Ask the doctor


Health Insurance 101 for Individuals and Families

The changing healthcare and healthpolicy exclusions so that you will not
insurance landscape in the United Statesbe surprised down the road if a claim is
has resulted in more individuals anddenied. This is important whether you
families purchasing health insuranceare purchasing a standard medical,
coverage on their own. Rather thantemporary, or student health insurance
touch on the number of reasons why thispolicy.
is the case, I would like to provide6. Does the insurance company you are
individuals and families findingconsidering have a substantial network
themselves in this position with tenof preferred doctors and hospitals in
basic ideas to assist them with gettingyour area? In addition to family
the best health insurance policy fordoctors, what type of access will you
their specific situation. Below is ahave to specialists and the best
combination of ten questions andhospitals in the event you or a family
suggestions that will provide the toolsmember is diagnosed with an illness that
necessary to get a medical insurancerequires specialized care? Also, what
policy that will best work for you andare your options for preferred health
your family.care providers when traveling?
1. What are your typical health and7. If you need to go "out of network",
medical care expenses in a calendarwill you still have coverage? Most
year? Most people are surprised wheninsurance policies will have coverage in
they go through this exercise to learnthe event you need to go outside of
that they would be financially bettertheir network for care. However, review
off in most years to purchase a highhow these out of network claims will be
deductible health insurance plan and usepaid. Will there be an additional
the premium savings to directly offsetdeductible? How are reimbursement
heath care expenses throughout the year.levels determined for out of network
2. How long do you anticipate needingclaims? What is your maximum out of
the health insurance coverage? Forpocket for out of network claims?
example, many companies sell temporary8. Are you looking for an opportunity to
policies that can be put in force forreduce your taxable income? If so, make
1-6 months and they are relativelysure your plan qualifies as a high
inexpensive. If you are in between jobsdeductible health plan and look into all
or in a waiting period for employerof the aspects of a Health Savings
coverage, this may be your best option.Account. In the right situation, HSAs
3. What is your budget? If your budgetcan be an excellent way to pay for
is tight, having a $1000, $2500 or eveneligible health care expenses, reduce
$5000 deductible is better than havingyour taxable income and save for
no coverage at all. The ability ofretirement.
doctors and hospitals to save and9. What are the financial ratings of the
prolong life in the United States is ininsurance company you are considering?
many cases extraordinary. However,A.M. Best, Standard & Poor's, and
their treatment is not free and goingMoody's are organizations that rate the
without health insurance coverage can infinancial stability of insurance
some cases result in you and/or yourcompanies.
family losing an entire life's worth of10. What type of customer service will
savings and assets.you get from your insurance agent? Do
4. Be careful to choose a plan thatthey specialize in health insurance? Do
covers the "big stuff". It is nice tothey have a staff that is willing and
have a policy that covers items such as:able to assist you in the event you have
physician office visits, routinea claim, billing, or other customer
physicals, outpatient testing, and bloodservice problem?
work. However, it is essential to haveIf you do not have the time or patience
coverage for major services such asto look into all of the items mentioned
cancer treatment, transplants, criticalabove, develop a relationship with an
illness, traumatic accidents, andindependent insurance agent that
infectious diseases. Find out thespecializes in evaluating and servicing
lifetime maximum amount as well as ifhealth insurance policies. A good
the policy contains "internal" dollarindependent insurance agent will be able
limits.to save you time, money, and be an
5. Always carefully read and understandexcellent resource for evaluating all of
the pre-existing condition clause andthe items mentioned above.



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