Health Insurance Important Points

Having a good, comprehensive health insurance plan is extremely important. If you don’t have a good health policy, your life could be pretty miserable. Imagine being seriously ill. Your appetite is gone. You’re depressed a lot of the time. You may be in considerable pain. On top of that, your lousy health plan is not covering the claims. That just adds to your bad situation.

So what should you look for in a good health insurance plan?

– First and foremost, you want a plan that doesn’t require you to sell one of your internal organs to pay for it. I’ll talk more about cost later in the article.

– Try to get an unlimited maximum lifetime benefit. If you are stricken with leukemia, you want the security of knowing that your health care won’t stop when the bills hit $500,000. If your state doesn’t offer unlimited coverage, get the plan with the highest maximum.

– Make sure your plan doesn’t have any caps on prescription drugs or hospitalization. You don’t want to be kicked out of a hospital after 30 days because that’s all your policy will cover. Especially if your illness is still being treated!

– You want substance abuse problems to be treated like any other illness. Some plans try to save money by limiting your coverage for drug or alcohol related claims. You don’t want those plans.

– Read the fine print to ensure that regular doctor visits and emergency room visits are covered. You’d be surprised how many companies try to limit these.

– Maternity must be covered. This is optional if it is impossible for you and your spouse to have any more children. Just be careful. Maternity coverage also applies to your dependents. So if you don’t get maternity coverage and your 13 year old daughter becomes pregnant, guess what? The plan won’t cover her pregnancy.

– Minimum limitations for pre-existing conditions. A pre-existing condition is an illness you were treated for before you purchase a health plan. Some states, like New York and New Jersey, require that pre-existing conditions are covered as long as you had prior health insurance. Other states don’t have those rules.

– No limits on which doctors and hospitals you can use. If you need a heart transplant, you want the best doctor in the country to do the transplant. If your health plan has a list of doctors you are allowed to use, and he’s not on the list, good luck.

If you are not rich and your employer is not paying for the health insurance, you will need to make tradeoffs. Try to get the best plan for the money. Here are a few other things to consider:

– Most states allow insurance companies to limit coverage for chiropractic visits, mental health care, physical therapy and home health care. Make sure your plan meets the minimum state requirements. You can contact the Department of Insurance in your state to get the rules.

– Some plans require that surgical procedures have to be pre-certified. Make sure you read all the rules, because if you don’t follow them you will get penalized. Try to buy a plan with a minimum amount of this red tape.

– Some plans look great on paper, but the insurance company is a fraud. Do not buy a health plan from Claims-R-Us. Make sure the insurance company is legitimate. Ask other people who use their plans if they actually pay claims with a minimum of haggling.

Now, back to cost. The first big point I made is that cost is important. But you don’t want to waste your money with a cheap plan that doesn’t pay any claims.

The best way to keep your cost down is to buy a plan with a high deductible. The deductible is the amount of money you have to pay out of your own pocket each year before the insurance company starts to pay the claims. Having a deductible as high as $2500 means that smaller illnesses that cost you a few hundred dollars will not be reimbursed by the insurance company.

You might think “What’s the sense of having insurance if I don’t get reimbursed for the little stuff?” It makes lots of sense. The higher deductible plans cost much less. Better to have a plan with a high deductible than to go without insurance because you can’t afford the premium on the low deductible options.

Even if you can afford the low deductible plan, it’s usually better to go with the higher deductible. My deductible is $2500 per year. I would have to pay about $1500 more per year in premiums for a similar plan with a $1000 deductible. Do the math! I save money every year my total claims are less than $2500. During years that my claims are more than $2500, my out of pocket costs would be the same with either plan. Even if the higher deductible plan cost me a few hundred dollars extra during the years when my claims hit $2500, I would still go for the higher deductible. That’s because in the last ten years, I’ve gone over $2500 in medical expenses only once. This might not work for you if you have high medical claims every year.

If your employer is paying for the health insurance plan, great. But you should still evaluate what you are getting. Tell your employer if the plan doesn’t measure up to my criteria. Do your homework!