I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are being published on the internet about health insurance companies not paying claims, refusing to cover certain diseases and doctors who receive no costs for medical services. Unfortunately, insurance companies are driven by profits, not people (although they need people to make profits). If the insurance company finds a legal reason not to pay a claim, they will likely find it and you, the consumer, will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that 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, giving policyholders 10 days (a 10-day free review period) to review their policy. Unfortunately, most people stick their insurance cards in their wallets and put their policy in a drawer or filing cabinet during their 10-day free search, and they usually don’t take their insurance card out until they get a rejection letter from the insurance company stating the policy out to actually get it to read through.
Insurance agent
The majority of people who buy their own health insurance rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. Because of this, many people who buy their own health insurance can tell you very little about their plan other than what they pay in premiums and how much they have to pay to meet their deductible.
For many consumers, purchasing health insurance alone can be a daunting undertaking. Purchasing health insurance is not like buying a car because the buyer knows the engine and transmission are standard and power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine private krankenversicherung vergleich what type of coverage is standard and what other benefits are optional. In my opinion, this is the main reason most policyholders don’t realize they don’t have coverage for a particular medical treatment until they receive a hefty bill from the hospital stating ‘service was denied’.
Sure, we all complain about insurance companies, but we know they serve a “necessary evil.” And while purchasing health insurance can be a frustrating, daunting, and time-consuming task, there are certain things you can do as a consumer to ensure you’re purchasing the type of health insurance coverage you really need at a fair price.
When dealing with small business owners and the self-employed, I have found that it is extremely difficult for people to distinguish between the type of health insurance coverage they “want” and the benefits they really “need”. Recently I’ve been reading various comments on various blogs advocating health plans that offer 100% coverage (no deductible and no deductible) and while I agree that these types of plans have a lot of “curb appeal”, I can Personal experience will tell you that these plans are not for everyone. Do 100% health plans offer policyholders more security? Probably. But is 100% health insurance something that most consumers really need? Probably not! In my professional opinion, when purchasing health insurance you need to strike a balance between four important variables; Desires, needs, risk and price. Just like buying options for a new car, you need to weigh all of these variables before you spend your money. If you’re healthy, don’t take medication, and rarely see a doctor, do you really need a $5 co-pay 100% prescription drug plan when it’s costing you $300 more a month?
Deductible
Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic co-pay compared to an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10 generic co-pay after you pay? once a year $100 Rx deductible? Wouldn’t the 80/20 plan still give you adequate protection? Don’t you think it would be better to put that extra $200 ($2,400 per year) into your bank account just in case you need to pay your $2,500 deductible or buy a $12 amoxicillin prescription? Isn’t it wiser to keep your hard-earned money than to pay higher premiums to an insurance company?
Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government is encouraging consumers to purchase HSA (Health Savings Account)-qualified HDHPs (High Deductible Health Plans) so they have more control over how their health care expenses are spent. Consumers who purchase an HSA-qualified HDHP can set aside additional money in an interest-bearing account each year so they can use that money to pay for medical expenses out of pocket. Even procedures not typically covered by insurance companies such as Lasik eye surgery, orthodontics and alternative medicine are 100% tax deductible. If there are no entitlements that year, the money paid into the tax-advantaged HSA can be rolled over to the next year, yielding an even higher interest rate. If there are no significant claims for several years (which is often the case), the insured will end up building a sizable account that enjoys similar tax benefits to a traditional IRA, potentially allowing you to earn an even higher interest rate.
In my experience, I believe that individuals who base their health plan on wants rather than needs feel the most cheated or “ripped off” by their insurance company and/or insurance agent. In fact, I hear nearly identical comments from almost every business owner I speak to. Comments like “I have to run my business, I don’t have time to be sick! I don’t even use my insurance!” Being an entrepreneur myself, I can understand their frustration. So is there a simple formula anyone can follow to make purchasing health insurance easier? Yes! Become an INFORMED consumer.
Every time I contact a prospect or call one of my referrals, I ask a handful of specific questions that relate directly to the policy that person currently has in their filing cabinet or dresser drawer. They know the policy they bought to protect them from going bankrupt because of medical debt. This policy they bought to cover the $500,000 life-saving organ transplant or the 40 chemotherapy treatments they may have to undergo if they are diagnosed with cancer.
What do you think happens almost 100% of the time when I ask these people “BASIC” questions about their health insurance policy? You don’t know the answers! Below is a list of 10 questions I often ask a prospective health insurance customer. Let’s see how many you can answer without looking at your policy.
Health insurance company
1. Which health insurance company are you insured with and what is the name of your health insurance company? ( e.g. Blue Cross Blue Shield-“Basic Blue”)
2. What is your annual deductible and would you have to pay a separate deductible for each family member if all family members get sick at the same time? ( eg . The majority of health plans have an annual deductible per person, such as $250, $500, $1,000, or $2,500. However, some plans only require you to pay a maximum deductible of 2 people per year, even if everyone in your family is in need of comprehensive medical care.)
3. What is your coinsurance percentage and what dollar amount (stop loss) is it based on? ( Example : A good plan with 80/20 coverage means you pay 20% of a dollar amount. This dollar amount is also known as a stop loss and can vary depending on the type of policy you buy. Stop losses can be so be as low as $5,000 or $10,000 or up to $20,000 or there are some policies in the market that do NOT have a stop loss dollar amount.)