7 Key Health Insurance Terms You Always Need to Know

Forget Obamacare. It is falling apart fast and in the process of being replaced by Congress and the President. 

Affordable health insurance is coming soon and knowing the meaning of key health insurance terms is essential whether you are comparing policies, or need to know what to ask an agent.

Below is a list of key health insurance terms to help you understand more about what your health insurance plan has to offer.

1. Deductible
The deductible refers to the amount of money that you need to pay before any benefits from the health insurance policy is paid. This is usually a yearly amount. Consequently, when the policy starts again, usually after a year, the deductible would be in effect again. Some services, like doctor visits, may be available without first meeting the deductible. Usually there are separate individual deductible amounts and total family deductible amounts.

2. Co-insurance
This is usually a percentage amount that is  your responsibility to pay. A common co-insurance split is 80/20. This means that the insurance company will pay 80% of the procedure and you are required to pay the other 20%.

3. Co-payments
Co-payment is a fixed amount that you are required to pay at the time of service. It is usually required for basic doctor visits and when buying prescription medications.

4. Out-of-Pocket
This is the cost you would pay out of your own pocket which can refer to how much the co-payment, coinsurance, or deductible is. Also, when the term annual out-of-pocket maximum is used, it is referring to how much the insured would have to pay of their pocket, excluding premiums, for the whole year.

5. Lifetime Maximum
This is the most amount of money the health insurance policy will pay for your entire life. Pay attention to individual lifetime maximums and family lifetime maximums as they can be different.

6. Exclusions
The exclusions are the procedures that the insurance policy will not cover. 

7. Pre-existing Conditions

This is something you had before obtaining the health insurance policy. Some plans will cover pre-existing conditions while others may completely exclude them. Then again, some health insurance plans will cover pre-existing conditions after a certain time period.

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Don't Buy Health Insurance Until You Read This

Keep Regular Dental Visits

It has been said that the best health insurance is moderation. 

However, even though you may be conscientious enough to get a regular physical examination, you may unexpectedly experience symptoms that may require you to get an urgent examination to find out what’s going on and to get treatment.

If hospitalization is necessary, then you have to get admitted. To meet these expenses without insurance can wreck havoc on your bank account.

According to the National Association of Health Underwriters, only 5 percent of Americans get their health coverage from an individual health insurance policy. Individual health insurance is a type of health care coverage that is provided to individuals rather than to employers or organizations. It can be sold to an individual or to a family.

There are 4 major advantages to choosing an individual health insurance plan rather than employer-based coverage:

1. You can customize your coverage, where employer-based coverage may provide limited options.
2. You have the freedom to pursue better rates with other companies.
3. Depending on your circumstances, it may be more affordable than employer-based health insurance, particularly if you're paying for coverage via COBRA.
4. It's not dependent on an employer. Individual health insurance plans protect you no matter where you work.

Maintaining health insurance coverage doesn't have to cost a fortune and neither does dental insurance. Here are a few ways to help keep your health insurance premiums low:

1. Costs can vary widely depending on the insurer, sometimes by as much as 50 percent for similar plans. Make sure you shop around.
2. The higher your deductible, the lower your monthly premium. You'll be responsible for more out-of-pocket costs should you need to file a claim, but the money you save on your premium may be well worth the risk.
3. Keeping yourself healthy can save you money on health insurance costs. Excess weight or tobacco and alcohol usage will drive up your premium.
4. If a member of your family isn't in perfect health or is of advanced age, it may be more affordable to purchase separate health insurance plans.

Protect yourself and your family with the health insurance coverage you deserve.

Any comments? Leave them below. For a free consultation, call (773) 614-3201 or e-mail me a bwillbar@gmail.com.  

11 Rules for Reading any Insurance Policy

I know you don't like to read your insurance policies, but let's face it you do need to. You're paying for them and you may eventually need to make a claim.  

Rarely do insurance brokers, even those who have been in the business for decades, take the time to read an entire policy. 

When they do so, they are generally seeking a specific answer or researching a problem -- undertakings that require them to review only individual parts of the coverage form and/or its applicable endorsements to determine the required answer or opinion.

Whether reading an entire policy or only sections, these 11 Rules can be applied in reading the policy form to make finding the needed answer easier and quicker.

These are not shortcuts to reading the policy, as there is no shortcut to reading any legal document, just pointers towards correct policy interpretation and application. Here are the 11 Rules for Reading any Insurance Policy:

1.  Ascertain who qualifies as an insured.
2.  Confirm that all Forms and Endorsements are attached.
3.  Read the Insuring Agreement first
4.  Read the Exclusions.
5.  Read the Exceptions to the Exclusions.
6.  When the policy refers to another section, read that section immediately.
7.  Pay attention to the conjunctions used in a list.
8.  Pay attention to key words and phrases.
9.  Read and understand the Definitions of Specifically Defined Terms.
10.  Understand and make sure all the policy conditions have been met.
11.  Confirm the coverage limits are adequate for the loss.

Do you have any questions concerning any of your policies, email me your questions. 

If you have any comments, leave them below.  

How to Choose the Best Medicare Supplement Plan for 2018

The Medicare Supplement Plans, sometimes called Medigap Plans, were required in August 1, 1992 to become standardized. 

That means that all companies that sell these Plans have to sell the exact same type of Plan.

Original Medicare has significant deductibles and coinsurance features that you as a Medicare recipient are required to cover.

What Med Supp was Designed For 
If you don’t have adequate personal finances to do so and you experience a serious illness and have to be hospitalized, you may find yourself in bankruptcy. The Medicare Supplement Plans were designed to address this type of situation.

After the recent revision in 2010 of the Medicare Supplement Plans, the new Plans are identified by these numbers – – Plan A, B, C, D, F, G, K, L, M, and N.

Take these factors into consideration when you make your choices. The most popular Medicare Supplement Plans for 2018 are Plan F, N, and G.

Plan F Medicare Supplement Plan
The best Medicare Supplement Plan is Plan F. This Plan pays 100% of the gaps in coverage left by Medicare and covers you quite well. With this Plan, and there are no co-pays, no deductibles, and no coinsurance. You also have the ability to go any doctor or hospital in the U.S. that accepts Medicare.

Plan G Medicare Supplement Plan
The second best Medicare supplement plan is Plan G. Plan G offers all the same coverage as Plan F, although plan G has an annual deductible, it often costs about $300 less per year in premium, so the savings can be worth it if you don’t mind paying the deductible each year at your first doctor visits.

Plan N Medicare Supplement Plan
The third popular plan for 2018 is Medicare Supplement Plan N. This Plan is similar to Plan G in that it also has a deductible. But it also requires a co-pay for office visits and a co-pay for ER visits. However, the ER co-pay can be waived if you are admitted to a hospital.

Plan G - The Best Medicare Supplement Plan
I think that the best Medicare Supplement plan overall for 2018 is the Plan G. Plan G offers you the best value for your money. After the annual deductible Plan G gives you the convenience of no co-pays and no other out-of-pocket costs, as well as ability to choose your own doctors and hospitals.

Moreover, in that this is not the most expensive plan, it will allow you to save as much money as possible while still maintaining good health care coverage. Now the next steps in securing your family's financial independence.

If you would like to learn more about the Plans and prices available in the Chicagoland area, call me at (773) 614-3201. Looking forward to hearing from you.

5 Ways You Can Save Money on Medicare Prescription Drugs

Medication costs can make up a large part of your budget, but a few tips on saving money can easily save you hundreds of dollars a year. 

The biggest single cost-saver? Picking the right Medicare plan.

Whether you are preparing to change your Medicare plan, or signing up for Medicare for the first time, you will want to make a careful selection so you don't end up spending more than you need to.

Asking your doctors a few key questions—such as, Is there a generic?—can save you a bundle more. 

Here are 5 tips you can save money on your prescription drugs:

1. Focus on choosing the right drug plan, which depends in part on which drugs you take.
The majority of seniors are enrolled under original Medicare, which includes hospital insurance (known as Medicare Part A) and medical insurance (Medicare Part B).

Getting drug coverage requires one of two additional extra steps. Seniors can either get drug benefits via a private plan regulated by the government, under what's called Medicare Part D, or they can get drug coverage bundled with a private Medicare Advantage plan. 

The alternative is a Medicare Advantage plan, also called Medicare Part C, which replaces original Medicare and often providesprescription-drug coverage as well. 

It is essentially a way to get Medicare A, B, and D all lumped into one. Medicare beneficiaries can enroll in Medicare Advantage to receive their benefits in a private health plan, such as a health maintenance organization (HMO).

You need to  evaluate on an individual basis which is your the best option. Depending on your prescriptions and other health care needs, Medicare Advantage may or may not be better for you than original Medicare.

2. Have Drugs Delivered.
For medications you take regularly for a chronic condition, opt for the convenience and potential cost-savings of mail-order. In addition to sparing you unnecessary trips to the pharmacy, mail-ordering can sometimes include a 90-day supply at a reduced cost, depending on your insurance company and what kind of meds you need.

Once you enroll in an insurance plan you should be able to go that insurer's website to order your prescriptions delivered, or you can do it over the phone.

Be sure to ask your doctor whether he or she needs to sign off on a 90-day supply. And take care to order refills before you need them so there isn't a gap of time when you don't have any pills.

Also beware of illegal pharmacies on the Internet, which can pose a serious danger by sending you fake or incorrect prescriptions. Legitimate pharmacies will ask for a faxed prescription from a licensed doctor and a detailed medical history. They will also clearly state their payment, privacy, and shipping fees, according to FBI warnings.

3. Go Generic.
Ask your doctor if this is an option. The brand-name version of the drug you take is significantly more expensive than the generic form, if one is available.For example, simvastatin is the generic version of the drug Zocor, which is prescribed to control elevated cholesterol. Thirty 40mg tablets of the brand version of the drug may cost between $88.90 and $113.20 a month, while the generic equivalent can go as low as $15 a month.

4. Double the Dosage, and Split the Pill. 
Sometimes pills that are double the dose of your medication cost the same as a single dose, and can easily be cut in half. For instance, if your doctor says you need a 10 mg dose of a particular drug each day, ask him or her whether your medication comes in doses of 20 mg and if they can safely be split in half.

Many drugs used to treat high blood pressure and depression can be split, as can all cholesterol-lowering drugs known as statins.

5. Enroll on Time.
The open enrollment period for Medicare is from October 15 to December 7, with changes taking effect January 1. You can enroll for the first time when you turn 65, and there are also Special Enrollment Periods for when you move or become eligible for Medicaid.

  

Though Medicare drug coverage is considered voluntary, you must be getting drug coverage from another source that is at least as good as the offerings through the federal government. If you do not, you can face a penalty fee that grows each month you delay enrollment.

If you are receiving another form of drug coverage, you may actually end up spending more if you sign up with Medicare. This applies to members of the Federal Employee Health Benefits Program, TRICARE (military health benefits), and Veterans Affairs. 

If you are an active worker on an employer plan, you will want to talk to your human resources department to make sure you understand all of your options.

If you have questions regarding your Medicare benefits, email me at 
Ask Will, bwillbar@gmail.com or call (773) 614-3201.

Know These Three Health Care Terms Before Obtaining Obamacare

Until Obamacare is repealed and replaced, you are stuck with it unless the new President is a Republican. 

If Hillary becomes President, Obamacare will continue and both the cost and the penalties will just get worse along with your choice of doctors and hospitals being seriously diminished. 

Nevertheless, here are the three health insurance terms you need to know before buying an Obamacare policy or just a regular health insurance policy.

Premium

The total amount paid to the insurance company for health insurance coverage. This is typically a monthly charge. Within the context of group health insurance coverage, the premium is paid in whole or in part by the employer on behalf of the employee or the employee's dependents. Unearned premium is the portion of a premium already received by the insurer under which protection has not yet been provided. The entire premium is not earned until the policy period expires, even though premiums are typically paid in advance.

Deductible

The amount of loss paid by the policyholder. A specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for service or claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans may or may not typically require a deductible, while most Indemnity and PPO plans do. In general, the bigger the deductible, the lower the premium charged for the same coverage.

Coinsurance

The amount that you are obliged to pay for covered medical services after you've satisfied any co-payment or deductible required by your health insurance plan. Coinsurance is typically expressed as a percentage of the charge or allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance. After paying 80 percent of losses up to a specified ceiling, the insurer starts paying 100 percent of losses.


Call (773) 641-3201 for answers to your health care questions or to get a quote. 

Any comments, leave them below.

Medicare Fundamentals: Part A and Part B

Over 47 million seniors age 65 and older, and people with certain disabilities and medical conditions, get their health care coverage through Medicare. While Medicare covers many health care services, it does not cover everything. Below is what you should know.

If you have Original, Fee-for-Service Medicare, the following applies to you:

Medicare Part A ("Hospital Insurance") does over: 

Inpatient care in a skilled nursing facility for a limited number of days, following a qualifying three-day minimum inpatient hospital stay for a related illness or injury

Home health services as ordered by a doctor (or other health care provider), including nursing care; physical, speech or occupational therapy; medical social services; home health aide services and medical supplies for use at home

Hospice care if you have a terminal illness with a life expectancy of 6 months or less, as certified by doctor, at home or facility where you reside. Limited coverage for stays in a hospice facility, hospital or skilled nursing facility for pain or symptom management

Services Medicare Part A does not cover include:

Custodial care or long-term care in a skilled nursing facility or nursing home. Custodial care includes non-skilled personal care, such as help with  bathing, dressing, eating, getting in and out of a bed or chair, or toileting.

Medicare does not pay for room and board costs or non-skilled personal(custodial) care in a nursing home, or long-term care or assisted living facility. It does cover Medicare-approved medical care and services, ordered and rendered by a Medicare-enrolled health care provider, such as a doctor or physical therapist, to the beneficiary who is a resident.                                                                            

    Services Medicare Part B ("Medical Insurance") does cover:         

• Doctors' visits, services and tests; outpatient care and services; some home health   services       not covered under Part A; Medicare-cove red durable medical equipment (DME), prosthetics, orthotics and supplies
• Medicare-covered services provided by non-physician health care providers, such as nurse practitioners, physician assistants, social workers, psychologists, physical therapists, and other
• Many preventive services and test
• Outpatient mental health care
• Kidney dialysis services and supplies
• Ambulance transport for medically-necessary services (limited)
• Chiropractic services (limited)
• Eyeglasses (limited to after-cataract surgery that implants an intraocular lens)
• Some prescription drugs (i.e. injections in doctor's office, certain oral cancer drugs
• Transplants and immunosuppressive drugs

Things that are not covered by Medicare, under either Parts A or B, include: routine dental care, dentures, hearing aids and exams for fitting hearing aids, cosmetic surgery and acupuncture.

For those who get coverage through a Medicare Advantage Plan (Medicare Part C), the story is a bit different. Medicare Advantage Plans are offered by Medicare-approved private insurers, and must cover all the services covered under Original Medicare, except hospice care, which continues to be covered by Original Fee-for­-Service Medicare even when a person is enrolled in a Medicare Advantage Plan.

These plans, which may charge a premium, deductible and co-insurance, may include extra benefits and services not covered under Original Fee-for- Service Medicare, such as dental and vision care, glasses, hearing aids and health and/or wellness programs. Most plans also include prescription drug coverage, available to those in OriginalMedicare under Part D.

 E-mail your Medicare questions to me at Ask Will at wwillbar@gmail.com