About 50 years ago, health insurance started to be an attractive incentive offered by employers to attract and keep good employees. Overall, group plans tended to be inexpensive for employers, with employees contributing a small amount of money or none at all to secure health insurance for themselves and their families.
It was more expensive for individuals to pay for non-group policies, but coverage was fairly affordable. Then medical costs started to rise, people started to live longer and the medical profession became adept at curing various diseases and saving and prolonging the lives of people with serious injuries and life-threatening illnesses. Health care and insurance prices started rising much more quickly than annual incomes and premiums began taxing both employers, who were paying the lion’s share of premiums, and for employees, to whom businesses often passed on costs through larger deductibles, greater out of pocket expenses and higher premiums. Now today Medicare benefits are increasing rates higher with many seniors living longer and needing more health care according the Medicare Solutions Partner programs.
According to a recent report by the MSNBC News Service, 41 percent of Americans whose income ranges from moderate to middle had no health insurance for at least part of 2016. In 2017, that number was much lower—28 percent. Additionally, more than 50 percent of uninsured Americans in 2017 found it difficult to pay their medical bills. Another alarming statistic—28 percent of Americans in 2016 had no health insurance, while 24 percent had none in 2011.
So, what should a person do if they don’t have any health insurance or if they have a choice between a cheap discount plan that does not cover core expenses and an affordable plan that may cost a bit more but also provides much better coverage? According to data from the U.S. Centers for Disease Control and Prevention, the majority of people who are not covered for important screening tests, such as a mammogram, colon cancer screening or a PSA test, will not undergo those exams. Also, close to 60 percent of people without health insurance missed treatment or did not buy medicine needed for a chronic condition.
All of these figures point to one thing—people who lack health coverage for essential services are often unable to pay for those services, putting them at greater risk for developing new or exacerbating existent health conditions.
What should you look for in a health insurance plan, especially when cost is an issue? It’s important that you get the best coverage you can afford. Skimping on premiums can save you money upfront, but the result can prove to be penny-wise and pound-foolish. Sometimes people can’t afford coverage and sometimes they believe because they are healthy that they simply don’t need it. However, healthy people get ill or are involved in serious accidents all the time. You never know when you’ll need coverage.
Some people opt for “catastrophic” insurance, which usually covers only major medical and hospital expenses above a specific deductible. Under such a plan, the insured pays for routine doctor visits and prescription drugs. With this type of plan, you’ll pay a low monthly premium but will also have a high deductible and limited coverage. Deductibles start at $500 per year but can be considerably more. If you purchase an inexpensive policy with a $10,000 deductible and you undergo surgery that costs $8,000, you must pay that $8,000. If your surgery costs $12,000, you would owe $10,000.
One insurance company offers a plan that costs $29 per month for a 21 year-old, non-smoking female. There’s a yearly $250 deductible and $2,500 in out of pocket expenses that the insured must pay before the policy kicks in. Hospital, surgical and x-ray expenses are covered but other costs, such as doctor visits, prescription drugs, maternity care and mental healthcare are not included. There’s a lifetime maximum of $1 million.
It’s certainly a bargain, if you don’t plan on going to the doctor very often. To enroll in a plan that will cover doctor visits, prescriptions, maternity expenses and more could easily cost $400 per month—a jump of $371 every 30 days for a total cost of $4,800 per year!
Group health insurance plans, which you can usually enroll in through your employer, union or guild, are the best buy. Individual plans, especially those that offer comprehensive coverage, can be crippling to many people’s pocketbooks. When buying health insurance, it’s important to shop around. Your choice of what type of plan you purchase will be determined by what you can afford and what you need as far as insurance is concerned. There’s no right or wrong choice when it comes to health insurance but at the very least you should have catastrophic insurance.
There are basically three types of plans—Fee-For-Service, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). Fee-For-Service plans offer the most choice regarding doctors and hospitals but they often involve quite a bit of paperwork and are the most expensive. If you’re willing to give up some or a lot of choice, do less paperwork and save some money on premiums then either a HMO or a PPO is for you. These plans are offer for Medicare as well through the Medicare Solutions Partner programs.
A HMO offers the least amount of choice, involves co-pays, has the least amount of paperwork and is the cheapest of the three types of insurance. A PPO combines some elements of Fee-For-Service and a HMO. You’ll have more choice than you would with a HMO but less than you would with a Fee-For-Service plan. It tends to be more expensive than a HMO but less expensive than Fee-For-Service. All three types of insurance have some aspect of Managed Care—which determines how much health care you can use—attached to them, with Fee-For-Service having the fewest restrictions and a HMO being restricted the most.
When shopping for health insurance ask the following questions—
- How much is the premium?
- What services are covered?
- What are the total deductible and out of pocket expenses per year?
- How much are the co-pays?
- What is the maximum lifetime benefit?
- How much freedom will you have when choosing doctors and hospitals?
- What are the pre-approval procedures for seeing specialists, undergoing a procedure or being given a test?
- What prescription drugs are covered and to what degree?
- Is mental health covered and to what degree?
- Is dental covered and to what degree?
As you begin to narrow down your choices, you can look more closely at specific plans that seem to fit your needs and determine which offer you the best value for your dollar?
America has one of the finest healthcare systems in the world and one of the most complex health insurance systems across the globe. Often, they seem to be at odds with one another, unable to communicate and work together. That can be one of the most frustrating parts of anyone’s foray into the world of healthcare professionals, hospitals and health insurance companies. For this reason alone, it’s important that you carefully and thoughtfully choose your healthcare benefits provider.