What exactly is a Delray Beach health insurance policy?

A Delray Beach health insurance policy is basically an agreement between you the policyholder and a Delray Beach health insurance provider.  This agreement states that for a fee the Delray Beach health insurance provider will allow you access to their network of medical professionals and help you manage the costs of seeking medical treatment.  The actual details of your personal Delray Beach health insurance plan will be a bit more complicated than this explanation but this is a good starting point on our discussion of the importance of having a great health insurance plan for you and your family.

Why do we need a health insurance policy?

A good health insurance policy is absolutely essential for all Americans.  A good health insurance plan makes sure that you have access to high quality medical care at a price you can afford.  Healthcare costs in America are extremely high and failing to have a health insurance policy in place prior to seeking medical treatment has caused millions of Americans to later file for bankruptcy.  You do not want to end up in this situation.  It is imperative that you find a good health insurance plan that meets you and your family’s needs today.

How do I get a good health insurance plan?

There are lots of ways for you to obtain the health insurance policy you need to protect you and your loved ones.  Most employers offer their employees access to a group health insurance policy.  If your employer does not offer this benefit to their employees, then there are hundreds of health insurance providers that are willing and able to supply you with the policy you need to make sure you and your family have the protection you need.  It is important that you first identify your health insurance needs prior to purchasing a policy.  You want to make sure that you have a policy that will meet your needs.  Not all health insurance policies are the same so it is crucial that you know what you need prior to purchasing.  Most health insurance providers are able to tailor a policy to meet your needs specifically.

First thing you need to know about Medicare is that you become eligible on your 65^th birthday. You have from three months before your birthday to three months after your birthday to enroll. It is not automatic. Turning 65 is pretty easy to do, so this part is easy. And you cannot be denied coverage just because of a medical condition. That is about the end of the easy portion.

The second thing you need to know is that Medicare comes in parts. And you want a lot of those parts but you don’t have to have all of the parts. And there are a lot of letters involved.

A, B, D, yes, and C. That’s my favorite order, even though that is not how I learned the alphabet in kindergarten. Medicare Part A covers the costs of hospital stays, as well as home health care. Medicare Part B covers the costs of doctors and outpatient services, including rehab and lab work. Part D covers prescription drugs. Part D is a separate program that you must enroll in, in addition to Part A and B. Medicare Part C is made up of other kinds of plans called Medicare Advantage plans, some of which include Parts A, B and D in one whole package. But some of them don’t. See? It got confusing, didn’t it?

Let’s talk about Medicare Advantage plans, because this is the most convoluted part. These MA plans are offered through health insurance companies. They are heavily regulated by the government, so each plan must include certain things, equivalent to traditional Medicare. However, each MA plan may offer more benefits, or lower co-payments, and therefore the costs will be different. United Healthcare is an insurance company that has Medicare Advantage plans that are promoted on the aarp.com web site. An individual must already be eligible and enrolled in a Part A and Part B plan to add on a Part C or Medicare Advantage plan. This is because these plans provide additional benefits, and do not replace Parts A and B.

As with most insurance plans, each Medicare Advantage plan will restrict your choice of doctors or providers to those in the plan’s network. This will occur with traditional Medicare also. Not all MA plans are available in all fifty states, so you will want to check with a local representative to help you choose among the available options in your region.

The third tricky thing about Medicare plans is that all enrollment and all changes to plans must be done during a designated enrollment period. This is typically the last two months of the year, although this year, it starts early, sometime in October. So be sure not to miss the enrollment period or you will be even grumpier.

Standard Medicare is made up of several parts. Most people are familiar with Parts A and Parts B, which include benefits for physician services, and hospital services. In addition, many people purchase Part D, which includes prescription benefits. Even all three of these parts, however, do not cover all necessary medical services. Therefore, many individuals also purchase Medicare Supplement Insurance Plans, referred to as Medigap, or Medicare Advantage Plans.

I Don’t Know is on Third, and is my Answer to the question Which Medigap Plan Should I Buy

Medigap policies can be purchased from different health insurance providers. Rest easy knowing that Medigap policies are standardized and regulated by the Center for Medical Services at the state and federal government level. Therefore, all of the benefits are standardized across plans, regardless of where you purchase it. The costs, however, are determined by each individual health insurance company, so you are able to shop around to find a good deal.

It is difficult to recommend one particular Medigap plan to all of my readers because there are many different Medigap policies. They are numbered (that’s not the right word) by letter. For example, there are currently Medigap Plans A through L. However, some of these Medigap policies get discontinued and others are created every year. Every state chooses which Medigap policies they want to offer to its residents. If you want to buy a Medigap policy, you would do well to work with an insurance broker to help you figure out which is the best plan for you that will work with your current standard Medicare plan.

A Medicare Advantage Plans are TOTALLY Different

Medicare Advantage plans are basically a package plan that is comparable to standard Medicare Parts A and B, which you purchase from a private health insurance company, instead of the federal government. The insurance company can bundle different additional benefits in with your Parts A and B. The co-payment amounts may be different, and the benefit amount may be different too. However, the covered services should be about the same as standard Medicare plans. You may have to pay some additional monthly premiums if your package includes more benefits, higher benefits, or lower co-payment amounts than if you had the standard Medicare package.

By the way, these Medicare Advantage Plans are called Medicare Part C.

So to recap, you can buy Medicare Parts A, B, and D. Or you can buy a Medicare Part C plan (Medicare Advantage), and in additional, you may also want to buy a Medigap Plan A through L. Got it? Good.

One of the biggest legislations to affect the U.S. is in regards to health insurance. The famous Health Care Reform Act that was passed in 2010 was actually more of a health insurance reform bill. It has ushered in many changes, especially in the category of pre-existing conditions. However, some things stay the same, such as premiums, deductibles, and coinsurance. So, what’s coinsurance?

The Purpose of Co-Insurance

Insurance is basically protection you purchase against the unpredictable. You have insurance on your home so that if a storm comes along and damages it, someone with more money than you have can fix it. It’s the same with your health. You don’t know if or when you will get sick or need certain medical care. You could save your whole life and watch it wiped out with one unexpected illness. So you hire a company to pay your bills.
The insurance provider is gambling. It gambles that the total claims on its resources will be less than the amount it takes in. Evidently, it’s a pretty good gamble, because insurance companies in the U.S. are, so far, quite solvent. This may change as pre-existing conditions are forcibly admitted to insurance coverage in 2014.

Where Does Coinsurance Enter the Equation?

Coinsurance is basically a sharing of the expenses of your coverage. It means that the risk of your insurance is split between 2 or more parties. This is not the same thing as a copayment, which will be discussed in another article.
Coinsurance is a percentage split between the insurer and the insured, with the insurer’s share posted first. It usually becomes effective when you reach your deductible. With your deductible, you pay for your own medical care, albeit at a discounted rate, until you reach a certain price ceiling. At that point, the insurance provider starts pitching in a certain percentage of your medical expenses. This is at least 50% for most policies, although it may go as high as 80%. You will be responsible for the remainder of the coinsurance.

Coinsurance will increase when you reach your maximum out of pocket. Health care reform has eliminated the kind of maximum out of pocket that insurance providers will pay, but not the kind that you pay. This means that when you reach your “stop loss limit” of $500 to $3,000, the insurance company coinsurance increases to 100% of your medical bills.

What Determines Coinsurance?

You and your agent will work out the details of coinsurance, deductibles, and premiums. In general, if you want to strictly keep the cost of insurance down, you’ll raise the deductible and equalize the coinsurance. This means that the insurance provider, with higher deductibles, has a longer period of time before they pay on your medical bills. With equalized coinsurance, say, 50/50%, you are paying more of your medical costs after you reach the deductible, as compared to 80/20%. Since both of these tactics are money savers for the insurance company, your monthly premium will be lower.

This month, I have seen football teams wearing pretty pink shoes, and you see the pink ribbon on many other athletic uniforms. Although pink is not traditionally a manly color, it sure makes those guys wearing the pink ribbons, and honoring those who have suffered due to breast cancer, appear very manly!

Breast cancer is the second leading cause of cancer death among American women. In the last few years, there has been some controversy regarding recommended screening for breast cancer. This has become a big issue within the health care reform movement. There are some clear cut risk factors that include family history, having a first child after the age of 30, and atypical hyperplasia. It is common knowledge that early detection leads to a better outcome. This is the emphasis on preventive screening services, which is included as a basis of some of the health care reform rules and regulations.

Health care reform has emphasized preventive services because of the economic savings related to prevention, when compared to treatment. According to www.healthcare.gov, the primary web site for health care reform in the U.S., the costs for the treatment of breast cancer exceeded $6 million in 1996. They report that using preventive screening and medication would greatly reduce that number.

After all the arguing back and forth, the final official recommendation by the U.S. Preventive Services Task Force (USPSTF) is that women should receive screening mammography every two years between the ages of 50 and 74. According to the USPSTF, there are really no statistically significant benefits to breast self-examinations (BSE), which is good for me to hear since I never did them anyway. Which I think is why BSE end up not being beneficial – no one did them! I only wish they had changed the recommendations a few years before I had to have my first mammogram, since it is not my favorite medical procedure. However, in case you are scared of your future mammogram, don’t be. I didn’t find it to be anywhere near as bad as everyone says. And in fact, I wrote on my calendar for the next one, “Do Not Dread”, in case I forgot it wasn’t so bad.

The health care reform laws have required health plans to cover preventive services that are recommended by the official organizations without charging a deductible, copayment, or coinsurance. This means that costs will no longer keep women from getting their recommended screenings, and having breast cancer be detected as early as possible, which is the key to successful treatment. I see this as a very positive benefit to those who have a good health insurance plan, and a positive of health care reform.

So, wear your pink ribbon proudly. You look pretty in pink!

You may not base your next job on what states have the cheapest health insurance. But if you have the flexibility to choose where you live, you can figure in insurance prices that will impact the cost of living in that area.

Survey Says…

An organization called the Commonwealth Fund has issued a scorecard on health insurance systems. This is a private foundation that focuses on health care. The Commonwealth Fund made it a project to find out what states have the cheapest health insurance. Using 32 factors, the Fund rated each state according to quality of health care, cost of services, and cost of insurance. Other evaluations included avoidable hospital stays, and deaths before the age of 75, which are considered premature death.
Of the 50 states studied, the top five are:
1. Hawaii
2. Iowa
3. New Hampshire
4. Vermont
5. Maine
The lowest scoring five states, with the highest medical and insurance costs, are:
1. Nevada
2. Arkansas
3. Texas
4. Mississippi
5. Oklahoma

States with cheap health insurance vary by culture

Spokespersons for the Commonwealth Fund have said that where you live in the United States will certainly affect the affordability of medical care. In determining what states have the cheapest health insurance the top five states, mentioned above, scored 2 to 3 times higher than the lowest 5 states. In fact, if the other 45 states offered the same quality of medical care, with the same insurance availability, there would be a substantial reduction of several diseases in the United States. It is estimated that 90,000 premature deaths (before age 75) would be avoided. These deaths are caused by infection, treatable cancers, diabetes, and respiratory disease. In the rest of the population, 22 million more people would be insured, if every state ranked as highly as the top 5. This would halve the number of people without insurance.

Ratings and Costs of state by state health insurance

When determining what states have the cheapest health insurance, The Commonwealth Fund found that high quality health care did, in some cases, accompany lower cost. This is in contradiction to most assumptions that high quality care is going to be equally more expensive. In fact, the trend they noticed was that in states with quality health care, the ones that had higher costs also tended to have a higher incident of preventable hospital use. Their re-admission rate after 30 days is also higher. The conclusion drawn from these figures is that the particular states in this situation need to pay more attention to prevention, primary medical care, and health care coordination.

Health Insurance is cheaper in states with warmer weather

Generally, if the populace is not healthy, they are not as productive. Quality medical care and the availability of this medical care inevitably translates into a healthier citizenry that is, therefore, more productive. Children learn better in school, and adults in the workplace are more productive if they are healthier. So, if you want to know what states have the cheapest health insurance, you can try out one of the top five.

AARP is the largest advocacy group for people over the age of 65 in the United States. You can even get health insurance bearing the famous AARP name. So, how does AARP health insurance work?
AARP Health Insurance

AARP Health Insurance Is Sought After In Many States

The truth of the matter is, AARP health insurance doesn’t technically exist. Insurance companies that are approved to administer Medicare are actually the insurers. They pay a fee to AARP to attach the well-known name. So, if you have an AARP health insurance policy, AARP is benefiting from your premiums. In fact, AARP doesn’t recommend any one insurance company. It is your choice and your responsibility to choose the right insurance coverage for your needs.

Medicare Advantage with AARP

Medicare Advantage, or Medigap insurance is delegated by the federal government to a number of well-known insurance companies such as Humana, Aetna, United Health Care, and BCBS, to name a few. If the company from which you purchase coverage pays royalties to AARP, then you will have AARP health insurance in name only, but through a well-known insurance company. This is important because larger insurance companies have better financial security.

AARP Health Allows Members To Enjoy Aetna Benefits

Through AARP health insurance, you’ll have access to Medicare Advantage or, if you so choose, Medicare Part D, which is the prescription drug plan. Part D is also included in Medigap, so you don’t need both.

Benefits from AARP Health Insurance

Having a membership with AARP does get you discounts on many medical goods and services. This is separate and apart from AARP health insurance, though. With AARP membership, you’ll find that you are eligible for discounts at many gyms, health food stores, and medical supply stores. You’ll also have access to dental, vision and hearing insurance and discounts. Prescription discounts are also available to members of AARP, and you can get the ADT companion service, too. So, there are many medical-related benefits to being a member of AARP, even if your AARP health insurance is actually BCBS, or some other company.

How Does AARP Health Insurance Work?

So, the way AARP health insurance works is the same as any other insurance policy. The agent for the insurance company takes your information and looks through the plans available in order to write you a policy that you can afford and from which you can benefit. If you are eligible for Medicare, you’ll probably have one of the 12 Medigap policies available.

Medigap through AARP Health Insurance

By federal law, Medigap offers 12 different insurance. About ½ of them are HMO type policies that require strictly network providers, or some variation thereof, and the other ½ are FFS indemnity policies.
Your insurance agent will look at your budget and medical needs and advise you on which type of policy will be best for you. For instance, if you are very healthy, with no maintenance medications, an FFS policy may be the best for you. You will have medical coverage for any catastrophic incident, but your premium will be low. Now you have a better idea of how AARP health insurance works.

Anything to do with the government is destined to be confusing, and Medigap is no different. What is Medigap, anyway? Here, you’ll find out.

Medigap has many different aliases

What is Medigap? It is a lot of things, and they all mean the same. Medigap is Part C of Medicare, and its official name is Medicare Advantage. And, of course, if the name of the program is Medicare Advantage, it will also be called MA. The function of MA is to provide supplemental insurance and prescription coverage for people enrolled in Medicare. Since the purpose of MA is as a supplement, it’s often called the “Medicare Supplement”, or simply “supplemental Medicare”.

MA was developed and enacted in 2003 because the government saw that there was a gap in health insurance coverage between the traditional part that provided hospitalization and doctor, and the total lack of prescription coverage. There was also a gap in what Medicare Part B paid doctors and what the patients owed, leaving the patients in a financial bind. Since MA fills in this gap in payment coverage, it is often called “Medigap” insurance, or even just “Gap” coverage. So, if you ask, “What is Medigap?” it’s all of these things:

• Medicare Part C
• Medicare Advantage
• MA
• Medicare Supplement
• Supplemental Medicare
• Medigap
• Gap

All of these terms are interchangeable.

What is Medigap, and How Do I Get It?

In order to get Medigap, or MA, you have to already be a member of Medicare. You have to enroll in Medicare Parts A or B, or both.

One of the unique qualities of Medigap is that it is administered by private insurance companies. Parts A and B are administered by the federal government, which supposedly takes care of all the doctor bills that you don’t pay. Part C, on the other hand, is taken care of by your insurance company. Medicare will send your Medicare payments to the insurance company, which then pays your doctors, pharmacies, and medical services. All you do is pay your monthly premium for these services, and any copays applicable, just like you would do with any other insurance policy.

What is Medigap, and Who Handles It?

Most of the major insurance companies in the U.S. are approved to administer Medigap. Aetna, Humana, Cigna, Blue Cross Blue Shield, and many others are well-qualified and able to administer Medicare funds for your prescriptions and medical services. Your insurance agent will know where to go to get you the right coverage.
If you don’t have an insurance agent anymore, because you’ve retired, call the insurance agent at your old job. He’s handled plenty of Medigap policies.

How Do I Know If I’m Eligible for Medigap?

Thirty days before you turn 65, you become eligible for Medicare Parts A, B, C, and D. This is the beginning of your open enrollment period, and it extends to 30 days after you turn 65. Then, there is an open enrollment period every year after that. This is so people who were still covered under employer’s insurance, or those who missed their open enrollment, can sign up.

How Does Insurance Work?

Health insurance is set up as protection for you and as a gamble for insurance companies. The insurance company collects premiums from millions of people, on the gamble that the amount they pay out will leave enough money left over to cover their own expenses, and make money.

Network Discounts and Office Coopays

One way health insurance companies save money on the premiums you invest with them is through networks. They sign on health care providers and services, forming networks. The really big companies, like Blue Cross Blue Shield, Humana, and Aetna, among others, have huge networks. In fact, you’ll find that almost every single health care provider is a member of at least one network, if not multiple networks.

There is a business sense to these networks. The insurance company guarantees payment for medical services and provides pools of patients to the medical community. In return the medical community gives substantial discounts to the insurance company. These discounts are passed on to you.

What is an Office Visit Copay? – We Explains

Here is where an office visit copay comes into the picture. With health insurance, especially HMOs and POS policies, most of the medical care you receive is through the network. These providers bill the insurance company directly for the office visit. The insurance company pays the majority of the doctor bill, but requires you to pay a copayment.
Your copayment for your medical goods and services may be anywhere from $5 to $35. It’s up to you and your insurance provider. The amount of copay is one of the negotiable elements when you’re setting up your health insurance policy. You can sacrifice a low copay to gain a low monthly premium in exchange.

Do You Need a Copay?

Do you go to the doctor very often? If you do, the chances are you’d do better with a low office visit copay. Many people sacrifice low copays and deductibles in order to get lower monthly premiums. However, this may be counterproductive for the person who has a lot of medical bills. In this situation, you’ll have to make a choice between a high insurance bill, or high medical bills, and the medical bills tend to go exponential. So, let’s see what happens with a low copay.

Office Coopays can get expensive

If you have an ongoing medical condition, or dependents who seem to be at the doctor every week, the small increase in your insurance premium may be a minor sacrifice in exchange for a $10 office visit copay at the doctor’s office every week. The office visit copays can be a real budget saver when you have toddlers who need ear tubes and constant antibiotics. You’ll not only have low office visit copays, you also have low copays on prescriptions. These savings will more than make up for your increased premium.

Private Insurance Companies – AARP

Medicare has approved many of the major insurance companies to administer Medigap and Part D. While AARP is one of these companies, they have a lot of competition. All of the major name in insurance, such as Blue Cross Blue Shield, Aetna, Humana, and many others, are also approved to manage Medicare funds for your medical care. Therefore, it really is possible to find lower rates than AARP provides for members.

AARP Medical Policies

Medicare Advantage, which is the supplemental coverage or Part D, is made up of 12 different policies. Half of the policies are HMO policies that involve network providers. The other half of the policies are PPO type policies that allow for more patient choice in coverage, but cost a little more. Each insurance company, including AARP, has the flexibility to decide which of these 12 policies to offer its clients. While the insurance company doesn’t have to offer all 12 policies, they do have to offer some of each type to be approved to administer Medicare. This flexibility gives insurance companies the chance to offer lower rates than AARP.

Prescription Drugs and AARP

Prescription drugs are divided into 6 classes by Medicare. Insurance providers have to offer drugs from each class to their clients. However, the insurance companies have the flexibility to choose which drugs from each class it will add to its formulary. You can often find lower rates than AARP for your prescriptions by shopping around with other insurance providers. Each provider is different, and you may be able to find a drug excluded by AARP on, say, an Aetna policy. Your insurance agent should be able to compare policies for you to find lower rates than AARP.

Medicare Supplements with AARP

Medicare Part C is the Medicare Supplement, or Medicare Advantage. It provides Medicare recipients the opportunity to recoup some of their expenses on Medicare Parts A and B coverage, along with the amount they spend on deductibles and copays. Parts A and B cover your hospitalization and doctor. You’ll have to pay premiums for Part B, which is for doctor visits. But, with Part C, you can get some of the premiums back, plus coverage for vision and dental. You can also include health club memberships. Possibly one of the biggest benefits to Medicare Advantage is your access to insurance company networks. You can pay lower rates than AARP and still access some of the biggest networks of providers in the country.
Regardless of the insurance company you choose, you’ll find there are many ways to find lower rates than AARP.