Personal Finance Tips

One of the more annoying features of the insurance world is its habit of distilling options down to simple sets of letters and then failing to clearly explain what the letters mean. In other words, insurers hide behind jargon and prefer not to explain clearly what you are buying. You are expected to assume the insurer has your interests at heart and pay over your money without a second thought. In many cases it works. Over the years, we have given up the unequal struggle and just say prayers we never fall sick. But, as premium costs have risen and the recession has cut back our spending power, trying to understand the options is back on the menu. So let’s start with an explanation of HMOs and PPOs. In fact, they both rely on a network of physicians, clinics and hospitals, but they differ significantly in the detail of how they deliver healthcare to you and your family.

A Health Maintenance Organization (HMO) is a network of healthcare professionals that enters into a contract with an insurance company. The insurer offers a captive group of people to refer to the network and, based on the expected volume of business, the network agrees a fixed fee for all the main services on offer. In theory, this works well for everyone. The fees are discounted because of the volume of business, so the insurer saves money and charges lower premiums. This is usually the cheapest form of health plan with very low copayments and, often, no deductibles. But there are problems. HMOs are very reluctant to accept people with existing conditions requiring expensive treatments. They prefer most of their patients to be reasonably healthy. The reason is basic economics. Every physician has to meet a quota of patients in a day. This means spending the shortest possible time on each consultation. Long diagnostic sessions disturb the quota and can result in penalties to both the doctors who miss their numbers and the patients who have slowed down the queue. There are also significant restrictions on patient choice. A nominated primary care doctor decides what referrals shall be made and to whom. HMOs are the cheapest form of care, but you have little control over the treatment you or your family receive.

A Preferred Provider Organization (PPO) uses the same basic approach but, because you pay more, you buy greater control over the treatment. The copayments are around 20% and there are usually deductibles. But, you have freedom to choose your own doctors. So long as you go see a physician in the network, you are covered. If you want to see someone outside the network, you usually only pay the difference between the network rate and the actual fees your choice collects.

So, when it comes to cheap health insurance, an HMO is the better option. But if you have the money and a health problem likely to need more extensive treatment, you should opt for a PPO. It always comes back down to your own personal needs and what you can afford. Cheap health insurance always comes with limitations. Read the small print before you buy into any plan and see exactly what you can and cannot do before you agree to buy the policy.

Well, for better or worse, the healthcare bill has been signed into law. There is no immediate benefit in being angry. There are a number of legal actions started by various Attorneys General alleging that the reforms are unconstitutional. Even if some of these cases succeed on the issue of mandatory insurance for private individuals, this will not necessarily strike down the whole bill. The likelihood is we will be left with all the provisions dealing with small businesses. Keeping it real, we have to start planning for the future on the law as it is. The good news is that the main raft of provisions will not become active until 2014. This gives the lawmakers plenty of time to have second thoughts. Just as important, there are sets of regulations to be written clarifying the detail of how some of the new features are to work at state level. However, this is an outline of what we can expect.

The states are to establish SHOP exchanges where small businesses can group together and buy insurance. For these purposes, until 2016, a business is considered small when it has no more than 50 employees, with states having the option of increasing the limit to 100 employees. To calculate numbers, you pro-rate the full- and part-time employees. Independent analysts predict group premiums will drop no more than 4%, while the value of the cover will rise by up to 3%. To bridge until the exchanges are operating, a tax credit system will come into force. If your business has less than ten employees with an average annual pay of less than $25,000, the credit is 35% of the health plan cost. There are partial credits where the number of employees is less than 25 and their average annual pay is less than $50,000. When the exchanges start, the credit increases to 50% for the first two years.

With immediate effect, there are a ban on terms designed to cap the value of claims, and limits on the right of insurers to cancel policies except in cases where actual fraud can be proved. As from 2014, the insurers must accept all employees without regard to pre-existing conditions. Their calculation of premium rates can only be based on location, age and whether an individual smokes. As from 2014, small businesses with more than 50 employees will be required to provide a health plan or pay an annual penalty of $750 for every full-time employee denied cover. This can rise to $2,000 if coverage is still denied.

So, tomorrow, you will be going out into the same market as before the reform bill became law. Finding cost-effective small business insurance will continue to be a struggle. Indeed, many insurers may increase premiums now so that, when the SHOP exchanges do come into force, they have a margin to play with to deal with the competition. However, when you buy, check that the new terms on the total value claimable and restrictions on the right to cancel have been introduced. If you buy your small business insurance through an agent, ask direct questions. It saves time fighting over whether wording is unlawful later on.

One of the results of the recession has been to reinforce the tendency to opt for term insurance as the first life policy. With the disappearance of credit and the pressure on employment, people have decide to switch to prudence. That means paying down the debts and cutting back on discretionary spending. Is this financial puritanism sensible? There are a number of factors to consider. First, a definition. A term policy is life coverage for a fixed number of years. Think of it as like a bet. If you are still alive at the end of the term, the insurance keeps all the premiums, and you and your dependents get nothing. Now, let’s focus on the psychology of the young. Most never bother thinking about insurance or, if they do, it’s a very low priority. Why bother worrying about something that’s unlikely to happen for decades? Statistically, this is a reasonable view. Just as many young people back their health and refuse to buy an individual health plan, the majority see no advantage in life insurance. Life expectancy has been rising steadily over the last 50 years. This calm confidence lasts until they enter a stable relationship. Until children appear. But, by then, the cost of living has gone up and, potentially, what was two incomes has become one. Then, buying term insurance is the cheap option.

The real question is whether buying a whole life policy early is always the right answer. The argument goes that you take on the higher premiums when, as a young single, you have the most disposable income. Inflation and pay increases slowly make the higher premiums more affordable. If you do become a two-income family, this really takes the pressure off. Hopefully, by the time children come along, you have already produced a financial situation in which the premiums are now affordable. Hmmm. Back to definitions: this policy insures your life, but also has an investment element that builds up a cash value over time. If you keep up the premiums, this provides security during retirement and for your dependents. Except, people do not make rational financial decisions. The young prefer to enjoy their youth rather than stay home and save for their retirement. Worse, the reality of most of the investment elements is that they represent poor performance. If you bought term insurance and invested the balance of the premium saved in regular investments, you would almost certainly do better. The hard reality is the insurance companies charge commissions for setting up your account and then impose management fees for investing your money. This slices the top off the investment returns.

So the conclusion is slightly bad news. The decision on what to buy is not directly related to the life insurance quotes you receive through a site like this. The best value is buying term insurance and having the self-discipline to invest a growing proportion of your income. If you do not have that self-discipline, the whole life, universal and variable policies represent compulsory savings. In effect, you are paying the life company to do the work of investing for you. The perfect choice starts with the life insurance quotes and diverts through the office of an independent actuary who will give you an educated guess on the quality of the investment returns from the whole life policy as against managing your own investments over the next thirty years or so. Now you can decide whether you want to trust yourself or accept a low but guaranteed yield from the insurance company.

There are several options available to maximize the chance for children to be included in a health plan. Employer-provided plans routinely offer cover for family members and adding children to private plans is relatively inexpensive. For those families with low incomes who cannot afford cover, there are federal and state funds available to pay for basic cover. But all these options disappear when the child becomes an adult. This is the magic time everyone used to look forward to. Finally, the law recognizes people are old enough to take responsibility for their own actions and removes the built-in protections. Except, of course, these new adults are either still in full-time education or joining the group with the highest unemployment rate in the country.

For young adults going through college and university, this is the time when debts are really starting to mount up. Tuition fees and living costs take years to pay off. Adding in the cost of a health plan is often the straw that breaks the camel’s back. Even though all the better colleges and universities offer good value group insurance, this is one additional cost too many. Younger people take the rational view. They have good heath and statistics on their side – the statistics show the vast majority of people enjoy good health during the prime of their lives. The main risks come from accidental injuries with many hit with big bills following traffic accidents. So most young people put off the decision on buying into a health plan and hope their parents will solve the problem for them.

This calculation may be about to change. The insurance industry applies a simple formula to set premium rates. It guesses how much it is going to pay out over the next twelve months, adds its operating costs and a profit margin, and then divides this total among all the people holding a policy, i.e. everyone in the group pays a more-or-less equal share. Because millions of young adults opt out, the cost of medical treatment falls unevenly on older people and those with existing medical conditions. The premium rates for everyone would fall if the cost of the nation’s medical bills was divided between all adults. That’s why the legislation working its way through the House and Congress includes proposals to make holding an insurance policy mandatory or to fine people who do not have a health plan. This is a form of single payer program because it matches the idea that all the employed should contribute a percentage of their earnings toward universal health coverage.

Health insurance is the big political hot potato right now. But, if medical costs are to be controlled and everyone is to pay only a fair amount for insurance, some changes will have to be made. Mandating insurance for the young is not a bad way of paying for universal coverage. As it stands, health insurance companies routinely refuse cover for people with pre-existing health problems. Allowing a redistribution of the additional costs of treating these people among the fit and healthy is the fair option. Whether the politicians will think so is another matter. The Republicans believe this infringes basic liberty. The Democrats are not united. It’s going to be interesting to see who wins the argument.