Getting Affordable Healthcare Coverage
Use Budget and Health Conditions to Pick the Right Health Coverage
© John Wu
Aug 28, 2009
Healthcare coverage in the United States is getting very expensive. With fewer dollars available for medical expenses, it is important for everyone to carefully evaluate their health insurance needs. It does not matter if a family is being supported through an employer health plan or an individual health insurance policy. Making the right choices allows access to medical care while minimizing the costs.
Keep in mind that company employer health plans tend to be much more generous and cheaper, due to the employer subsidizing part or all of the monthly premiums. Most individual health insurance policies have far less benefits with higher deductibles and copayments in order to keep monthly premiums affordable.
Switching to Higher Deductibles
Savings of up to 50% are possible by switching to a high deductible health plan (HDHP). Those who are healthy and don't need frequent medical care stand to benefit the most from high deductibles. HDHP are usually tied to Health Savings Accounts which are used to cover medical expenses incurred while inside the deductible. Those who have ongoing medical problems should avoid high deductible policies since the out of pocket costs will be higher than a traditional plan.
Healthcare Benefits, Limitations, and Exclusions
Look carefully at any health insurance plan's healthcare benefits and exclusions. For example, there are many healthcare plans out there that exclude mental illness or caps the plan's reimbursement for mental illness. Those in individual plans need to consider the risk of excluding a particular illness even though it may come up in the future. Switching individual health insurance from one policy to another can be nearly impossible once a new medical problem excluded by the plan crops up.
One of the most important limitations of any health insurance policy is the maximum amount of healthcare benefits the plan will cover. A policy with a $10,000 maximum can be wiped out with just one trip to the emergency room. Even $100,000 may not be enough for certain conditions such as colon cancer due to the high cost of chemotherapy drugs.
Dependent Coverage
Check each policy's coverage rules when it comes to dependents. Many plans allow dependents over 18 to be covered if they are enrolled full time at a college or university. Some may cover domestic partners. With employer based plans, the rules on dependent eligibility are often determined by the company.
Many individual plans will not cover maternity expenses without adding a maternity rider, and will not allow female customers to add that coverage after the initial policy has been written. Female customers who may someday utilize the maternity benefit should buy a maternity rider at the time of the initial purchase. Most employer plans cover pregnancy, but contact the insurance company to be sure.
Prescription Drug Benefit
Many healthcare plans do not include any prescription plan benefits at all. Some of those that do have a drug benefit only cover a small amount, such as $500 per calendar year. There are some drugs that are very expensive for a 90-day supply. Abilify, according to drugstore.com prices, costs $1,816 for 90 tablets at the 30mg dosage as of August 2009.
Most health insurance plans have a formulary, which is a list of prescription drugs that the insurance company is willing to cover. It can be very difficult to get a non-formulary drug covered, even when the prescription is written by a plan doctor.
Although there are significant savings to be derived from going without a prescription drug benefit and paying cash for cheap generic drugs, the cost can be very high if a medical condition can only be treated with an expensive brand name prescription drug. Those who are going with individual polices that require underwriting should keep this risk in mind.
By choosing the right options for health insurance, it is possible for consumers to make an informed choice on affordable healthcare that doesn't bust their budget or put their family at high risk of financial catastrophe.
References:
John Hopkins University. "Information about Choosing Health Insurance."
Langford, Stacey L. "Buying Private Health Insurance." Smart Money.
 |
 |
