Retirement Planning and Estate planning with Insurance

Retirement Planning and Estate planning with Insurance:
Insurance coverage for Retirees and Seniors

Retirement sounds exciting and liberating but be sure to plan accordingly to limit your headaches. Retirement planning is a big deal and without help it can make your retirement a bad experience. Plan your insurance needs before you retire! There are certain insurance policies you need to maintain and certain policies you could consider changing once you retire.

Life Insurance
Your life insurance needs may change once you retire. You've worked most of your life to accumulate enough money to last the rest of your life. When accumulating or planning your retirement did you assume costs associated with taxes on your estate or costs associated with your funeral would easily be covered with your retirement savings? What about other expenses you may have? If you've assumed these expenses within your retirement savings then you may not necessarily need a life insurance policy. If you have accumulated enough retirement savings to pay for all your final expenses plus whatever else you wish to do with it then chances are you are covered. It's a good idea to consult with your retirement specialist to ensure your covered and depending on your assets and liabilities perhaps a short term life policy will cover you. Most of the time retirees have paid off their homes. If this isn't the case and there are only a few years on the mortgage you may want to consider a 5 or 10 year term life policy to cover any expenses the asset may not. Life insurance for retirees is case-by-case and truly depends on the size of your assets.

Homeowners Insurance
As I mentioned above there are often instances where retirees have paid for their homes and no longer pay a mortgage. You still need to cover your home in case of a loss. Likely your retirement savings aren't enough to pay for your retirement and completely replace your home so it's imperative you maintain your home insurance policy once your retired.

Auto Insurance
Like your homeowners insurance you should continue to insure your automobile. The last thing you should consider is paying for a new car or liability claims due to a car wreck. If your driving significantly less because your retired and no longer drive to work then you should talk to your Insurance company about discounts available to those that drive less than a certain amount of miles per year.

Health Insurance
You need to apply for health insurance as soon as possible. The longer you wait the older you get and the harder and more expensive health insurance costs. If you're retiring before 65 you will definitely need coverage. Once you reach age 65 you will be eligible for Medicare. So if you retire early at age 50 assume you will need enough retirement savings to cover at least 15 years of health insurance premiums. There are ways to adjust your premiums but that would entail higher deductibles or finding a group to join. Individual health insurance policies are expensive and especially for those over age 50 so do your diligence and start receiving quotes now.

Long Term Care Insurance
You like many others may consider purchasing Long Term Car Insurance when you retire. Long Term Car Insurance is an insurance policy that covers things generally not covered by health insurance or Medicare. Long Term Care covers things such as a live-in Nurse who would be hired to help do regular daily activities such as bathing, dressing and eating. Long Term Care does not cover health issues directly such as a heart problem or doctors visits. It is a great opportunity to purchase a policy that will allow you the liberties of staying and living at home and knowing you won't burden your loved ones with your daily activities. So Long Term Care Insurance is a policy that one should consider when planning retirement.

Organize your Insurance Policies

Keep your Insurance Policies organized in case of an emergency

Be sure to organize your insurance information yearly. Organizing it yearly will keep you fresh on coverages and most important it reminds you what you have and where you have it. The last thing you want to do after a car accident, a health issue or a death in the family is to search for any information regarding insurance coverage.

Ideas for keeping Insurance information organized.

Write down or type out the contact information for each type of insurance you own. So for your Auto Insurance write down the contact person's name and phone number. Do the same for your Health Insurance, Life Insurance and any other Insurance policies you own. Give a copy of the contact information to several friends or family members in case of an emergency. Build a folder for each type of Insurance you own and save policy information in the folder. Consider keeping the folders in a fireproof safe or in a safe deposit box at your local bank.

Consider consolidating all your insurance needs with one insurance company. One point of contact can make getting the information you need significantly less stressful. In addition to having one point of contact most Insurance companies provide rate discounts for those that carry multiple lines of insurance with the company.

Insurance Rates & Insurance Premiums

Why do insurance quotes vary depending on the company?

There are a couple reasons insurance policy premiums vary depending on the company offering the coverage. Insurance companies calculate policy premiums differently buy most are calculated using past risk assumptions and an equation actuaries use to assume risks.

Past risk assumption is what some may refer to as trends the company has seen in it's data that a particular occurrence may be a result of a particular factor such as age and location. A good example to explain the use of trends is in car insurance. Car insurance premiums can differ greatly depending on the company. I have received quotes for a car that ranged from $500 to $1100 every six months. All policies were the same as far as coverage is concerned and all companies were highly rated. So why is my policy $500 per six month for one insurance company and $1100 for another? For my particular quote, the company that quoted $1100 per six months evidently found issuing my policy to be significantly riskier than the company that quoted $500 per six months. The $1100 company must have had less than favorable returns on policy holders with the same variables as my age, car and location. Believe it or not, insurance companies are in business because it is a profitable business. They are in this business to make money and insuring a higher risk policy has the potential to cost the company more money therefore these premiums are more expensive.

Actuaries take these trends and either implement them into the equation or associate them with the equation used to generate policy premiums. The equation used is likely somewhat different for every company. It may not be an equation at all but a table with several factors of an insured when tabulated present an insurance premium. Each insurance company and there Actuaries develop algorithms or equations to calculate risk and insurance premiums. For this reason alone is why insurance premium rates differ depending on the insurance company. Shop around, find a policy offered by a reputable company that is affordable.

Online Health Insurance Quotes

Consider getting a free online health insurance quote

We've seen lots of trends with the CompuQuotes website and one that we've noticed is that people are less likely to receive a free online health insurance quote than other types of insurance. The amount of people looking for health insurance is much higher compared to the amount of health insurance quotes delivered.

Is it because most people associate health insurance with a single company and why get a quote when your assumption is that only one company will insure you? Many people don't realize how many health insurance options there are. You could be saving thousands a year. Wouldn't it be nice to buy a car with the savings you receive on your health insurance?

The fact is that there are lots of very reputable health insurance companies with different prices. Your health insurance is like all other types of insurance in that each company has different calculations in how they determine your premium. Company A may have a premium of $200/month and Company B may have a premium of $400/month. You'll never know unless you get the free quote.

True the process of receiving a quote is a little longer. There is quite a few more qualifiers than auto, home or life insurance quotes. Either way, your health insurance is likely your largest insurance expense so doesn't it make sense to compare and shop different companies and take more time to save that money?

Don't waste any more time, We want to see more online health insurance quotes than any other type of insurance!

Company Health Insurance Benefits

A viable alternative to Company Health Insurance Benefits

In most instances, an individual applying for a position in a company reviews the health insurance benefits the company offers. Good healthcare benefits can often times solidify a potential employee on a position and likewise a poor health insurance benefit program can turn a potential employee away. Assuming your employer offers a fantastic set of health care benefits there are still problems.

Assume you're employed with this company at age 30. Your in great health, things are going well and the company is thriving. After working for this company for 15 years the company has problems and either lays you off or the company goes out of business. Now your 45 years old and not in the best health. You may have had some depression issues or perhaps some back problems. You can get health insurance through COBRA but it is very expensive so eventually you would like to get off of COBRA and get a more affordable health plan. The job market isn't great so you decide to work from home on your own projects. You apply for a more affordable health insurance policy and you get declined due to your health history. This is an extreme example and your situation could be different. Maybe you leave to start your own company, maybe you leave to take care of a family member, the point is that when you leave the company you don't take your health benefits with you, they stay with the employer. Once you lose these health benefits you will need to find and purchase health insurance and hopefully you can find a comparable policy at close to the same premium.

A solution for Employers that make Health benefits even more attractive!

A new trend in healthcare benefits companies are offering is individual health insurance policies where the premium is expensed. The employee is encouraged to find and purchase their own health insurance policy and each premium is then expensed so the employer is offering great coverage and a viable alternative to standard health insurance benefits. If you leave for any reason, you take your health insurance policy with you continuing your insurability and as long as you keep the policy in force you have very little to worry about. Sure you'll have to cover the premium but odds are it will be cheaper than COBRA and you won't have to be concerned about applying and possibly being declined.

If this interests you, ask your employer to look into it.

Medicare and Medicaid Insurance Coverage Guide

Please note that some information may be outdated. Please be sure to contact the appropriate parties if you have any questions regarding the accuracy of the data.

MEDICARE AND MEDICAID

Q. What is Medicare?

A. Medicare is a Federal health insurance program established in 1965 for people aged 65 or older. It now also covers people of any age with permanent kidney failure, and certain disabled people. It is administered by the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services. Local Social Security Administration offices take applications for Medicare and provide information about the program.

Q. What is the difference between Medicare and Medicaid?

A. Medicare is a Federal health insurance program for the elderly and disabled regardless of income and assets. Medicaid, on the other hand, is a medical assistance program jointly financed by the State and Federal governments for eligible low-income individuals. Medicaid covers health care expenses for all recipients of Aid to Families with Dependent Children (AFDC), and most States also cover the needy elderly, blind, and disabled who receive cash assistance under the Supplemental Security Income (SSI) program. Coverage also is extended to certain infants and low-income pregnant women, and, at the option of the State, other low-income individuals with medical bills that qualify them as categorically or medically needy.

Q. How many people are covered by Medicare?

A. Medicare currently covers approximately 35 million people, of whom about 3 million are disabled and some 150,000 are kidney disease patients.

YOUR MEDICARE COVERAGE

Q. What does Medicare cover?

A. Medicare has two parts: Hospital insurance (Part A) and Supplementary Medical insurance (Part B). Part A helps pay for inpatient care in a hospital or skilled nursing facility, or for care from a home health agency or hospice. If you are admitted to a hospital, Medicare provides coverage for a semiprivate room, meals, regular nursing services, operating and recovery room costs, intensive care, drugs, laboratory tests, X-rays, and all other medically necessary services and supplies. Covered services in a skilled nursing facility include a semi-private room, meals, regular nursing services, rehabilitation services, drugs, medical supplies, and appliances.

Part B helps pay for physician services, outpatient hospital care, clinical laboratory tests, and various other medical services and supplies, including durable medical equipment. Doctors' services are covered no matter where you receive them in the U.S. Covered services include surgical services, diagnostic tests and X-rays that are part of your treatment, medical supplies furnished in a doctor's office, and drugs which cannot be self-administered and are part of your treatment.

Medicare pays only for care that it determines is medically necessary.

WHAT MEDICARE DOESN'T COVER

Q. Are there services Medicare does not cover?

A. While Medicare helps pay a large portion of your medical expenses, there are various health care services and products for which Medicare will not pay. These generally include custodial care; eyeglasses, hearing aids, and examinations to prescribe or fit them; a telephone, TV, or radio in your hospital room; and most outpatient prescription drugs and patent medicines. Medicare also does not pay for cosmetic surgery, most immunizations, dental care, routine foot care, and routine physical checkups. Although some personal care services (for example: bathing assistance, eating assistance, etc.) can be covered along with skilled care, they are never covered alone except under the hospice benefit.

PAYING FOR MEDICARE

Q. How is Medicare financed?

A. Medicare Hospital Insurance (Part A) is financed mainly from a portion of the Social Security payroll tax (the HCA) deduction. The Medicare pan of the payroll tax is 1.45 percent from the employee and 1.45 percent from the employer on wages up to $125,000 in 1991. Medicare Medical Insurance (Part B), which is optional, is financed by the monthly premiums paid by enrollees and from Federal general revenues. The monthly premium in 1991 is $29.90. The premium pays about 25 percent of the cost of the Part B program and general tax revenues pay about 75 percent.

WHO'S ELIGIBLE?

Q. Who is eligible for Medicare?

A. Generally, people age 65 and over can get Part A benefits if they can establish their eligibility for monthly Social Security or Railroad Retirement benefits on their own or their spouse's work record. In addition, certain government employees whose work has been covered for Medicare purposes, and their spouses, can also have Part A.

In rare cases, involving those who became age 65 in 1974 or earlier, Part A may be available if these people meet certain United States residence and citizenship or legal alien requirements.

Part A is also available to most individuals with end-stage renal disease, and to those who have been entitled to Social Security disability benefits or Railroad Retirement disability benefits for more than 24 months, and to certain disabled government employees whose work has been covered for Medicare purposes.

Any person who is eligible for Part A is also eligible to enroll in Part B. Enrollees in Part B must pay a monthly premium of $29.90 in 1991.

MEDICARE ENROLLMENT

Q. How do I sign up for Medicare?

A. If you are already getting Social Security or Railroad Retirement benefit payments when you turn 65, you will automatically get a Medicare card in the mail. The card will usually show that you are entitled to both Part A and Part B, and the beginning dates of your entitlement to each. If you do not want Part B, you can refuse it by following the instructions that come with the card. If you are not receiving such payments, you may have to apply for Medicare coverage. Check with Social Security to see if you are able to get Medicare under the Social Security system or based on Medicare-covered government employment; check with the Railroad Retirement office if you are able to get Medicare under the Railroad Retirement system. If you must file an application for Medicare, you should do so during your initial seven-month enrollment period that starts three months before the month you first meet the requirements for Medicare.

GETTING MORE INFORMATION

Q. Whom do I call to get more information about Medicare?

A. If you want to know how and when to sign up for Medicare, or how to change an address or replace a lost Medicare card, contact any Social Security office.

ENROLLING LATE FOR PART B

Q. When I enrolled in Medicare Part A, I did not sign up for Part B. Is that coverage still available to me on the same terms?

A. You may still enroll in Part B during the annual general enrollment period from January 1 to March 31, and your coverage will begin on July 1. However, your monthly premium may be higher than it would have been had you enrolled in Part B when you enrolled in Part A. In most cases, if you defer your enrollment in Part B, you must pay a monthly premium surcharge. The surcharge is 10 percent for each 12-month period in which you could have been enrolled but were not.

You may not have to pay the surcharge if you are covered by an employer health plan. Delayed enrollment without penalty is generally available if you have been covered by an employer health plan based on your or your spouse's current employment since you were first able to get Medicare. In that case, you can enroll in Part B during a special 7-month enrollment period. The period begins with the month the employer group health plan coverage ends, or with the month the employment on which it is based ends, whichever is earlier. In the case of certain disability beneficiaries, the special period begins when Medicare replaces the employer group health plan as the primary payer of the beneficiary's covered medical services.

DO YOU HAVE BOTH PART A & B COVERAGE?

Q. How do I know whether I'm covered by one or both parts of Medicare?

A. Your Medicare card shows the coverage you have [Hospital Insurance (Part A), Medical Insurance (Part B), or both] and the date your protection started.

Q. What does the letter mean that appears after my health insurance claim number on my Medicare card?

A. It is a code used by Social Security to indicate the type of benefits you are receiving. There may also be another number after the letter. Your full claim number must always be included on all Medicare claims and correspondence.

BUYING MEDICARE

Q. If I am not entitled to Medicare based on employment, can I buy the coverage?

A. Individuals age 65 or over who are United States residents and either United States citizens, or aliens who have been lawfully admitted for permanent residence and have resided in the United States for at least five years at the time of filing, can purchase both Part A and Part B, or just Part B. The monthly premiums in 1991 are $177 for Part A and $29.90 for Part B.

GETTING MEDICARE-COVERED CARE

Q. Are there different health care systems Medicare beneficiaries can use to get their Medicare benefits?

A. Yes. You can receive services covered by Medicare either through the traditional fee-for-service (pay-as-you-go) delivery system or through coordinated care plans, such as health maintenance organizations (HMOs) and competitive medical plans (CMPs), which have contracts with Medicare.

Whether you choose fee-for-service or coordinated care, you get all of Medicare's hospital and medical benefits. The care provided by both systems is comparable. The differences in the two systems include how the benefits are delivered, how and when payment is made and how much you might have to pay out of your pocket. Most of the information in this booklet pertains to fee-for-service health care. For more information about coordinated care plans, request a copy of the leaflet titled Medicare and Coordinated Care Plans from any Social Security office.

FEE-FOR-SERVICE

Q. How does the fee-for-service system work?

A. Under the fee-for-service health care system you have freedom of choice. You can choose any licensed physician and use the services of any hospital, health care provider, or facility approved by Medicare that agrees to accept you as a patient. Generally a fee is paid each time a service is used. Medicare, within certain limits, pays a large portion of the hospital, physician, and other health care expenses.

HMOs AND CMPs

Q. How do coordinated care plans work?

A. In a coordinated care plan (HMO or CMP) a network of health care providers (doctors, hospitals, skilled nursing facilities, etc.) generally offers comprehensive, coordinated medical services to plan members on a prepaid basis. Except in an emergency, services usually must be obtained from the health care professionals and facilities that are part of the plan. Care may be provided at a central facility or in the private practice offices of the doctors and other professionals affiliated with the plan.

ENROLLING IN AN HMO

Q. Can I enroll in a HMO?

A. Yes. You may enroll in any HMO or CMP that has a contract with Medicare. The only requirements are that you live in the plan's service area and be enrolled in Medicare Part B. Medicare makes a monthly payment to the plan to provide you with Medicare-covered services. Some plans provide additional services, and most charge enrollees a monthly premium and nominal copayments when a service is used. Contact plans in your area for enrollment and coverage information.

DISENROLLING FROM AN HMO

Q. If I enroll in a coordinated care plan, can I later return to fee-for-service Medicare coverage?

A. Yes. You may disenroll from a coordinated care plan at any time. Your coverage under fee-for-service Medicare will begin the first day of the following month. You may also change from one plan to another simply by enrolling in the second plan.

CHARGES YOU PAY

Q. Do Medicare beneficiaries have to pay any charges out of their own pockets when they use covered services?

A. Yes. Both Part A and Part B have deductible and coinsurance amounts for which you are liable. You also must pay all permissible charges in excess of Medicare's approved amounts for Part B services, and charges for services not covered by Medicare. These charges do not apply to you if you are enrolled in a coordinated care plan. Instead, you generally must pay a monthly premium to the plan and nominal copayments when a service is used.

HELP FOR LOW-INCOME BENEFICIARIES

Q. Is assistance available to help low-income Medicare beneficiaries pay Medicare's premiums, deductibles and coinsurance amounts?

A. Yes. If your annual income is below the national poverty level and you do not have access to many financial resources, you may qualify for government assistance under the State Medicaid program in paying Medicare monthly premiums and at least some of the deductibles and coinsurance amounts. The national poverty income levels for 1991 are $6,620 for one person and $8,880 for a family of two. If you think you may qualify, you should contact your State or local welfare, social service or public health agency.

PART B DEDUCTIBLE AND COINSURANCE AMOUNTS

Q. How much are the Part B deductible and coinsurance amounts?

A. The Medicare Part B deductible in 1991 is $100 per year. This means that you are responsible for the first $100 of approved expenses for physician and other medical services and supplies. The deductible is paid when you are first charged for covered services. After the deductible has been met, then Medicare starts paying. Medicare generally pays 80 percent of all other approved charges for covered services for the rest of the year. You are responsible for the other 20 percent. If the physician or supplier does not accept assignment of the Medicare claim (that is, accept Medicare's approved amount as payment in full), you are responsible for all permissible charges in excess of the approved amount. You also generally are liable for charges for services not covered by Medicare. Them is no deductible or coinsurance for home health services.

PART A DEDUCTIBLE AND COINSURANCE AMOUNTS

Q. How much are the Part A deductible and coinsurance amounts?

A. The Part A deductible is $628 per benefit period in 1991. This means that if you are admitted to the hospital, you are responsible for the first $628 of Medicare-covered expenses. After that, Medicare pays all covered expenses for the first 60 days. For the next 30 days, Medicare pays all covered expenses except for a coinsurance amount of $157 per day in 1991. You are responsible for the $157 per day. Whenever more than 90 days of inpatient hospital care are needed in a benefit period, you can use your lifetime reserve days to pay for covered services. Every person enrolled in Part A has a lifetime reserve of 60 days for inpatient hospital care. Once used, these days are not renewed. When a reserve day is used, Medicare pays for all covered services except for a coinsurance amount of $314 a day in 1991. You are responsible for the $314 a day. Because the Part A deductible applies to each benefit period, you could have to pay more than one deductible in a year if you were hospitalized more than once.

SKILLED NURSING FACILITY CARE

Q. What if I require care in a skilled nursing facility after leaving the hospital?

A. If, after being in a hospital for at least three days, you receive covered care in a skilled nursing facility that has been approved to participate in the Medicare program, Part A will help cover services for up to 100 days per benefit period. Medicare pays all covered expenses for the first 20 days and all but $78.50 per day in 1991 for the next 80 days. You are responsible for the $78.50 per day.

BENEFIT PERIOD

Q. What is a benefit period?

A. A benefit period is a way of measuring your use of Medicare Part A services. A benefit period, which applies to hospital and skilled nursing facility care, begins the day you are hospitalized and ends after you have been out of the hospital or skilled nursing facility for 60 days in a row. It also ends if you remain in a skilled nursing facility but do not receive any skilled care there for 60 days in a row. There is no limit to the number of benefit periods you can have.

PROCESSING MEDICARE CLAIMS

Q. Who processes Medicare claims and payments?

A. Medicare claims and payments are handled by insurance organizations under contract to the Federal government. The organizations handling claims from hospitals, skilled nursing facilities, home health agencies, and hospices are called "intermediaries." You almost never have to get involved in the Part A claims process. The insurance organizations that handle Medicare's Part B claims are called "carriers." The names and addresses of the carriers and areas they serve are listed in the back of The Medicare Handbook, available from any Social Security Administration office.

MEDICARE APPROVED AMOUNT

Q. How does Medicare determine its approved amounts for physician services?

A. Medicare's approved amount, which is also referred to as the reasonable or allowable charge, is determined in the following manner for most Part B claims:

When a doctor submits a claim, the Medicare carrier compares the amount submitted with the doctor's usual charge for the service and with the amounts other physicians in the community usually charge for the same service. The lowest of the three becomes the approved amount. After you have met the Part B annual deductible ($100 in 1991), Medicare generally pays 80 percent of the approved amount and you are liable for the other 20 percent. A NEW SYSTEM FOR DETERMINING THE AMOUNT PHYSICIANS WILL BE PAID FOR PROVIDING SERVICES COVERED BY MEDICARE WILL BE INTRODUCED IN 1992.

ACCEPTING MEDICARE ASSIGNMENT

Q. What does it mean when a physician accepts assignment?

A. Physicians and suppliers who accept assignment of Medicare claims agree to not charge you more than the Medicare approved amount for services and supplies covered by Part B. They are paid directly by Medicare, except for the deductible and coinsurance amounts for which you are responsible. Some physicians and suppliers have signed agreements to participate in Medicare. In doing so, they have agreed to accept assignment of Medicare claims all of the time. Other physicians and suppliers will accept assignment on a case-by-case basis or not at all.

PHYSICIANS WHO DON'T ACCEPT ASSIGNMENT

Q. What if a physician does not accept assignment of a Medicare claim?

A. Physicians and suppliers who do not accept assignment of Medicare claims may charge more than the Medicare approved amount and collect full payment directly from you. Medicare then pays you 80 percent of the approved amount for the covered service, less any unmet portion of the $100 Part B deductible. You are liable for all permissible charges in excess of Medicare's approved amount.

LIMITING A PHYSICIAN'S CHARGES

Q. Is there a limit to the amount a physician can charge a Medicare beneficiary for a covered service?

A. Yes. Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge Medicare beneficiaries for covered services. In 1991, charges for visits and consultations cannot be more than 140% of the Medicare prevailing charge for physicians who do not participate in Medicare. For most other services (surgery, for example) the limit is 125 percent of the prevailing charge for nonparticipating physicians. In 1992 the limiting charge for all services covered by Medicare will be 120 percent of the fee schedule amount for nonparticipating physicians and in 1993 it will be 115 percent of the fee schedule amount.

FINDING PARTICIPATING PHYSICIAN

Q. How can I find a Medicare-participating physician or supplier?

A. The names and addresses of Medicare-participating physicians and suppliers are listed by geographic area in the Medicare-Participating Physician/Supplier Directory. You can get the directory for your area free of charge from your Medicare carrier (listed in the back of The Medicare Handbook) or you can call your carrier and ask for names of some participating physicians and suppliers in your area. This directory is also available for review in Social Security offices, State and area offices of the Administration on Aging, and in most hospitals. Physicians and suppliers are given the opportunity each year to sign Medicare participation agreements.

FILING A PART B CLAIM

Q. When a physician provides Medicare-covered services to a Medicare beneficiary, does the physician or beneficiary file the claim with the Medicare carrier for payment?

A. For Medicare-covered services and supplies received on or after September 1, 1990, the physician or supplier is required to submit the claim for the beneficiary. For services and supplies provided prior to that date, the physician or supplier was not required to submit the claim unless the physician or supplier participated in Medicare or had agreed to accept assignment of the claim.

WHAT TO DO WHEN YOU HAVE A PROBLEM WITH A CLAIM

Q. Whom do I call if I have a question about a Medicare claim for a doctor's services?

A. Call the Medicare carrier for your area. The carrier's name and toll-free telephone number are listed in the back of The Medicare Handbook and appear on all Explanation of Medicare Benefit (EOMB) forms.

Q. How long should I wait before contacting the Medicare carrier to check on the status of a claim?

A. Allow 30 to 45 days for the claim to be paid. If you have not received a check or an Explanation of Medicare Benefit (EOMB) payment statement after 45 days, call the Medicare carrier for your area.

APPEALING A CLAIMS PAYMENT DECISION

Q. What recourse do I have if Medicare denies payment for a claim or pays less than I think it should?

A. You have a fight to appeal Medicare's coverage and payment determinations for both the hospital (Part A) and medical (Part B) segments of Medicare. The appeals processes are explained in The Medicare Handbook.

AMBULANCE SERVICES

Q. Does Medicare cover ambulance services?

A. Medicare Part B can help pay for certain medically necessary ambulance services when: (1) the ambulance, equipment, and personnel meet Medicare requirements; and (2) transportation by any other means would endanger your health. This includes transportation from a hospital to a skilled nursing facility, or from a hospital or skilled nursing facility to your home. Medicare will also cover a round trip from a hospital or a participating skilled nursing facility to an outside supplier to obtain medically necessary diagnostic or therapeutic services not available at the hospital or skilled nursing facility where you are an inpatient.

MEDICARE COVERAGE FOR WHEELCHAIRS, PACEMAKERS, AND ARTIFICIAL LIMBS

Q. Does Medicare cover prostheses and medical devices?

A. Yes. Medicare covers these items when provided by a hospital, skilled nursing facility, home health agency, hospice, comprehensive outpatient rehabilitation facility (CORP), or a rural health clinic. Medicare also covers cardiac pacemakers, corrective lenses needed after cataract surgery, colostomy or ileostomy supplies, breast prostheses following a mastectomy, and artificial limbs and eyes. Coverage also is provided for durable medical equipment, such as wheelchairs, hospital beds, walkers, and other equipment prescribed by a doctor for home use.

NURSING HOME CARE

Q. Does Medicare pay for long-term care in a nursing home?

A. No. Medicare only helps pay for post-hospital extended care in a skilled nursing facility (SNF). A SNF is a specially qualified facility with the staff and equipment to provide skilled nursing care, a full range of rehabilitation therapies, and related health services. Medicare only pays when a skilled level of care is required as a continuation of a hospital stay and the care is provided in a SNF that participates in Medicare. Even if you are in a SNF that participates in Medicare, Medicare will not pay if the services you receive are mainly personal care or custodial services, such as help in walking, getting in and out of bed, eating, dressing, and bathing. A SNF that participates in Medicare will inform you at the time of admission about potential Medicare payment and your rights to seek payment.

CHIROPRACTIC SERVICES

Q. Will Medicare pay for a chiropractor's services?

A. Medicare helps pay for only one kind of treatment furnished by a licensed chiropractor: manual manipulation of the spine to correct a subluxation that can be demonstrated by X-ray.

PSYCHIATRIC COVERAGE

Q. Does Medicare pay for care in a psychiatric hospital?

A. Yes. Medicare Part A helps pay for up to 190 days of inpatient care in a participating psychiatric hospital during a beneficiary's lifetime.

CHECKING FOR CANCER

Q. Does Medicare pay for cervical- and breast-cancer screenings?

A. Yes. Medicare Part B helps pay for Pap smears to screen for the detection of cervical cancer and for X-ray screenings for the detection of breast cancer.

HOME HEALTH CARE

Q. Does Medicare cover home health care?

A. Yes. If you need skilled health care in your home for the treatment of an illness or injury, Medicare pays for covered home health services furnished by a participating home health agency. To qualify, you must be homebound, need part-time or intermittent skilled nursing care, physical therapy, or speech therapy. You also must be under the care of a physician who determines you need home health care and sets up a home health care plan for you.

COVERAGE LIMITS

Q. How long can home health care last?

A. Home health care can continue for as long as you are under a physician's plan of care and the services you require are the type of services Medicare covers, such as skilled nursing, physical therapy, and speech therapy. Home health aide services are also available if you are eligible. Daily skilled care is available on a limited basis to those beneficiaries who qualify.

WHO PAYS?

Q. How much does Medicare pay toward the cost of home health care?

A. Medicare pays the full approved cost of all covered home health visits. There is no coinsurance on home health care. You may be charged only for any services or costs that Medicare does not cover. However, if you need durable medical equipment, you are responsible for a 20 percent coinsurance payment for the equipment.

MEDICARE AND HOSPICE CARE

Q. What is hospice care?

A. Hospice is a special way of caring for a patient whose disease cannot be cured and whose medical life expectancy is six months or less. Patients receive a full scope of palliative medical and support services for their terminal illnesses.

Q. Is hospice care available to Medicare beneficiaries?

A. Yes. Medicare beneficiaries certified by a physician to be terminally ill may elect to receive hospice care from a Medicare-approved hospice program. Under Medicare, hospice is primarily a comprehensive home care program that provides medical and support services for the management of a terminal illness. Beneficiaries who elect hospice care are not permitted to use standard Medicare to cover services for the treatment of conditions related to the terminal illness. Standard Medicare benefits are provided, however, for the treatment of conditions unrelated to the terminal illness. Medicare has special benefit periods for beneficiaries who enroll in a hospice program.

PROs

Q. What are PROs?

A. Utilization and Quality Control Peer Review Organizations (PROs) are physician-sponsored organizations in each State that the Health Care Financing Administration (HCFA) contracts with to ensure that Medicare beneficiaries receive care which is medically necessary, reasonable, provided in the appropriate setting, and which meets professionally accepted standards of quality. Among other things, PROs are responsible for intervening when quality problems are identified and for making every attempt to resolve them. They ensure that beneficiaries are advised of their appeal rights and review all written complaints from beneficiaries or their representatives concerning the quality of care rendered. If you are admitted to a hospital, you will receive a notice explaining your rights under Medicare and how to contact the PRO if the need arises.

MEDICARE AND FOREIGN TRAVEL

Q. If I require medical services outside the United States and its territories, will Medicare pay the bills?

A. No. But there are three exceptions. Medicare will help pay for care in qualified Canadian or Mexican hospitals if:

(1) You are in the United States when an emergency occurs, and a Canadian or Mexican hospital is closer to, or substantially more accessible from, the site of the emergency than the nearest U.S. hospital that can provide the emergency services you need.

(2) You live in the United States and a Canadian or Mexican hospital is closer to, or substantially more accessible from, your home than the nearest U.S. hospital that can provide the care you need, regardless of whether an emergency exists, and without regard to where the illness or injury occurs.

(3) You are in Canada travelling by the most direct route between Alaska and another State when an emergency occurs, and a Canadian hospital is closer to, or substantially more accessible from, the site of the emergency than the nearest U.S. hospital that can provide the emergency services you need.

WHO PAYS FIRST?

Q. Is Medicare always the primary payer of a beneficiary's medical bills or are there situations when another insurer must pay first?

A. There are a number of situations in which another insurer is the primary payer of your health care costs and Medicare is the secondary payer. For example, Medicare may be the secondary payer if you are covered by an employer group health insurance plan, are entitled to veterans benefits, workers' compensation, or black lung benefits. Medicare also can be the secondary payer if no-fault insurance or liability insurance (such as automobile insurance) is available as the primary payer. In cases where Medicare is the secondary payer, Medicare may pay some or all of the charges not paid by the primary payer for services and supplies covered by Medicare. This issue is discussed in more detail in the publication titled Medicare Secondary Payer, available from any Social Security office.

MEDIGAP INSURANCE

Q. What is "Medigap" insurance?

A. Medigap insurance is private health insurance designed specifically to supplement Medicare's benefits by filling in some of Medicare's coverage. A Medigap policy generally pays for Medicare approved charges not paid by Medicare because of deductibles or coinsurance amounts that you are liable for. There are Federal minimum standards for such policies which most States include as pan of their programs to regulate Medigap policies. Because Medigap policies can have different combinations of benefits and the policies may vary from one insurance company to another, you should compare policies before buying. Compare the benefits and the premiums. Some policies may offer better benefits than others at a lower premium.

MEDIGAP TO BE STANDARDIZED IN 1992

Q. Is it true that Medigap policies are to be standardized?

A. Yes. During 1992 most States are expected to adopt regulations limiting the Medigap insurance market to no more than 10 standard policies. One of the 10 will be a basic policy offering a "core package" of benefits. The other nine will each have a different combination of benefits, but they all must include the core package. Insurers will not be permitted to change the combination of benefits in any of the 10 standard policies. Individual States will be allowed to limit the number of the different standard policies sold in the State to fewer than 10 if they wish to do so, but must ensure that insurers offer the basic policy. For more information on this subject, contact your State insurance department.

GAPS IN YOUR MEDICARE COVERAGE

Q. What are the "gaps" in Medicare coverage?

A. In general, they are charges for which you are responsible. They include Medicare's deductibles and coinsurance amounts, permissible charges in excess of Medicare's approved amounts, additional days of care in a hospital or skilled nursing facility, and the charges for the various health care services and supplies that Medicare does not cover. Medigap insurance can cover some or all of these charges, depending on the policy.

ONE MEDIGAP POLICY IS ENOUGH

Q. Do I need more than one Medigap policy?

A. No. One good policy tailored to your needs at a price you can afford is sufficient. Beginning in 1992 most States are expected to make it unlawful for an insurance company or agent to sell a second or replacement Medigap policy to an individual unless the purchaser states in writing that the first policy is to be cancelled. Medicare beneficiaries enrolled in coordinated care plans (HMOs and CMPs) or who are eligible for Medicaid usually do not need Medigap insurance. If you have insurance from an employer or labor association, you may also not need Medigap insurance.
MEDICARE SELECT

Q. What is Medicare SELECT insurance?

A. Medicare SELECT is the name for a new Medigap health insurance product that is expected to be introduced in 1992 in 15 States to be designated in 1991 by the Secretary of the U.S. Department of Health and Human Services. During the three-year period currently authorized under Federal law, Medicare SELECT will be evaluated to determine how it should eventually be made available throughout the Nation. Medicare SELECT is private insurance, it is not issued by the government and it is not part of Medicare. It is designed to supplement Medicare coverage.

Q. What is the difference between Medicare SELECT and other Medigap insurance?

A. The principal difference is that Medicare beneficiaries who buy a Medicare SELECT policy are expected to be charged a lower premium for that policy in return for agreeing to use the services of a network of designated physicians and other health care professionals. These health care professionals, called "preferred providers," will be selected by the insurers. Each insurance company that offers a Medicare SELECT policy will have its own network of preferred providers. Policyholders usually will be required to use a preferred provider if the insurance company is to pay full benefits. Medicare will continue to pay its portion of covered benefits regardless of whether a preferred provider was used or not. Beneficiaries who buy other Medigap insurance policies are not required to use doctors and other providers designated by the insurance company.

GETTING MORE INFORMATION ABOUT SUPPLEMENTAL INSURANCE

Q. Where can I get information about insurance to supplement my Medicare benefits?

A. Contact your local Social Security office, State office on aging, or your State insurance department and ask for a copy of the Guide to Health Insurance for People with Medicare. It describes Medicare's benefits and the types of private insurance available to supplement Medicare. If you need help in selecting supplemental insurance, check with your State insurance department. Some departments offer counselling services.

MEDIGAP COMPLAINTS

Q. Whom should I contact if I have a complaint about the agent who sold me a Medigap policy?

A. Suspected violations of the laws governing the sales and marketing of Medigap policies should be reported to your State insurance department or Federal authorities. The Federal toll-free telephone number for registering such complaints is 1-800-638-6833.

SECOND SURGICAL OPINIONS

Q. Whom do I call if I want a second surgical opinion?

A. If your physician has recommended surgery for a non-emergency condition covered by Medicare and you want the names of doctors in your area who provide second opinions for elective surgery, call your Medicare carrier. Many conditions that do not require immediate attention can be treated equally well without surgery.

REPORTING FRAUD

Q. Where do I report suspected cases of Medicare fraud?

A. If you have evidence of or suspect fraud or abuse of the Medicare or Medicaid programs, call your Medicare carrier.

CHANGING YOUR ADDRESS

Q. I moved. How do I get my address changed?

A. You should call your local Social Security office and ask that your Medicare file be changed to reflect your new address.

Indemnity Health Insurance

Is Indemnity Health Insurance Better Than Managed Care Insurance?

Indemnity health insurance (sometimes referred to as a fee-for-service policy) was, at one time, the most popular kind of health insurance. In fact, it was the only kind of health insurance in America. It was out shadowed in the nineties by the introduction of managed care insurance. But many employers still offer indemnity today.

Is Indemnity Health Insurance More Expensive?

Indemnity health insurance is more expensive than a managed care plan on two different levels. First of all, the premiums (the amount of money you pay each month) are higher.

There are several reasons for this. Since it’s not a managed plan (like an HMO), there tend to be more unnecessary procedures…so the insurance companies end up paying more money. As with everything in life, the added expenses get passed along to the end users (the ones buying the insurance). The premiums for indemnity health insurance policies are also higher because managed care plans are more focused on group rates. They generally only provide insurance through large groups (like employers) and contract healthcare providers into a network where they receive lower fees. Without this kind of ‘bulk buying’, the prices are naturally higher.

Indemnity health insurance is also more expensive because it usually covers a smaller amount. With an HMO or PPO, you might pay small co-pays for doctor and hospital visits. Indemnity health insurance usually only covers a percentage of medical bills…and that’s after you’ve met a deductible. Such plans often won’t cover preventive healthcare like check-ups and vaccinations.

Why Would Anyone Choose Indemnity Health Insurance?

There are several reasons someone might choose indemnity health insurance over a managed care plan. The most obvious reason is because sometimes a managed care plan isn’t available. Indemnity health insurance is offered more as an individual plan, or to small businesses when they won’t have enough policy holders to qualify for group rates with an HMO or PPO.

Another reason someone might prefer indemnity health insurance is that it offers more freedom than managed care plans. A person isn’t restricted to a network of doctors and hospitals…they can go anywhere in the country. Someone with indemnity health insurance also doesn’t have to worry about referrals when going to a specialist. In most cases, they don’t need approval from their insurance company.

What Else Should I Know About Indemnity Health Insurance?

As already mentioned, most indemnity health insurance policies have deductibles. This is the amount of money the patient must pay before the insurance company starts covering the costs. You can lower the premium payments by choosing a policy with a very high deductible.

Indemnity health insurance usually only pays a percentage of the medical costs after you’ve met the deductible. Let’s say your deductible is $500 and your policy covers 80% after the deductible. If a hospital visit costs $700, the insurance would pay 80% of $200 ($160).

Indemnity health insurance policies often have out-of-pocket maximums. That is, the maximum amount of money a patient would have to spend on covered procedures within a year. This amount is generally very high, and lowering it would cause higher premiums.

Finally, indemnity health insurance policies only pay the UCR (Usual, Customary and Reasonable fees). They base such fees on what health care procedures cost in your surrounding area. For example, let’s say your hospital visit cost $700, but the indemnity health insurance policy’s UCR is $650. Then the policy would only pay 80% of $150 (remember the $500 deductible) or $120.

So is indemnity health insurance better than a managed care plan? That all depends on your situation…and if a managed care plan is even available.

HMO Health Insurance

HMO Health Care: The Good, The Bad, The Managed

What is HMO Health Insurance and why does it have such a bad reputation?

HMO health insurance (Health Maintenance Organization) is a form of Managed Care Insurance. The idea is that an organization (the one providing the health insurance) works with doctors and hospitals to form a network.

These doctors are contracted with the HMO for lower prices, and might subject themselves to the organization for ‘utilization review’. The HMO reviews the dollar amount or number of visits that a person would use in one month, and scrutinizes for excessive medical care.

When signing up for an HMO health insurance policy, you would choose a Primary Care Physician within the network. That physician then becomes your main source for healthcare, and must give you a referral before you’re able to seek other medical help (like from a specialist). Women would choose an OBGYN when signing up…who would also be able to give referrals. And, of course, parents would choose a pediatrician for their children.

HMO Health Insurance Provides Less Expensive Care

With a setup like this, the HMO health insurance company is able to lower the over-all cost of health insurance (and increase the amount of benefits) in several ways. As mentioned before, the healthcare providers are contracted for lower prices in exchange for network inclusion. It’s like buying health care in bulk and then reselling it.

Since HMO health insurance reviews the utilization, they also save money by making sure patients do not receive unnecessary treatments…this lowers the over all cost of the insurance itself, and in turn allows them to increase the benefits amount.

HMO Health Insurance Can Seem Restrictive

The utilization review…it can be somewhat limiting. For example, Doctor Noname wants his patient to receive a CAT scan, but someone reviewing the case disagrees. The doctor then has to hassle with the HMO health insurance case worker before his patient can receive the care. Some people find this intrusive and difficult to deal with.

There are two ways to look at this. On the one hand, Dr. Noname is the one seeing the patient. He sees a person…not a case number. He is able to put the patient’s symptoms into context with the patient’s current health condition.

On the other hand, and this is something people often forget, HMO health insurance providers are looking at the big picture. Not necessarily always at the money saving aspect, but as a way of troubleshooting patient afflictions. That’s really part of what a doctor does…troubleshoots.

HMO Health Insurance is a Numbers Game

Think of it in terms of a car or an office machine. Not all technicians are the same. A rookie might spend an hour trying to figure out what’s wrong with a machine and someone with more experience might only spend five minutes. The HMO health insurance company adds years to a doctor’s level of experience.

When you hire a small copier dealer to repair your office machine, the technician is free to troubleshoot in any way he sees fit. He could replace the wrong part and end up costing the customer money. But some big corporations (like Xerox) train their techs to follow troubleshooting procedures…ones they put together by looking at the big picture. So even inexperienced technicians are able to quickly find a problem. And this is part of the concept behind HMO health insurance policy restrictions.

HMO health insurance might not be the best plan for everyone, but it allows companies to provide affordable health care for a large number of people…people who need good benefits with low premiums. This is what makes HMO health insurance an important part of the industry.

PPO Health Insurance - HMO vs. PPO

PPO Health Insurance Plans
The Alternative to HMO?

PPO health insurance (Preferred Provider Organization) is very much like HMO health insurance. They are both ‘managed care organizations’…hence they take part in managing the healthcare for the insured persons. There are many similarities, and several differences.

How is PPO Health Insurance Similar to HMO?

PPO health insurance, like HMOs, form a network of doctors and medical providers. Those providers are contracted by the PPO to give a lower rate to insurance policy holders. They basically purchase healthcare at bulk rates and resell it…the Walmart of medical care. In this way, they pass the savings to customers. But the health care providers also benefit because of the huge market it brings them.

PPO health insurance providers, like HMO providers, also sometimes subject their network to ‘utilization reviews’. This is where the organization tracks medical care either in dollar amounts or in number of visits per patient. They use it to keep patients from receiving unnecessary treatment…not just to save money (although it does have this effect) but also for the safety of the patient. There are some doctors who would perform unnecessary treatment for money.

PPO health insurance providers also use the utilization review because it pulls statistics together to help identify afflictions. In this way, doctors with less experience come under the eye of ‘big brother’. Although, some people think of such limitations as an intrusion.

How is PPO Health Insurance Different than HMO?

PPO health insurance generally allows policy holders to visit any doctor within the network without a referral from their primary care physician. HMOs usually want a referral before an insurance policy holder can visit a specialist. As a matter of fact, with PPO health insurance, policy holders aren’t even required to choose a primary care physician.

PPO health insurance also (usually) handles patient billing a little differently. With PPO insurance policies, the patient often pays medical expenses and then is reimbursed. Sometimes the health provider invoices the PPO instead of the patient, but the responsibility to pay the invoice still rests on the patient, because treatments don’t require as much approval as they would with an HMO.

Another difference between PPO health insurance and HMO is that PPOs generally allow you to visit doctors and health care centers outside the network. Although, they try to discourage it by paying a smaller percentage of the bill. How much less differs from policy to policy. Some states even limit the percentage of decreased rates.

Is PPO Health Insurance Better than HMO?

This all depends on your situation. PPO health insurance can generally provide all of the benefits someone would need…including specialized services, even if someone has a chronic condition. Some people choose PPO health insurance because it has fewer restrictions. But fewer restrictions mean more money. PPO health insurance costs more than an HMO, and the benefit amounts are usually a little bit lower. Some PPOs require policy holders to pay a deductible. But to some, the money is well worth the added freedom.

What factors affect Health and Life Insurance rates?

Rates or policy premiums are affected by two major influences. The main influence is one's personal health or family health history. The second major influence that affects one's life or health insurance policy premium is age.

Not knowing exactly how much weight age holds in determining life and health insurance policy premiums we do know that two individuals (one 18 years old and the other 60 years old) with the same health and health history show that the 60 year old will always have higher health and life insurance premiums. The amount of weight age holds is likely calculated into a quoting algorithm put in place by actuaries.

Personal health and family health history is a major contributor when calculating health and life insurance premiums. More common for life insurance due to fraudulent activities most life insurance companies will request blood and urine samples to ensure no pre-existing conditions exist. A licensed professional will come to your home to draw blood and collect a urine sample as well as ask dozens of health related questions. Some policy questions involve high blood pressure, heart disease, cancer, diabetes, cardiovascular disease and other serious health risks. Now, there is a Guaranteed Issue Life Insurance policy where the life insurance company has taken an average assumption regarding risk and they will insure any healthy person without blood or urine samples. These Guaranteed Issue Life Insurance policies are capped to a certain benefit meaning the most life insurance you could get is $150,000 or so. If you have perfect health you will find that a standard term policy will have more affordable premiums than a Guaranteed Issue simply because you are paying for some risk with the Guaranteed Issue. The Guaranteed Issue is a good option for those that don't have time or don't deal with needles very well. Please note that with a Guaranteed Issue Policy you still have to answer health related questions and not telling the truth usually ends up with a voided policy or a policy that will not pay death benefits.

Unfortunately, one's health and family history isn't always controllable. Some diseases are hereditary and perfect health which equals affordable health and life insurance policies is not possible. Be in the best health your body or family history allows for and buy health insurance that provides good benefits and is still affordable.

Self Employed Health Insurance

Things you should know when purchasing self employed health insurance

There are more small businesses and self employed than ever. New tax laws and the availability of the Internet encourage entrepreneurs to consider starting a new venture. For the most part, small business owners or self employed have had health and/or dental insurance provided by their previous employers. Your employer provided health benefits and your premium is often taken out of your paycheck or simply included in the position. After accepting the job you received a member card and a policy in the mail. When you or your family is ill you go to the doctor and pay your copay. One never really thinks about dental or health insurance coverage above and beyond what policy was issued by your previous employer as you had zero choices.

The biggest difference for small business or self employed is the availability to choose your own insurance policy. This means you have the opportunity to Educate yourself on the different insurance companies and types of coverage.

Along with the choice to choose your insurance provider you will need to consider the benefits or drawbacks of buying a personal insurance policy or buying a group/business policy. There are many differences with the two types of polices so one should refer to an agent for the respective insurance company.

Self Employed Health Insurance is an affordable benefit you can purchase for your family or your employers. If you believe your small business will grow quickly you should consider a group plan to offer potential employees. Self-employed or work from home businesses may find a personal policy more beneficial. As mentioned above, one should definitely speak with a professional agent and be sure to explain your situation in great detail so the agent can provide the best possible presentation.

Unemployed Health Insurance - COBRA

If I change jobs or become unemployed, can I bring my coverage with me?

If you switch employers, you have the right to carry your group health insurance coverage with you to a new job for up to 18 months under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

You must pay the full premium, but at group rates that are far cheaper than the individual rates you would pay for similar coverage. Health insurance under COBRA is available if you are in the following situations:

1. You leave a company and become unemployed or self-employed for up to 18 months.

2. You are a widow or widower or child of an employee who dies while working for the same company for three years or more.

3. You are the divorced spouse or child of an employee who has left the company he or she was employed at for at least three years.

4. You are the child of an employee who left a job and have not yet reached age 23.

NOTE: If you need COBRA benefits, you must fill out the appropriate forms from your employer’s benefits department within 60 days of leaving your job. If you do not act within that time, you may be denied coverage.

Information provided by Insurance Information Institute

Average Insurance Costs - average cost of auto, home, health & life insurance

As we all know, costs of insurance premiums differ depending on dozens of different factors. I will remind you that this is not concrete data, the figures below are what estimate to be average costs of auto, health, life and homeowners insurance premiums. How do we get our estimates? We take average cars, average home costs, average family size and ages to determine what we feel are sound averages.

So insurance costs differ and some of the reasons insurance premiums differ are related to ones location, ones age and even the frequency of payment can fluctuate an insurance premium. Yes, in some instances if you agree to pay for the whole year in advance you can get a discount on your insurance premium. Those that pay monthly will likely miss out on the discounts provided by paying less frequently. Location seems to play a big role in how actuaries and underwriters determine insurance premiums. This makes sense in certain instances such as a home insured in a coastal state where damage from catastrophes such as hurricanes and earthquakes are more common than inland states. In fact there are many reasons why ones homeowners insurance premium may differ. Health and Life insurance premiums differ depending mostly on one's age and current health state while auto insurance rates are determined mostly on vehicle type, drivers age and driving history.

So now we have the basic reasons why insurance costs differ lets look at some averages.

Average cost of Homeowners Insurance - $1000 per year
Average cost of Auto Insurance - $800 per year
Average cost of Health Insurance - $1800 per year for adult individually and $4800 per year for a family.
Average cost of Life Insurance - $500 per year

One thing we didn't mention above was the different types of insurance products one can purchase that effect an insurance premium. For example, Term Life Insurance is less expensive than Whole Life Insurance policies. An HMO or PPO is less expensive than an Indemnity Health Insurance policy.

Of course, your cost for insurance policies will not be the exact averages we've listed above so be sure to receive your own free insurance quotes.

Considering Small Business or Self-Employed Health Insurance

Do you own a small business, or are you a freelancer or independent contractor that works for yourself? There are many personal and financial benefits to self-employment and small business management, but one tricky area for you may be the whole domain of health insurance. If you were previously employed, you probably enjoyed the benefits of health insurance through your work, where a percentage was paid by you and the rest through your work. However, now that you’re “on your own,” so to speak, finding, attaining, and paying for health insurance becomes a whole different ball game.

A significant number of small business owners and self-employed individuals either operate with a reduced amount of health insurance coverage, or with no insurance whatsoever, mostly for reasons of ignorance or rising rates. In fact, according to a Kaiser Family Foundation study, nearly 25 million self-employed Americans (and their families) are without health insurance.

You may not think you need any health insurance coverage now that you’re self-employed or managing your own business. However, statistics say that small business owners, freelancers, and contractors without health insurance are at high (in fact, double) risk for the financial implications of both sickness and injury should they occur. First, they have to bear the full costs for care and treatment related to their injury or sickness, and second, their injury or sickness could negatively impact their business if they’re out of commission for a period of time. You will certainly want to avoid these unfortunate situations.

This is where health insurance comes in, and it’s definitely something to consider if you’re self-employed in any fashion. You have a number of options where health insurance is concerned. Buying individual health insurance is one, although you’ll soon find that this option can be quite expensive. But if this is the route you may want to take, do some research and comparison shopping with different health insurance plans and policies. Acquiring an MSA (Archer Medical Savings Account) is another option, as is choosing COBRA (Consolidated Omnibus Budget Reconciliation Act), a federal law requiring employers to allow their employees who are leaving to purchase health insurance through their group plan. However, MSA and COBRA can also get quite pricey, particularly the latter if you are used to your employer covering a large portion of the health insurance expense.

You could also look into acquiring a health insurance plan through some type of professional organization or association, or find health insurance specifically geared toward the self-employed and small business owners through government-based, partially-funded (subsidized) programs.

Something else to keep in mind with respect to health insurance for the self-employed is that you’ll likely be able to take advantage of some tax breaks and deductions. In the past, if you kept track of (itemized) your expenses for tax purposes, you could usually claim the difference between what you spent on medical-related expenses that were not reimbursed and 7.5 percent of your adjusted gross income in a year.

However, since 2003, all self-employed individuals are able to claim all their medical expenses as business expenses, regardless of their adjusted gross income, and often even if you don’t itemize your deductions on your tax return.

It’s recommended to sit down with a qualified health insurance agent who specializes in self-employment cases to discuss your options and eligibility.

Health Insurance Options for the Self-Employed

One of the biggest concerns self-employed workers often have is locating, as well as being able to afford, health insurance for to help cover their medical expenses. Health insurance rates and deductibles tend to be high for the self-employed worker, leaving many self-employed workers without medical coverage in which they could afford. The following paragraphs will discuss some of the health insurance options available for self-employed workers.

Please keep in mind that some of the laws regarding health insurance for the self-employed will vary from state to state. However, COBRA, or Consolidated Omnibus Budget Reconciliation Act, is a federal law. It simply requires any company employing more than 20 employees to permit those terminating their employment to continue their current health insurance coverage for a minimum of 18 months. This is good news for employees leaving a company in order to pursue self-employment. COBRA will enable these workers ample time to find other health insurance arrangements to best meet their individual needs.

One option a person pursuing a self-employed career can consider for health insurance is being added to a spouse's policy. If a spouse is gainfully employed, by a company that provides health insurance options, it is very likely it would be less expensive to be added to that policy, as opposed to trying to find one independently. Some companies are even offering health insurance coverage for domestic partners.

If a self-employed worker does not have a spouse or a domestic partner, there are other options they can consider when it comes to health insurance options. Some states now allow self-employed works to present themselves as a "group of one", thus purchase a health insurance policy at group rates. The premiums for "groups of one" are most generally less expensive than premiums on a typical individual policy.

If a worker is just beginning in self-employment, and simply cannot afford a health insurance policy of any time, seeking part time employment can be a solution. Many companies now offer health insurance benefits to their part time employees, although sometimes the employee must first work through a probation period. This option will allow the self-employed worker time to build their business, and still maintain health insurance while doing so.

When shopping for an individual health insurance policy for a self-employed worker, it is very important to do some research. As stated earlier, health insurance laws will commonly vary from state to state. What may apply to self-employed workers seeking insurance in Texas, may not apply to self-employed workers seeing health insurance coverage in Ohio. Doing thorough research when trying to find the best health insurance policy for a self-employed worker can be vital for this very reason.

During the research process, it is as equally as important to compare prices of different health insurance policies available for self-employed workers carefully. The ultimate costs of individual health insurance plans can vary greatly depending on several factors. These factors can include:

• age
• medical history
• the individual health insurance provider

In some cases, the individual health insurance provider will require an applicant to pass an in depth medical exam before they are approved for coverage. Because of the overall high costs involved with this type of health insurance plan, it is very important to compare costs of several different policies with extreme care.

What Kind of Health Insurance is Best for You?

When it comes to choosing health insurance, many of us just pick the one that will take the smallest bite out of our paycheck each month. Choosing health insurance on the basis of premium cost is one way to go about making a choice, but it could end up costing you a lot in the long run. Before you make a decision that will affect you and your family’s health care for years to come, take the time to research your options and choose the one that will offer the benefits that your family needs.

There are a number of different types of health insurance, each suited to a particular need or type of use. Choosing the right one is a matter of knowing the kind of coverage that will suit your family’s needs the best.

Indemnity Insurance
Indemnity insurance, also known as fee-for-service health insurance, is the oldest type of health insurance. The insurance company establishes a schedule of fees that lists how much they will pay providers for various procedures. The subscriber – that’s you – is free to choose from any doctor they want, including specialists, to provide the medical care that you want. The doctor bills the insurance company, who pays the amount set out in the fee schedule. You’re then responsible to pay the rest out of your pocket. Usually, you’ll be responsible for a deductible – an amount you pay out of pocket each year before the insurance coverage kicks in – and may also have to pay a co-pay when you visit the doctor. Indemnity insurance offers you the most flexibility, but in general, you’ll pay far more for that flexibility.

Preferred Provider Organizations
Preferred Provider organizations, or PPOs, are networks of doctors and health care providers who agree to accept certain fees for certain services. With a PPO, you choose a doctor or medical provider from within the network when you need medical attention and your cost will be lower than if you choose a doctor who is not a part of the network. You don’t need a referral to access specialist services, and don’t usually have the advantage of having a primary care physician to manage your health needs. Your out of pocket expenses will include a deductible that you have to meet before insurance coverage kicks in and a co-pay when you visit a doctor or provider. If you choose a doctor outside the network, you’ll also end up paying the difference between what the plan will cover and what the doctor charges, as well as, typically, a higher co-pay.

Health Maintenance Organizations
HMOs, sometimes called managed care organizations, first came into being in the mid-1970s. They operate on the principle that prevention is the first step to good health. In order to ensure that patients get necessary care, HMOs generally require that you choose a primary care physician who manages all of your care. Your primary care physician will make referrals to specialists if needed, and you always have the option of seeking a second opinion. The HMO is generally the least expensive type of insurance as far as out of pocket expenses are concerned. In generally, your financial responsibility will be confined to a co-pay whenever you visit the doctor. HMOs encourage annual physicals, eye exams and screening tests in the name of preventing illnesses and early diagnosis and treatment.

Those are the major options. Others include discount health plans, long term care plans and point of service plans. Each has its own advantages and disadvantages, so shop wisely before deciding on one coverage.

How Insurance Companies Are Working for Your Health

Medical insurance is a major concern for most Americans. With the rising cost of medical care, health insurance is an ever increasing portion of the monthly budget. Depending on your employer and the region of the country where you live, a family health plan can set you back as much as $1000 a month. The high cost of health insurance is directly tied to the high cost of medical care. The costs of caring for a broken arm, for example, can run up into several thousands of dollars when you count in casts, X-rays, pain medication and lab tests.

While accidents and catastrophic illnesses can take a chunk of cash in one fell swoop, the costs of managing chronic conditions like diabetes, high blood pressure and heart disease is even higher. Between daily medication, periodic testing and emergency care for related conditions, it can literally cost hundreds of thousands of dollars a year to manage care for active diabetes.

That fact lies behind many of the initiatives and changes to typical health insurance over the past twenty years. These are some of the things that health insurance companies are doing to lower the costs of medical care – and encourage a healthier America.

Prevention lowers the cost of health insurance.
Nearly all major health insurance plans encourage and pay for routine medical care. It only makes sense – healthy people need less medical care. The best way to lower the cost of medical care overall, the insurance companies finally realized, is to make sure that their subscribers have access to preventive and maintenance care. Many health maintenance organizations offer annual checkups and medical screenings for conditions like high blood pressure and elevated blood sugar levels for free because catching health conditions early means managing them more effectively – and less expensively.

Knowledge helps reduce costs for all.
Nearly every major health insurance company in the country underwrites millions of dollars worth of research annually to help identify the best ways to provide and track treatments for various medical conditions. Working on the belief that preventive care reduces later medical costs, health insurance companies fund initiatives to offer health insurance for free or at reduced rates to underinsured populations, educate their subscribers around health issues and bring eye, dental and medical care to populations that can’t afford routine care.

In doing so, they lower the cost of health insurance for everyone by lowering the expense of caring for uninsured patients in medical crisis. Those costs, usually footed by the hospital or medical facility, are passed on to the insurance companies in the form of higher medical costs for everyone, and to the consumer as higher cost for health insurance.

Opening the door to alternative and complementary treatment opens the door to lower costs.
Many health insurance companies now offer benefits for subscribers that aren’t usually considered as “medical care”. These things include health club memberships, nutritional consultations, yoga and meditation classes and smoking cessation programs. Most cover counseling sessions for stress management since stress is recognized as a major contributing factor to illnesses. They may fund wellness clinics to educate consumers about the value of exercise and balanced diets, offer the loan of medical equipment for special situations and cover acupuncture, chiropractor sessions, massage therapy and even vitamin and mineral supplements.

By taking the initiative in education and research, the major health insurance companies are working hard to reduce health care costs for all. Check with your health insurance company to see what benefits they offer that could help you stay healthy.

I’m pregnant, can I get health insurance now?

If you are already pregnant, unfortunately the options for insurance are slim to non-existent. It is a good idea to plan ahead and get health insurance in place before you become pregnant, but if it's already too late and you are pregnant without insurance, you may have a few options available.

Medicaid is an option for you if you are within the low-income guidelines set out by Medicaid. If you are a college student, the student health center at your college may be able to offer you some advice and leads for health insurance.

Another option for you is to attempt to get into a group health plan that will cover your pregnancy. You could do this by getting a job that offers an employer sponsored health insurance plan that provides for maternity coverage or by getting a group policy that covers maternity and pregnancy through a professional organization or chamber of commerce.

There are some states in the US that offer Children's Health Insurance Program that covers pregnant women. The CHIP program is a federal-state program that provides health benefits to children whose parents can't afford insurance but still make too much to take advantage of any of the existing welfare programs. Subsequently, after your baby is born, they may be eligible for health insurance under the Children's Health Insurance Program and in some states; the mother may also qualify for health insurance through the program with her child or children.

The federal law bars group health insurance plans that do cover maternity from considering pregnancy to be a pre-existing condition. What this means for you is that if you change health plans while you are pregnant, the new health insurance provider can not deny any of your claims related to your pregnancy, as long as they have maternity coverage. It's important to recognize the loopholes though that many women fall into while they are pregnant that could mean a lack of prenatal care coverage.

The downfall to this law is that it applies mainly to group health insurance plans and does not extend to individual health insurance plans. This could mean that if you are pregnant and on an individual health insurance plan and you change to another individual health insurance plan, you may not have pregnancy coverage at all, or you may have to wait for a period of time. However, in some cases you will be offered insurance to cover your pregnancy but it will likely be very expensive.

It is very important that you take responsibility for health coverage into your own hands. No one is responsible to ensure your coverage for health insurance—even your employer is not required to offer health insurance. Before you get pregnant, or if you think you may end up getting pregnant, get onto a health insurance plan with maternity coverage. Keep in mind that many insurance companies have a waiting period of eligibility, from one to three months, so it’s best to get onto the plan in advance of getting pregnant.

What Is Catastrophic Illness Insurance?

A catastrophic illness can, even with full medical insurance, wipe out a family’s savings. The high deductibles and expenses associated with illnesses like cancer, heart attacks and strokes can quickly drain savings accounts and retirement accounts and make it difficult to pay for necessary care. Catastrophic illness insurance can help cover the necessary medical expenses and provide needed funds for care.

Many catastrophic illness policies are specific to a particular illness. There are policies that will pay benefits if you are diagnosed with cancer, have a heart attack or a stroke, or require long-term care because of age or disability. None of these policies will cover you for conditions that were pre-existing, but they can be invaluable if you are ever diagnosed with a covered illness.

What is the likelihood that you’ll need catastrophic illness coverage? Your likelihood of being diagnosed with cancer before the age of 60 is about six times greater than your likelihood of dying before the age of 60. You’re more likely to need cancer insurance than life insurance – but far more people carry the latter. Approximately 60% of those who reach age 65 will eventually require long term care – but less than 10% of us have insurance that will cover the costs.

The benefits from a catastrophic illness policy can be used to cover expenses that are not normally covered under medical insurance policies. Those may include the cost of in home nursing, or of converting a home to make it wheelchair accessible. They can pay for alternative and supplementary treatments that traditional insurance policies won’t cover, including nutritional counseling, therapeutic massage and complementary medical treatments. A catastrophic illness policy may cover the costs of experimental treatments or treatments like organ transplants that are only partially covered by typical health insurance policies.

How important is critical or catastrophic illness insurance? According to Dr. Marius Barnard, brother of Christian Barnard who performed the world’s first successful heart transplant, 37% of home foreclosures in Canada are the result of heart attacks, strokes and cancer. By contrast, less than 7% of home foreclosures were the result of the death of a family breadwinner. The settlement from a catastrophic illness policy could save your home, and save your family from years of debt to pay off the high bills associated with your illness.

There are many different types and configurations of catastrophic illness policies. Some can be purchased like whole life policies. Others offer term coverage for terms up to ten years. There are policies that will return the entire premium paid if you don’t make a claim against them before the age of 65. Some insurers even offer a referral service as part of their critical illness insurance package.

Pricing on critical and catastrophic illness policies varies from insurer to insurer and from policy to policy. Some policies only cover one stated illness. Others may cover up to thirty possible diagnoses, with a schedule of benefits for each diagnosis. Obviously, the cost varies according to the benefits and the conditions covered. To learn more about catastrophic illness coverage and long term care coverage, speak to an insurance agent.

Top 10 Tips when buying insurance - health, life, auto and homeowners

1. Buy life insurance when your young and healthy.

2. Smoking will dramatically raise prices of your life and health insurance premiums.

3. Buy Return of Premium instead of regular term life insurance. (You get all your premium back once the term is done.)

4. Don't let your health insurance lapse. (You may not be eligible if your health is not the same as it was before)

5. Lock into a health insurance policy when your young. (Getting health insurance when your older is much more difficult)

6. Always go with a large known company. (This is true for all your Insurance needs)

7. Always negotiate your claims, especially with auto insurance. (Your auto insurance company will try to give you the least amount they can)

8. Research homeowners insurance prices in the area your considering before you purchase your home. (Some homeowners insurance can be extremely expensive depending on the location. Ocean front property in hurricane spots can run very high premiums).

9. Be sure your Doctor records events accurately. (A misdiagnoses can mean increased health insurance premiums or if your uninsured it can mean uninsurability.)

10. Security alarms, certain siding and roofing materials can dramatically lower homeowners insurance premiums. (Consider these factors when building your dream home.)