You’ve finally realized that it’s time to switch health insurance providers. Perhaps they increased your rates or rejected another claim. In either case, you’ve taken on one of the most daunting challenges imaginable. And you may have no idea. You’re going to have to learn this the hard way. Your newfound research will most likely overwhelm you to the point where you settle for the best or cheapest package that seems adequate. When this new company repeats its mistreatment of you in a year or two, you can go shopping again. I’m unsure, but I think the marketing materials are purposefully complicated. Numerous insurance companies supply a wide variety of plans for medical care. Since different providers don’t provide information about their goals similarly, making a fair comparison is impossible. All you receive is a glossy color booklet featuring smiling people and pages and insurance pages describing the fine print. How can you be sure that what you’re hearing is accurate? What important exceptions do they fail to disclose until you file a claim? This is when they realize it’s too late. Well, what do you do? How do you decide which insurance plan is best? Finding a new health insurance policy appears to raise more questions than solutions. The possibility exists that I can be of assistance.
Let’s begin with the necessity of insurance and the kind you’ll require. Keep in mind that I didn’t specify the desired type. Most people stick with the same insurance policy year after year because they are comfortable with it, understand how it operates, or believe there is no other option. They are blinded by their desires and incapable of articulating actual needs. Many insurance salespeople and brokers will happily sell you any coverage you ask for without taking the time to determine your precise requirements.
Both groups and individuals can purchase insurance. You’ve probably heard of group coverage if you’ve ever worked for a firm, big or small. They must accept you regardless of your health at the time of application. The copayments for doctors’ visits and medications are also typically relatively modest. Having this peace of mind while searching for health insurance is what you’ve been hoping for. Typically, employers will cover half or more of your monthly premium. However, you will still be responsible for a large portion of the premium each month. It’s similar to filing your taxes, but you won’t get any money back. Even a single business owner can obtain a group plan for his or her company. A business group of one method may be available to you if you have been the sole proprietor of a small business in your state for at least a year. In general, the cost of a group plan will be double that of an individual policy. I mean, what’s the point?
Simply put, they provide extra protection and are accessible on a guaranteed issue basis regardless of the applicant’s condition. They may be the only source of protection for those with serious illnesses. The premiums will be substantially higher because the insurance company must cover them. Similar to vehicle insurance, the insurance industry uses a “high-risk pool” to underwrite the “state basic” and “state standard” policies sold throughout the country. These regulations are (you guessed it) imposed by your state, so regardless of which provider you choose, you’ll get the same protections. The time of year you can sign up for one of these plans is restricted (called an “open enrollment period”).
Private insurance plans are issued in the name of the policyholder. Their current and projected healthcare requirements and medical history all have a role in the cost of their insurance premiums. From a business perspective, this makes it logical, but it still feels unfair. The insurance firm operates like any other corporation. They’re looking to maximize their earnings, of course. They achieve this goal by reducing or eliminating the need to make payments on claims. They accomplish this by increasing premiums, decreasing coverage, introducing riders, etc. They are only interested in insuring those in the best of health since these people have the lowest likelihood of filing claims while reliably paying their premiums year after year. They see the financial rationale in it, but we don’t. Most people get health insurance, expecting it to cover potential future medical costs and any existing medical bills they may have. An insurance company may “rider” a condition for two years or more, meaning that claims related to that condition will not be paid. In extreme cases, they may refuse to insure anyone in the family, even though they would benefit from health insurance.
Don’t give up if an insurance company initially says no to coverage. There’s still a possibility for you, maybe. You could either apply for insurance through your state’s program or appeal their decision by providing further information about the ailment for which coverage was rejected. Your state may grant you coverage if you have a severe medical condition and have been turned down for insurance. To learn more, go to your state’s Insurance Department online. Only major medical plans (those covering hospital stays or those with a high deductible of at least $2,500) qualify. After the deductible is met, some plans cover 100% of medical expenses. Not only are they not cheap, but I caution you. The best option is to enroll the person with the medical problem in the state health insurance program while enrolling the rest of the family in a health insurance program that meets federal requirements. In the long run, you could save money while enjoying increased levels of protection.
A single, concise article would be inadequate to capture the breadth and depth of the industry. In other articles, I compare and contrast the advantages and disadvantages of various insurance providers, including HMOs, PPOs, and EPOs, and different coverage options like Medicare, Medicaid, and health savings accounts.
Health insurance expert and Colorado resident Scott Rowen pens this piece. Rowen has worked in the industry for 18 years.
Learn more about selecting the best insurance policy for your needs. Scott can be reached at [email protected].
See his website for additional details on Errors and Omissions Insurance.
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