Medical Insurance – Is Some Better Than None?

About 50 years ago, health care insurance started to be an attractive incentive offered by businesses to attract and keep good employees. Overall, group programs tended to be affordablefor businesses, with employees contributing a small amount of money or none at all to secure health care insurance for themselves and their families.

It was more expensive for individuals to pay for non-group policies, but coverage was fairly affordable. Then medical expenses  started to rise, people started to live longer and the medical profession became adept at curing various diseases and saving and prolonging the lives of people with serious injuries and life-threatening illnesses. Health careand insurance prices started rising much more quickly than annual incomes and premiums began taxing both businesses, who were paying the lion’s share of premiums, and for employees, to whom businesses often passed on expenses  through biggerdeductibles, greater out of pocket expenses and higher premiums.

According to a recent report by the MSNBC News Service, 41% of U.S. citizens whose income ranges from moderate to middle had no health care insurance for at least part of 2005. In 2001, that number was much lower—28 percent. In addition more than 50% of uninsured U.S. citizens in 2005 found it challenging to pay their medical bills. Another alarming statistic—28% of U.S. citizens in 2005 had no health care insurance, while 24% had none in 2001.

So, what should a person do if they do not have any health care insurance or if they have a choice between a affordable discount plan that doesn’t cover core expenses and an affordable policy that may cost a bit more but also provides much better coverage? According to data from the United States Centers for Disease Control and Prevention, the majority of people who are not covered for important screening tests, such as a mammogram, colon cancer screening or a PSA test, won’t undergo those exams. Also, close to 60% of people without health care insurance missed treatment or did not buy medicine needed for a chronic condition.

All of these figures point to one thing—people who lack health coverage for essential services are often unable to pay for those services, putting them at greater risk for developing new or exacerbating existent health conditions.

What should you look for in a health care insurance plan, especially when cost is an issue? It is important that you get the best coverage you can afford. Skimping on premiums can save you money upfront, but the result can prove to be penny-wise and pound-foolish. Sometimes people cannot afford coverage and sometimes they believe because they are healthy that they  do not need it. Thus, healthy people get ill or are involved in serious accidents all the time. You never know when you’ll need coverage.

Some people opt for “catastrophic” insurance, which generally covers only major medical and hospital expenses above a specific deductible. Under such a plan, the insured pays for routine medical provider visits and prescription drugs. With this kind of plan, you’ll pay a low monthly premium but will also have a high deductible and limited coverage. Deductibles start at $500 per year but can be considerably more. If you buy an affordablepolicy with a $10,000 deductible and you undergo surgery that expenses  $8,000, you must pay that $8,000. If your surgery expenses  $12,000, you would owe $10,000.

One insurance company provides a plan that expenses  $29 per month for a 21 year-old, non-smoking female. There’s a yearly $250 deductible and $2,500 in out of pocket expenses that the insured must pay before the policy kicks in. Hospital, surgical and x-ray expenses are covered but other expenses , such as medical provider visits, prescription drugs, maternity care and mental medical are not included. There’s a lifetime maximum of $1 million.

It is certainly a bargain, if you do not plan on going to the medical provider very often. To enroll in a plan that will cover medical provider visits, prescriptions, maternity expenses and more could easily cost $400 per month—a jump of $371 every 30 days for a total cost of $4,800 per year!

Group health care insurance programs, which you can generally enroll in through your employer, union or guild, are the best buy. Individual plans, especially those that offer comprehensive coverage, can be crippling to numerous people’s pocketbooks. When obtaining health care insurance, it is important to shop around. Your choice of what kind of plan you buy will be determined by what you can afford and what you need as far as insurance is concerned. There’s no right or wrong choice when it comes to health care insurance but at the very least you should have catastrophic insurance.

There are basically three kinds of plans—Fee-For-Service, Health Maintenance Organization (HMO)s  and Preferred Provider Organizationss . Fee-For-Service programs offer the most choice regarding medical providers and hospitals but they often involve quite a bit of paperwork and are the most expensive. If you are willing to give up some or a lot of choice, do less paperwork and save some money on premiums then either a Health Maintenance Organization (HMO) or a PPO is for you.

A Health Maintenance Organization (HMO) provides the least amount of choice, involves co-payments, has the least amount of paperwork and is the cheapest of the three kinds of insurance. A PPO combines some elements of Fee-For-Service and a Health Maintenance Organization (HMO). You’ll have more choice than you would with a Health Maintenance Organization (HMO) but less than you would with a Fee-For-Service plan. It tends to be more expensive than a Health Maintenance Organization (HMO) but less expensive than Fee-For-Service. All three kinds of insurance have some aspect of Managed Care—which determines how much heathcare you can use—attached to them, with Fee-For-Service having the fewest restrictions and a Health Maintenance Organization (HMO) being restricted the most.

When shopping for health care insurance ask the following questions—
<ul>
<li>• How much is the premium?</li>
<li>• What services are covered?</li>
<li>• What are the total deductible and out of pocket expenses per year?</li>
<li>• How much are the co-payments?</li>
<li>• What is the maximum lifetime benefit?</li>
<li>• How much freedom will you’ve when selecting medical providers and hospitals?</li>
<li>• What are the pre-approval procedures for seeing specialists, undergoing a procedure or being given a test?</li>
<li>• What prescription drugs are covered and to what degree?</li>
<li>• Is mental health covered and to what degree?</li>
<li>• Is dental covered and to what degree?</li>
</ul>
As you begin to narrow down your choices, you can look more closely at specific programs that seem to fit your needs and determinewhich offer you the best value for your dollar?

America has one of the finest medical systems in the world and one of the most complex health care insurance systems across the globe. Often, they seem to be at odds with one another, unable to communicate and work together. That can be one of the most frustrating parts of anyone’s foray into the world of medical professionals, hospitals and health care insurance businesses. For this reason alone, it is important that you carefully and thoughtfully select your medical benefits provider.