Independent Health Insurance Agents
Why Is Having Good Health Insurance So Important?
“Without health insurance,” Ralph Nader who co-authored Winning the Insurance Game says, “it is unlikely that you will be able to find a doctor to call your own or to obtain treatment for illness or injury. Without health insurance, you could even be turned away from hospital emergency rooms unless it is a life-or-death situation. Even then, patients have died because treatment was refused. In short, health insurance is vital to the health and welfare of each and every one of us.”
Consider this: according to a study by Harvard Law and Medical Schools, nearly half of all Americans who file for bankruptcy do so because of medical expenses. Yet, three-quarters of the people who filed for bankruptcy actually had health insurance. So why had they fallen into such dire financial straits? They received big bills because of high premiums, co-payments, and gaps in coverage.
“Just having health insurance isn’t enough anymore,” Kimberly Lankford, author of The Insurance Maze says, “choosing the right coverage at the right price is what makes the difference. Many people, however, have no idea how to shop for health insurance.”
Making the wrong decision at the outset can be expensive. According to the Kaiser Family Foundation, the average annual cost for a family plan is about the same as the annual salary of someone working full-time for minimum wage. Yet, making the wrong decision by trying to save too much money on premium can be even more costly on the back end.
How to Shop for Health Insurance
Temma Ehrenfeld of CBS Money Watch says, when you begin shopping for a policy, look for these six features:
- Premiums you can afford - As with other types of insurance, the higher your deductible (your out-of-pocket cost), the lower your premium. A low deductible may sound enticing, but your premium payments could be astronomical. A 59-year-old Indianapolis man who doesn’t smoke might pay more than $900 a month for a plan with a low $500 deductible.
- Annual out-of pocket limit - This annual maximum amount is key because it not only includes your deductible but co-pays for prescriptions and co-insurance costs for doctor visits. Look for an out-of-pocket maximum of about $6,000 for an individual and about $12,000 for a family.
- No coverage ceilings on key health costs - Specifically: Avoid upper limits on hospital and outpatient medical treatment, visits to doctors, drugs, and diagnostic imaging tests.
- Uncapped annual benefits - Some health insurance policies cap annual benefits at $100,000. But that’s not high enough if you get really ill. For example, according to the National Business Group on Health, the indirect and direct costs of a single heart attack total almost $1 million. Under the health-reform law, “unreasonable” limits will be eliminated this year; all yearly limits will be gone by 2014.
- Lifetime benefits that are unlimited or capped at no less than $2 million. The standard $1 million cap isn’t enough. The new law will eliminate lifetime benefit caps.
- Coverage of everything “medically necessary” for a problem. Even with this language in a policy, assume that any services that aren’t listed aren’t covered. To guard against absurd exclusions, scrutinize the legally binding contract, called the “EOC” (Evidence of Coverage). Insurers and agents may say it is available only after purchase, but insist. If this doesn’t work and you have specific concerns, ask your health insurance independent agent — and have him or her put any promises in writing, advises Nancy Metcalf at Consumer Reports.
Don’t Try to Shop for Health Insurance on your Own
"When you are buying coverage on your own, you are walking through a minefield," Karen Pollitz, project director of Georgetown University's Health Policy Institute says. In order to understand the fine print, "you would need a lawyer sitting next to you."
Rex Bowden Sr. of Global Insurance Consultants says, "It's fluid. Sometimes what you think it means, it may not mean."
In short, since your health insurance independent agent can provide you a choice among many different providers and can fully explain your various options, don't try to handle your insurance needs without a health insurance independent agent you trust.
Insurance needs and laws are complex. Coverage varies wildly from company to company. Laws are vastly different from state to state. Your independent agent knows the laws and companies that provide coverage options. They can help you match what you can afford to pay with a prudent insurance plan.