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How Health Insurance Works


When I consider purchasing an individual health insurance plan for myself or my family, do I have any financial obligations beyond the monthly premium and annual deductible?

Answers: It depends on the plan, but some plans have the following cost-sharing elements that you should be aware of.

Co-Payments: Some plans include a co-payment, which is typically a specific flat fee you pay for each medical service, such as for an office visit. After the co-payment is made, the insurance company typically pays the remainder of the covered medical charges.

Deductibles: Some plans include a deductible, which typically refers to the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.

Coinsurance: Some plans include coinsurance. Coinsurance is a cost sharing requirement that makes you responsible for paying a certain percentage of any costs. The insurance company pays the remaining percentage of the covered medical expenses after your insurance deductible is met.

Out-of-pocket limit: Some plans include an out-of-pocket limit. Typically, the out-of-pocket limit is the maximum amount you will pay out of your own pocket for covered medical expenses in a given year. The out-of-pocket limit typically includes deductibles and coinsurance. But, out-of-pocket limits don’t typically apply to co-payments.

Lifetime maximum: Most plans include a lifetime maximum. Typically the lifetime maximum is the amount your insurance plan will pay for covered medical expenses in the course of your lifetime.

Exclusions & Limitations: Most health insurance carriers disclose exclusions & limitations of their plans. It is always a good idea to know what benefits are limited and which services are excluded on your plan. You will be obligated to pay for 100% of services that are excluded on your policy.

Beginning September 23, 2010, the Patient Protection and Affordable Care Act (health care reform) begins to phase out annual dollar limits. Starting on September 23, 2012, annual limits on health insurance plans must be at least million. By 2014 no new health insurance plan will be permitted to have an annual dollar limit on most covered benefits.

Some health insurance plans purchased before March 23, 2010 have what is called “grandfathered status.” Health Insurance Plans with Grandfathered status are exempt from several changes required by health care reform including this phase out of annual limits on health coverage.

If you purchased your health insurance policy after March 23, 2010 and you’re due for a routine preventive care screening like a mammogram or colonoscopy, you may be able to receive that preventive care screening without making a co-payment. You can talk to your insurer or your licensed eHealthInsurance agent if you need help determining whether or not you qualify for a screening without a co-payment.

There are five important changes that occurred with individual and family health insurance policies on September 23, 2010.

Those changes are:
1. Added protection from rate increases: Insurance companies will need to publically disclose any rate increases and provide justification before raising your monthly premiums.
2. Added protection from having insurance canceled: An insurance company cannot cancel your policy except in cases of intentional misrepresentations or fraud.
3. Coverage for preventive care: Certain recommended preventive services, immunizations, and screenings will be covered with no cost sharing requirement.
4. No lifetime maximums on health coverage: No lifetime limits on the dollar value of those health benefits deemed to be essential by the Department of Health and Human Services.
5. No pre-existing condition exclusions for children: If you have children under the age of 19 with pre-existing medical conditions, their application for health insurance cannot be declined due to a pre-existing medical condition. In some states a child may need to wait for the state’s open-enrollment period before their application will be approved.

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Is It Really Feasible To Purchase Life Insurance?

Many times people wonder if life insurance is something that they really need in their lives. Since they are already on a tight budget, adding another expense, particularly for an item that is intangible, doesn’t seem to make any sense.

In essence, the answer to this dilemma is that life insurance solves to problem of a beneficiary being left totally with resources should the death of the breadwinner occur. If a wage earner were to die, he or she could leave their family totally without any stream of income that they are currently counting on for their monthly living expenses. Without such an income, it is possible that a spouse and children would have difficulty making ends meet, and even have difficulty with food and shelter.

It is a fact that funerals are quite expensive, and without life insurance, spouses and relatives will have to scrape together enough money to provide for that expense. Since the time of death is largely unexpected, that can become a very difficult time. It can cause bills to go unpaid, and in the worst case, the family could lose their home because of their inability to make the payments. This could all be avoided making a small payment each month for a life insurance policy.

When consumers understand all of this, they can begin to shop for comparable policies of life insurance online at the taik.org website, whether to buy term (protection only), or permanent (policy has a cash value) and compare them to meet their needs. The amount of the life insurance amount should be sufficient to cover all debts and amounts owed, including the amount of the mortgage on the house.

A person wanting to purchase life insurance should call a licensed life insurance agent who will be able to design a life insurance program that will cover the needs of the family, and be able to design it to meet the budget of the family.

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Facts About Medicare Supplemental Insurance

Medicare supplemental insurance plans, also called Medigap policies, fill in the gaps that are left between the medical costs Medicare pays and the medical charges it does not. Anything that Medicare does not cover is left to the beneficiary to pay out of his or her own pocket.

Because many medical expenses are unexpected ones, this can pose a financial challenge to individuals over 65 who live on fixed income. Medigap insurance is an affordable, predictable product that prevents an individual from being unable to get all the health care they need, from hospital stays to surgeries.

Most coverage from Medicare is offered through Part A and Part B. Part A covers hospital stays and some hospice or nursing home care. Part B covers doctor’s visits, medical equipment and some preventative care. To ensure you are able to get all the coverage needed, it is a good idea to have an additional supplemental insurance plan to keep you from having to face unexpected medical costs.

You need to be a Medicare beneficiary to qualify for supplemental coverage. You cannot be a Medicare Advantage Plan recipient, however. There are several different types of supplemental or Medigap insurance. You want to review the details of these plans before making a purchase.  You can do that easily by checking out sites like MedicareSupplementQuotes.net and getting a set of personalized Medigap quotes.

You will note Medigap policies by their designated letter. There are 10 plans available from A through N. Check with your private insurance agent to get the details on each plan. Some require deductibles be met before coverage kicks in. Some plans offer dental and vision care, but primarily Medigap policies do not include these services.

It is important to note that Medigap insurance does not cover long-term care. This is something you need to look into purchasing separately. Finally, a husband and wife need individual plans.

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Choosing the Right Life Insurance

life-insuranceA quick lesson in what you need to know about life insurance, including the types of policies available and determining how much coverage you need.

There are two types of policies.

You will find term policies, sometimes referred to as pure insurance coverage, and whole life policies which have many different variants. Whole life policies combine an investment vehicle with pure term insurance and build a cash value.

Most insurance policies are sold, not bought.

Insurance agents sell the overwhelming majority of whole life insurance in the United States. The life insurance industry has a vested interest in pushing high-commission, high-profit whole life policies.

Whole life policies are more expensive.

Insurance policies that include an investment component cost much more than term policies do. Many consumers get talked into buying a whole life policy, but because of the added cost, cannot afford a policy with adequate coverage, leaving them underinsured.

Whole life policies are largely sold on exaggerations and assumptions.

The returns quoted by agents selling whole life policies are nothing more than a guess, not the real return. Some companies suggest they are using conservative numbers, but in reality their numbers are on the high side to attract more buyers.

Separation between insurance and investment.

There are less expensive places to invest your money that do not feature the high commissions and high costs of whole-life policies. Keep your investments separate from your insurance policies.

Make sure you purchase adequate amounts of term coverage to satisfy your needs.

When it comes to the future well-being and financial security of your family and loved ones, this is no place to go cutback. Term insurance rates are generally pretty low. Make sure you buy enough to cover their needs.

Match financial needs with the term of your policy.

You want the policy to last at least past the time when your dependents will move out of the house and be on their own, or until a time when your retirement income would kick in and take care of them.

Take advantage of your health.

The best time to buy health insurance is when you are healthy. Older people and those with health problems will pay steeply higher rates for the same life insurance policy.  High risk life insurance quotes will always be more expensive.  There is no need to purchase life insurance before you have dependents, unless there are plans in the very near future to bring some into the world, however you must think about your future insurability.

Be honest.

If there is a large claim to be paid out, and insurance company will investigate before making the payment. Being dishonest or misleading the insurance carrier on your application can result in the claim not being paid. That is a large price to pay just to try to save a few bucks on premiums.

Make use of the power of the internet to shop around.

Thanks to the internet, there has never been an easier time to shop for life insurance. You can get plenty of free quotes in just a few minutes at sites like TermLife360.com. No need to deal with pushy salespeople. You can find everything you need right from your desktop.

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What is Whole Life Insurance?

When you are in the market for life insurance, one of the primary types that you will be able to choose from is whole life insurance. With whole life insurance, you can protect your loved ones in the event of your death, and you can grow a cash value for the future. Here are the basics of whole life insurance and why you might want to consider it.What is Whole Life Insurance?

Whole life insurance is a permanent type of life insurance that stays with you until you pass away or stop paying for the policy. As long as you continue to make the premium payments, the policy will stay in effect, and it will pay out a death benefit when you die.

Cash Value

In addition to the death benefit works and of the whole life insurance policy, these policies also come with a cash value component. Part of the money that you pay to the insurance company every month or year goes into an investment account. This money is then invested by the insurance company and returns are added to the policy holder’s accounts. Over time, this creates a cash value that grows with your policy.

Once you have accumulated some cash value, you could choose to utilize it in a few different ways. You could cash out the policy and take the cash value. Another option is to borrow against the cash value. With this option, you have money that you can use for any purpose and then pay back to the insurance company later.

Planning for Retirement

Some people use whole life insurance products as a for retirement planning. The nice thing about using life insurance is that you can borrow against the policies without having to pay taxes on the money that you receive. Since the money that you get is technically a loan, this is not considered income. Then you can make a nominal payment back to the insurance company for years until the loan is paid back. Depending on your tax status and how much money you have in your retirement accounts already, this can be a good way to save for the future if you’ve already reached your retirement account limits.

Considerations

Whole life insurance policies tend to be more expensive than term life insurance policies for the same death benefit. You can get some free whole life insurance quotes here and compare the rates. However, they are permanent, which means your family is going to get a death benefit at some point no matter what happens. At the same time, the policy also grows a cash value for you without you needing to do anything.

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Explaining Medigap Insurance

Ever since 1965, when President Lyndon Johnson signed the bill into law, American citizens over the age of 65 have been covered by the Federal health insurance program known as Medicare.

But like most forms of insurance, Medicare will not cover all the costs involved with doctor visits, hospital stays and prescription drugs. In fact, it is estimated that an average couple will need close to $250,000 for medical expenses not covered by Medicare. Where are the out-of-pocket costs going to come from?

As it turns out, 90% of Medicare recipients have some form of supplemental insurance and one form of this supplemental insurance is known as Medigap. Medigap insurance is sold by private insurance companies and is meant to fill the gaps in Original Medicare insurance. These policies can help pay a share of certain costs of Medicare covered services, such as coinsurance, co-payments or deductibles. Some Medigap policies also cover certain benefits that Medicare does not cover, such as an extra 365 days of hospital care once you’ve used your Original Medicare hospital benefits.

Navigating the world of Medigap plans can be a daunting experience, but here are a few of the basics.

•In order to buy a Medigap policy you must have Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).

•Medigap policies only cover one person. If a couple wants Medigap insurance they must purchase separate policies.

•Medigap policies are strictly regulated and must follow Federal and state laws. When purchasing Medigap insurance make sure the policy is clearly identified as “Medicare Supplement Insurance”.

•Medigap policies are identified by letters A through N and insurance companies in most states can only sell you a standardized policy. What this means, for example, is that a Plan F policy will offer the same basic benefits, no matter which insurance company offers it. Therefore it pays to shop around, as cost is usually the main difference between Medigap policies sold by different insurance companies. However, when shopping around for coverage remember that the best medicare supplement for you is not just the cheapest one. You also want to factor in the reputation and service offered by the insurance carrier.

•The best time to get Medigap insurance is within six months of turning 65 and enrolling in Medicare Part B. This is known as the Medigap open enrollment period. During this period you must be accepted, regardless of your health history, and the policy must cover all pre-existing conditions.

Finally, keep in mind that Medigap policies only work with Original Medicare. If your Medicare coverage is provided through a Medicare Advantage Plan (like an HMO or PPO), you will not need a Medigap policy.

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Understanding Medicare Advantage and Medicare Prescription Drug Plans Open Enrollment Period

It is important for seniors to understand when they can enroll in the different parts of Medicare. We are going to focus on Medicare Advantage Plans (Medicare Part C) and Medicare Prescription Drug Plans (Medicare Part D). Who can sign up and when can they sign up will be covered here.

When Can Someone Sign Up?

There are defined periods when someone can sign up for a Medicare Advantage Plan or Medicare prescription drug coverage, or make alterations to their existing coverage. The first such period is if you are newly eligible for Medicare because you just turned 65. You can sign up for a Medicare Advantage Plan with or without prescription drug coverage or a Medicare Prescription Drug Plan during a 7-month period around your 65th birthday. The period covers the 3 months before the month in which you turn 65, the month in which you turn 65, and the 3 months after you have turned 65.

Individuals who are newly eligible for Medicare because they are disabled and under 65 can sign up 21 months after they start receiving Social Security or RRB benefits. Your opportunity to sign up will last through the 27th month after receiving Social Security or RRB benefits, and coverage begins on the 24th month.

If you do not have Medicare Part A coverage, and you enroll in Medicare Part B coverage during the Part B General Enrollment Period (January 1st – March 31st), you can enroll in a Medicare Advantage Plan and/or Medicare Prescription Drug Plan between April 1st and June 30th.

Enrollment Periods Each Year

Each year you will have the opportunity to make changes to your Medicare Advantage Plan or Medicare prescription coverage for the following year. The first period is the Open Enrollment Period. The dates sometimes change year to year, but generally are from about October 1st to December 1st.

During Open Enrollment you can change from Traditional Medicare to a Medicare Advantage Plan, change from a Medicare Advantage Plan back to Traditional Medicare, switch from your current Medicare Advantage Plan to another Medicare Advantage Plan, make the leap from an Advantage plan that does not offer prescription drug coverage to one that does or vice-versa, join a Medicare Prescription Drug Plan, or drop your Medicare Prescription Drug coverage completely.

The second enrollment period is from January 1st to February 14th. During this time you may switch from a Medicare Advantage Plan into Traditional Medicare. Your coverage will begin the first day of the following month. If you do make the switch, you will have until February 14th to also join a Medicare Prescription Drug Plan if you wish to.

Special Enrollment Periods

There are certain circumstances in which you would qualify for special enrollment periods. These are as follows:

  1. You move.
  2. You become eligible for Medicaid.
  3. You qualify for extra help with Medicare prescription drug costs.
  4. You are receiving care in an institution such as a long-term care facility.

If you fit once of these circumstance, you will want to visit the Medicare website for further details and rules that apply.

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Some Tips To Quit Smoking

smokingThousands and thousands of people across the country have tried and failed to quit smoking. There are also many thousands who have decided to quit and successfully done it. Here are a few tips from those who have managed to drop their smoking habit.

Know Why You Are Quitting

You want to quit smoking, but do you know why you want to quit smoking. “Because smoking is bad for you” is not a strong enough reason to quit. We all know it is bad for us. You probably knew smoking was bad for you long before you started smoking. To really be motivated to quit, and stay motivated to quit, you need a personal reason to quit. Maybe the desire to feel younger and look younger is your reason. Maybe you want to stay healthier to be around longer for your children and grandchildren. Perhaps you have decided to undertake a daunting physical challenge like running a marathon. Whatever the reason, it needs to be something important to you to help fight the urge to have “just one”.

Cold Turkey Is Not The Way To Go

If you are thinking about quitting, just completely cutting loose may seem like a good idea, but for most of us it is not. Out of those who try to go cold turkey without any medication or therapy, 95% end up relapsing. Nicotine is addictive and your body will crave it. If it does not get the nicotine it is craving, nicotine withdrawal will occur. Headaches, dizziness, depression, and irritability can set in. You are far better off trying to wean yourself off of it, then dropping the habit all at once.

Try some sort of nicotine replacement therapy. Nicotine gum or patches can double your chances of successfully quitting smoking.

Tell Everyone You Plan To Quit

Tell your friends, family, co-workers, and even your pseudo-Facebook friends. Just like any other goal, telling people about it will help hold you more accountable to it. You might want to even take it a step further and find a local support group to join. Managing your mind is just as important as managing your cravings while trying to quit.

Stress Management

Nicotine does have a relaxing effect on our bodies. Once you quit, you need to find another way to help cope with stress. Massages, relaxing music, yoga, and exercise are all popular methods people use to relieve stress. During the first few weeks after you quit smoking, try to avoid stressful situations when possible. Stress is one of the causes of people falling back into their old smoking habit.

Avoid Alcohol

There are certain things that you may do that will trigger your craving for a cigarette. Alcohol is a very common one, so try to avoid it or at least drink less when you first quit. If you usually smoke right after eating, try chewing a piece of gum instead. Many people who smoke love a cigarette with coffee. If you are one of them, switch to tea for your caffeine for the first few weeks.

Be Active

Physical activity will help to reduce your cravings for nicotine and can soften some of the withdrawal symptoms. If you are feeling a craving, go for a walk or a jog. Even something simple like doing some yard work can help. In addition to helping you fight your cravings, the extra exercise will help prevent some of the weight gain that is fairly common with those who first quit smoking.

Quitting smoking is not easy, whether you have been a smoker for 20+ years or the past 3 years. Do not give up. If you do not succeed your first time, that does not mean you should not try again. Giving up your smoking habit can have a hugely positive impact on both how you feel and how you look. It is worth the challenge.

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DASH Diet Ranked Best Overall

diet-techniquesFor those of you who have tossed away hundreds, even thousands, of dollars on diet fad after diet fad, you may be shocked to learn that the best diet plan might actually be free. U.S. News & World Report has released a ranking report and gives its number one spot for overall best diet to the DASH (Dietary Approaches to Stop Hypertension) diet.

The DASH diet was originally developed by the National Heart, Lung, and Blood Institute. It was designed to lower blood pressure, and it is available for free online.

There were diets ranked in seven other categories, such as healthy eating, easiest to follow, and weight loss. Weight Watchers took top honors in three categories: best weight loss, easiest to follow, and best commercial diet.

When it came to preventing and managing diabetes, the DASH diet tied with The Biggest Loser diet as the best. DASH also won top honors in the best diet for healthy eating category.

The rankings were based on reviews of 29 diets by a panel of experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease.

Each diet was ranked in the following seven categories:

  • How easy it is to follow
  • Short-term weight loss
  • Long-term weight loss
  • Nutritional completeness
  • Safety
  • Diabetes prevention and management
  • Heart disease prevention

The cost of each diet was not factored into the rankings. Many well-known diets topped the rankings, such as Weight Watchers, but others, like DASH and TLC diets, do not have the brand name recognition and were developed by government researchers. The TLC diet finished second to DASH in best overall diet.

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A Guide To Guaranteed Life Insurance

If you aren’t too familiar with guaranteed issue life insurance, it is a kind of insurance where an insurance company doesn’t ask questions about your health.  All they ask is your age.  That is why is it also called no exam life insurance.

Many people think that guaranteed issue life insurance must be superior to regular insurance.  You might be thinking the same thing.  However, truthfully, it isn’t always the best choice.  In fact, when it comes to insurance, just like everything else in life, you do get what you pay for.

How Guaranteed Issue Life Insurance Works

The premiums on guaranteed life insurance are more expensive.  Usually the benefits aren’t too great either.  A majority of policies only offer from $5,000 to $50,000.  The main benefit that this type of insurance offers is that you aren’t required to have a medical exam in order to qualify for a policy.  Even if other insurance companies have refused you, you’ll still be able to get guarantee issue life insurance quotes.guaranteed issue life insurance policy

You might be wondering if this is the kind of insurance you should get.  In our opinion, you should only get it if it’s your only choice.  In other words, if other insurance companies have refused you.

However, even if you have been turned down, that doesn’t mean you have to give up.  You can still ask for regular life insurance quotes along with a set of guaranteed issue life insurance quotes.  Keep in mind, an accountant or actuary calculates life insurance premiums.  It is still possible to find companies that offer regular life insurance policies, even for individuals who have been turned down in the past.

To conclude, guaranteed issue life insurance really isn’t superior to regular life insurance.  If you don’t have any other option, however, this type of policy is always available.  Like any other kind of insurance, make sure to ask for quotes from three companies at least before purchasing guaranteed issue life insurance to get the best deal.

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