Health Specialist

Posts Tagged ‘Plans’

Health insurance is deemed as a serious issue. But it’s not only serious in the sense that elderly population is on the rise. But the crux of the matter is this: just when an average worker goes on a fixed income and no longer affords to settle payments for private health coverage, medical bills are likely to go up in skyscraping amounts. This is when medical insurance will come to save the day.

There may be a lot of considerations and specific terms and conditions to take into account, but the good thing is numerous health coverage are up for grabs for those who are in search for medical assistance plan that will suit both their funds and needs. To provide you of a bigger and clearer picture, the following are types of medical plans together with their brief descriptions:

PPOs (Preferred Provider Organizations)

This is a type of health coverage that gives you an incentive to remain under a specific insurance company’s coverage by necessitating only a least amount of co-payment if you agree to consult a network doctor under the insurer’s directory. Then again, if you choose to see a doctor that is out of the network, you would have to pay for a bigger amount of co-payment. Preferred Provider Organizations lets an insured consult other specialists even without their consent, however, should anything happen to you, your insurer won’t be liable to it. And, that includes any preventive measures. PPO’s terms and conditions are complicated, so better be sure that you know a few things about this insurance type. Don’t forget to ask questions and learn which cases are covered and which are not. So in the end, you won’t be wasting your hard earned money for something that you do not know anything of.

HMOs (Health Maintenance Organizations)

This is considered as that most economical and cheapest of all insurance types. Apart from this, HMO is also flexible in terms of insurance coverage. Unlike PPO, preventive care services are covered by the plan with lower co-payment rates. However, in exchange to all the flexibility, convenience, and affordability this insurance provides, you as the insured must only see and consult approved medical specialists. You are also required to seek permission from a network physician prior to consulting other professionals in the medical field.

POS (Point-of-Service) Plans

This is also known as an open-ended HMO or PPO where an insured is permitted to use other health providers’ plans and are likewise encouraged to get health services from networks that are outside the coverage. However, you will be asked to pay for heftier co-payment or deductible costs. In POS, if you want your insurer to get you covered from everything that concerns your medical expenses, your health insurance plan requires you to use your primary physician for you to be able to get referrals to other medical specialists. So, if you want an insurance that will cover even the preventive care services and the rest of your medical bills, going for Point-of-Service health plans will help ease your medical burdens and worries.

New Orleans area residents without health insurance will have access Saturday to a massive free health clinic that organizers say will boast at least 400 medical professionals and support workers with resources to serve at least 2,000 patients.

The event, which will take up 166,000 square feet at Ernest M. Morial Convention Center, is the second nationally this year in a series of health fairs sponsored by the Louisiana Free Clinic Association and the National Association of Free Clinics, a not-for-profit based in Washington, D.C.

Doors are open from 8 a.m. to 5 p.m., with 2,000 appointment slots available, plus the ability to take some walk-ups. No one will be charged. Uninsured or underinsured individuals can make appointments by calling 877.233.5159.

Dr. Rani Whitfield, a Baton Rouge physician acting as medical director for the clinic, said he also wants more medical professionals — from specialist physicians to emergency medical technicians and medical administrators — to help staff the event.The staff will offer general medical exams and limited lab tests and will give all patients information about where they can get follow-up care. As of Tuesday evening, immunizations were not part of the plans, though organizers said they would accept any contributed vaccine supplies.

Nicole Lamoureux, executive director of the national clinics organization, said, “We want to underscore what goes on every day at 1,200 free clinics around the country.” But, she said, “Free clinics are just a Band-Aid on a much larger problem” of access.

That network of facilities served about 4 million people in 2008, Lamoureux said. The economic downturn will push the total above 8 million this year, she said.

National research suggests that as many as 70 percent of the clientele at free clinics come from homes where at least one adult works full-time. Whitfield said Louisiana clinics have similar numbers. “Uninsured does not necessarily mean unemployed,” he said.

More than a fifth of Louisianians — nearly all of them adults, given the success of government programs covering children — have no insurance.

The series of mass clinics are designed to make uninsured patients aware of what services are available and to call attention to the difficulty that many Americans have in accessing quality care. In Houston, the one-day event drew almost 2,000 people. Future stops include Little Rock, Ark., and Kansas City, Mo.

It’s graduation time. Do you know where your health insurance is? Depending on your health plan, it might be gone. For many American students still covered under a parent’s insurance, health coverage ends upon graduation; they will be left to navigate the increasingly expensive and complicated world of health insurance as they struggle to find jobs.
Luckily for some, since 1994, 30 states have passed laws extending the age at which young adults are allowed to be dropped from their parent’s plan. In Massachusetts, insurance companies must cover children for two years after they lose dependent status or until age 26, whichever comes first. In New Jersey, a dependent may stay on his parent’s plan until 31 as long as he is unmarried. Connecticut, New York and Maryland, among others, all have similar laws that extend coverage, while California and Washington, D.C. have no such laws. Obama’s health care plan would guarantee that children remain eligible for their parent’s plan until age 26.
Despite these laws, young adults aged 18 to 25 are the most likely age group to be uninsured. According to the U.S. Census Bureau, in 2008, 28 percent of Americans aged 18 to 24 lacked health insurance. Given that only 11 percent of children under 18 lacked health coverage in 2004, this is a precipitous decline for those children who now fall into the 18 to 24 age group. The likelihood of being uninsured decreases with age over 25, and in total, 15 percent of Americans were uninsured in 2008.
The Independent talked to a number of seniors and recent graduates about their attitudes toward their health insurance decisions. On the whole, most seemed more interested in finding a job than in finding health coverage.

What You Should Know About Health Plans

In general, large monthly premiums mean small deductibles and small monthly premiums mean large deductibles.
A monthly premium is the amount of money you pay per month for your coverage. A deductible is the amount of money that you must pay out of your own pocket before the health insurance company will begin to pay for any health care costs. For example, if you have a the BlueChoice HSA plan from Blue Cross Blue Shield, your deductible is $2700 per year. In a given year, you will have to pay $2700 of your own money on medical expenses before Blue Cross will start to help you out. So, logically, if you are responsible for paying a large deductible, then you won’t be responsible for a high monthly fee, and vice-versa.

Your out-of-pocket expenses in one year will not exceed a set amount.
One of the most important aspects of health insurance is that even if you have a catastrophic year of medical problems, you will hopefully not go bankrupt. Let’s say you have been hospitalized and have already paid enough to cover your deductible. The BlueChoice plan says that once you have paid the deductible, hospitalization will only cost you $600 per day while Blue Cross pays the rest. However, you will not have to pay more than $5,250.

Some plans require that you pay coinsurance once you have reached your deductible.
Health insurance companies can specify a percentage of health expenses that you must pay until you have reached your out-of-pocket maximum.

When you visit the doctor or get a prescription, you usually only have to pay a co-pay and the insurance company will pick up the rest.
A co-pay is the fixed amount of money that your health insurance company charges for doctors’ visits or prescription medication. Co-pays for visits to specialists cost more than those to a primary care doctor, and co-pays for generic drugs are lower than for brand-name ones. If you have the BlueChoice plan, preventative care, like annual check-ups to your primary care doctor or OB/GYN are totally free, but if you choose to see a doctor for any other reason, you must pay the full cost of the visit until you have paid your deductible. After that, you only pay your co-pay.

You can save money, tax-free, for health care.
Health Savings Accounts (HSAs), created in 2003, operate just like savings accounts for health care expenses. If you have a plan with a large deductible, it will most likely offer you an HSA. You can deposit money into the account, before taxes, and it will accrue tax-free interest. You can withdraw the money to pay for a long and comprehensive list of “qualified” health care expenses. If you withdraw the money for any unqualified expenses you are subject to a ten percent fee.

The type of plan you have will determine your doctor “network.” Visits to doctors outside of your network may not be covered by your plan.
A Health Maintenance Organization (HMO) plan has the most restrictive rules but it is usually are the cheapest option. You are required to have a primary care physician who will see you for most of your appointments and refer you to specialists if need be. Your plan will only cover visits with doctors who have specifically made an agreement with your HMO-your network. Another choice is a Preferred Provider Organization (PPO) plan, which does not require that you have a primary care doctor and offers a much larger network of approved doctors. You can also choose to see a doctor outside of the network, but this will cost you more.