5 basic facts about health insurance policies in a bad economy
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| insurance policies |
Many health insurance plans have specific exclusions that eliminate your benefits for anything that might have been covered under Workers' Compensation or similar laws. Now read the last sentence again.
COULD HAVE BEEN COVERED!?
That's right. Most self-employed people and even some small business owners do not have Workers' Compensation.
There are insurance plans designed to cover you on and off the job, 24 hours a day, if you are not required by law to have Workers' Compensation coverage.
2. ARE YOU WRITING IT?
Independent contractors (1099), home-based business owners, professionals, and other self-employed individuals generally do not take advantage of the tax laws available to them.
Many people who pay 100% of their own costs are eligible to deduct their monthly insurance payments.
That alone can reduce the net out-of-pocket costs of a suitable plan by up to 40%. Ask your accounting professional if you are eligible and/or check the IRS website for more information.
3. INTERNAL LIMITS
All true insurance plans use some form of internal control to determine how much they will pay for a particular procedure or service. There are two basic methods.
- -Scheduled benefits
Many plans, some of which are marketed specifically for the self-employed and independent, have a clear schedule of what they will pay for a doctor's office visit, hospital stay, or even limits on what they will pay for 24-hour tests. hours. period.
This structure is usually associated with “Indemnity Plans” If you are presented with one of these plans, be sure to look at the benefit schedule in writing.
It's important that you understand these types of limits up front because once you reach them, the company won't pay anything above that amount.
- -Usual and Customary
"Usual and Customary" means the payment rate for a doctor's office visit, procedure, or hospital stay that is based on what most physicians and facilities charge for that particular service in that particular geographic area. or comparable.
"Usual and customary" charges represent the highest level of coverage in most major medical plans.
4. YOU HAVE THE CAPACITY TO BUY!
If you're reading this, you're probably shopping for a health plan. Every day, people buy everything from groceries to a new house.
During the buying process, the buyer typically evaluates value, price, personal needs, and the general market. With this in mind, it is very disconcerting that most people never ask how much a test, procedure, or even a visit to the doctor will cost.
In this ever-changing health insurance market, it will become increasingly important to ask our medical professionals these questions. Asking the price will help you get the most out of your plan and reduce your out-of-pocket costs.
5. NETWORKS AND DISCOUNTS
Almost all insurance plans and benefit programs work with medical networks to access discounted rates.
Broadly speaking, networks are made up of medical professionals and facilities that agree, by contract, to charge discounted rates for services provided.
In many cases, the network is one of the defining attributes of your program. Discounts can range from 10% to 60% or more.
Medical network discounts vary, but to ensure you minimize out-of-pocket costs, it's imperative that you preview the list of network physicians and facilities before committing.
This is not only to make sure your local doctors and hospitals are in the network, but also to see what your options would be if you needed a specialist.
Ask your agent what network it's on, ask if it's local or national, and then determine if it meets your individual needs.
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