. According to HIAA president Donald Young, M.D, this survey provides solid evidence...

How I fought my HMO and won – without a lawyer

In January of 1990, I was in a serious snow-skiing accident. Traveling about 50 miles per hour, I fell and one of my skis sprang up and struck my head just one half-inch under my eye. My front two teeth were completely avulsed, I sustained bone damage and, resultant from a plastic orthodontic retainer I was wearing that broke apart on impact, I lacerated my tongue, lips and gums. My sister, searching the crash site immediately after I fell, found my two front teeth in the snow — completely intact. I was rushed to a hospital where a doctor cleaned and prepared my wounds. The following day I saw an oral surgeon who re-implanted my original teeth into their sockets. Soon after, an endodontist performed root canals on the two re-implanted teeth. All the medical costs incurred were covered, at first, by my dental plan (until that ran out) and later my medical plan came back in, reimbursed the dental plan and paid the balance. In 1994 I moved from Washington (state) to California, all the while maintaining continuous health insurance coverage and getting routine dental and health exams. First Sign of a Problem On October 6th and 7th, 1995, I participated in a 200 mile running relay race from Calistoga to Santa Cruz, California. Each of the 8 members of my team ran three legs of the race (approximately 8 miles each.) In my second leg of the race, I was running up a hill between San Francisco’s Ocean Beach and Pacifica. As I reached the top of the hill, a mild headache I had became a serious...