In a lot of cases, our health insurance coverage comes from a group plan that is offered to you by your employer or by your spouseâs employer. For individuals who do not have insurance through their employer, individual policies exist as an option as well.Â
Of course, you can also opt for having no coverage at all, but in the case of an emergency, this could be detrimental to your financial health. No matter your age or marital status, itâs worth looking into your options for a good health care plan to protect yourself from a medically-induced financial struggle.Â
No matter what kind of plan you choose, there will always be some out-of-pocket expenses, which means youâll have some decisions to make. Deciding what type of healthcare plan to choose can be stressful, but it doesnât have to be overwhelming. In the sections below, we will discuss the key factors that play into choosing the right health insurance plan.Â
Types of health plans availableÂ
There are a lot of different terms to learn when sorting through health insurance plans, and each of them come with their own set of distinctions. Before we discuss the difference between HMOs, PPOs, POS Plans and Indemnity plans, itâs important to start with the most common types of health insurance categories:Â
- Indemnity of Fee-for-Service Plans: Health insurance plans that enable you to go to any doctor or specialist that you want without a referral are called indemnity, fee-for-service, or point of service (POS) plans. The insurance company will cover a predetermined amount of your medical expenses, and you will be responsible for the remaining balance. These plans tend to be the most flexible since there are no set restrictions on the medical providers youâre allowed to use, and you are usually not required to choose a primary care physician.Â
- Health Maintenance Organizations (HMOs): A Health Maintenance Organization (HMO) is a band of healthcare professionals and medical facilities that offer a set package of medical services at a fixed rate. This plan does require that you have a primary care physician (PCP), who would serve as the middle-man when it comes to health care. Your primary care physician would then decide whether or not seeking out a specialist is necessary. If your PCP finds it necessary for you to see a specialist, they will then issue you an in-network referral.Â
- Preferred Provider Organizations (PPOs): A Preferred Provider Organization (PPO) has the same organized care characteristic that you will get from an HMO, but with the benefit of more flexible options. A PPO allows you to seek healthcare outside of your network if you feel the need to. Keep in mind that doing so will usually cost you more in out-of-pocket expenses, but a PPO would still cover some of the cost, unlike an HMO. If having a wider variety of options is important to you, then a PPO might be a good option for you.Â
Pros and cons of each health plan
Each type of plan comes with their own implications. Ultimately, youâll have to figure out what is most important to you in order to make your decision. Letâs compare the pros and cons of each plan.
Pros: The major advantage of this type of plan is that you are able to choose where you get your medical care from and which doctor to go to, without the need for a referral or a pre-approval.Â
Cons: Indemnity plans will usually come with much higher premiums and deductibles, making them more expensive than perhaps an HMO or PPO. Another area where these plans fall short is the route you may have to take to get coverage. You may have to pay for your medical services out of your own pocket, and subsequently submit a claim to get reimbursed by your insurance company. Thereâs no telling how long this could take, and you also face the risk of not getting reimbursed at all.Â
Health Maintenance Organizations (HMOs)Â
Pros: The best thing about getting an HMO insurance plan is that your out-of-pocket medical expenses are usually pretty affordable, and you can expect to pay the same amount for each visit, depending on whether itâs a primary care physician or a specialist.
Cons: In most cases, any services that you receive from a medical professional outside of your healthcare network will not be covered with an HMO plan. Another drawback is that you have to get referred by your primary care physician in order to see a specialist. This may not be seen as a disadvantage to some, but for others it could be seen as an unnecessary extra step in the process if you already know what you need.Â
Preferred Provider Organizations (PPO)
Pros: This type of plan offers customers much more flexibility than they would have with an HMO with a lot lower rates than one might experience through an indemnity plan.Â
Cons: The main drawback with a PPO is that the out-of-pocket costs are generally less predictable.
Choosing a Health Plan is a post from Pocket Your Dollars.
A lot of us donât like to think about this, but inevitably there will come a time where we will all need help taking care of ourselves. So how can we start preparing for this financially?
Many people opt to purchase long-term care insurance in advance as a way to prepare for their golden years. Long-term care insurance includes services relating to day-to-day activities such as help with taking baths, getting dressed and getting around the house. Most long-term care insurance policies will front the fees for this type of care if you are suffering from a chronic illness, injury or disability, like Alzheimerâs disease, for example.Â
If this is something you think youâll need later on, itâs crucial that you donât wait until youâre sick to apply. If you apply for long-term care insurance after becoming ill or disabled, you will not qualify. Most people apply around the ages of 50-60 years old.Â
In this article, we will discuss long-term care insurance, how it works and why you might consider getting it.Â Â Â
How long-term care insurance works
The process of applying for long-term care insurance is pretty straight forward. Generally, you will have to fill out an application and then youâll have to answer a series of questions about your health. During this point in the process, you may or may not have to submit medical records or other documents proving the status of your health.Â
With most long-term care policies, you will get to choose between different plans depending on the amount of coverage you want.Â
Many long-term care policies will deem you eligible for benefits once you are unable to do certain activities on your own. These activities are called âactivities of daily livingâ or ADLs:
- Incontinence assistance
- Getting off and/or on the toilet
- Getting in and out of a bed or other furniture
In most cases, you must be incapable of performing at least two of these activities on your own in order to qualify for long-term care. When itâs time for you to start receiving care, you will need to file a claim. Your insurer will review your application, records and make contact with your doctor to find out more about your condition. In some cases, the insurer will send a nurse to evaluate you before your claim gets approved.Â
Itâs very common for insurers to require an âelimination periodâ before they start reimbursing you for your care. What this means is that after you have been approved for benefits and started receiving regular care, you will need to pay out of pocket for your treatments for a period of anywhere from 30-90 days. After this period, you will get reimbursed for your out-of-pocket expenses and from there.
Who should consider long-term care insurance
Unfortunately, the statistics are against our odds when it comes to whether or not we will eventually need some type of long-term care. Approximately half of people in the U.S. at the age of 65 will eventually acquire a disability where they will need to receive long-term care insurance.Â Of course, the problem is, long-term care can be really expensive. Unless you have insurance, youâll be paying for your long-term care completely out-of-pocket should you ever need it.
Your standard health insurance plan, including Medicare, will not cover your long-term care. The benefits of buying long-term care insurance are that:
- You can hold on to your savings: Many uninsured seniors have to dip into their savings account in order to pay for their long-term care. Because itâs not cheap, many of them drain their life savings just to be able to pay for it.
- Youâll be able to choose from a larger variety of options: Being insured gives you the benefit of being able to choose the quality of care that you prefer. Just like with anything else, you get what you pay for when it comes to healthcare. Medicaid offers some help with long-term care, but youâll end up in a government-funded nursing home.Â
How to buy long-term care insurance
If youâve recently started thinking about shopping for long term-care insurance, youâll want to keep a few things in mind:
- Do you mind being insured on a policy with an elimination period?
- Can you afford all of the costs including living adjustments?
- Are you interested in a policy that covers both you and your spouse, otherwise known as âshared careâ?
There are a few different ways to go about getting long-term care benefits. You can either buy a policy from an insurance broker, an individual insurance company, or in some cases, your employer. Obtaining long-term care insurance through your employer is probably going to be cheaper than getting it as an individual. Ask your employer if itâs included in your benefits.Â
Many people also opt to shop for hybrid benefits insurance policies. This is when a long-term care policy is packaged in with a standard life insurance policy. This is becoming a lot more common in the world of insurance. Keep in mind that the approval process may be slightly different for a hybrid insurance policy than of that of a stand-alone long-term care insurance policy. Make sure to ask about the requirements before you apply.Â
Best long-term care insurance packages
There are not very many long-term care insurance companies that exist as there once was. Itâs hard to wrap our heads around purchasing something that we donât yet need. However, here are a few examples of companies that offer competitive long-term care packages:
- Mutual of Omaha: This company offers benefits of anywhere between $1,500 and $10,000. While the main disadvantage of this companyâs packages is that they do not cover doctorâs charges, transportation, personal expense, lab charges, or prescriptions, you CAN choose to receive cash benefits instead of reimbursements. This company also offers discounts for things like good health and marital status. This companyâs insurance policies offer a wide range of options and add-ons so you can make sure that all your bases are covered.
- Transamerica: This companyâs long-term policy, TransCare III, is good if you donât want to hassle with an elimination period. If you live in California, this may not be the best choice for you because Californiaâs rates are a lot higher than the rates in other states. Your maximum daily benefit can be up to $500 with this program, with a total of anywhere between $18,250-$1,095,000.Â
- MassMutual: Popular for their SignatureCare 500 policy which comes in both base and comprehensive packages, is a long-term care and life insurance hybrid. This is very appealing to many seniors wanting to kill two birds with one stone. This company also has a 6-year period as one of their term options, which is pretty high.
- Nationwide: This program sets itself apart from many other programs available because it allows you to have informal caregivers like family, friends, or neighbors. You will receive your entire cash benefit every month and it is up to you to disperse the funds as you would like. Currently, this company does not have their pricing available online, so you will need to speak with an agent to discuss prices.
Understanding Long-Term Care Insurance is a post from Pocket Your Dollars.