Private Fee for Service Plans Going, Going, Gone

When Medicare Advantage bites the dust there is help for those affected.

This is pretty scary information for seniors. Several of the bigger insurance companies are getting rid of their private fee for service plan completely. While this might not sound like a big deal, it ultimately affects one million seniors by leaving them with no coverage.

The private fee for service plans are run by private insurance companies with money received from the government. The idea behind them was that the insurance companies would handle running these plans much more efficiently than the mainstream Medicare. The private fee for service plans are part of Medicare Advantage, under the knife for serious cuts and in some cases, total elimination in 2010.

The major reason these programs are dropping like flies is that recent legislation drastically affects the dollars allocated for reimbursing physicians. With less money to spend, insurance companies can’t operate programs like this any longer. It boils down to a business decision. No money coming in means no one is able to put money out and stay in business. With the private fee for service plans on the chopping block and Medicare Advantage going away, patients nationwide are scrambling to find health care alternatives.

One very reasonable alternative for seniors is the Medicare supplement policy; something that has been available since the 60s. With due diligence, older Americans are able to get a policy covering bills that Medicare doesn’t pick up. Premiums for Medicare supplement policies are highly competitive right now due to the coming changes in 2010 and the fact that insurance companies are seriously trolling for new business.

Patients in the private fee for service plan do have guaranteed issue provisions that allow them to slip into Medicare supplement policies and avoid the usual underwriting rigmarole. While it may seem like a giant pain to start looking for a replacement policy, now is actually the best time to do so.

One thing that many seniors fail to understand is that all Medicare supplements are the same. They pay the same “approved by Medicare” claims and offer the same benefits. With this in mind it pays to shop around to various insurance carriers and get a “deal” on premiums. It does happen and now is the time to shop and get a bargain.

To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

Managed Care HMOs

Don’t know what HMO stands for? Health maintenance organizations are managed care programs.

In terms of affordable health insurance, health maintenance organizations (HMO), which are managed care programs, assist people to stay in good health. At least that is the idea behind them.

Put another way, the philosophy of HMO health insurance plans is that if a person stays healthy and maintains that health, they will prevent disease. The care provided by the HMO will help people stay well. Staying well means rising health care costs will be controlled.

When health insurance plans like HMOs were first launched on the market, people who opted to buy affordable health insurance paid a fixed monthly premium that was prepaid. What those people got in exchange for affordable health insurance was access to health care offered by a certain network of providers that included clinics, hospitals and other medical care providers. This meant that although people were getting affordable health insurance, they were restricted to using “only” the procedures, benefits and doctors, etc. that belonged to the network.

HMOs were initially implemented by the government in 1973 to get rid of individual health insurance plans and offer affordable health insurance to everyone who wanted it. When they first came out, companies were buying individual health plans for workers.

Over time it looked like the better deal would be to get businesses to buy subsidized low cost health plans for employees and not expensive individual ones. Seeing a great opportunity, insurance companies started pressuring physicians to join HMOs. Fact is, doctors were told if they didn’t join, the insurance companies would see to it that they’d take their patients away with cheaper health care through the HMO. The threat worked and many joined the HMO plan to save their practices.

The more things change, the more they don’t always change for the better. What happened with HMOs is that every time a doctor renewed with them, the rules were changed and got stricter and stricter, mandated that they see more patients and get more services pre-approved. HMOs used to be the cat’s pajamas, but by the end of the 1980s and with a stack of unpaid and denied claims, people began to leave HMOs in droves.

The interesting thing here is that denied claims were denied because of bad investments the insurance companies made, not because of the claims themselves. The insurance companies invested in real estate, and when the boom went bust they couldn’t cover HMO claims. Unfortunately over time it became an almost “ritual” for HMOs to deny claims. So much so, that today it seems to be a part of the way they do business.

Thankfully, a new breed of attorneys has begun chasing HMOs for those denied claims; claims that include medical malpractice (med mal), bad faith and even wrongful death. In a nutshell, this boils down to the HMO may be sued if an individual dies due to the HMO denying cover for necessary medical treatment; for denying valid claims and for med mal perpetrated by an HMO doctor. In most states, government regulators are also tweaking their laws that govern HMO plans.

To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

Nuts and Bolts of the HSAs

It’s pretty much a given that when it comes to health care the premiums will keep going up.

With health care premiums on their way up just about every year, it should come as no surprise that a lot of companies are starting to offer health savings accounts as a benefit for working. These accounts are beginning to replace PPOs and HMOs.

The most attractive thing about health savings accounts is the fact that they are tax free when linked to an insurance policy with a high deductible; usually about $1,250 for a single person and $2,500 for a family. When you hit the deductible you get comprehensive coverage. Many people are finding that they like this type of arrangement.

Since it’s a bit of a burden to handle some of the upfront out-of-pocket expenses, you have the option of handing over (pre-tax of course) anywhere up to $2,650 for a single person and up to $5,250 for a family.

All you need to do is tuck that away into a health savings account. Remember as well that when you take money out of a health savings account it is also tax free just so long as the money is used for medical expenses.

Not too many people seem to realize that any money that isn’t spent in the health savings account will roll over automatically year after year. That money can then either earn interest or you can invest it into participating mutual funds. This would kick up your returns and, with some luck and smart investing, you could find yourself sitting on a tax free bundle of cash for health care costs.

Here is another tip for employers. They are able to save between 25 to 30 percent on health premiums just by the simple expediency of switching to health savings accounts. That would mean lower premiums for workers. Really, both employers and workers get a good deal when they switch to health savings accounts.

However, some companies are finding it hard to sell the concept. For example, some health care plans have a very low deductible of about $150. It’s pretty hard to sell a worker on switching to a plan with a much higher deductible. Furthermore, those who have been used to having a co-pay when they visit a doctor are rather put out by having to pay the whole amount up-front.

Another barrier to companies offering health savings accounts is the perception that they aren’t for the average Joe Blow worker and are instead for those who are in good health and have lots of money. Over time these objections have proven to be invalid and many workers are now reaping the advantages of health savings accounts. Many industry pundits think these accounts will be the wave of the future, as they are certainly attractive options.

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

Health Insurance and Your Lenses

How many people do you know who give much thought to their lenses when thinking about health insurance?

There are so many health care options available on the market that it confuses people. Companies have a wide variety of benefits they offer employees and due to the recession many of those options are being changed to be more advantageous to the company and not necessarily the employee.

For example, many organizations are strongly encouraging their workers to switch plans or fork over money out-of-pocket to cover the deductible on existing plans. Another option is combining a high deductible plan with a health saving account.

Of course health savings accounts are fairly popular because they tend to serve two purposes. They’re a high deductible health insurance plan combined with a tax deductible savings plan, the health savings account. What this means for those interested in this is that a high deductible insurance plan means the first $1,000 to $3,000 for any medical service is paid for completely by the person with the plan.
There are some exceptions such as annual physicals and other preventative care, which is covered with a small co-payment. The deductible has to be paid in total before the insurance company kicks money in. After that point however, you would not pay anything.

Now you might be thinking where on Earth would a company employee get that kind of money to meet a deductible that high? That is where the health savings plan comes into play. Internal Revenue has created special accounts so that all contributions are totally tax free. That means the funds in the account may be used to deal with any health-related expense such as eyewear (your lenses), vision exams, dental and yes, even acupuncture; not to mention any other services not usually covered by your primary health provider.
Now here is a good tip to save some money. High deductible health plans offer some really nice savings when compared to traditional plans. This may mean your employer might use part of the difference to fund your health savings account.

And one other hint that may come in handy is that you may be able to use your health savings account to buy glasses online. This would be applicable if your employer is contributing money to your savings account. This would then mean glasses would cost nothing out-of-pocket and their expense would go toward your deductible. So buy your glasses online with your health savings debit card. What a great deal, tax free eyewear for a really reasonable price.

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

Health Care Scams and Frauds

You’d think that when you got to be older that things would settle into an easy and pleasant routine. Instead, seniors are subject to more scams than ever, including health care cons.

Whatever happened to the time when seniors were revered and held in great esteem? When they were the history and our legends, and stood for progress? When they fought for us to make this nation great and free and lived to tell those battle stories? What happened in the 21st century is recession, lives lived longer than ever, escalating health care costs, and a total confusion about what Medicare and Medicare supplements offer. What happened are insurance companies ripping off unsuspecting seniors because they can.

Why prey on seniors? The answer to that is easy. Preying on seniors is like shooting fish in a barrel. They’re there, they have no place to go and sometimes no family support, usually have money saved up for a small nest egg and aren’t technologically savvy or that aware of what goes on around them, especially if they have cognitive difficulties.

Seniors have become “easy” targets for scammers and schemers and insurance companies who would rather rip them off than make sure they have what they need in terms of proper health insurance. Unfortunately, it is incredibly easy to take advantage of some seniors. Consider this; ALL seniors are on Medicare of some sort, but asking them how their policy works usually draws a blank stare.

Start asking them questions about whether or not there is a deductible for parts A through D and they don’t know if they pay one or not. Is there anything better in terms of a Medicare Supplement plan other than alphabet letters A through L? Again, many elderly people don’t know the answer. Ask if their Medicare Advantage plans (soon to be extinct) cost more by way of co-pays and deductibles than it really saves on their premiums, and once again, they are not sure.

Most seniors are aware of the news about health care reform and their major concern is whether or not their plans will be taken away and how to keep paying for them if the price goes up. That is the focus of America’s seniors – will they lose their plans, what will replace them and how much will it cost. It’s not much of a wonder why a senior on a limited budget would jump at the chance to save money on health insurance if it were offered to them. It would be easy for someone to say, “You can save a lot of money with my plan.”

The point to be made is that there is a great deal of confusion over the existing Medicare system, over what will happen to it and about what will replace it or improve it, or not. Unfortunately there are scam artists lurking out there, dressed in insurance broker clothing, who are more interested in making money from uninformed and confused seniors. For example, there have been cases where seniors had Medicare Supplement plans and were enrolled in the Advantage plan, which is illegal.

There are also cases of elderly people being invoiced twice for the same co-pay amount and paying it because they thought they should. Was the double billing unintentional or not? It could have been double billed on purpose, as Medicare fraud is at an all time high.

Are there solutions to situations like this or are the system and the people in it doomed to be ripped off? With more attention to education about health care and health insurance and looking out for one another, there is hope. Our finances are personal and need to be protected. People need to get wise and get articulate about their health insurance. Knowledge is indeed power.

To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

What’s a Health Care Cooperative?

Right now, the only “public” option for affordable health insurance is Medicare, which is only for those over 65 years old. If there isn’t another “public” option for others, this has ramifications for Medicare and Medicaid.

Right now in the U.S. there is a single payer government plan, Medicare, for those over the age of 65. The plan works as well as it can, given the debt load of the nation and the spiraling costs of health care. There isn’t anything else like this idea for other people who can’t afford health care or can’t afford much coverage at all. This is where health care reform is supposed to come in.

The clear problem with health care reform that doesn’t have a government option or component is that those who aren’t in Medicare or Medicaid may wind up raiding those programs to get what they need. That may mean a decrease in funding and greater difficulty in accessing programs for those over 65; a sort of Robin Hood approach of robbing the richer programs to pay for the poorer programs.

The substitution of the so-called health care cooperative for the government option is simply a thinly veiled excuse for the creation of more insurance companies. The usual example trotted out of a health care cooperative is something called Group Health. In fact, Group Health is an “insurance” company that reinvests its yearly revenues not redistributes them among members. It is only governed like a cooperative, making it one in name only.

Group Health’s fees are a tad lower than other insurance outfits, records are computerized and physicians get performance based salaries which seems to be a code word for “keeping costs down to a minimum.”
To access affordable health care by this route, those needing medical assistance are assigned a team of primary care practitioners, meaning you have no say in the matter. If access isn’t readily available to see the doctor, you will see a nurse; no ifs, ands or buts. If keeping medical costs down is the raison d’être for the insurance company, chances are expensive tests are not ordered that often and treating deathly ill patients would not be a preference.

Drugs and procedures, how medicine is practiced, and health insurance coverage decisions are made by the company – made by an insurance company. Think about that for a minute. Reading between the lines here, Group Health isn’t really “group health,” it is an insurance company with a bottom line to stay in business and make money. Staying in business by cost cutting medical care is a scary idea.

Will this come to pass? Only time will tell, and since the health care reform bill is gathering some dust right now, no one seems to know what will transpire for the future. For now Medicare and Medicare supplements are doing yeoman’s duty and allowing people the choice of physicians. It may not be perfect, but it limps along, working for “now.” Stay tuned for what the future may bring, and in the meantime do some thinking about what alternatives might work for your health care. The President has said if people like their health care they can keep it. Can they?

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.

Major Issues Still Remain with Health Care Reform

While it sounded like a good plan to have health care reform on the go by Labor Day, the deadline came and went. What’s next?

Next is what the House chooses to do when they sit in September. Some of the ridiculous issues raised over the summer months have up and gone away, but others remain that will likely be a great deal more contentious and have greater ramifications.

The leading issue seems to be the “public plan,” which is a polite way of speaking about a kind of government insurance plan that would be available to those who had absolutely no other health insurance options. While this sounds like a dandy plan on the surface, there are those that insist it would be a government takeover of health care, not always a good thing given the current state of affairs.

On the other side of the fence there are those that make the case that the public plan is ultimately necessary for any kind of reform to be effective. If access to health care is an issue that is supposed to be resolved, then this particular point of view tends to make sense to a large number of people.

Taking a step backward to get a clearer view of the debate, one comes to the conclusion that both sides of the argument have a point, but neither is totally right. That isn’t too much of a surprise given that it’s politicians doing the infighting. Really, the questions that ought to be asked, rather than focusing on poverty and access to health care, might be, “How will the government make Medicaid better and stronger?”

This question makes sense since the original universal health care changes have been tanked for now and the focus shifted to expanding health insurance coverage to certain segments of the population. Obviously, one of those segments is people living in poverty. Everyone should have a safety net for medical expenses, and there isn’t one right now. Instead, families face potential bankruptcy and total financial ruin over medical bills.

Ironically, the one program that should be able to help those in such dire circumstances – Medicaid – doesn’t guarantee either insurance or health care to people in poverty. Reform, if it is indeed on its way, needs to perhaps have Medicaid returned under the federal government’s wing and change the reimbursement doctors are given so they may assist people in poverty. That would make a significant change in the health care system.

If poorer people did have access to health care, it would keep them from having to use hospital emergency rooms. Just think about how much this one small change would mean to the system wide budget that faces escalating costs, thanks to poor people using ERs as doctor’s offices.

Clelland Green is with Benepath.com, a leader in providing health insurance quotes. Benepath provides individuals, families, and businesses with affordable health insurance quotes in just a few mouse clicks. To learn more about Health insurance quotes, affordable health insurance, affordable health insurance quotes, health insurance plans, visit Benepath.com.