Dipping into your State Health Insurance Pool - What Are The Requirements?

State health insurance is a branch of health insurance that is for high-risk individuals with chronic and/or pre-existing conditions. Most common diseases to see on this type of insurance are HIV, AIDS, kidney disease, obesity, and diabetes. This high-risk pool is designed to act as a safety net to offer some form of insurance to these people but for a hefty premium.  This program has fewer participants due to the cost. This plan is not low-income friendly. Rates can be as much as double what the normal market value for health insurance is. The pool does tend to offer better benefits but is definitely geared to those people that truly afford insurance. So, most people who fall under this category and require this type of plan are likely to be uninsured due to not being able to afford a plan. This plan is last resort for persons with such illnesses that land them for emergency or hospital care frequently, and it that case pays for itself quickly. Some of the few persons who cannot afford this are lucky enough to have a spouse in the work place that is able to add them to their policy from their employer, these plans cannot discriminate due to chronic or long-term illnesses. The State Health Insurance Pool knows its rates are high, and claims so are medical costs for the chronically ill. They have to charge more to be able to get ahead and stay afloat.

Most risk pools are nonprofit associations ran by the state. Usually they do not use taxes to operate their business. Most persons requiring this type of service usually are filling up the gap in cost of what their normal plan won't cover or is a temporary pit stop till they can find a plan that accepts them at a lower cost. The people who qualify for this type of coverage must be a resident of the state they are applying in. Most states require you live there for at least six months and some up to one full year before reaching residency status. You also need one of several possible documents from other insurance companies. You will need proof of rejection from at least one company denying them benefits similar to the ones being asked for. You can use proof of insurance with a higher premium as well. You may also be eligible if you can show proof of insurance with a rider or rated policy. Any of the above mentioned could get you approved to apply for the risk pool in the state you reside in. A reciprocity agreement is when a person who is eligible for the plan and is currently on a similar plan, met the waiting period quota, and not used up the lifetime maximum benefits can still be eligible if they move to another state after they meet the residency requirement. Not all states, but most, have this agreement included into their plan.

There is a list of those who are not eligible in the high-risk pool besides non-residents. You are no longer eligible if you move to another state but if you have a reciprocity agreement, you can become eligible in the state you now reside after residency has been established. Most people who are eligible or receive Medicaid or Medicare are also not eligible. Many states do have a high-risk plan for Medicare eligible persons, but if you receive or could receive Medicaid than you don't qualify. If a person has terminated their coverage in another plan and less than 132 months have passed they are not eligible for the pool till that time is up. Those who have used their maximum lifetime benefits for their plan are also not qualifying. Inmates of a public institution are also not eligible for the risk pool. Other specific exclusions can include state decided specific diseases or medical conditions that they just don't want to cover. An enrollment cap may also be in affect so only a specific amount of persons may be actively enrolled at any given point of time. All other applicants who are eligible will be placed on a waiting list till there is an opening. There seem to be a higher list of those who don't qualify then who do for this high-risk benefit that costs an arm and a leg anyway.

Different Types of Health Insurance Explained

Health is the biggest and most crucial asset of every living being. An unhealthy animal and individual can never truly experience any joy. It is the wealth of health that provides the requisite potential to topple over all odds and to move ahead with life. So such an essential part of a person’s life demands extra care and concern. An ideal way to secure an individual’s prized possession for him and for those who love him is a health insurance policy.

A health insurance policy is meant to financially assist a person in case there occurs a setback to his health. For instance he is afflicted by some grave disease, meets an accident, becomes handicapped etc.  In order to provide complete service and for the all round development of the individual the health care system of America offers ample of options or different types of health insurance for its citizens. Some of these are explained below:

•    Preferred Provider Organization or PPO is a discount form of health insurance policy. PPO has a complete network of health care providers from hospitals to doctors. If an individual has taken PPO policy and takes treatment from any of these assigned providers, the PPO covers his complete medical treatment. While if the person takes recourse to some other doctor or institution, he gets served at a reduced rate. PPO’s thus facilitate medical services at abridged rates.

•    One immensely cheap form of health insurance is the catastrophic health insurance. This sort of policy is basically meant for the people who have the financial means to manage regular illnesses and hospitalizations. The deductibles i.e. the sum of money an individual for these policies are quite large for this policy. At times there are caps on the amount the policy will pay in case of illness. 


•    A Short term health insurance policy is akin to a life insurance policy in the sense that both can be adopted for a specific tenure. This policy covers catastrophic to comprehensive cases and excludes the situation of pregnancy and childbirth. Quite often it is hard to qualify for these policies as there are strict conditions or qualifying procedures. Moreover these policies may not cover any pre-existing medical conditions. 

•    HMOs or the Health Maintenance Organizations also offer health insurane t significantly lower premiums. But the disadvantage is that they confine the sources a person may seek in non-exigency situations. HMOs do not cover the precautionary measures such as immunization, mammograms and physicals. There are quite a few issues associated with the HMOs. For instance it is believed that doctors receive financial perks for deducting the cost of medical services to patients. One way to do this is to pay monthly fee to the doctor for each patient despite of delving in to the issues of what treatment the latter one needs.


•    There are also full-service health insurances. The lucrative feature of these policies is that they cover all sort of illnesses, cover any medical treatment the patient takes regardless of the institution or doctor and the deductibles are at the discretion of the policyholder. He may pay a high or a low one.

•    Medicare or Medicaid insurances are meant for the retired or the low-income individuals.

Defining Point of Service (POS) Health Insurance

A POS or Point of Service plan is kind of like an HMO and PPO combined type health care plan. You have more flexibility than a regular HMO, but pay a smaller fee and deducible than a PPO. It is perfect for those people who need more flexibility but want to pay less. You will be asked to select a general provider that is off the list of acceptable doctors. This will be your primary care physician and he or she will be the one to manage what care you receive. He or she will direct you to specialist and hospitals as needed that are also participants in the plan. Usually there are many providers from each specialization to choose from and typically covers a wide geographic area. With this type of policy, you will not have a large deducible if any, and still have a minimal co-pay on visits and prescriptions. Of course, this is if you stick with the preferred providers list. You also may want to make sure what drugs are covered under this plan and if you have to pay more for newer on not generic medications. Some doctors don't think about what kind of insurance you have when writing out the prescription and you need to remind him or her if you are only allowed to buy generic to be covered.

You will also have a choice to see out-of-network providers when you need a specialist and they are not on the list. Most POS plans require you get a doctor's referral prior to seeing another doctor or specialist. Once referred to a specialist within the network, you will have to be prepared to pay more. If you choose to do this, you will be billed directly and must submit the claim to the insurance company your self. Your insurance company will pay their flat rate for whatever you had done and you will be responsible for the rest. You may also be responsible at the time of service to pay the entire amount and wait to be reimbursed your self from your insurance. If you chose to see a specialist on you own, the cost will be higher and around 50% if you were not referred. You will be required to pay a higher amount if you go out-of-network. So in essence, you have the right to see whom you chose, but at your own expense. The POS plan will only pay their flat rate for specific medical issues and not above it, unless it is an emergency situation. Many people like the idea of having more say in their health care choices, while others care more about saving money and don't care who they go to. What you chose will depend on what you personally want and what is more important.

The emphasis on this plan is prevention of illness or disease to cut the cost to both the individual and the insurer. Most other plans such as HMOs and PPOs have the same basic emphasis. You are encouraged to take an active roll in your health and do what it takes to remain not sick and disease free for as long as possible. The idea is to see the doctor less so both you and your carrier together spends less money. The idea with this plan is that if you have to put more money into your health care you will think twice at whether or not you really need to go. If you want to waist the insurance companies money you have to waist your own too to do it. Medical insurance companies are in business to make money, they want you to stay healthy so they can collect your premium and not have to pay it out to the health care provider. So, for those people who do not want to pay as high as a monthly premium tends to opt for this type of health insurance plan. This one will ensure a low rate with out having to worry about huge deductibles or co-pays if used more like an HMO. So, if you think that this sound like something you are interested in, talk to several different companies and get some policies to look at. Make sure to look at what is covered as well as the price. Do a little research in the various insurance policies that are available. The one that you need to pick will depend on your priorities.

Cover Yourself - The 6 Top Things to Look for in a Health Insurance Plan?

When deciding on health insurance, one needs to be aware of his or her needs first and foremost. Many plans are similar but slight variations in coverage and expense. Most insurance companies offer similar deductibles and cover all the standard routine issues that arise in health. Some plans are more expensive and make the insured responsible for more expense but offer a wider range of control. Some plans are designed for the budget consciences individual and has more restrictions but costs less. So look at what type of health needs you have and think about how often you need to visit a doctor. Make sure your doctor is cooperative in giving referrals when needed as well. Here are some things to think about when deciding what plan is best for you.

1) What plan benefits are offered to the insured? Most plans provide normal medical coverage. But see what other services you may need and if they are available easily or at all. Make sure that you are aware of any additional fees that might be placed on you if you see certain types of doctors or other medical professionals. Does this plan have restrictions on pre-existing conditions or chronic illnesses that can cause a premium increase or higher co-pay in the future. Know what you are getting and make sure that it works for you. If you aren't sure call the company directly and speak to someone who can answer all your questions.

2) Physical exams and health screenings as a form of entry into a plan. Does this work for you or not, and do you not want to disclose your medical issues prior to getting a quote. Many insurance companies want to have you seen by one of their physicians to make sure you won't cost them money by having any chronic illnesses. If you have some medical conditions that require frequent visits and treatments you may not want to look at these providers for help with coverage.

3) Care by specialists. If you require the care of specialists, such as a cardiologist, nutritionist for diabetes or obesity, or any other type, you want to make sure this is fully covered on your chosen plan. You don't want to just sign up for a plan that is in your price range and then find out you can't see the doctors you need to. Be sure to see all the information on added coverage above and beyond just basic needs.

4) Hospitalization and emergency care. Most HMOs require a referral from your primary care doctor before you may go to the hospital. Some insurance companies will not pay for hospital visits on the weekends unless the doctor was called and gave the referral prior to you going. Some will even require that you wait till the next available business day to see your doctor first if it isn't a life or death emergency. If you have conditions that might require a trip to the hospital, be sure that your policy works for you. In the middle of a panic attack is not a good time to wait for the "on-call" to call you back, give permission, and call the hospital for you. You need to know that are safe to call and get emergency care and get the referral the next business day.

5) Prescription drugs and what will the company pay for? You might want to take into account how many prescriptions you need and what the cost of each one is. If you are used to small co-pay, it can be a slap in the face to find out you have to pay 20% of a $150 prescription. Many people who require some or lots of daily medications will benefit more from a HMO that has a small fee like $5 or $10 per prescription and/or a small deductible.

6) Vision care and dental services. Find out if these are included in your plan or whether you need to purchase one or both separately. Many plans will include yearly and emergency eye exams and visits. Also many offer some coverage on eyewear to some extent. Most dental plans are separate and require a separate insurance or slightly higher monthly fee to be added.

Considering Long Term Care Insurance - Is it An Unnecessary Expense?

Long-Term Care Insurance is still fairly new on the market and a lot of people don't know that it even exists or what it covers. Even those who have heard the term don't know always when benefits are paid, how they are designed, and who qualifies or needs coverage. Many people don't think about this type of coverage until it is too late to get a great rate and higher benefits. They wait till they are past retirement age and closer to needing to cash in the benefits instead of investing earlier and maximizing your options. It is becoming more of a common practice for people to start thinking about what will happen 30, 50, or more years ahead. Many people invest in 401Ks, IRAs, stocks and bond, and other types of investments to prepare for the future. Many people think this will pay for living expenses and leisure activities once retired. Things don't always go according as planned.

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.

Can You Afford To Have Health Insurance?

You may think that the best way to acquire health insurance coverage, is simply to obtain the complete coverage that you can afford. Off course to some extent it is true, and if you have many liquid resources then it is  a good idea to obtain a good complete individual health insurance plan that includes everything from a small fees for hospital visits to full dental coverage. But, if you are not good budget, you may consider getting a smaller policy that you can afford and pay for some of  medical expenses from you regular budget.

If you are trying several other methods that are costly to fill and refill, or that need regular check ups with your medical adviser or doctor to make sure that you have the right cure, it is important to obtain a complete health plan. However, if you are searching for other ways to meet your health costs, it may make sense not to get such  plan. If you do not have any dependents and do not need to make regular hospital visits for any reason, consider whether you really need a full health insurance plan that gives you complete coverage. Paying more cost than your requirements for health insurance can be a heavy burden, so it is good to think creatively and realistically about what you really require and if it is possible to get the care you require without a large monthly payment to a health insurance providers.

Many people know that using a combination of free clinics and lower health insurance coverage, they are able to get by  much less money that they would pay for comprehensive health insurance. It is a cool idea to have coverage that can help alleviating the burden if you suddenly develop a condition that requires urgent care. However, it is a good idea to look for different kinds of plans that are available, as one of the most plans designed specially to give you emergency coverage may be a much better way than a plan that will leave you generally well insured.

It is not a good way to apply different trick with your health care, so make this sure that you if do not opted for the maximum amount of insurance that you can afford, then you have a plan for how to meet any medical cost that may arise in future. Think about other possibilities that you can use to get money for your health care needs, such as starting an investment savings account where you store away the money you would be paying for insurance every month. This will help you to get prepared for anything. Don’t forget coverage entirely though.

Can You Afford Not To Have Health Insurance?

Many people think the best way to get health insurance coverage is simply to get the most complete coverage one can afford. This is, to some extent true, and if you have a lot of liquid resources it is a good idea to get a comprehensive individual health insurance plan that includes everything from a small deductible for hospital visits to full dental and vision coverage. However, if you are on a very tight budget, you may want to consider getting a smaller plan than you can afford and paying for some of your medical expenses out of pocket.

If you are juggling several different prescriptions that are costly to fill and refill, or that require frequent check ups with your doctor to make sure that you have the right dosage, it is important to get a full health plan. However, if you are looking for ways to economize on your health costs, it may make sense not to get such a comprehensive plan. If you don’t have any dependents and don’t need to make regular hospital visits for any reason, consider whether you really need a full health insurance plan that gives you complete coverage. Paying more than you need for health insurance can be a heavy financial burden, so it is worth thinking creatively and realistically about what you really need and if it is possible to get the care you require without shelling out a large monthly payment to a health insurance provider.

Many people find that through a combination of free clinics and minimal health insurance coverage, they are able to get by spending much less money than they would pay for comprehensive health insurance. It is still a smart idea to have coverage that will help alleviate the financial burden if you suddenly develop a condition or meet with an injury that requires emergency care. However, it is a good idea to look into what kinds of plans are available, as one of the many plans designed specifically to give you emergency coverage may be a much better choice than a plan that will leave you generally well insured.

It is never a good idea to gamble with your health care, so make sure that you if don’t opt for the maximum amount of insurance that you can afford, that you have a plan for how to meet any medical expenses that may arise. Think about other ways that you can designate money for your health care needs, such as starting a savings account where you store away the money you would be paying for insurance every month. This will help you make sure that you are prepared for anything. Don’t forgo coverage entirely though. At the very least purchase a high deductible plan that will cover you in the case of a serious illness or injury. Otherwise one serious illness or injury could wipe you out financially.

Battling an Unfair Health Insurance Claim Can Really Pay Off

Are you having trouble getting your insurance company to pay your medical health costs? Join the club. When managed care entered the insurance scene a decade ago, its mandate was to contain rising medical costs. One way to do that is to deny claims, even when claims are legitimate. The consumer backlash led to many states establishing independent review panels and requiring insurance companies to develop in-house appeal procedures. Forty-two states now have independent review boards whose decisions can override those of insurance companies. Most consumers don't even realize these review boards exist.

Another problem is that too many people just give up when their insurance claim is denied initially. The appeals process can be long and frustrating and many people don't have the patience or time to pursue a claim no matter how legitimate. People must be persistent and they can win. Particularly if there's substantial money involved, the time you dedicate to appealing insurance company decisions can pay off usually more quickly 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 with out paying anymore.

If your first appeal gets turned down, 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. Which 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 to fight you 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 some flexibility when you can document that you or your child's health warrants more care than your policy usually covers. Here's how to get started:

Do Your Homework

Read your Policy: What are the benefits? Which kinds of services are included? Outpatient or inpatient 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 all 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's serious. In this case, you will need documentation to validate 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 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. If the doctor says 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 prerequisites for receiving health benefits?

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?

Which services must be pre-certified--by whom?

Be positive, polite and patient with the customer service representative. Remember that he/she is 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 get nowhere 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's justifiably belong to you.

Auto insurance & the internet - a marriage made in Heaven!!

The internet is all about information, and, more critically, the ability to compare facts, data and information from several different sources quickly and efficiently.

Arguably, as a direct result of this simple fact, nobody has felt the effects of a potential customer’s ability to find, check and compare such data than companies trying to sell services (as opposed to products) online.

Unlike a physical product, a service is not tangible, you cannot pick it up, feel it, or touch it. Thus, a service provider needs to supply the maximum amount of information, because the more information the potential customer has, the more confident he is likely to be when making the buying decision.

What better way to do this than via the worldwide web?

A perfect example of this is the automobile or car insurance marketplace. In the past, if you wanted to get the most competitive quotation for your car insurance, you had to “shop around” by trudging from one insurance broker or company’s office to another, or by getting on the telephone to do the same thing.

The problem with this was that it was often difficult, if not impossible to know whether you were truly comparing like with like. There were (and, to a large extent, still are) so many potential variations from one company’s policy to another that it was almost impossible to know whether the two policies that you were comparing really did offer identical levels of protection and benefits.

This was not always a bad thing. For example, all car insurance companies tend to “load” the premium (i.e. charge extra) for “young drivers” to be included on a policy, which can be bad news for parents using the family car to teach their son or daughter to drive. However, Company “A” may define a young driver as someone below the age of 18, whereas Company “B” will use a threshold of 21 years of age.

If your child was 19, the chances are that Company “A” will be the best bet in these circumstances.

In other words in the old days, it was absolutely necessary to “read the small print”, to avoid ending up with a automobile insurance policy that really did not meet your requirements, although it appeared at first as if it did.

Coming right back up to the present day, whilst the small print is still extremely important, the internet has effectively ensured that  it is no longer so small! It is now possible to make meaningful and accurate comparisons of exactly what two companies are offering with their car insurance policy at the touch of a button.

You are still “shopping around” but you are doing it at our own speed, from the comfort of your own home.

In this way, the internet has made finding the best car insurance a far less stressful business than it was in the past, and has also guaranteed that the policy you buy is absolutely the most suitable for your own circumstances.  To read more, http://webbiz99.com/carinsurance/

Affordable Health Insurance An Absolute Bargain

In today’s world where nothing seems to be certain anything can happen in a blink of an eye, we must make sure from our point of view that we take the necessary steps towards achieving some amount of sanity in life. That sanity can come if you go for health insurance. With health insurance the person becomes satisfied and a satisfied person can achieve more than a discontented one. It is important that whatever valuable a person has should be insured but health being one such thing which needs insurance more than most as once good health is lost would be difficult to recover.

There are many different ways by which you can go in for health insurance so that it does not affect your pocket that much. The various policies available to you are:

• Fee for service insurance in this type of health insurance it pays the each portion of medical you get such as doctors visit or anything else and you pay the remaining costs. Premiums are a little higher but manageable.

• Managed care plans is the other option available to the users for health insurance in this the insurance company has contacts with doctors and hospitals to provide you with services. You pay the monthly premiums and a small amount of co pay to the service providers usually ranging in between £10 – £15 this is a cheaper form of health insurance hence very affordable

• COBRA is an acronym for consolidated omnibus reconciliation act of 1985. With this you can get health insurance. This is under the federal government so approachable to everyone.

The types of policies in these include

• Guaranteed renewable
• Non cancelable

These three ways provide you with the option of going in for health insurance. Also you can choose between an individual policy and a family policy for your health insurance plan.

An independent broker can help you a great deal in understanding the health insurance policy that you would need to take depending on your credit and your needs. Apart from that he can give answers to all the queries which would further enhance your understanding of health insurance. There are a plenty of options available to you to choose from in case of health insurances.

It is difficult for people with pre existing conditions which include pre agreement diseases to get insurance cover. However they can go in for coverages like:

• Open enrollment
• Health insurance provability and accountability act (HIPAA)
• State requirements
• High – risk pools
• Temporary coverage

This can serve the purpose of people with pre existing conditions.

Most of the things in life can be recovered but health is one thing that is difficult to recover without proper care. That proper care can be received with health insurance. After all it is your own health and concerns not only you but all the people around you.

A New Idea To The Health Insurance Crisis In America

Lack of health insurance coverage for over 41 million Americans is one of the nation’s most pressing problems. While most elderly Americans have coverage through Medicare and nearly two-thirds of non-elderly Americans receive health coverage through employer-sponsored plans, many workers and their families remain uninsured because their employer does not offer coverage or they cannot afford the cost of coverage. Medicaid and the State Children’s Health Insurance Program (SCHIP) or HAWK-I here in Iowa help fill in the gaps for low-income children and some of their parents, but the reach of these programs is limited. As a result, millions of Americans without health insurance face adverse health consequences because of delayed or foregone health care and extending coverage to the uninsured has become a national priority.  -(Information taken from kff.org)

The number of people that are forced to go without health insurance is nothing less than a crisis in this country today. We have fallen into a vicious cycle over the last few decades in which health insurance premiums have become too expensive for even a middle class family to afford. This in turn results in the inability of the uninsured to cover medical costs which often times results in the financial ruins of the family, and in turn results in the continuing loss of income by the medical community, which in turn drives the cost of medical expenses higher, finally cycling back to the insurance company which then must drive the premiums of health insurance higher to help cover the rising cost of health care.

Many proposals have been tossed around by politicians on both sides of the isle ranging from socializing health care comparable to the Canadian system, to endorsing health savings accounts and cracking down on frivolous law suits against the medical community. Many of these proposals have good points, but along with whatever good points they bring they also bring major downfalls. For instance; a socialized national health care program would eliminate the need for health insurance all together and the cost would be taken on by taxes, which in theory doesn't seem like a bad idea. However, the downfalls to this system include a deficit in new doctors willing to get into the field due to the inevitable decline in income while the demand would grow due to no personal responsibility. In short if people didn't have to worry about deductibles or copays that would normally keep the person from seeking medical treatment for minor things, they would simply go to the doctor every time they had an ache or pain. So now we have waiting lines for people with major health problems since everyone is scheduling an appointment while at the same time we are loosing doctors due to lack of incentive.

The current battle cry by the republican Bush administration is to push HSA's (Health Savings Accounts) which reduce premium by taking a less expensive high deductible health insurance plan with a tax deferred savings account that earns a small interest on the side that you contribute to along with your premiums each month. Any money withdrawn from the savings account for qualified medical expenses are taken "tax-free", and unlike a flex spending account like many people are familiar with in employer based plans, you don't lose the money you put into the account that you don't use. Basically if you never used any of that money in the savings account you could withdrawal or roll it over into another vehicle once you turn 62 1/2 penalty free to be used for retirement. This is a viable option for some people, however for many the premiums for these plans are still too expensive, and the problem remains that if you need major treatment in the first few years of the policy you will not have a big enough amount in the savings account to help cover the gaps leaving that person responsible for a large portion of the cost out of pocket.

Now we come to what I believe is one of the biggest problems from a health insurance agent's point of view, which is the inability for persons with pre-existing health conditions to obtain coverage. From the number of people that contact my office searching for health insurance coverage, I would have to say that about half of them have a health condition that will either result in an insurance company declining that persons application, or result in an amendment rider which basically excludes coverage for any claims related to that condition. An example of a condition that I run across constantly is hypertension or high blood pressure. This condition will sometimes result in a company declining an application all together if other factors are involved, but most generally result in an amendment exclusion rider. You may think that this isn't that big of a deal, after all, blood pressure medicine is about the only thing they would have to pay for out of pocket, but what many people don't realize is that this rider will exclude ANYTHING that could be considered part of this condition including heart attacks, strokes, and aneurisms which would all result in a huge out of pocket claim. Consider the fact that my father had a double by-pass surgery recently that ended up with a final bill of around $150,000. This whole amount would have had to come out of pocket had he had a hypertension rider on his health insurance policy, not to mention the added cost of 2 months off of work thrown into the mix. On a modest income of $40,000 per year this would have ruined him financially.

So what how do we fix this problem? Obviously the proposals thus far have been flawed from the beginning, and even if one of these plans gained support from the American people chances are it would never be passed into law simply due to political infighting. One side wants to keep health care privatized while the other wants to socialize it, which as we discussed before both have upsides and downsides. It seems that we are doomed on this issue and there is no real ideas or light at the of the tunnel right? Maybe not, let me tell you about a client I had in my office a couple of years ago.

A young woman came in wanting to compare health insurance plans to see if there were any options for her and her family. She had several children and had been on Title 19 Medicaid and had been going to college paid by the state. She had recently graduated from college and had gotten a job with the local school system, however for whatever reason she was not eligible for health insurance benefits. Obviously she still couldn't afford 5 or 6 hundred dollars per month for a plan so she went back to the aid office and explained her situation. They ended up working with us to find an acceptable private health insurance plan and reimbursed her for a percentage of the cost which I didn't even know was possible!

This got me thinking, consider how many more people would be able to obtain coverage if they could be reimbursed by the government a percentage of the premium according to their income. For example; take a young married couple in their 20's with one child, let's say that their family income is $25,000 and that the average premium for a $500 deductible health insurance plan for them is $450. Just as an example let's say that the government determined that a three person family with an annual income of $25,000 is reimbursed 50% of their premium taking the actual cost to the family to $225 per month. This is now an affordable enough premium for the family to consider.

With this merging of private insurance with government assistance we get the best of both worlds. Of course the next question goes to cost, how much more would this cost the American tax payer and how much would this raise taxes? I don't think that it would cost the tax payers much more an here's why I think that: First off we would bring down significantly the amount of uninsured people that are unable to pay for the medical care they get in turn driving down the total cost of health care. Secondly the number of people that are forced into bankruptcy and driven to Medicaid Title 19 assistance due to medical bills stemming from catastrophic medical conditions that don't have health insurance coverage would be significantly reduced. This is important to keep in mind considering that once someone is on Medicaid they are receiving health care basically 100% covered by the government so there is no more incentive to not seek treatment for minor or non-existing conditions. On the flip side many conditions that would have not been caught before they became severe because a person didn't seek treatment due to not having insurance coverage would now be caught before they turned into a catastrophic claim. Finally, if the government allocated a certain amount of money to help cover claims by people that have pre-existing conditions the private insurance companies could do away with exclusions and declines due to already existing health problems, this is already done is some states such as the HIPIOWA Iowa Comprehensive Plans which insures Iowa residents that can not obtain coverage elsewhere.

You may be sitting there thinking that this is all just wishful thinking and that these ideas could never be implemented, but all of these ideas are already being implemented. The problem is that only some states do some programs and not even most health insurance agents know that some low income families can get reimbursed for health insurance premiums. If these programs were all standardized and put into effect on a national well publicized level I believe it would put one hell of a dent in the uninsured population in this country. Now I don't pretend to know what the reimbursement levels should be for what income levels but I do know that anything is better than nothing, and in my opinion this is the best middle ground we could find. The Democrats would be happy with the socialized aspect of the reimbursement, and the republicans should be happy that health care remains privatized giving this solution a better chance at a by-partisan backing.

I have faxed this idea to several senators and congressmen but always received the same type of standard response about how they are concerned with health care and that they are working hard to find a solution knowing full well that no one really even read my letters. The only way to get these ideas out into the public is for you that read this to pass it on to others by word of mouth, by email, or by linking your websites to this webpage. If enough buzz is created than these ideas would get the consideration that they deserve, and if enough people like you and I demanded that a solution be found than perhaps enough stress can be placed on the politicians to get something done. The number of uninsured Americans is only going to go up, the cost of health care is only going to go up, and the cost of health insurance premiums are only going to go up if something isn't done now! Until then the only thing that I as a health insurance agent can do is to compare all of the options out there and present you with the lesser of all of the evils, which in too many cases the option that is chosen is the biggest evil of going without coverage.

10 key reasons why a person needs life insurance

Insurance is designed to protect a person and the family from disasters and financial burdens. There are many kinds of insurance of which, the basic and most important is considered to be life insurance. It provides for the dependants after your death.

Since there are certain financial commitments you need to meet throughout life and do contribute in some way to the family income, you need to provide something even in death—to secure the home, help the family meet expenses for a while, protect dependant parents, or secure the children or spouse.

Financial obligations could include funeral expenses, unsettled medical bills, mortgages, business commitments, meeting the college expenses of the children, and so on.

How much insurance a person needs would vary, depending on lifestyle, financial needs and sources of income, debts, and the number of dependants? An insurance adviser or agent would recommend that you take insurance that amounts to five to ten times your annual income.   It is best to sit down with an expert and go through the reasons why you should consider insurance and what kind of insurance planning would benefit you.

As an important part of your financial plan insurance provides peace of mind for any uncertainties in life.

1.    Life insurance correctly planned will on premature death provide funds to deal with monies due, mortgages, and living expenses. It offers protection to the family you leave behind and serves as a cash resource.

2.    It secures your hard earned estate on death by providing tax free cash which can be utilized to pay estate and death duties and to tide over business and personal expenses.

3.    Life insurance can have a savings or pension component that provides for you during retirement.

4.    Some policies have riders like coverage of critical illness or term insurance for the children or spouse. There are certain rules regarding eligibility for riders which you will need to determine clearly.

5.    Having a valid insurance policy is considered as financial assets which improves your credit rating when you need health insurance or a home loan or business loan.

6.    In case of bankruptcy, the cash value as well as death benefits of an insurance policy is exempt from creditors.

7.    Life insurance can be planned such that it will cover even your funeral expenses.

8.    Term life insurance has double benefits, it protects and you can get your money back during strategic points in your life.

9.    Insurance protects your business from financial loss or any liabilities in case a business partner dies.

10.    It can contribute towards maintaining a family’s life style when one contributing partner suddenly dies.

Insurance is vital to good financial planning and security but you would need to assess your personal risk and long term commitments. Insurance stands a person in good stead throughout life and can be used in case of emergencies during a life time by requesting a withdrawal or loan.

The Top 10 Ways to Lower Your Health Care Costs

If your medical expenses are increasing, you’ll want to know how to lower them and keep them low. Here are 10 easy ways to reduce your health care costs.

1. Maintain a health lifestyle — it sounds basic, but it really works. If you take advantage of available wellness programs, maintain a healthy weight, exercise regularly, stop smoking, and have regular checkups, you can greatly reduce your medical expenses.

2. Take advantage of free health screenings —if your health insurance doesn't provide adequate health screenings, or if you don't have any health insurance coverage at all, look into free health screenings. Local clinics and hospitals often provide a variety of screenings, such as blood pressure, cholesterol, and mammograms.

3. Compare your health insurance options — you’ll need to get your own coverage if you don’t have employer-sponsored health insurance. Shop around. Because premiums vary widely, you'll probably save money if you get quotes from several companies. Evaluate each plan's coverage and features, taking into account exclusions, limitations, and the freedom to choose health-care providers. Also find out how much you'll end up paying out of pocket in the form of co-payments, coinsurance, and deductibles, because even relatively small amounts of money can really add up if you make frequent visits to your doctor.

4. Reduce the costs of your prescription drugs — if you take prescription drugs regularly, you know they can eat up a large portion of your budget. To save money, order your prescriptions though the mail by using a traditional or online pharmacy. If you belong to a prescription drug plan through your health insurance plan, you may be able to get a three-month supply of your prescription drug through the mail for the same price you would pay for a one-month supply at your neighborhood pharmacy. You can also ask your pharmacist or doctor to recommend a less-expensive generic drug whenever possible.

5. Always check your medical bills for errors — taking a few minutes to go over the charges can save you money in the long run. Check to make sure that the bill accurately reflects the procedures you have undergone and takes into account any applicable insurance coverage you may have. Some errors, such as wrong computer codes, are common, and you may be billed for health care you never received. Contact the appropriate billing office if you think you've found a mistake. If you've received an explanation of benefits from your insurance company that you believe is wrong, ask the company to review your claim.

6. Keep track of your medical expenses — at tax time, you may be able to deduct certain medical expenses if you itemize, and your total medical expenses exceed 7.5 percent of your adjusted gross income. Allowable medical expenses include everything from health-care services to medical aids such as eyeglasses and hearing aids. Keep track of these expenses during the year.

7. Consider joining your spouse's health plan — review both your coverage and your spouse's coverage to see if it makes sense for either of you to join the other's plan. Keep in mind that most plans allow you to add a spouse to your plan within a certain time period after you get married. Otherwise, you may have to wait for the plans' annual open enrollment period.

8. Negotiate a discount with your healthcare provider —you can sometimes negotiate to lower your medical bills. While it may not always work, it doesn't hurt to ask your doctor, hospital, or pharmacy if they're willing to come down in price. Before you begin to negotiate, do a little research to find out what other healthcare providers in your area are charging. You can also ask your healthcare provider if they'll lower their price if you pay in cash up front.

9. Contribute to a flexible spending account — check to see if your employer offers a flexible spending plan that will allow you to put pretax dollars in an account. If so, consider participating. You will be reimbursed for your out-of-pocket medical expenses, such as prescription drugs, dental care, and co-payments. Because flexible spending contributions are taken out of your pay before federal and state taxes are calculated, you get to use pretax dollars to pay your medical bills.

10. Understand your health insurance benefits — your health insurance may cover more than you think. Many insurance companies now provide services that are designed to help you stay safe and healthy. For example, you may receive discounts on vitamins, alternative medicines, health club memberships, or bike helmets. You may also be surprised at the range of coverage your health plan offers. For instance, it may cover dental care for young children, chiropractic care, and acupuncture. Read your plan membership materials to find out what products and services are available through your health plan before you pay for them on your own.

Staying healthy is the best way to reduce your health care costs. Getting a quality health insurance policy and understanding its benefits will also go a long way to keeping your medical bills as low as possible.

Insurance Made Easy: A Guide For The Consumer

For most of us, insurance coverage represents a love-hate relationship. We hate paying for the premiums, but love having the right kind of coverage when it is needed. We realize that is important to have insurance coverage, but just the thought of contacting different insurance agents, or researching different insurance plans, can not only be a scary experience, but incredibly overwhelming. Knowing what types of insurance are available, and making sure you have the correct coverage for your life’s needs is a task that should be given careful consideration.

Using the following suggestions, whether you are a novice or a veteran insurance buyer, will help you to make critical insurance coverage decisions. First and most important, is to ask yourself the question; what kind of insurance do I need? There is auto insurance to protect yourself and others when driving. Health coverage is a vital issue to address, as well as life insurance, disability and long-term health care. If you have a home, you need to protect your most valuable possession with home-owners insurance. There are many types of insurance for each of the categories mentioned. Asking the right questions can make all of the difference in deciding on the policy that fits you best.

Auto Insurance

Auto insurance is required in most states. You may not be required to carry full coverage, which includes collision, comprehensive and medical coverage; but you are required to carry liability coverage. Liability is the foundation of any auto insurance policy. If you are at fault in an accident, your liability insurance will pay for the bodily injury and property damage expenses caused to others in the accident, including your legal bills. However, if your vehicle is damaged, the expense to repair it will not be covered without having a full coverage policy. Collision, comprehensive and medical coverage are for your benefit. Collision will pay for the repair to your vehicle, while comprehensive coverage will pay for damages to your car that weren’t caused by an auto accident. Medical payments coverage will pay for you and your passenger’s medical expenses after an accident. This coverage will pay no matter who is at fault.

Collision coverage is usually the most expensive part of a policy, you can choose a higher deductible, say $500 or $1000, and keep your premium costs down. If you have a newer vehicle and have a lien against it, the lending institution will require that you have full coverage. By working with a professional insurance agent, the agent would be able to give you many cost saving suggestions that you could take advantage of to lower your rates, and still give you the coverage you need.

Health Insurance

Health insurance is one of the largest expenses that we face today. Educating yourself about the different types of health insurance available will assist you with your insurance buying decision. There are many types of plans, but essentially two kinds of health insurance: Fee-for Service and Managed Care.

Fee-for-Service assumes that the medical professional will be paid a fee for services provided. Managed Care encompasses various plans and can include: health maintenance organizations (HMOs), preferred provider organizations (PPO), or point-of-service (POS). These plans provide comprehensive health services to their members and offer financial incentives to their members to use providers in their network. Health insurance is one of the least understood types of insurance; many people feel they do not need health coverage, but just one major illness or accident can force you into bankruptcy when you can’t pay your bills. This is why you need to understand all the different types of plans available and what plan would best suit your needs and budget. Meeting with an insurance professional and asking the right questions, can save you many sleepless nights of worry and provide you with some peace of mind.

Life Insurance

There are some basic things to consider when you are assessing your life insurance needs. You should first consider your financial situation and the standard of living you would want your dependents or survivors to maintain. Would you want a policy that would cover funeral expenses and final medical bills, or do you have a family to consider where your coverage would also pay outstanding debts, child-rearing expenses, and educational costs? There are two main types of life insurance available. They are Term Life and Permanent or Whole Life.

Term provides death benefit protection for a specified period of time. You can buy a policy in increments of 10, 20 or 30 years. These are usually less expensive, but your rates can increase each time you renew your policy. With Permanent, the costs of the policy are stretched out over a longer period of time, usually spread out over your entire life. Permanent can also be used as a savings vehicle. Once the premium has been paid, the company invests the additional funds. It’s a very important choice as to what insurance company you choose. A knowledgeable and experienced agent can answer all of these and your personal questions about life insurance.

Disability Insurance

Is disability insurance really necessary? Many of us can easily become sick or disabled tomorrow and not be able to work for two or three months. Would you have enough savings to cover your living expenses? There are two types of disability insurance. Short term and long term disability.

Short term will pay you a percentage of your salary for a short period of time. These policies are usually not very expensive, and usually cover a period of three to six months. Long term disability insurance picks up where your short term leaves off. Long term will pay a percentage of your salary until you are 65 years old. Disability insurance can be costly when you by it on your own, but it should be a part of everyone’s financial plan. It could easily be argued that you need disability coverage more than life insurance.

Long-term care Insurance

Another form of insurance that people around 50 years of age should consider is long term care insurance. There are many confusing forms of this insurance, but it essentially covers costs you would incur when you can no longer perform activities of daily living, such as dressing yourself, bathing yourself, or the need of skilled nursing care at home or in a care facility. Medicare and Medicare supplemental insurances don’t cover most long term care expenses. This is a very important insurance, you would need the help of an insurance professional, one who specializes in long term care insurance, to make sure you have the best coverage to fit your long term care needs.

Homeowner’s Insurance

If you are a homeowner and you have a mortgage on your home, your lender requires you to have homeowner’s insurance. There is much more to consider than how much your coverage will cost, you need an adequate policy that will give you the right level of protection; plus special provisions for your valuables and other possessions. You may need additional coverage for things such as earthquakes or floods. Before you get a policy, you will need to take an inventory of what you have in your home. Know what your insurance limits are, learn the difference between replacement-cost and actual-cash-value coverage. Again, consulting with an insurance professional and one who will listen and understands your specific needs is essential.

With all of the different types of insurances available, it is best to be prepared when selecting a policy. Choosing the wrong insurance policy can have disastrous consequences for both you and your family. There are many decisions that need to be made when looking for insurance, such as deciding what type of insurance you would need, and also considering what you can afford. You want to be able to speak to an insurance agent who will not pressure you or try to sell you insurance coverage you do not need. A professional can suggest and compare different plans and advise you which plan would best fit your own unique needs. All the while, offering this service at no cost to you.

Health Insurance

Health insurance is designed to offer financial protection against losses experienced due to illness, accidents, or injury. This type of insurance comes in many forms that offer differing levels of coverage. It can be purchased as part of a group policy or may be purchased by an individual.

Group policies are generally purchased through an employer, associations, or unions. They may be less expensive because the costs associated with administration are reduced. In addition, the employees or association may pay part of the premium.

Group health insurance has become an incentive for potential employees who are trying to cover their or their families' health care expenses. Some policies offer managed care. Depending on the policies of a managed care provider, preventative health care may be part of the plan. Preventative measures may include regular checkups.

Individuals may purchase individual health insurance polices in the absence of company provided benefits or if they are self-employed. Generally individual health plans can be more expensive, however, they also have some benefits.

For example, individual policies can be customized for your specific needs. Shopping around for health insurance can be helpful by allowing you to compare the benefits and cost of different types of coverage. Consulting with caring agents will help you determine the policy that is best for you and what level of coverage you'll need.

You may be able to save money on the premium of your policy if you carry a higher deductible. The deductible is the amount of out of pocket expenses you pay before your coverage begins.

Health insurance can cover a variety of expenses. For example, it may pay for the cost of hospitalization or surgery. It may also pay other hospital expenses such as the cost of the hospital room.

All health insurance policies are not equal in this regard. Some policies will pay a flat rate daily for the cost of a room. Other types may pay everything after the deductible for the room.

Health insurance may also cover expenses due to a disability, and may cover rehabilitation such as physical therapy, or aftercare. Disability insurance, a type of health insurance, may pay expenses for loss of income in addition to health care expenses.

Some policies also provide benefits for medication or necessary medical devices such as a pacemaker. Also, some contemporary health insurance policies provide some dental coverage. However, it's important to note that levels of coverage will vary between policies, sometimes significantly.

Health insurance may also cover you for existing conditions; however there may be up to a year delay before coverage begins for policies of people with pre-existing conditions.

Health insurance may seem like an undue expense when you are young and healthy, but it's invaluable when you need it most. Consult with a health insurance agent to make sure you have a good understanding of the benefits of your plan. They can help you answer any questions you may have about the conditions and benefits of your policy.

It can also be helpful to compare a number of health insurance companies, so you can get the best policy for your individual needs at the lowest rate.

Becoming educated about your policy from enrollment on can help reduce stress levels during a medical emergency. In this way you can also be more proactive with your own care. And you can have peace of mind knowing that if an unexpected situation happens, you will be covered.

For more information, see Make-Getting-Insurance-Easy.com/health-insurance

3 Ways Your Health Insurance Company Is Scamming You

The growing number of consumers taking up health insurance plans has led to the mushrooming of scam health insurance providers. These providers often target new retirees and the elderly individuals and small-business owners, who can't negotiate better rates with legitimate insurers. Be very cautious before you invest in any health policy. Read on to get an idea about 3 ways in which your health insurance company can scam you.


1.    Failure to pay claims

Usually fraud health insurance agents sign up a huge number of people quickly by offering them lucrative deals. These insurance providers keep paying small premium amounts and medical claims, but if there is a substantial claim amount or regulators catch them, these illegal companies vanish as if they never existed.

So, just beware if you are getting delayed payments or your service provider is offering fake excuses for the failure to make the payments. If you have signed up for these illegal plans, you may be liable for the medical bills of your employees as well.

2.    Non-licensed health plans

If the company from which you have bought your health care policy is not licensed by State Insurance Commissioner, you can be in trouble. If all the protections of insurance regulation do not apply on your service provider, then the company may be phony. In this case your service provider is scamming you by selling non-licensed health plans.


Insurance agents are not allowed to sell any legitimate ERISA or union plan as federal law governs them. So, if your insurance agent tries to dupe you by selling an “ERISA” or “union” plan, report them to your state insurance department.


3.    Unusual coverage offered at lower rates

If you are offered an unusual coverage irrespective of your health condition and that too at lower rate and much more benefits in comparison to other insurers, its time for you too hit the panic button. Do not get fooled by the lucrative offer, else you can be taken for a ride. The ‘scamsters’ aim to collect huge amounts as early as possible so, they try to sell maximum number of policies at attractive prices.