Traditional health insurance is the one that most people think of when they think of health insurance. You pay the insurance company a premium every month, and if you have an accident or need for health coverage, you have a deductible amount you must pay and then the insurance company pays the rest of the bill. You often have an inexpensive office and/or prescription co-pay with traditional health insurance.

Since people are now living longer, health insurance companies have begun to look for more ways to reduce their costs, developing different health plans such as PPOs. PPOs are plans which will cover nearly all of your medical expenses as long as you stay within a preferred network of physicians or hospitals. This network creates a “preferred provider” list that you can choose from. Treatment outside of this network of providers is covered but only at a reduced rate, meaning you end up paying more to see a physician outside the network. By limiting the hospitals and physicians covered in their network, the insurance company can control, to an extent, their costs and lower your premiums. POS plans work like PPO’s, but require you to have a primary care physician through whom you can receive referrals for specialists. If you need to see a dermatologist or neurologist, you must first visit your primary care physician for an initial diagnosis in order to receive a referral to a specialist for a more thorough diagnosis. POS plans also have a preferred provider network, and if you choose to visit a specialist or physician outside that network, your coverage will be limited.

HMO’s combine a stricter version of PPO’s and POS plans. HMOs have a defined list of physicians, often much smaller than PPO networks, which you may see. You will not be covered at all if you see a physician outside your HMO network. Furthermore, you must also get a referral from your primary care HMO physician to see any specialist. However, these restrictions mean that you pay an extra low or no monthly premium.

HSA’s were recently signed into law by President Bush. You can deposit money into a special non-taxed, interest-gaining savings account that must be used for medical expenses. The ideal situation for an HSA is to combine the account with a low-cost, high-deductible insurance plan. The savings account is designed to allow you to cover the high deductible if you find the need to cover expensive medical costs while the insurance company will pay the rest of the bill.

Again, it’s important to carefully consider each option before choosing a health insurance plan. Your health is important, make sure it is protected in the best way possible.

The first line of defense in keeping your health insurance needs to a minimum is to take care of yourself and stay healthy (so you don’t need the insurance). Stay active, avoid processed and junk foods focusing primarily on lots of fresh fruits and vegetables, get plently of rest and avoid unnecessary stress.

COBRA is a law in which many people could be eligible to remain on an employer’s health insurance plan even after they lose their employment. The most ideal person for this coverage is someone who is between jobs and is not in need of long-term help. It can last at least a year to those who qualify, but the premium amount is still an expense that some unemployed individuals may not be able to take care of due to their lack of income. If you are able to pay the premium and are eligible, COBRA will also cover your spouse and children who are dependent on you for insurance. The best way to determine if you could receive health insurance is to contact your local employer’s benefits department and fill out the required forms.

You can also shop around for typical health insurance. There are many free health insurance search services proven reliable. By reviewing these websites, or speaking with one of these insurance experts, you can get help finding the most affordable health insurance that will fit your specific needs. They know the rates of thousands of insurance companies and can fix you up with appropriate coverage for your specific needs. If you have a spouse or children, having health coverage is a necessity. Life is full of unexpected events and you cannot ensure that everyone will stay completely healthy until you have insurance again because accidents do happen. Finding affordable coverage on your own can be a challenge, but with the new online services this is getting easier. The experts at these companies are offering their assistance to you, often as a free service. Whether you need to find something short-term or for an extended period, they are qualified and dedicated to helping you.

If you find yourself unemployed at any time in your life, you are probably without health insurance. This can be a challenge whether you have a family or not because medical expenses can put you into debt quickly. Luckily, there are ways of finding affordable coverage providers that can keep your health, as well as your finances, safe. A simple doctor visit can cost you significantly more money than it would with insurance. Don’t let yourself become one of the many people who are unfortunately living life without proper insurance coverage.

College health insurance benefits vary from campus to campus. Although many people think that they are free, this is not the case. While there is usually no charge for an office visit and routine checkups, the student will have to pay for lab work and other specialist type of visits. Benefits will usually pay completely for only types of covered services at the campus health center. In the event that you have to see an outside doctor then the student’s coverage can drop up to 70% and run the risk of being required to pay a high deductible.

If you have a pre-existing condition, then you may have challenges with getting treatment at the school health center. Having a pre-existing illness or disability does not mean that you will be disqualified from obtaining a college health insurance plan, but you may not be able to get treatment for that pre-existing illness. This can lead to a number of problems if a new problem arises and is a product of a pre-existing illness.

All plans are different, so be sure you find out everything you can about your college’s plan. Be sure to check if you or your child will be covered during breaks when students are not taking classes like fall, summer and winter breaks. This is important because you don’t want to have an accident and find out that the insurance becomes inactive when they are not in school. Many colleges have coverage during summer break, but some do not. 

Make sure you understand the plan. Can the member use any provider they want or is it an HMO? This is just as important because you want to know where you can go in the event of an emergency, and there is nothing worse than finding out after the fact that you will be stuck with paying the full amount for a medical bill.

There really is no definitive answer as to whether you should or shouldn’t commit to getting college health insurance. Be sure that you understand your plan fully so that no problems can arise in the event of an emergency. While it is not free insurance, it surely will save you money in the event of an accident or illness.

What happens in the unfortunate incidence of an accident and you need help with your daily living activities? Or, you get to a point in your elder years that you require home care, as you grow older? You may decide you would rather live in you home for a long as possible and would need to have enough for personal home care. Some seniors enjoy assisting living facilities that provide 24 hour nursing care, but still let you be as independent as you can. There are also those unfortunate instances where nursing home facilities are need to tend to varying degrees of illness. Long-term care is designed to provide you help with these services due to a long-term illness or disability. The average cost of these types of care can cost around $40-$100 thousand per year and sometimes more. It is a very quick way to eat your saving and social security benefits. If you think Medicaid or Medicare will help, think again. Even if and when you qualify, your saving is now gone and they will only pay up to 50% of the cost, someone has to come up with the rest. Long-Term Care insurance can help with these costs in the unfortunate event you require nursing care.

Who should consider Long Term Care Insurance? If you think you will not qualify for Medicaid or full Medicare benefits due to a large saving, assets, or high income, this is a program for you. You do not want to end up having your children to pay for these expenses while you have to have them and possibly well after your death. It will keep you able to leave your loved ones a little something instead of sucking all your assets dry. Also if you can afford to pay the premiums you will likely not qualify for assistance so would truly benefit. If you currently have chronic health issues or have a family history of a long-term illness you would be off purchasing now than waiting. It will be too late to get a policy after you have already developed a long-term illness or disability. If you think at any point you might fall into any of the categories you might want to consider getting a plan earlier to be safe and covered. You can purchase a policy from most large insurance companies. As always, every state has different insurance regulations, therefore it is best to check with your state on specific determining factors and qualifications.

This coverage will help provide nursing-home care, home-health care, personal or adult day care usually for individuals above the age of 65 or with a chronic or disabling condition that needs constant supervision. LTC insurance offers more flexibility and options than many public assistance programs. Long-term care is usually very expensive, which is why most people need insurance. For example, on average, nursing facilities providing skilled care charge $150 to $300 per day, or over $80,000 a year or more. Even custodial home care at three visits per week, can cost over $9,000 a year. Most LTC insurance policies will cover only a specific dollar amount for each day you spend in a nursing facility or for each home-care visit. Thus, when considering an LTC insurance policy, read the policies carefully and compare the benefits to determine which policy will best meet your own needs.

Many of these plans will cover you up to six months in another country. When you speak with the insurance company, be prepared to give an extensive list of information to them. This will range from health problems you’ve had in the past ten years, your hereditary conditions to substance abuse, and almost everything else, if it has anything to do with your health, be prepared to disclose the information. If you are planning on traveling with more than one family member, then be prepared to give information for each family member as well.

Many times your basic coverage will include emergency treatment regardless of which facility it is administered. This is not the case with minor medical treatment. It is important to know whether you are buying an insurance plan that is an HMO or PPO. If you are under an HMO or health maintenance organization, then you will be limited to receiving care from only the providers who are in their network. You can retrieve a list of all the companies within your insurer’s network upon request. If you are under a PPO, or preferred provider organization, you will have the opportunity to pick the best facility you see fit, but your insurer will only cover a portion of the incurred cost.

If you plan on staying abroad for more than six months then you will need to look into what is called expatriate health insurance. Only larger companies supply this type of insurance, as it is much more extensive with the type of options that can be applied to each policy. The type of treatment options that are covered with expatriate health insurance are those that are labeled as specialty treatments, like acupuncture and chiropractic therapy. There are many options that can be applied to expatriate health insurance depending on your family’s needs and how long you plan on spending abroad.

There are many options for health insurance when you are traveling abroad. While many individuals never consider purchasing insurance when traveling to another country, this should be at the top of your list when planning for a trip. Health insurance should not be taken lightly. Be sure you understand every aspect of your policy before deciding with any one particular company.

Why switch? First, my existing carrier increased my premiums regularly. This was interesting, because I didn’t make one claim in over 3 years and only used 1 doctor visit a year towards my deductible. I certainly wasn’t a strain on their program, in fact, they made out quite well from my premiums. Second, they didn’t have a flexible payment plan. Either I had to pay annually by check, or monthly by ACH debit from a bank account. Neither plan fit my needs.

So in doing some research, I realized that since I hadn’t made a claim in 3 years, and rarely, if ever, used the insurance, I could move to the next level. To get a better premium I needed to increase my deductible and switch to another health insurance company.

I started my search at eHealthInsurance and looked for available plans in my state. There were many, but I quickly sorted by price and reviewed the plan details. They have a nice system that allows you to search by many different criteria and review the plans in detail.

Here’s what I looked for:

• PPO Network
• high deductible options
• family coverage
• overall good company ratings
• flexible payment options

Within about an hour I had selected the plan that made the most sense for myself and my daughter and applied. The system allowed my to apply online without making a phone call or leaving my computer (although help was available by phone or email if I needed). I selected a plan with a high deductible, $7,500 per year.

Within 24 hours I had received a call from the underwriter, answered a few questions, and was approved for the policy. I selected my activation date and confirmed the premiums. Start to finish it took less than 2 days to get a new policy, and under $90 a month for both myself and my daughter along with a flexible payment plan and PPO coverage.

Here are some quick tips that can help you make this work.

If you have pre-existing conditions or have more than one or two health issues, this process won’t be as fast or easy.

You see, the healthier you are, the easier it is to get excellent coverage, fast. It just makes sense. If you are healthy, the insurance company has a much lower risk of spending any money on you and will welcome you with open arms, glad to accept your monthly premium. The more issues you have, the higher risk they have of expenses on your conditions. The more time they take, the more conditions they add and the more questions they ask.

Many may say the high deductible I selected doesn’t make sense since they use their insurance so often. But look at it another way. Don’t think of your insurance as a bank account when every time you need to see the doctor you want to get your money’s worth from your premium and have a low co-pay. I don’t care about the co-pay. I go to the doctor, maybe, once a year and spend a total of $70 at the visit.

If I opted for a lower deductible, it would raise my premium, on average, $75 a month. $75 times 12 months equals an additional $900 in premiums over the year. Why spend that much so I can have a lower deductible and co-pay if I plan to spend less than $100 a year on doctor visits?

The best way to look at a health insurance policy is to think of it as a safety net in case of a major emergency. Don’t think of it as a way to pay for routine exams, illnesses, etc. Set aside a few hundred dollars each quarter and pay for any routine visits in cash. It will save you hundreds and thousands each year in premiums. The doctor doesn’t need to process your claim through the insurance company, which saves them money and most are glad to accept less for a cash payment.

If you want to save money, I recommend doing everything you can to be healthy. See my previous article Five Ways To Trim Your Medical Costs and Save for tips on getting in top shape, and save money on your health insurance premiums in the process.

That’s right, more and more companies are taking a controversial approach by ‘encouraging’ employees to get fit by lowering their insurance premium deductibles if they pass a yearly physical fitness test. If they don’t, they pay a much larger deductible.

Would you get in better shape to save thousands every your on your health insurance?

This plan rewards those that are healthier and file fewer claims. Until now, everyone paid the same regardless of their physical health.

This is a case of simple economics… and it works. For example, in the video below, you’ll see how an Arkansas county saved over $1.5 million dollars in a year and half after implementing their new health incentive plan. When they started, they were in the red half a million dollars. It shows how an economic incentive can help make lifestyle changes and benefit everyone.

In times when health care costs are skyrocketing, this type of incentive is needed… and it’s a win-win situation. Overweight employees lose weight, feel better, have more energy and are more productive. They also add years to their life and most likely live better quality lives at home. Employers save money and can pass on the savings to the employees that pass the tests.

Initially many employees find this an intrusion and violation of their rights. After going through the program for some time, they seem to appreciate the benefits for themselves and their employer.

1) Stop smoking is the biggest one. Not only do you get sick more often than the average person, it gets worse. Many smokers are treated for several bouts of bronchitis and pneumonia each year. Smoking also makes you susceptible to colds and other infections. You will also pay a higher premium on your insurance and in some cases won’t get full coverage for cigarette related illnesses or diseases. Plus the money you save on quitting smoking can go to bigger and better things than your medical issues.

2) Eliminate or minimize alcohol use. In addition to being completely void of nutrition, alcohol lowers your immune system defenses. People who consume more than 3-4 alcoholic beverages in a week are at far greatest risk of catching a viral or bacterial infection. Even if you do most of your drinking at home where you are safe from others germs, you still are very susceptible. Once the immune system has lowered its defenses you are risk anywhere you have to go and even in your home if you live with others who leave the house. Drinking excess alcohol can also lead to other very expensive health issues, such as alcoholism, addictions and liver disease. To be diagnosed and treated for chronic liver problems can be very expensive to say the least. Not to mention once you have liver disease, getting medical insurance with another company will be very difficult and costly for a pre-existing condition. Plus current insurance premiums will most likely increase now that you have a chronic condition.

3) Eat a nutritious and healthy diet to maintain your body’s strength and vitality. The type of foods one puts in their mouth can be the difference between life and death in some cases. Eating right and getting all the nutrients and vitamins can severely reduce the risk of many diseases. Cutting out fatty, fried foods can keep your heart and circulatory system strong and healthy, and lower your risk of a heart attack and/or stroke. The vitamins and minerals found in fresh whole foods also promote a strong immune system, which can help keep you infection free more often. Just adding more zinc to your diet can help boost your immune system enough to prevent catching colds and the flu. Concentrate your diet on mostly fresh, preferably organic, vegetables, fruits, nuts, seeds and natural grains and eliminate processed foods (most anything in box, wrapper or served in a restaurant) Look for natural whole food snacks and foods.

4) Get plenty of exercise and activity. The better condition and tone your body is in, the less likely you are to get sick or have weight related health issues. It is very important to get exercise to keep your body happy and healthy, and prevent your funds from going to unneeded and undesired medical treatments. Regular and consistent exercise can help prevent heart related health problems later on in life with will be a great cost savings as well. It promotes a better circulatory system and a stronger heart muscle. Exercise also promotes better oxygen intake, which helps the lungs be more efficient. Increased oxygen also aids in better metabolism and can keep weight in check and reduce other illnesses like diabetes and asthma. You don’t need to go to a gym or buy lots of exercise equipment, just a simple and quick home fitness program will work well.

5) Make sure you have time or make time for rest and relaxation. Keeping healthy also includes staying happy with a positive outlook on life. Reduce your stress, get plenty of sleep each night, and set aside leisure time. It is important to enjoy life and do things that ease tension and promote happiness. Fun and proper rest can cut down the risk of developing mental issues such as depression or anxiety that can cost a great deal of money in treatment and control of the disorder. Having a balance in ones life can really promote clarity and great mental health. Being burnt out or stressed out is associated with many disorders such as depression, anxiety, ulcers and other digestion issues, headaches and insomnia. All of these ailments, and others, that can be prevented will save you money on doctors visits, medication, tests and treatments.

By following these suggestions you can choose a low cost health insurance plan with a large deductible knowing that you are covered in an emergency and save significantly on monthly insurance premiums.

Another issue is that too many people just give up when their insurance claim is initially denied. The appeals process can be frustrating and long and most people don’t have the patience or time to pursue a claim no matter how legitimate it is. People must be persistent and they can win. Especially if there is a substantial amount of money involved, the time you dedicate to appealing insurance company decisions can usually pay off faster than you think. A Kaiser Family Foundation study recently found that 52% of patients won their first appeal for each claim made. The insurance companies aren’t getting away without paying anymore.

If your first appeal gets turned down, continue to press on. The study found that those who appealed a second time won 44% of the time. Those who appealed a third time won in 45% of cases. This means the odds are in your favor no matter how long it take. Remember that every time you appeal it costs the insurance company more money and they are not only going to lose money to you, but also in court costs. Medical health benefits are particularly tricky because insurance companies usually have a cap on the amount of money they’ll spend in a given year, or on the amount of visits they’ll pay for. But there’s often flexibility when you can document that you or your child’s health warrants more care than your policy normally covers.

Here’s how to get started:

Do Your Homework

Read your Policy Thoroughly: What are the benefits? Which kinds of services are included? Inpatient or outpatient care? Is it a serious or “non-serious” diagnosis?

Know the law: Contact your local Health Association to determine your states legal requirements regarding insurance payments for an illness. Does your state require full or partial parity? Are parity benefits available only to patients with “Serious Illness” or is a so-called non-serious illness also included?

Provide written documentation: Some insurance companies may not consider some diagnosis serious. In this case, you will need documentation to validate the required services. Obtain a letter of medical necessity from your doctor and get test results showing the medical need for you or your child to receive certain services, based on the diagnosis.

Keep good records: Remember, you’ll be dealing with a bureaucracy. Keep the contact names and numbers of everyone with whom you speak, the dates on which you spoke, and what transpired in the conversation.

Start early: If you can, start the appeals process prior to initiating treatment. For example, if the doctor states your child will need to be seen once a week for a year, begin immediately to appeal your insurance company’s policy of reimbursing only 20 visits a year.

Call and ask the insurance company:

• What are the pre-requisites for receiving health benefits?
• Which services must be pre-certified — and by whom?
• How many visits are allowed annually for you or your child’s diagnosis? Can multiple services be combined on one day and be counted as only one day or one visit?

Be polite, positive and patient with the customer service representative. Remember that they are only the messenger, not the decision-maker. They are the gatekeepers and can either provide you with access to a decision maker or make your life miserable, depending on how you interact with them.

Be persistent. There are no magic bullets. Be like a dog with a bone and don’t give up until you get the answer you want. If you don’t get anywhere after several calls, ask for a supervisor or a nurse in the pre-certification department.

Remember that you do have the right to appeal if your claim is denied. Most consumers get discouraged and will not continue to pursue a claim that should or could be paid. Insurance companies count on that happening, so get out there and claim what justifiably belongs to you.

Come to find out, this was not medical insurance at all and the sales representative never told this poor lady. She found that out after her cards arrived in the mail. In tiny writing at the bottom, it read, “not an HMO, PPO insurance or managed care company”. It was basically a discount plan. These plans do not have the same coverage as a full medical health insurance policy. Before making a commitment, make sure you know what you are getting and if it fits your needs.

So what is a discount plan? The plans claims to save people money by offering discounts on physician visits, prescription drugs, dental work, eye care and other treatments for a monthly fee. Unlike normal health insurance, which is very costly and very selective about who it covers, a discount health plan accepts everyone, no matter what health conditions they may have. You will use a list of doctors that are willing to charge discounted rates to the subscriber. The discount plan is not the same as health insurance coverage, so you will pay more for visits and other services that you wouldn’t with a regular medical plan. The average savings is approximately 25% and that could be very expensive if you have to see a specialist or require surgery. These networks claim to have as many as 400,000 doctors and 50,000 hospitals available to choose from, but what if none of them are near you? You can get a savings of up to 30% on both generic and brand name drugs which could also be costly if your prescriptions are expensive or if you have multiple prescriptions. If you have an existing health plan but have a high deductible, this extra plan may help save you some money. But to use the savings plan as a complete health plan isn’t recommended. It really isn’t designed for that and will cost you more than a competitive HMO.

HMOs and other medical plans can offer full medical coverage at great rates. Managed care plans are recommended for those who are limited on funds. They offer the best policies for the least amount of money. Most of these plans are available to anyone and can save you considerably. You can make the plan even more affordable by asking for a higher deductible, which will lower your monthly expense. Most HMO’s do not have one at all but, you can request one, and most basic PPO’s and POS’s only have a small one, usually $200 to $500 per year, which you can also asked to raised to lower your monthly payments. The co-pays are also very reasonable with these types of plans. If you choose to purchase an HMO, expect to pay about $5-$10 per office visit and per prescription. With PPO’s and POS’s you will have a 20% co-pay with both visits and medications. The differences are how strict they are and you pay more of a co-pay to have extra flexibility. Usually a PPO or POS plan is less expensive and you have more freedom to see whom you want so the insurer makes you more responsible for payment. HMO’s tend to be the least expensive and best policies for people with fixed incomes.

Review your needs and double-check what you are getting. If you need full medical coverage with low co-pay then a discount plan will not work for you. If you are already covered by a medical group but have a large deductible then you might benefit from the extra savings a discount plan can offer. Also, ask whether the plan is health insurance that covers your treatment, or is a discount plan that still requires you to pay all medical bills yourself less the discount. Beware of slippery sales pitches. Make sure you know what’s being offered. Discount health plans may only sell you access to a large mailing list of medical providers that it purchased commercially. Don’t assume you’re getting access to a large provider network just because your discount card displays the network’s name and logo. If you plan to use a specific listed doctor, hospital, pharmacy or other provider, ask a few questions before you sign up. The more details and information you get, the better decision you can make for your health insurance needs.