The Insurance Insider

Unfortunately, Medicare benefits continue to be reduced each year while medical costs continue to rise.  It is becoming ever more important to consider something to fill the gap. Medicare supplements are the answer. 

(NewsUSA) - There are many decisions to make when planning for retirement. Here is one important question to ask yourself as you prepare to leave the work force: “Will Medicare be enough to cover my medical needs?”

Designed to go hand-in-hand with your regular Medicare coverage, Medicare supplement insurance helps cover what your Medicare insurance does not. This private insurance, often called “Medigap,” helps fill the gap between health care costs and Medicare coverage.

Here are some tips from Mutual of Omaha on purchasing Medicare supplement coverage:

* Understand Medicare. Find out what your Medicare insurance does and does not cover.

* Find the best fit. Determine the supplement plan that best fits your needs based on your health and financial situation. Study all Medigap plans before deciding which one is best for you.

* Figure out when to enroll. The best time to buy Medicare supplement insurance is during your open-enrollment period, which starts the first month you are at least age 65 and enrolled in Medicare Part B. It ends six months later.

* Find the right insurance company. Consider the price as well as the level of customer service provided before and after the sale. Check the reputation of the company and its financial stability before you buy.

For more information, visit www.mutualofomaha.com.

You may also want to consider Medicare Part D. This plan provides affordable options for prescription drugs not covered by Medicare.

(NewsUSA) - Do you know how to spot insurance fraud?

By appealing to consumers’ insurance cost concerns, criminals successfully entice more than 100,000 Americans into purchasing sham health insurance every year.

Scam insurance is not new - people have been selling fraudulent policies since health insurance came into being. But with today’s skyrocketing health care costs, more consumers are seeking affordable access to quality care, which provides scam artists with fertile hunting grounds.

Experts say it is important to evaluate the agent selling the plan. Agents who claim that they do not need a license to sell insurance or imply that their product is exempt from state regulation should be rejected. Consumers should be wary of any agent claiming to represent a medical provider who solicits customers door-to-door or patrols neighborhoods encouraging residents to visit a mobile clinic for routine checkups or tests.

Many organizations, including the National Association of Health Underwriters, are educating their members and consumers about how to recognize insurance scams and protect against them.

To keep from being victimized, consumers need to do their research and use a reputable insurance agent or broker who is knowledgeable about scam insurance. Consumers can locate a local NAHU member to find the right health insurance plan by going to www.nahu.org and using the “Find an Agent” feature.

Most states sponsor fraud bureaus that investigate insurance scams, and some even reward whistleblowers if there is a conviction. A complete list of contact information is available on the Coalition Against Insurance Fraud Web site, www.insurancefraud.org. In most cases, complaints can be reported safely, easily and anonymously.

The financial effects of these schemes are felt throughout the entire health care industry. Victims of insurance fraud will have to repay uncovered medical bills and depending on how long they go without legitimate insurance coverage, may also lose health care insurance access permanently. Health care facilities and medical professionals, meanwhile, may never be paid for the treatments they administer.

(NewsUSA) - Health care costs have continued to skyrocket and every politician, business owner and employee is trying to find ways to cut costs.

The recent Buying Trends Study, released by the National Association of Health Underwriters and ChapterHouse LLC, shows that nearly 90 percent of insurance agents and brokers predict that the health insurance market will look remarkably different within the next five to 10 years. They predict a shift away from traditional plans and a migration to consumer-driven health plans.

With open enrollment season upon us, consumers have a chance to evaluate these consumer-driven plans and decide if these new options might be right for them. Past editions of this study have accurately predicted other health care changes, so these findings carry a great deal of weight among industry leaders.

Consumer-driven health plans, which include health reimbursement accounts and health savings accounts, are high-deductible medical plans that are coupled with a savings account. Employees can use those funds to pay their health care costs.

With lower premiums than traditional health insurance plans, consumer-driven health plans enable consumers to choose what kind of health care services they would like to receive, making them more active participants in the decision-making process.

Nearly 30 percent of employers are planning to offer these consumer-driven health plans, and employees will need to determine if they are ready to switch to this new way of approaching health care.

For more information, including a comparison of consumer-driven health plans, visit NAHU’s Web site at www .nahu.org/legislative/charts /NewHSAchartAug04.pdf.

The study also revealed that there is not much hope for those awaiting nationalized health care. Only 3 percent of respondents felt that there was a likelihood of adopting a single-payer system and only 7 percent saw U.S. government mandates in America’s future.

While the future of health care is still unknown, the study predicts that America is headed toward private market initiatives to help solve this crisis.

A common misconception about health insurance is a group insurance policy costs less than a similar individual plan.  Group insurance is generally more rather than less expensive for the following reasons:

Initial Cost: Because the employer typically pays a portion of the employee’s premium (from 25-100%), many believe that group insurance costs less than an individual plan.  While the net cost to the employee may be less than a plan they can find on their own, the actual cost is almost always higher.

Since the passing of the Health Insurance Portability Act, group plans are now required to offer coverage to every member regardless of health. An employee with HIV or terminal illness must be accepted just as any healthy employee. Due to this requirement, the only real option for the insurance company is to charge more for coverage.  This tends to penalize the healthy employee - they pay more to offset the cost of the unhealthy employee.

Renewal Costs: Once a group plan is in force, the insurance carrier no longer has the option to reunderwrite the risk. If a business’s employee develops a severe medical condition, the carrier will not know about it until they present themselves for treatment.  To cover this exposure, almost every carrier will charge more in subsequent policy years. Even if no claims are submitted by anyone in the group, the insurance company will charge more for the renewal premium.

Almost every new health insurance policy written will contain a “preexisting conditions” exclusion for any medical condition an individual currently has.  Pregnancy would fall in this category.  While it may be nearly impossible to find a standard insurance plan to cover the impending delivery, there are some options that are available.

Most states offer low-cost affordable health insurance for individuals and/or their children (and this includes children within the womb in many cases!). In Indiana, we have a program called Hoosier Healthwise designed specifically for low income families. Pregnant women can be eligible for full coverage or pregnancy coverage depending upon the family’s income and assets.  If you live in any other state, check with your state’s government website (website address is probably http://www.in.gov, just replace the “in” with your state’s abbreviation).

Another consideration might be some type of point of service health program. These programs do not provide insurance “coverage” but reduce the cost of health care services if the individual chooses to utilize the services of a provider in their network. Since they are not insurance products, they may not include an exclusion for maternity.  Discounts range from 20-60%. While this option will not pay entirely for the delivery, it may be a cost effective non-insurance solution.