Personal Finance Tips

The widely-discussed reform of healthcare industry in the US owes much of the stir around it to the simple fact that having your health insured in our country isn’t affordable for millions of people of different demographic groups. In other words, it’s just too expensive to be within the family budget of most US citizens. But how much does it cost to get your health insured these days, anyway?

This strongly depends on several factors that may vary your cost significantly. Things like your health condition, age, workplace, location, income and other live factors play a very important role in shaping your final rates. Not to mention the provider you’re getting your coverage from. The form in which you get your health insured also plays a crucial role, because getting your insurance in a group from your employer usually costs less than if getting it on your own.

But what comprises the final insurance costs?

Many people get confused by the fact that there are more elements to insurance costs than just the rates you seen when quoting your price. Here are the most important of them:

Premiums

Premiums are periodic fees (usually, monthly) that have to be paid to the insurance company for receiving any medical services under your plan. If you have an individual plan then you are paying your premiums on your own. If you are covered under a group plan at work, your employer pays the premiums, usually requiring you to pay a small part of this amount. Premiums depend on your health condition, your age and your income status. Premiums also vary significantly between insurance companies, so you’d better spend some time on comparing health insurance quotes before you sign your plan.

Out-of-Pocket expenses

Out-of-pocket expenses are all the additional costs of health insurance plans that are extended beyond premiums. These usually include deductibles, co-payments and co-insurance. With some plans these expenses can be limited to a maximum amount, while other plans have no limitations at all, so be on the lookout for that.

Deductible is the amount of money you have to pay on an annual basis before your actual coverage kicks in. You will most commonly encounter them in PPO plans for the services received outside the network. And as with other types of insurance products, you will have to pay lower premiums if your deductible is higher.

Coinsurance is the part of the medical cost you have to meet after paying the annual deductible. It is usually 20-30% of what you pay for the services when going to the doctor.

Co-payments represent a fixed fee for certain services within your plan. In many HMO and PPO insurance plans co-payments are set for things like doctor’s visit or prescription medications.

And what are the average costs?

• Across the US, the premium is $2,985 for individual health insurance and $6,328 for a family plan.
• The annual premium differs significantly between states. If a family in New York had to pay $13,296 as an annual premium, the very same plan in Iowa was worth $5609.
• The amount of deductible paid has a strong effect on the annual premium. A family plan that had no deductible had a premium of $12686, while a $10,000 deductible shed this amount more than in half, with $5380 to be paid.

Let’s leave the politics of healthcare reform to one side and focus on a proposal to change the law to allow free market competition between insurers in different states. A policy consistently mentioned by the Republican party is to break the state monopolies in the insurance market. Since the 1800′s, the individual states have claimed the sole right to regulate the sale of insurance within their own borders. Each state has asserted the right to license insurance companies and to set the terms on which they can conduct business. This has led to a patchwork of different sets of regulations with each state creating unique laws. In turn, this forces an insurance company to set up separate subsidiaries to trade in each state. No licensed company can sell a policy to someone who has a residence in another state. There was a brief moment in 1944 when a decision of the Supreme Court allowed the possibility of federal supervision. But the lawmakers in Washington immediately changed the law to retain state control. Why is this a bad thing? The national insurance companies have divided up the states between them and choose not to compete against each other. This keeps the number of insurance companies in each state artificially low and, because there is no real competition, premium rates are higher than they should be for weak policy terms.

You are reading this article on the internet. When online, you can buy more or less any product or service across state or national boundaries. Although there are some restrictions, e.g. some states limit your right to import drugs from foreign countries, there is an almost free market where you can search for the cheapest price and buy whatever you need. There is no possible economic justification for retaining this historical privilege for insurance companies. All it does is preserve their ability to maximize their profits at your expense. For example, in Minnesota three insurance companies dominate 80% of the market for health plans. There is no doubt that, if more companies entered the market, the premium rates would fall. During his run for President, Senator John McCain was in favor of free markets for health plans. President Obama supports it and the proposal is in both versions of the healthcare reform bills currently stalled in Washington. But because the Republican party’s only policy is to oppose everything the Democrats propose, it seems even this simple change in the law may be lost. What will the result be? The anticompetitive behavior of the insurance industry will continue and you, the consumer, will suffer.

Could the law change tomorrow and allow everyone access to cheap health insurance wherever it can be found? The problem is that the states have different sets of regulations and compliance leads to different costs. The playing fields are not level. So, premiums are significantly lower in those states which have the fewest consumer protections. It would not be fair competition if people living in Minnesota, which has strong consumer protections, could all get health insurance quotes from states with little or no consumer protections. The only way in which there could be a free market is to have a single set of federal regulations for the sale of health insurance plans. Sadly, the political parties do not want to talk about this even though we would all benefit. In the US, the political elite’s interests do not match the needs of the ordinary citizens.

What is an individual health insurance plan? Speaking technically, it is an agreement between the insurer and the customer regulating that the insurer will pay for listed customer’s medical services in case of an emergency against a certain fine. But the main question that many people are asking is about the elements to be considered before going with such an individual health insurance option.

There’s no doubt that the quality of medical and preventive services has made a huge leap forward compared to say 50 years ago. sciences have made rapid advancements in today’s world. Still, going off without health insurance is quite a risky decision even taking all the progress into account. Today, insurance companies are competing for customers, trying to offer the most advanced health insurance plans that would include just any thing imaginable for a reasonable price. So if you aren’t employed with a big company or your employer doesn’t provide group health insurance options, getting an individual health insurance plan is the right thing to consider.

We recommend you to consult with your insurance agent or broker in case your individual policy makes part of an integrated group health insurance policy. Sometimes such options are more costly than simple individual plans but in contrast provide more opportunities and larger coverage. In case you’re married be sure to check with your partner’s employer if they can include you in their group health insurance plan. And if there are no other options left, individual health insurance policy is just what you need. Even if the rates would be higher than with group health insurance or your coverage will be limited, still it’s a far better option than simply going off without any medical coverage in case of an illness or exceptional situation. It’s better to find a health insurance expert who will help you find cheap health insurance solutions for individuals with respect to your financial abilities and actual needs.

And there are plenty of options to choose between when going with an individual health insurance plan – Preferred Provider Organization, Health Maintenance Organization, High Deductible Health Insurance or Health Savings Accounts Qualified High Deductible.

When thinking of an individual health insurance plan experts recommend considering health savings account plans that cater certain benefits for the customer. This way you will be able to save some additional amounts of money on a monthly basis by decreasing your premiums. And this type of plans also offers tax favored savings accounts so you should think well about going with that option if you want cheap health insurance with certain benefits like the money accumulated each year with your savings.

Even if your employer provides group health insurance solutions you still may want to get an additional health insurance plan to cover things not included in your group policy. In such case you will have to get an individual health insurance policy and tailor it to your exact needs. That is also a very good option if you have family members not included in your employer’s plan.

When dealing with a health insurance plan, whether a new one or the one you have already purchased, the specific language of its contents can be confusing for most people. All these provisions, coverage options and payments make little sense unless you are an insurance expert. And it’s not that rare that a person asks what does their policy provide even after having it for some time. Don’t worry, we are here to help you. Below you will find the most commonly used health insurance terms you will find in any policy with brief and comprehensive explanation that will help you understand your insurance policy better.

Deductible

Deductible is the sum of money the policy-holder has to pay out of pocket before the policy benefits will kick in. This amount is typically set on an early basis, meaning that a certain part or the whole deductible in the current year, this amount will be renewed in the next one. Certain services provided by the insurance policies such as physician visits are available free of deductible. If you have your family members included into your policy, there’s usually a separate distinction between individual and group deductible amounts.

Co-insurance

The sum of money you have to pay on your own before your policy starts covering you in addition to the plan’s deductible. Certain plans will require only co-insurance payments for some types of services without requiring you to pay the deductible.

Out-of-Pocket

It’s a general term denoting all payments that you have to make on your account before the policy coverage kicks in. This usually refers to deductibles, co-payments and co-insurance. When speaking of annual out-of-pocket maximum this term refers to the overall costs of the insurance policy during the year minus the premiums.

Lifetime Maximum

This term refers to the maximum sum of money you can receive with your insurance policy in the course its entire duration period. Most health insurance plans have separate lifetime maximums for individual and group purposes so pay attention when reviewing the policy or getting health insurance quotes.

Exclusions

As you can guess, these are provisions that your health insurance plan won’t cover.

Pre-existing Conditions

This refers to all health conditions that you were diagnosed with before purchasing the policy. Certain insurance companies will not cover such conditions, while other companies will. Learn about this option when you getting health insurance quotes especially if you have certain health problems you want to cover.

Waiting Period

This is the period of time the policy-holder will have to wait before receiving any benefits from the insurance policy.

Coordination of Benefits

In case the policy-holder has source of coverage additional to the present policy the benefits received from all the policies will be coordinated in order to make sure that the person does not receive double coverage.

Grace Period

The period of time starting after the premium payment due date that the person is still able to pay without risking the policy to be void.