Types of Health Insurance Plans

There are several health insurance plans available in the US: Managed Care, Fee-for-Service Plans, Health Maintenance Organizations (HMOs), Point-of-Service Plans (POS), Preferred Provider Organizations (PPOs).

Managed Care Plans.

Managed care is very popular in the United States. This type of plan helps insurance companies to control the medical care costs. All kind of plans have some sort of managed care program. Generally speaking you might be asked to take approval from your insurance company before any medical care is received otherwise the costs may not be covered by them.

Fee-for-Service Plans.

Fee-for-Service Plans is the traditional health insurance type of plan in the US. Under this plan the insurance company will pay your fees when you use medical care.

This is a flexible medical insurance plan as it allows switch of doctors and hospitals and you can do this through the country. However you have to careful as only part of the expenses are covered by the insurer and you have to carefully check the conditions of your insurance policy not to end up with huge medical care costs that you have to pay.

Health Maintenance Organizations.

Health Maintenance Organizations (HMOs) are prepaid plans. If you are a member you pay some fee every month. In return when you need to use any kind of medical care it is arranged from the organization. The HMOs use their group of doctors and practices or other doctors that have contact with the group. Usually your family members are also covered by this kind of health insurance plan.

If you are insured under this plan you will have to choose a primary doctor who will monitor your health and refer you to specialist when needed.

Point-of-Service Plans.

The Point-of-Service Plans (POS) will provide you with medical services if you pay a monthly fee. They will either refer you to a doctor from the doctors working in their organizations or to other medical care providers in the plan. Even if you choose to use medical case services outside the plan your heal care expenses might be covered by the policy.

Preferred Provider Organizations

The Preferred Provider Organizations (PPOs) is some kind of combination between the fee-for-service plan and a health maintenance organization. If you are insured under this plan you will have to choose a doctor or a hospital from the list of approved health care providers. Similar to the HMOs you can choose to be treated by a medical institution or a doctor outside their network and still get some coverage. However you might need to pay the larger proportion of the bill yourself.

How to Choose a Health Insurance Plan

Years ago choosing a health insurance plan was not a big trouble. Of course there were less health insurance plans to choose from but also people were able to go to almost any doctor and hospital to receive medical care.

Today things are a bit more complicated not only because there is a wide choice of different insurance schemes, but because of the restrictions each one hides. Moreover almost all of the health insurance plans available have some managed care policy that means that it is not possible to use any doctor, any hospital and even a medical service of certain costs.

For the average American picking up the right health insurance plan is a bit complicated especially if he doesn’t know much about the plans available. In general there are several insurance schemes – Indemnity plan (also called fee-for-service plan), managed care, Health Maintenance Organization (HMO), Point-of-Service plan (POS). each one of these has it advantages and disadvantages so it is best to read about them and see which conditions are best for you and your family.

The next question that might bother you is where you can get one of these plans. The first resource is the group policies. Usually you can get a managed care or indemnity plan through a group policy. The policy can be offered by your employer or through the job of a member of your family.

If your company doesn’t offer group policies or if you are self-employed, you can get an individual health insurance policy. Another option is to check if your professional organization is offering group policies. Keep in mind that individual health insurance policies are likely to cost more than the group insurance policies.

Old people can apply for a federal insurance program called Medicare. A choice between a fee-for-service and managed care plan is available. Low-income people can also benefit from a federal health insurance program called Medicaid. It is very popular among children and pregnant women and offers managed care health insurance plans.

The best way to compare health insurance plans is to ask yourself some questions that will show you the right way. What services are offered by each plan? What will be the chose of doctors, hospitals and other medical care institutions? Where you will have to go to receive care? What are the costs? Once you have the answers of these basic questions the right health insurance plan will become obvious.

Home Insurance Plans

Scores of people are on the market searching for the best deals on home insurance, with few unaware that when they applied for their mortgage loan a measure of insurance coverage was incorporated into the agreement.

Home insurance comes in many forms, including basic packages, full coverage, standard plans, and home-based business coverage. Many mortgage coverage plans differ, but overall it is similar to motor coverage. Many home insurance plans will cover fire, theft, unnatural and natural disasters and so forth. If you are filing a claim on a break and entry, be advised that few home insurance policies will request a police report and if that report does not indicate a window or door was broken then the company will not provide reimbursement. Thus, thieves are tricky and sometimes breaking in doesn’t entail causing harm to the home. Therefore, read the terms and conditions carefully to know what the policy will cover.

Researching the marketplace can help you find the bargains, however if you have a home-based business you may want to research to learn all you can about the coverage, since few policies are not worth the hassle. There are various questions to ask when you are considering home insurance, including what the plans entail. You may wonder which policy is right for you, thus research can help you find answers to those questions. Policies are different, so you will want to know what coverage is offered to you if you live in an area where floods are frequent, and if coverage is available to you, you want to know the rates of the policies.

Again, there are various home insurance policies, including coverage for mobile homes, condominiums and so forth. Therefore, if you own a trailer or condominium you will need a special type of coverage to care for your needs when insurance is needed. Coverage for home insurance alters, since homes value depreciates over time, and the structural of the home deteriorates. If the homeowner hasn’t invested in upgrading then the policies may consider various aspects before offer home insurance. Most home insurance agencies expect a home to be built of brick, thus if the home is not constructed of brick the company may feel the home is a high-risk. Most policies offer the same type of coverage, though few have more exclusions and restrictions than others do do do.

Deductibles are attached to most insurance policies, and often people find it difficult to determine which level of deductible to choose. This is often because the customer or policyholder does not understand the entire concept of deductibles. Most insurance company’s deduct the deductibles from the reimbursement and then send the remaining balance to the policyholder. Thus, the deductible is how much you are willing to pay out of pocket, which starts at around $200 to $1000 or more. The policyholder is wise to choose a higher deductible if possible, since this will reduce the cost of premiums. Furthermore, when a deductible is applicable, again most companies’ deduct it from the claim and send you the remaining balance. Understanding the deductibles on home insurance is essential since if you agree to a deductible of $500 and you file a claim worth the value of $1000 on your home, then you will receive $500 back from your claim.

The deductible is not the problem; rather the premiums are what most policyholders are concerned with. The premiums often increase when the policyholder files a claim. The premiums may not increase rapidly, but the next time you renew your policy the premium will go up often. Premiums often go over and above since the companies’ are providing incentives. In other words, the company hopes that claims are not filed, but if it should happen then they want their money too. The premiums then cover the expenses the company will pay to reimburse you from loss, damage, and so forth.

If you are searching for home insurance it pays to go online, since overhead is cut from the picture the companies’ can offer lower premiums and insurance rates. Often customers can get various quotes from the online sources, which helps them to determine which policies are best suited for their needs. Finally, if you have a current mortgage, make sure you do not already have coverage available through your lender.

When Your Health Insurance Plan Won’t Pay

The very nature of managed care health insurance plans increases the likelihood of a legitimate health insurance claim being denied. Bear in mind that managed care (health maintenance organizations, or HMOs, and preferred provider organziations, or PPOs) exist for the purpose of controlling costs for the health insurance company. Many health care procedures, surgeries, durable medical equipment and drugs, particularly the more expensive ones, require prior authorization from the health insurance plan before the plan will pay. Claims are reviewed to determine “medical necessity” of the claim. Health care services or products deemed “not medically necessary” will almost certainly be denied for payment by the health insurance plan.

Health insurance companies do make mistakes, however, and it’s certainly possible that a covered expense will be denied. What recourse does the health plan member have when one disagrees with the decision of the health plan? Here are some steps to take in dealing with a denial of payment.

1. Review the explanation of benefits (EOB) sent to you from the health insurance company. The EOB should state what services or goods were billed and briefly why benefits were denied.

2. Review your particular health insurance policy. What benefits does the health insurance policy state for the particular service or product? Should the claim be covered according to the policy?

3. Does the health plan have special criteria to be met in order for an particular expense to qualify as “medically necessary” and be considered a covered expense? For example, many managed care plans will cover drugs on their formulary. Other, nonformularly drugs may not be covered at all, or may be covered only if the formulary drugs have been tried and failed. An expensive MRI procedure may only be covered if certain symptoms are present. Check your policy to determine whether the expense qualifies as “medically necessary” by the health insurance company. Your health care provider must submit sufficient documentation to the health insurance plan to justify the need for the expense.

4. Is the health care provider “in-network” (contracted) with your health insurance plan? If not, does your managed care plan cover “out-of-network” (non-contracted) providers? Most HMO plans do not cover “out-of-network” providers; many PPOs will pay for services by “out-of-network” providers, but usually at at lower rate than paid to “in-network” providers.

If, after reviewing the health insurance policy and the EOB, you feel that the claim should have been a covered benefit by the insurance company, you should first request in writing that the insurance company provide you with the information that they used to base their denial of benefits. The health insurance company is required to provide you with this information on request. Review this information carefully. Many times the health insurance company was not provided with appropriate or sufficient documentation from the provider to justify the claim. If this is the case, contact the provider and request that they submit more medical records that support the claim for benefits. It may also be helpful for the provider to write a letter to support the claim in addition to the medical records. Your claim may be resolved in this manner.

All health insurance companies have a process in place by which plan members can appeal the decisions of the health insurance company. If providing further documentation does not resolve the dispute, then an appeal must be filed with the health insurance plan. Your provider may help you with this, and they may not. Read the member handbook and/or policy and follow the procedure for appealing the denial of the claim. Be prepared to submit more documentation to support your appeal. Keeping a record of all interactions with the insurance company is vital. Record all phone conversations and include the name of the person you spoke with, a brief summary of the conversation, and the date and time. File all correspondence sent and received, and have it readily accessible.

Senior Life Insurance Plans

Are you a senior looking for an affordable life insurance plan?

If so, there are several things you may want to consider before you make your purchase of life insurance.

First, think about what it is you want your life insurance policy to accomplish – what is your goal?

Many seniors choose to buy a life insurance plan to provide their spouse with money to maintain their lifestyle, pay off a mortgage or credit card debt, or to help out with their own final expenses including a funeral, memorial service, burial costs and other relates expenses.

Whatever your goal is you’ll want to compare multiple life insurance plans and prices from several of the highest rated insurance carriers before making a decision as to which policy is best for you.

Although there are many insurers that offer coverage to seniors, not all pricing is the same. Each insurance company has their own set of guidelines when it comes to underwriting seniors for approval, and how they will price your policy.

Some insurers are competitive with seniors that are healthy, not on medication, and do not use tobacco, while others are more competitive with no exam term insurance plans for seniors.

When choosing your coverage make sure you consider the following:

The financial strength rating of the insurance carrier.
The length of time the insurer has been in business.
How long the policy provides coverage – your entire lifetime or for a specific number of years.
How long your premium is guaranteed to remain the same.
When you have 100% (full) coverage – either immediately, or after 2-3 years, which is considered a graded benefit life policy.

If you are healthy and need lifetime protection it may be a good idea to compare insurance plans for policies that do require a medical exam, as you will get the best rate on your policy if you are in good health.

On the other hand, if you are not healthy and finding it difficult to get accepted for a senior life insurance policy you may want to consider going with a no exam life policy.

Senior no exam plans offer people over 50 the option of buying a policy without having to take any physical examination. There may or may not be health questions for you to answer.

The advantage of a no exam plan is that you may apply online and even start your insurance coverage right away with some insurers. And, there’s no need to meet with an agent, no hassles or sales pressure, and no doctor visits, needles, blood or urine testing.

However, a disadvantage may be the increased premium you pay for a term life policy without any health exams.

Another option for seniors is guaranteed acceptance insurance for people who are unable to get coverage from other insurers due to their age or health problems.

If you think you need insurance as a senior make sure you shop around and compare several quotes online to help you get started in determining how much your insurance may cost and which insurers may offer you the best deal.