Finance Tips

There’s much debate around the healthcare system reform proposed by President Barack Obama. And while there are many people who protest against it, and those who support it, it is important to know what it is all about in the first place. Here is a short overview of the reform, which is comprised of three essential parts:

1. Assure all American citizens with access to comprehensive and affordable health coverage

The main features of this part are:

• New Public National Health Plan, which will be very close to the current health coverage provided to federal employees. The main difference is that the new plans will be available to all US citizens for a reasonable price no matter of their financial situation. Deductibles and co-payments will be reduced to minimum, while low-income persons will have the possibility to use additional subsidies.
• National Health Insurance Exchange, which will allow US citizens to look for private health plans. It will set regulations on private insurance providers in order to make sure that private plans are not too different form public ones.
• New business mandate requiring national enterprises to pay for the Public National Health Plan.
• Individual mandate aimed specifically at children.
• More support provided to existing programs like Medicaid and SCHIP.

2. Improve the quality of healthcare services and lower their costs

This initiative presumes federal financial assistance for improving the quality of the services and lowering the costs, with additional assistance to enterprises that cover high-risk employees.

To President’s belief the following actions may also contribute to lowering cost and improving services:

• Special disease management programs for improving chronic care.
• Improving transparency in what concerns quality and costs of healthcare offered by providers.
• Lowering the rates of medical errors.
• Introducing financial incentives to stimulate substantial improvements.
• Providing support for researching new and alternative healthcare technologies.
• Eliminating ethnic disparities in access and quality of healthcare services.
• Popularizing health IT.
• Stronger regulation of insurance and drug markets in order to lower medication costs and allow cheap health insurance.
• Preventing Medicare private plan participants from overpaying.

3. Wellness and healthy lifestyle promotion

This initiative is to be supported through the following actions:

• Special wellness programs at working places.
• Eliminating child obesity with school activities.
• Better education for present and future healthcare workers.
• Promotion of healthy lifestyle in communities.

Saving possibilities with the new initiatives

President Obama estimates that in average a typical American family will be able to save about $2,500 on an early basis after the plan will be implemented. These are the possible sources for such savings:

• Health IT introduction and implementation.
• Improved quality of services.
• Limitations on health insurance provider profits.
• Federal funding of catastrophic coverage that will lead to cheap health insurance.
• Universal coverage availability.

As you can see the Plan requires significant federal funding and that is one of the major points of those who are against it. Other arguments include direct implication to health insurance market, which of course is not quite welcome by the insurance companies. But is the idea of cheap health insurance for everyone that bad?

Perhaps this is an unnecessary statement of the obvious, but the point of insurance is to give people a financial safety net. Should an emergency or disaster strike, money you would struggle to find is paid out by your insurance company. But the squeeze has been on for the last decade as medical costs and the prices of essential drugs have been rising fast. In fact, so fast that the insurers cannot pass on all the increases to their policyholders. It was hard to raise premium rates while the economy was doing well. It became impossible to raise premiums when the recession hit without there being investigations by each state’s Commissioners for Insurance and complaints from everyone else. There comes a point when the insurer cannot get any more blood from the stone and has to sacrifice profits. This has left the medical profession, the hospitals and clinics in a winning position, while the pharmaceutical industry’s profits have continued to rise despite the recession. At the other end of the spectrum, the patients are the losers. There are some who discover the small print in their policies denies cover for the very illnesses they have. There are others whose savings are not enough to pay the deductibles and co-payments. And then there are those whose policies are cancelled when they make a claim for a chronic disease or disorder.

There is a new piece of research from the Commonwealth Fund, an independent, non-profit body. In 2007, it carried out a detailed survey among 2,600 people aged between 19 and 64. When their coverage was analysed, 20% were found significantly underinsured. Why was this happening? Because they were already spending more than 10% of their income on health coverage, whether as premiums, deductibles or both. When the underinsured were added to the uninsured, this represented 42% of adult Americans. Like the uninsured, this forces the underinsured to think twice before they have treatment with more than half either refusing treatment or struggling with debt because of treatment.

In the push for healthcare reform, the focus has been on the uninsured. But this fails to recognize the injustice suffered by the underinsured. No one should be forced to choose between refusing needed treatment and potential bankruptcy. It is therefore going to be an interesting year in prospect as the reform slowly comes into force. Both the poor and the middle class need access to cheap health insurance with reasonably comprehensive coverage. This will further squeeze the insurance industry because it will be denied the right to refuse coverage to those with pre-existing conditions and will be forced to establish group health insurance for those who have struggled to find affordable plans. In all of this, the key to success will be the ability of government and the insurers to impose more control over costs. President Obama has negotiated with the pharmaceutical industry and there is some agreement to hold down prices for those in Medicare and Medicaid. The for-profit healthcare industry also sees some self-interest in moderating its price increases and has given undertakings to the Administration. If some of the pressure is removed from the insurance industry, premium rates will stabilize and the reforms should offer a more fair system to all with a health plan. We can only hope for the best while we wait and see what happens.

If you have been asking questions about healthcare coverage you have definitely heard about health savings accounts (HSAs). Some people advocate that they are the next step in the domain of health coverage, while the others believe that only healthy and rich citizens can benefit from such plans. Before answering these questions it is better to learn what HSAs are in essence and how do they work.

What is a HSA?
A typical health savings account is comprised of two elements:

1) Savings account with interest bearing:
– Yearly deposits of up to $2,900 ($5,800 in case of a family) introduced to the savings account are to be taxed. The money deposited will usually roll over on a yearly basis. However, the money you withdraw from the account for healthcare purposes are tax-free. So are any withdrawals after you officially retire.

2) Healthcare coverage plan with a high deductible
– The minimum deductible amount should be not less than $1,100 ($2,200 in case of a family). That is the amount of money to be paid out-of-pocket before getting the actual benefits.

– When the annual deductible is paid the actual coverage kicks in. You will have to pay all the specified co-insurance and the plan will cover all that remains.

– The overall amount of money to be paid out-of-pocket is limited to $5,600 ($11,200 in case of a family). In other words, after you have spent $5,600 on healthiness services your insurance company will pay for all health costs exceeding that amount.

What are the pros of health savings accounts?
– Because of the fact that any money withdrawn for healthcare use is not taxed, HSAs are a good way of saving more money in your pocket.
– In case you keep the funds without withdrawing them from the account you will have more money after you retire. And since you can freely withdraw the money for any reason after you turn 65 it is a good additional source of retirement money.
– Cheap health insurance plans with higher deductibles have lower premiums than typical plans.
– HSAs don’t depend on your working place and you will keep it the same no matter what.

What are the cons of healh savings accounts?
– Those who have substantial needs in healthcare services will find little use in HSAs since they provide main benefits when the money is kept in the account for an extended period of time.
– People with serious health issues will find it hard to get high-deductible insurance plans, especially if they were already denied of typical plans.
– Some HSAs have additional fees that in sum can make the plan quite costly for the customer.
– Because of high out-of-pocket expenses people tend to go without care, which usually results in complications and more serious and expensive health concerns.

Will a HSA be useful for me?
In case you have no serious health problems and are able to pay the required out-of-pocket expenses than HSAs will definitely be a good option for you. However, you must understand that HSAs require you to be more conscious about your medical costs and the coverage provided by these accounts is much less comprehensive and diverse than with typical health insurance plans. Having an active position in managing own healthcare is a must with HSAs, so if you’re not ready for that then it will be not of a much use to you.

Health insurance market sure looks confusing to those who have to deal with it for the first time in their life. But as with anything that seems complicated at first, health insurance is quite easy to understand when you take some time to learn the basics of it. Of course, don’t expect to become an insurance market specialist overnight but the following tips will certainly help those inexperienced with health insurance shopping to get a decent policy for a fair price.

What you can get?

Individual insurance plans – the most common option for people with normal income, especially those who aren’t offered with group insurance by their employers. The vast majority of insurance companies offer such policies and the diversity of coverage options is very wide here. However, make sure to learn what are the requirements in your state and check if the insurance company is licensed in your area before getting the plan.

High risk pools – some pre-existing conditions will make it hard for you to get typical individual health insurance. That’s where high risk pools may come in handy. Such plans are available only in certain states, so make sure to learn if there are any in your area. If yes, then it would be a good option for those who are considered to be a high risk policy-holder. The rates are relatively high here, but for some it may be the only option for adequate coverage.

HIPAA coverage – this type of insurance best appeals to those who have been recently dropped of employer sponsored group coverage and don’t fall under COBRA coverage too. Health Insurance Portability and Accountability Act (also known as HIPAA) health insurance can be purchased in any state and is particularly useful to those who have pre-existing conditions. Thus, it’s a good alternative to high risk pools or an option where the pools are unavailable. Speak to your insurance agent to decide which option is better for you.

Where you can get it?

Insurance agents – these are independent individuals that provide health insurance quotes and plans from numerous companies. Each insurance agent has his own selection of companies he provides services of, and if there are any question he is the person to ask. However, first make sure that the agent you’re speaking with is licensed to work in your area before getting any services or signing policy contracts. You can do that at your state’s insurance department.

Department of insurance – while not being a direct seller of health insurance, the state insurance department can give you valuable information on local agents and providers you can buy from safely. If there are any complaints about any particular provider, this is the place to learn about them.

Online sellers – the recent trend in many insurance companies going online, as well as the development of independent sources can be a very helpful and easily accessible source of information regarding health insurance. It is very easy to get health insurance quotes online with these sites and shopping for a plan takes you only a couple of minutes.

In case you are looking for a comprehensive type of health coverage with much room for flexibility that still has a reasonable price-tag, a PPO insurance plan may be just the thing you need to cover your health needs.

Preferred Provider Organizations represent a network of medical workers, facilities and other professionals that are contracted by the insurance company in order to get more competitive fees for their customers. So those who are getting their medical services within the specified network will be charged with lower rates than if looking for them outside. However, you can still receive medical coverage outside the network too, only that your rates will be higher compared to what you get within the network.

PPOs can be regarded as a mix of traditional indemnity health plans and later-developed managed care options. In what concerns the network organization of medical services, PPOs are quite similar to HMO insurance plans. However, when you get a PPO plan, you aren’t required to choose a primary care provider (PCP). It’s the main difference between these two quite similar health insurance plan types. And since there aren’t any PCPs in PPO plans, you aren’t required to provide a referral when addressing any given specialist within the network. And when you receive your medical care in a facility or with a specialist outside the specified network your copayments will be considerably higher, but you still will receive partial coverage.

The advantages of PPO plans:

• PPO plans help keeping out of pocket costs within certain annual limits.
• PPO plans let you consult with any medical service provider even if he or she doesn’t make part of your network.
• PPO plans offer substantial money saving potential when receiving healthcare services within the specified network of doctors and facilities.

The disadvantages of PPO plans:

• PPO plans require you to pay the deductible before receiving any coverage.
• PPO plans make services you get outside the specified network a lot more expensive.
• PPO plans have higher copayment rates if compared to other managed plan types.

Flexibility has its price

As my may guess, when a plan provides more flexibility and options it will usually cost more than a cheap health insurance plan with greater restrictions. That’s why PPOs are generally more expensive than HMOs.

Even in case you choose a lower amount of coverage with your PPO plan, there are additional fees and payments that will make your plan more expensive. So don’t base your estimations on the amount of coverage alone.

For instance, besides the usual premiums you have to pay every month, there are also additional coinsurance fees, except for the cases when you use a preventive healthcare service. There is also a deductible to be paid before you can receive any benefits from your PPO plan.

How to get a good plan?

Sometimes it may be quite hard to get a good PPO plan that would provide increased flexibility for a reasonable price. If you feel that a PPO plan is just the thing you need to cover your medical costs, you first would want to get health insurance quotes from numerous providers or talk to your insurance agent about the options you have. Shopping around doesn’t take much time but as a result you can expect substantial savings if you manage to select the right provider.