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December 27, 2004

Different Types of Health Insurance Plans

Traditional health insurance
Up until about 30 years ago, most people had traditional indemnity coverage. These days, it's often known as "fee-for-service." Indemnity plans are a bit like auto insurance: you pay a certain amount of your medical expenses up front -- in the form of a deductible -- and afterward the insurance company pays the majority of the bill.

Advances in modern medicine increased the cost of providing health care and made it possible for people to live longer. Those advances caused many insurance companies to look for ways to reduce their costs of doing business, giving managed care the boost it enjoys today.

Get a Traditional Health Insurance Quote Today

Fee-for-service
For years, indemnity or fee-for-service coverage was the norm. Under this type of health coverage, you have complete autonomy when it comes to choosing doctors, hospitals and other health care providers. You can refer yourself to any specialist without getting permission, and the insurance company doesn't get to decide whether the visit was necessary.

You don't, however, have complete autonomy. Most fee-for-service medicine is managed to a certain extent. For instance, if you're not already incapacitated, you may need to get clearance for a visit to the emergency room.

On the down side, fee-for-service plans usually involve more out-of-pocket expenses. Often there is a deductible, usually of about $200, before the insurance company starts paying. Once you've paid the deductible, the insurer will kick in about 80 percent of any doctor bills. You may have to pay up front and then submit the bill for reimbursement, or your provider may bill your insurer directly.

Under fee-for-service plans, insurers will usually only pay for "reasonable and customary" medical expenses, taking into account what other practitioners in the area charge for similar services. If your doctor happens to charge more than what the insurance company considers "reasonable and customary," you'll probably have to make up the difference yourself.

Traditionally, preventive care services like annual check-ups and pelvic exams haven't been covered under fee-for-service plans. But as the evidence mounts that preventive care can prevent more costly illnesses down the road, some insurers are including them.

Fee-for-service plans often include a ceiling for out-of-pocket expenses, after which the insurance company will pay 100 percent of any costs. Needless to say, the ceiling is usually pretty high.

In a nutshell, fee-for-service coverage offers flexibility in exchange for higher out-of-pocket expenses, more paperwork and higher premiums.

Get a Fee-for-service Health Insurance Quote Today

Managed care
Managed care has been around in one form or another since the 1930s, but it really took off in the last 10 years. As it grew, it evolved, leaving us with three basic types of managed care plans. Today, the majority of people with private health insurance have some type of managed care.

Although there are important differences among the different types of managed care plans, there are some similarities. All managed care plans involve an arrangement between the insurer and a selected network of health care providers, and they offer policyholders significant financial incentives to use the providers in that network. There are usually explicit standards for selecting providers and a formal procedure to assure quality care.

Get a Managed Care Health Insurance Quote Today

Preferred Provider Organizations (PPOs)
One step over the managed care border is the Preferred Provider Organization. PPOs have made arrangements for lower fees with a network of health care providers. PPOs give their policyholders a financial incentive to stay within that network.

For example, a visit to an in-network doctor might mean you'd have a $10 co-pay. If you wanted see an out-of-network doctor, you'd have to pay the entire bill up front and then submit the bill to your insurance company for an 80 percent reimbursement. In addition, you might have to pay a deductible if you choose to go outside the network, or pay the difference between what the in-network and out-of-network doctors charge.

With a PPO, you can refer yourself to a specialist without getting approval and, as long as it's an in-network provider, enjoy the same co-pay. Staying within the network means less money coming out of your pocket and less paperwork. Preventive care services may not be covered under a PPO.

Get a PPO Health Insurance Quote Today

Exclusive Provider Organizations (EPO)
Exclusive Provider Organizations are PPOs that look like HMOs. EPOs raise the financial stakes for staying in the network. If you choose a provider outside the network, you're responsible for the entire cost of the visit.

Get an EPO Health Insurance Quote Today

Point-of-Service (POS)
Point-of-service plans are similar to PPOs, but they introduce the gatekeeper, or Primary Care Physician. You'll need to choose your PCP from among the plan's network of doctors.

As with the PPO, you can choose to go out of network and still get some kind of coverage. In order to get a referral to a specialist, though, you usually must go through your PCP. You can still choose to refer yourself, but it'll mean more hassles and more money coming out of your pocket.

If your PCP refers you to a doctor who is out of the network, the plan should pick up most of the cost. But if you refer yourself out, then you'll probably have to deal with more paperwork and a smaller reimbursement. You may also have to pay a deductible if you go outside the network.

POS plans may also cover more preventive care services, and may even offer health improvement programs like workshops on nutrition and smoking cessation, and discounts at health clubs.

Get a POS Health Insurance Quote Today

Health Maintenance Organizations (HMOs)
Most of the time, when you talk about HMOs, you're really talking about closed-panel HMOs -- the least expensive, but least flexible type of health plan. They also tend to be geared more toward members of group plans than individuals.

In exchange for a low co-payment (or sometimes no co-pay at all), low premiums and minimal paperwork, an HMO requires that you only see its doctors, and that you get a referral from your primary care physician before you see a specialist. If you can still pick up the phone, you'll probably need to get clearance before you can visit the emergency room.

An HMO may have central medical offices or clinics (such as those used by Kaiser Permanente), or it may consist of a network of individual practices. In general, you must see HMO-approved physicians or pay the entire cost of the visit yourself. HMOs have the best reputation for covering preventive care services and health improvement programs.

Get an HMO Health Insurance Quote Today

For more information on purchasing Health Insurance, or to receive a Health Insurance Quote, visit our partner InsureMyHealth.com today.

Posted by healthinsurance at 07:27 PM

December 20, 2004

Health Insurance Regulations and Issues in California

Diversity is a good thing except when it divides people or causes unforeseen disadvantages to certain minority groups.

California is a very diverse place. According to the United States Census Bureau, the state is made up of many difference races, with groups including Caucasian, African-American, Pacific Islander, Hispanic and Asian, as well as people of mixed race and those of Native American origin. California is a wonderful example of the diversity that makes America what it is – a beautiful place people of all backgrounds can feel comfortable calling home.

There are numerous benefits to diversity, both culturally and colorfully. When it comes to health insurance and health care, though, language and cultural differences can be a barrier. If something important is misunderstood, a big problem can result. For example, a young Hispanic woman who needs care for her asthmatic son might not be able to properly communicate his symptoms and health history to the emergency room physician. An elderly Asian man with diabetes might have trouble understanding his doctor’s instructions on how to manage his condition.

These scenarios are not only troubling, but likely, when you consider that according the Census Bureau there are well over 7 million Americans who speak English "not well" or "not at all". Many states, including California, are concerned about the effect this has on the quality of healthcare available to these individuals.

In response, the California Managed Risk Medical Insurance Board has put in place a program that makes sure that those covered under the state’s health insurance program, Healthy Families, have access to the services of an interpreter when receiving health care. Additionally, the program provides other assistance for those who are at risk of having cultural or language differences impair their access to quality care.

For more information on purchasing Health Insurance, or to receive a Health Insurance Quote, visit our partner InsureMyHealth.com today.

Posted by healthinsurance at 10:12 PM

December 13, 2004

Uninsured vs. Insured in California

Within the Golden State that is California, all is not necessarily golden in terms of who does and does not have health insurance.

California is one of the most populous states in the nation. According to the United States Census Bureau, it is home to well over 30 million people of all racial and ethnic backgrounds. But regardless of their age or the language they speak each of them has one thing in common – they all need health insurance.

There are many ways for California residents to obtain health insurance. Some are eligible to participate in group health insurance plans sponsored by their employers. Others purchase individual health insurance for themselves and their families. Low-income individuals are often eligible for Medicaid, and seniors for Medicare. Both these government-sponsored programs are designed to protect the most vulnerable Americans from having to deal with healthcare costs on their own.

Being uninsured leads to higher healthcare costs in the long run because conditions and problems that could be easily cured or arrested with early detection often go undiagnosed because people can’t afford to visit their doctor.

The Kaiser Family Foundation reports that there are around 6,448,540 uninsured Californians – that is over 15 percent of the state’s total population. Of those who are insured, the Foundation reports that over 2 million require individual health insurance because they are not eligible for coverage through their employer or through Medicaid or Medicare.

Even the over 8 million Californians who do qualify for Medicaid or Medicare often require supplemental coverage. Many insurance companies offer programs specifically designed to meet the requirements of people who want or need more coverage than Medicaid or Medicare provides. For example, a senior might be interested in a program that includes discounts on services such as vision check-ups and corrective lenses, dental care or even chiropractic services.

For more information on purchasing Health Insurance, or to receive a Health Insurance Quote, visit our partner InsureMyHealth.com today.

Posted by healthinsurance at 09:54 PM

December 06, 2004

Health Status of Californians

Where does the State of California rank in terms of its residents embodying the stereotypical picture of sunny California healthy living?

Of the fifty states, California is ranked 22nd by the United Health 2003 State Health Rankings. Many Californians enjoy good health, and the state has a low incidence of smoking when compared to other states. However, the state does less well when it comes to controlling other risk factors such as violent crime and infectious disease. It is not surprising that a populous state such as California faces challenges in these areas.

Unfortunately, not all demographic groups in California enjoy the same access to healthcare. Prenatal care, for example, is a key part of making sure that babies have the best chance possible to be born healthy. Moms-to-be are advised to visit the doctor often during each stage of their pregnancy so that their health, and that of their baby, can be monitored and the necessary tests, such as a gestational diabetes screening, can be administered.

Even those who are only considering a pregnancy can benefit by talking to their doctor first. Getting a head start on pregnancy by quitting smoking, improving nutrition and taking the recommended prenatal vitamins as prescribed by your doctor can make a big difference.

However, among expectant American Indian mothers, only around 68 percent have access to prenatal care. This is a startling disparity when compared with the over 80 percent of Asian and white women who are able to obtain necessary prenatal medical services. Regardless of their demographic background, women without health insurance are much less likely to receive prenatal care than are insured women. California and all the states should work to make sure lack of health insurance doesn’t keep pregnant women from getting the care they need to have a healthy baby.

For more information on purchasing Health Insurance, or to receive a Health Insurance Quote, visit our partner InsureMyHealth.com today.

Posted by healthinsurance at 02:15 PM

December 01, 2004

Shopping for Health Insurance in California

For the first real entry to this blog, we're going to briefly discuss what you should be looking for when purchasing health insurance in California. The points discussed below are not exclusive to California residents only, and can be used by any American when purchasing Health Insurance.

Deciding which health insurance plan to purchase is not a universal decision, but rather a highly personal one involving considerations such as benefits and budgetary constraints.

Shopping for health insurance is a challenging process for any consumer. Since California is made up of so many diverse individuals with many different ways of life, it is important for all Californians to know what factors to consider when shopping for the health insurance that is right for their situation.

Whether you are a young person with a new job who has not been working long enough to qualify for benefits, a family man with several children whose employer does not offer insurance, a college student who is no longer eligible for coverage under their parents’ plan or a senior whose Medicare benefits are inadequate, or a self-employed individual, making sure you get the right coverage at the right price is very important. However, there is so much to consider it can be intimidating.

Before you begin looking for insurance, have a plan in place. Decide what type of coverage you need by asking yourself questions like:

Once you have thoroughly considered these issues, move on to your budget and decide how much you can realistically afford to pay for coverage. Remember, individual health insurance can be expensive; however, with the proper research and preparation, consumers can find the plan that is right for them.

For more information on purchasing Health Insurance, or to receive a Health Insurance Quote, visit our partner InsureMyHealth.com today.

Posted by healthinsurance at 12:08 PM