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Health Insurance 101 with Industry Insider and Watchdog, C. Steven Tucker. This show focuses on Consumer-Driven Health Insurance products for Small Business owners, the self-employed, individuals who are paying high monthly premiums for employer sponsored group Health Insurance coverage or COBRA continuation coverage or for anyone interested in learning how to shop for the best Health Insurance at the lowest price. This show will be of special interest for those individuals who have recently lost their jobs and are confused about their COBRA benefits or for those who are looking for more affordable COBRA alternatives. Topics will range from COBRA subsidies, State Insurance Risk Pools, Health Savings Accounts, Guaranteed Issue Defined Benefit Health Insurance plans and many other interesting topics. Listeners will also learn how they can build retirement income using a "Medical IRA" attached to a Consumer Driven Health Insurance plan, what options they have if they have been declined Health Insurance coverage and are labeled as "uninsurable" and how they can obtain legitimate Health Insurance coverage for pre-existing medical conditions even after they have been declined.
Date / Time: 4/30/2009 11:09 PM UTC
If you are not familiar with the new "American Recovery and Reinvestment Act Of 2009" then you need to learn more at the U.S. Department of Labor web site. In a nutshell, this new Federal Act entitles you to a 65% reduction in your monthly COBRA continuation premium if you lost your job after September 1st, 2008. Granted it only lasts for 9 months, but it is most certainly going to help millions of American's who have lost their employer sponsored group health insurance coverage.
*
However, there are "strings attached," for those who earn more than $125,000 or $250,000 for married couples filing a joint federal income tax return, in that, if your income meets or exceeds these amounts, you may have to repay all or part of the premium reduction. Therefore, if you are in a higher income bracket, you may wish to consider waiving your right to the premium reduction as it may increase your income tax liability for the year. For more information on how higher income earners are affected by this Act, please refer to the March 25, 2009 Issue of Forbes Magazine.
But, what if you decide to elect COBRA? The question then becomes, "What do you do after the 9 month COBRA subsidy expires or when your COBRA runs out altogether?" Luckily, there are several lower cost alternatives to paying high priced COBRA continuation premiums. And, depending on what state you live in, there may be other health insurance options that you can select when your 9 month subsidy expires or when COBRA finally runs out at the end of 18 months. They are as follows:
State Continuation of Coverage
Individual Health Insurance Policy
Small Group Health Insurance Plan
State Risk Pool Coverage
Defined Benefit Health Insurance Plan
Let's take a look at these alternative plans:
1. The first option is "State Continuation of Coverage." Many States offer State Continuation of Coverage. While State Continuation of Coverage does not follow Cobra continuation laws, it does allow you to continue your employer sponsored group coverage for up to 9 months even if your former employer employed less than 20 employees. This law does not apply to self-funded plans, so make sure to check with your State's Department of Insurance to see if your State mandates State Continuation of Coverage.
2. The second option, an "Individual Health Insurance Policy" is typically the best and most affordable alternative for relatively healthy individuals. An individual health plan can be purchased at any time and is a great way to maintain many of the same kinds of benefits that you had through your former employer's sponsored group health plan.
However, an Individual Health Insurance policy has to be "underwritten" before it is issued. During the "underwriting" process, the insurance company scrutinizes the applicant's health history to determine if it will extend an offer for insurance coverage. This process allows the insurance company to "decline" coverage to applicants with serious pre-existing or chronic medical conditions or to modify the coverage it extends to the applicant.
Today, the "Individual" health insurance market has become quite competitive; therefore, many insurance carriers are willing to offer health insurance coverage to individuals with certain controlled pre-existing medical conditions, like high blood pressure or high cholesterol.
Other times, the insurance company will offer the applicant coverage, but will refuse to cover a specific body part or pre-existing condition. In these cases, the insurance company issues what is known as an "exclusion rider." An exclusion rider is a way for the insurance company to exclude coverage for a specific body part or a specific medical condition (e.g. right knee, uterine fibroids). Exclusion riders can be permanent (body part or condition excluded coverage for the life of policy) or temporary, (body part or condition excluded coverage for a specific period of time.)
Often, if an exclusion rider is placed on a body part and the insured receives no further treatment on that body part or if the rider is in place to exclude a pre-existing medical condition and the insured's condition completely resolves, the policyholder can request that the insurance company remove the exclusion rider from the policy. Typically, requests to remove a rider can be made after one or two years. Ultimately, the insurance company will makes the final decision on whether the exclusion rider will be removed.
An HSA qualified HDHP (Health Savings Account qualified High Deductible Health Plan) may offer a more affordable consumer-driven healthcare option to individuals that are searching for a health plan with very low monthly premiums. Typically, these plans offer policyholders greater flexibility and control in where their health care dollars are spent. Plans often come with a fixed aggregate family deductible, which mean that a separate deductible does not have to be met for each family member on the plan.
In addition to the significant cost savings, policyholders can fund their Health Savings Account (HSA) to pay for routine medical expenses or alternative medical therapies, like acupuncture. Any money in the HSA that is not used for medical expenses can be rolled over to the next year and excess funds can be transferred to a tax deductible, tax deferred, interest bearing account, commonly referred to as a "Medical IRA." These types of health plans can offer tremendous tax advantages to policyholders. Not only can policyholders save money on their health insurance premiums, but they also can use this savings to build a nest egg for retirement. Many HSA administrators now offer thousands of no load mutual funds to transfer your HSA funds into so you can potentially earn an even higher rate of interest.
For more information on HSA qualified HDHPs, click here.
3. The third option is a "Small Group Health Insurance Plan." This type of plan can be purchased immediately and might just be what the doctor ordered for those individuals that that have been "declined" coverage for an "Individual" health plan. It might also be another option for individuals who are looking for coverage without an "exclusion rider" on a pre-existing medical condition because group health insurance provides "guaranteed insurability," which means that all applicants and their families will receive health insurance coverage for all pre-existing medical conditions.
Because recent layoffs and a tough job market have created opportunities for many professionals thinking about starting their own business, here are a few things to keep in mind when considering group health insurance coverage. Typically, a company must have a minimum of two employees. Insurance companies typically allow husband and wife to enroll separately so the two-employee minimum can be met. The company must have a Federal Tax ID number, which means that sole proprietors, will have to incorporate, unless they have an existing business with a Federal Tax ID. To qualify for a small group plan, at least two of the employees on the plan must work a minimum of 30 hours per week and must receive a wage for the 30 hours worked.
On a Small Group Health Insurance plan, a large portion of the monthly premiums are determined by the health status of those individuals participating in the plan. Even if only one individual has a serious medical condition, that individual's condition is likely to adversely affect everyone's health insurance premiums. This means that even healthy group participants will pay a higher monthly premium. It may also mean that premiums can increase dramatically (up to 300% higher or more depending on your State) if someone covered on the group plan develops a serious condition or if an individual with a serious medical condition is hired at a later date.
This is important to keep in mind if your business is likely to grow, as your insurance contract may require you to offer new employees health insurance benefits and also require the corporation to pay a portion of your employees health insurance premiums.
The main advantage of a Small Group Health Insurance Plan is that it provides seamless continuation of coverage for those individuals who have pre-existing conditions such as Diabetes or Cancer providing that they have a minimum of 18 months of prior continuous health insurance coverage with no lapse in coverage of more than 63 days.
4. The forth option is a "State Insurance Risk Pool." This option is primarily for individuals who have serious medical conditions and who have been "declined" individual health insurance coverage. Many states, but not all, provide individuals with pre-existing conditions the opportunity to obtain seamless continuation of health insurance coverage after their COBRA continuation expires, or if they lost their employer sponsored group coverage due to a policy cancellation and they were unable to obtain an individual health insurance policy on the open market because of their pre-existing conditions.
State Insurance Risk Pools often offer immediate coverage to individuals that would normally render someone "uninsurable" on the individual health insurance market. To qualify for a State Insurance Risk Pool, applicants have to show "proof of credible coverage" for a minimum of 18 months prior to application, with no lapse in coverage of more than 63 days. Although Risk Pool coverage is also available to those who have been "declined" coverage on an Individual Health Insurance policy, there is usually a 6 or 12 months waiting period before preexisting conditions will be covered if the applicant fails to show "proof of credible coverage." To find if your state has a State High Risk Insurance Pool, click here.
5. A fifth alternative, recently advertised on the Fox News Channel is now available. It is a known as a "Defined Benefit Health Insurance Plan." These affordable policies can be purchased at any time and are issued on an individual basis regardless of health history, which means they can be a unique option for individuals that have been "declined" individual health insurance coverage.
However, these policies should be considered last, because coverage is limited and they are not designed to act as a comprehensive major medical plan. Although these policies offer limited benefits, they do offer an unlimited surgical benefit, therefore, they can be a financial lifesaver for anyone who is in need of surgical treatment for a pre-existing condition and might be exploring lower cost surgical options oversees. In addition, these plans also offer up to $1,000 a day for hospital coverage lasting up to 100 days. Outpatient doctor office visits & Labs.
Fortunately, these plans are HIPPA qualified, which means that all pre-existing conditions will be covered from day one, providing that the insured has "proof of credible coverage." Again, "credible coverage" is defined as health insurance coverage that has been in place for a minimum of 18 months prior to application, with no lapse in coverage for more than 63 days. To learn more about "Defined Benefit" health insurance plans, click here.
In all cases, Individuals should keep in mind when deciding whether to continue their health insurance coverage under COBRA that they will continue to pay for a health plan that was designed and purchased by someone else; specifically, their former employer. In addition, great portions of the COBRA premiums they pay are dependant, and will continue to be dependant, on the health status of their former employer's group.
Since the majority of employer sponsored group health plans have a low deductible, monthly COBRA premiums will be significantly higher. Therefore, it is prudent for anyone considering COBRA continuation coverage to explore all of their health insurance options, especially an "Individual" Health Insurance Policy.
This is especially true if one is healthy and rarely goes to the doctor and continues a their employer sponsored group health plan that offers a $20 Copay for doctors visits and a $15 Copay for prescription medications. If these are benefits that the individual is not likely to use, they might want to think twice before selecting COBRA continuation coverage.
In fact, healthy individuals can usually reduce their COBRA premiums as much as 50% or more by purchasing an Individual Health Insurance policy with a higher deductible. Furthermore, families can experience dramatic savings and have more control over their health care expenses by purchasing an HSA qualified HDHP.
Regardless of the decision, it is important for consumers to explore all of their healthcare options prior to making a purchasing decision. Taking the time to perform your own due diligence before making a health insurance selection may not only save you money, but it may save your life.
To see a list of Frequently Asked Questions (FAQ's) relating to Health Insurance, click here.
About the author: C. Steven Tucker, is the President of Small Business Insurance Services, Inc. He is a multi-state licensed insurance broker who has been serving the Small Business community and Self-Employed for 15 years. C. Steven has served as a Subject matter expert for the Wall Street Journal and Fortune Small Business Magazine and hosts his own internet radio show, entitled, "Health Insurance 101." He is also touted for being a consumer watchdog against greedy insurance companies, insurance scams and unscrupulous agents on Twitter.
Original Air Date: 4/30/2009 10:00 PM UTC
Original Air Date: 4/28/2009 10:00 PM UTC
Original Air Date: 4/23/2009 10:00 PM UTC
Date / Time: 4/15/2009 12:32 AM UTC
I have been a health insurance broker for 15 years now, and every day I read more and more "horror" stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not receiving reimbursement for medical services. * Unfortunately, the reality is, insurance companies are driven by profits and not people (albeit they need people to make profits) which means that insurance companies often look very hard for a legal reason not to pay a claim. However, what most people fail to realize is that there are very few "loopholes" in an insurance policy, which actually give the insurance company an unfair advantage over the consumer.
In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving their policyholders a 10-day free look period, to review their policy. Unfortunately, the majority of policyholders put their insurance cards in their wallet and throw their policy in a drawer or filing cabinet during their 10-day free look period. And, it usually isn't until they receive a "denial" letter from the insurance company after they submit a claim for reimbursement, that they take their insurance policy out of their filing cabinet to read through it carefully.
Since many small business owners rely heavily on the insurance agent to explain the plan's coverage and benefits, typically, individuals who purchase their own health insurance know very little about their plan. Although policyholders may know what they pay in monthly insurance premiums or what amount they have selected for a deductible, they may not really understand their insurance benefits in their entirety.
Purchasing a health insurance policy is NOT like buying a car, in that, the buyer knows that the engine and transmission are automatically included, air conditioning is standard and that power windows and seats are optional.
* There are so many variables that consumers have to be aware of when it comes to buying health insurance. These variables, and confusing insurance terminology, are often difficult for the average consumer to understand which is why many small business owners actually put off looking for a new health plan until their rates have skyrocketed to the point that they can no longer afford the monthly premiums.
Business owners, who find themselves in this position, often place a greater emphasis on how much the new plan will cost, rather than placing an emphasis on what benefits the new plan will actually offer.
Quite often, consumers that base their purchasing decision entirely on price, don't even realize that their new plan may not provide coverage for specific medical conditions or that the amount allotted for certain treatments may be extremely limited. And, it usually isn't until they receive a large bill from a medical provider which states that "claims were denied" that they realize that they made a critical mistake in plan selection.
As a small business owner, myself, who primarily deals with other small business owners, I have come to the realization that part of the problem is that it is extremely difficult for individuals purchasing their health plan on the open market to distinguish the difference among health plans. It is also equally difficult for consumers to determine what type of health insurance coverage they actually need for their particular situation.
Remember, there is a big difference between the type of health plan consumers actually "need" and the type of health plan consumers actually "want."
Let me explain.
Recently, I have read many blog articles that seem to stress that consumers should purchase health plans that offer 100% coverage with a very low deductible. 100% coverage means that after the deductible is met, usually $250, the plan will pay 100% of all covered medical expenses.
Although I agree that these types of health plans have a great "curb appeal." I can tell you from personal experience that these plans are not for everyone, nor are they affordable.
Will a low deductible plan that offers 100% coverage offer the policy holder greater peace of mind? Probably. But is a low deductible health plan that offers 100% health insurance coverage something that most consumers really need? Probably not.
In my professional opinion, consumers must achieve a balance between four important variables; wants, needs, risk and cost when they purchase a health plan. Just like the car analogy, it is important for healthcare consumers to understand what type of health insurance benefits are automatically included or standard and which health insurance benefits are optional.
For example, on most health plans, maternity and prescription drug coverage is optional.
With this in mind, if one is healthy, takes no medications and rarely goes to the doctor, do they really need a 100% plan with a $5 co-payment for prescription drugs if it costs them $300 dollars more a month?
Would it benefit a person to pay $200 more a month to have a 90/10 plan with a $250 deductible, or should they purchase an 80/20 plan with a $2,500 deductible which allows them to save $200 a month? Wouldn't the 80/20 plan still offer you adequate coverage? Isn't it more cost effective to put that extra $200 that would be spent on insurance premiums, totaling $2,400 per year in their bank account, "just in case" they may get sick or injured and might need to pay thier $2,000 deductible? * Isn't it smarter to keep your hard-earned money yourself, rather than pay higher monthly premiums to an insurance company for an illness or injury that may never happen?
This is just one example of consumer-driven health care. Another example is an HSA qualified HPHP. A HSA qualified HDHP (Health Savings Account qualified High Deductible Health Plan) may offer a more affordable healthcare option to individuals that are searching for a health plan with very low monthly premiums.
Typically, these plans offer policyholders greater flexibility and control in where their health care dollars are spent. Plans often come with a fixed aggregate family deductible, which mean that a separate deductible does not have to be met for each family member on the plan.
In addition to the significant cost savings, policyholders can fund their Health Savings Account (HSA) to pay for routine medical expenses or alternative medical therapies, like acupuncture. Any money in the HSA that is not used for medical expenses can be rolled over to the next year and excess funds can be transferred to a tax deductible, tax deferred, interest bearing account, commonly referred to as a "Medical IRA."
These types of health plans can offer tremendous tax advantages to policyholders. Not only can policyholders save money on their health insurance premiums, but they also can use this savings to build a nest egg for retirement. Many HSA administrators now offer thousands of no load mutual funds to transfer your HSA funds into so you can potentially earn an even higher rate of interest.
In my experience, I believe that individuals who purchase their health plan based on "wants" rather than "needs" feel the most defrauded or "ripped-off" by their insurance company and/or insurance agent.
In fact, I hear almost identical comments from almost every business owner that I speak to about health insurance.
Comments, such as:
Again, as a small business owner myself, I can understand the frustration that many small business owners express. So, here is the $64,000 question:
Q. Is there a simple formula that everyone can follow to make health insurance buying easier?
A. YES. Become an INFORMED insurance consumer!
If you are wondering what I mean by this, let me explain:
Every time I contact a prospective client or call one of my client referrals, I ask that person a list of questions about their current health insurance policy. You know, that policy that is in their dresser drawer or filing cabinet. That same policy that they bought to protect themselves and their family from that "worse case scenario" so they wouldn't have to file bankruptcy or lose their home due to unpaid medical debt.That policy that they thought promised coverage for that $500,000 life-saving organ transplant, for the 40 chemotherapy treatments that they may have to undergo if they were diagnosed with cancer or the many months of physical and/or speech therapy that they might need to fully recover from a stroke.
Q. So, what do you think happens almost 100% of the time when I ask these individuals "BASIC" questions about their health insurance policy?
A. They almost always do not know the answers!
The following is a list of 10 Questions that I routinely ask a prospective health insurance client. *
1. What Insurance Company are you insured with and what is the name of your health insurance plan? For example, Blue Cross Blue Shield-"Basic Blue."
2. What is your Calendar Year Deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? For example, the majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needs extensive medical care.
3. What is your Coinsurance percentage and what dollar amount (stop loss number) is it based on? For example, a good plan design works this way. After you have satisfied your calendar year deductible, the insurance company will pay 80% ($8,000) and you will pay 20% ($2,000) of the first $10,000 in medical bills that you incur each year. This first $10,000 is termed the "stop loss number." After this brief sharing arrangement is over, the insurance company pays 100% up to the Maximum Lifetime Benefit, which is typically, $2-5 Million per insured for the rest of that calendar year. Then, everything starts over again on the first day of each subsequent calendar year. Stop loss numbers can be as little as $5,000 or $10,000 or as much as $20,000. However, be aware that there are some policies on the market that have NO stop loss number at all! Therefore, it is critical that you ask what your stop loss number is before you purchase a plan.
4. What is your Maximum Out of Pocket Expense per year? Keep in mind that the Maximum Out of Pocket Expenses per year includes all deductibles plus all coinsurance percentages plus all applicable access fees, service deductibles or other fees.
5. What is the Lifetime Maximum Benefit the insurance company will pay if you or someone in your family becomes seriously ill and does your health plan have any "per illness" maximums or caps? For example, some plans may have a $5 Million Lifetime Maximum, but there might be a benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for the $5 Million of Lifetime Coverage.
6. Is your plan a Schedule Plan, in that it only pays a certain amount for a specific list of procedures? For example, Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, (N.A.S.E.) endorses schedule plans under the name "Health Markets."
7. Does your plan have Doctor Copays and are you limited to a certain number of doctor co-pay visits per year? For example, many plans have a limit of how many times you go to the doctor per year for a copay and, quite often the limit is 2-4 visits.
8. Does your plan offer Prescription Drug Coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? For example, some plans offer you prescription drug benefits right away, while other plans require that you pay a separate drug deductible before you can receive prescription medication for a copay. Today, many plans offer no copay options and only provide you with a discount prescription card that only gives you a 10-20% discount on all prescription medications. This is a dangerous policy design that can lead to catastrophic out of pocket expenses if you were to contract any one of a host of major medical conditions such as, Multiple Sclerosis or Rheumatoid Arthritis that require expensive outpatient maintenance medications which are usually not available in Generic form.
9. Does your plan have any reduction in benefits for Organ Transplants and if so, what is the maximum your plan will pay if you need an organ transplant? For example, some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs as much as $500K or more. In addition, this $100,000 maximum may also include the cost of expensive anti-rejection medications that have to be taken after a transplant. If this is the case, the insured will often have to pay for all anti-rejection medications (a.k.a. Immunosuppressants) out of pocket. Keep in mind that these medications are among the most expensive medications which individuals requiring an organ transplant will have to take for the rest of their life.
10. Do you have to pay a Separate Deductible or Access Fee for each hospital admission or for each emergency room visit? For example, some plans, like the Assurant Health's "CoreMed" plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Keep in mind that many plans have benefit "caps" or "access fees" for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit "caps" could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance if the fee for that particular service exceeds $500. "Access fees" are also additional fees that you are required to pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 "access fee" per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible.
Now that you have read the list of questions that I ask a prospective health insurance client, ask yourself:
How many questions you were able to answer?
If you were not able to answer all ten, don't be discouraged. That does not necessarily mean that you are not a smart consumer. I am sure you comparison shop for everything else. Maybe you were just extremely confused by all of the insurance terminology or you had a "bad" insurance agent who did not take the time to really explain the type of coverage you were purchasing.
So how would you know if you dealt with a "bad" insurance agent? Because a "great" insurance agent would have taken the time to help you really understand your insurance benefits and s/he would have answered all of your questions about your health plan purchase BEFORE you signed on the dotted line.
Remember, insurance agents are not different from any other professional. There are "great" insurance agents and brokers that care about clients and offer exceptional customer service, and then there are "bad" agents that avoid answering questions and typically don't return phone calls when clients leave messages about unpaid claims or skyrocketing health insurance premiums.
* Q. How do you know if you have a "great" agent?
A. A "great" agent will recommend a health insurance plan based on all four variables; wants, needs, risk and cost. A "great" agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And, lastly, a "great" agent looks out for YOUR best interest and NOT the best interest of the insurance company.
Another way to tell whether or not you have a "great" or a "bad" insurance agent is to determine how many of the ten questions you were actually able to answer without looking at your health insurance policy. * If you were able to answer all ten questions, you have a "great" insurance agent.
If you were able to answer at least seven out of ten questions, you probably have a "good" insurance agent. * But, if you were only able to answer a few questions or less than seven out of the ten, you most likely have a "bad" insurance agent.
Always keep in mind that your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don't be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and, more importantly, does not cover. * If you don't feel comfortable with the type of coverage that your insurance agent suggests or if you think the price for the plan is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you make a purchase.
And, always make sure that you read all of the "fine print" in your health plan brochure and please remember to take the time to read through your policy during your "10-day free look period."
Remember, if you don't understand something, or aren't quite sure what the asterisk (*) next to the benefit description really means in terms of coverage, call your insurance agent or contact the insurance company directly to ask for further clarification. Furthermore, make sure you take the time to perform your own research on the Internet.
For example, if you research Mega Life and Health and Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find out that there have been multiple class action lawsuits brought against these companies since 1995. Many health insurance companies, especially the ones that have to pay huge insurance fines often change their name and target more unsuspecting consumers. In fact, today these companies are selling health insurance under the name "Health Markets."
So please perform your own due diligence and ask yourself, "Is this a company that I can trust to pay my health insurance claims?"
Additionally, find out if your agent is a "captive" insurance agent or an insurance "broker."
Why?
"Captive" insurance agents can only offer ONE insurance company's products. In contrast, an "Independent" agent or insurance "Broker" can offer you a variety of different insurance plans from many different quality carriers.
Over the years, I have developed strong and trusting relationships with my clients and I am constantly developing new clients through existing client referrals. This is partly because of my level of insurance expertise and primarily due to the level of personal service that I provide. * Because personal service is extremely critical to building long-term client relationships, this is the main reason that I caution people to be very careful when using online quoting engines and online applications to buy health insurance on the Internet.
Again, in my professional opinion, there are too many variables to consider when shopping for health insurance. Therefore, I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an independent agent or broker, my advice to you would be to use Ebay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make....your health insurance policy.
Lastly, if you have any concerns about an insurance company, contact your state's Department of Insurance BEFORE you buy your policy. Your state's Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policyholders. * Also, if you suspect that your agent is trying to sell you a fraudulent insurance policy, for example, you have to become a member of a union to qualify for coverage, or s/he isn't being honest with you, your state's Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.
In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer and you can understand "Why The Best Policy Is A Great Agent." Whatever decision you make in regards to your health insurance, please always remember to heed the following words of wisdom.
Date / Time: 4/14/2009 10:55 PM UTC
Universal Healthcare is primarily an ideology championed by the Democrats. However, contrary to popular belief, a nationalized health care system for all Americans, has never been on the agenda for President Obama. Read more about President Obama's healthcare policy here.
His agenda, instead, has always been to assist those who are rendered uninsurable and or are in need of assistance in obtaining health care coverage due to low income. Part of his plan is to expand the role of SCHIP and State Insurance Risk Pools so that those who are rendered "uninsurable" on the individual major medical market have "guaranteed insurability" through their respective State Insurance Risk Pools. * Although many states already have a State Insurance Risk Pools, some states, like Arizona do not. These states desperately need such Insurance Risk Pools and until recently, have not been able to adequately provide coverage to the "uninsurable" due to the lack of funding. * In fact, President Obama's plan is to provide more Federal funding to existing State Insurance Risk Pools to drive the premiums down. Thereby, making this option more affordable for those who cannot obtain "individual" health insurance coverage on the open market. To see if your state has an Insurance Risk Pool, click here:
In terms of Universal Healthcare for everyone in the United States, however, we must research how well "socialized medicine" has actually worked for other countries. Although proponents of a single payer system often bring up the point that it has worked flawlessly for other countries like France and Canada, the fact remains that many people living in these countries have a different perspective on how effectively their health care system is working.
For example, to see the faces and stories of Canadians who are at the mercy of Canada's Universal Healthcare system, please watch these short, but very informative video documentaries by Stewart Browning:
In fact, many Canadians hire high priced "health care brokers" to arrange medical procedures in the United States because of the terrible bureaucracy that controls health care in Canada. Quite often, we also hear the main stream media reporting on the number of uninsured in the United States.
Something that is rarely discussed, however, is who the uninsured really are. For the real facts on who make up the 47 million uninsured, please watch:
"Before turning to government as the solution, some unheralded facts about America's health care system should be considered," says Scott W. Atlas, a senior fellow at the Hoover Institution and a professor at the Stanford University Medical Center. * Americans have a better survival rates than Europeans for common cancers:
Americans have better access to treatment for chronic diseases than patients do in other developed countries: For example, 56 percent of Americans benefit by taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.
Lower income Americans are in better health than comparable Canadians: Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."
* Americans spend less time waiting for care than patients in Canada and the United Kingdom: Canadian and British patients wait about twice as long -- sometimes more than a year -- to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer. Currently, approximately 827,429 people are waiting for some type of procedure in Canada and nearly 1.8 million people are waiting for a hospital admission or outpatient treatment in England. * Source: Scott W. Atlas, 10 Surprising Facts About American Health Care, National Center for Policy Analysis, Brief Analysis No. 649, 3/24/09 * Because of how the Single Payer System is designed, Canadian citizens have no where near the level of healthcare choices that American citizens do. As a matter of fact, until very recently (2005) it was not even possible for a Canadian citizen to pay for their own healthcare or to purchase a private health insurance policy that would "bump them up the long waiting list" to expedite their medical treatments. * Fortunately, because of a recent court ruling, some Canadian citizens have now been given the right to purchase their own private health insurance. However, access to care in Canada is still limited, and there are many hard battles yet to be fought.
Let's take a look at one brave doctor, Dr. Chaoulli, who took his client's case all the way to the Canadian Supreme Court and won. Dr. Chaoulli launched his legal challenge in the Canadian court system when his client, George Zeliotis, waited more than a year for hip-replacement surgery. * In this case, Canada's high court, who found for the Plaintiff, issued the following statement: "The evidence in this case shows that delays in the public healthcare system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public healthcare. The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital healthcare result in physical and psychological suffering that meets a threshold test of seriousness." * Furthermore, Justice Marie Deschamps said, "Many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life. The right to life and to personal inviolability is therefore affected by the waiting times." * The Vancouver, British Columbia-based Fraser Institute which keeps track of Canadian waiting times for various medical procedures states in their 14th annual edition of "Waiting Your Turn: Hospital Waiting Lists in Canada (2006)," that, "the total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 17.7 weeks in 2003 to 17.9 weeks in 2006." * Depending on which Canadian province you live in, to have an MRI you may be required a wait between 7 and 33 weeks! To have orthopedic surgery you may be required to wait 14 weeks before you can see a general practitioner to obtain a referral to the see the orthopedic surgeon and then another 24 weeks from the time you see the orthopedic surgeon to the time you actually have surgery.
So, before you jump on the Universal Healthcare bandwagon, please watch the aforementioned videos (all of them) and then spend some time reading through the real life horror stories of Canadian citizens who were left in the lurch by the Canadian healthcare system, which has been documented in a very well-researched article published in the Wall Street Journal titled "Too Old For Hip Surgery." * These videos and the WSJ article will at least give you some greater insight into what could happen when government is in total charge of controlling our healthcare and medical decisions.
If fact, if we think about it, What has our government done correctly to convince the American people that they should hand over our healthcare freedoms for them to control?
"How will the government, once it tells 300 million people "go see the doctor pay everyone's medical bills?" * If you want to know what such a government endeavor will really cost the U.S. Tax Payer, please read the April 12, 2009 Wall Street Journal article entitled "The End of Private Health Insurance."
Real healthcare reform can be accomplished when the fraud and abuse is weeded out of our existing Federal and State entitlement programs via a legitimate needs assessment and when the quality and safety of healthcare is systematically improved.
Citizens must also do their part by becoming informed health insurance consumer and they must also learn how to become an advocate for themselves when important medical decisions are made. Additionally, American should carefully citizens the decision to trade health care choice for the temporary financial security that our government may promise.
In my opinion, we must continue to work diligently to improve our existing system and to keep the bulk of our nation's risk in the private health care sector where it belongs.
Date / Time: 4/14/2009 9:55 PM UTC
If you are one of the 47 million Americans that have joined the ranks of the uninsured, what you may not know is that you may have to pay more for your medical treatment than your privately insured counterparts.
When individuals without insurance get sick, they usually have to pay much more for the same medical services for the simple reason that large insurance companies often negotiate lower with doctors, hospitals, pharmacies, and others health care providers for their policyholders. * This means that the average uninsured working man or woman who suffers a mild heart attack can be stuck with a hospital bill that is in excess of $30,000 compared to the $10,000, negotiated rate, which is charged to an insured patient's private insurance carrier. In many cases, uninsured individuals are charged 3-4 times more for the exact same medical treatment that is administered to patients with private insurance.
Additionally, uninsured patient with huge medical bills are usually aggressively pursued by collection agencies. In fact, new bankruptcy laws make it extremely difficult to discharge medical debt.
Statistically, if you don't have health insurance coverage, you have a 25% greater chance of developing a life-threatening disease or condition than those who have health insurance. Here are some startling statistics from the National Institute of Medicine (IOM) - an educational arm of the National Academy of Sciences:
Today, there are more uninsured Americans than any point in history. According to the U.S. Census Bureau, approximately 15.9 percent of Americans are walking around without health insurance coverage and paying for medical expenses out of pocket. * Although treatment for a sore throat or broken ankle can be a manageable medical expense for some families, more expensive treatments like surgery or chemotherapy can be financially devastating.
If you are the type of person that wouldn't risk driving your vehicle without car insurance, consider the fact that there is a statistically greater chance that you will suffer from an illness or injury than an auto accident.
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C. Steven Tucker is a multi-state licensed health insurance broker, insurance industry insider, watchdog and health insurance consumer advocate. He is President of Small Business Insurance Services, Inc. a brokerage company that has been helping small business owners and the self-employed find affordable, quality individual and small group health insurance coverage for 15 years.
Contact Info: C. Steven can be reached toll-free at 866-724-7123 or on his cell at 630-674-1551, via email at steve@sbisvcs.com or through his web site at www.smallbusinessinsuranceservices.com