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Should You Buy Health Insurance Online?

Monday, August 3rd, 2009

With the economy eliminating so many jobs and in spite of COBRA (which is very expensive unless one qualifies for the special 65% govt reimbursement), many people are losing their company provided health insurance and turning to the private market.

The first place most people turn to is the Internet.. and in most cases, they are disappointed as they expect to find a quote and offer, but instead, they are told that their information will be forwarded to one to five local agents.

Within seconds, the phone begins to ring, and by about the third call, the seeker is both ticked off and disappointed.

But to get to the answer of the lead in question, the answer is a strong, bold, and unequivocal “NO”. In fact, in most cases one can not buy insurance on the Internet period.. but let me clarify.

There are really two types of insurance.. or at least medical protection that is perceived as insurance. One type plan is an indemnity plan where the insuring company publishes a set schedule for certain things such as doctor visits, in and outpatient diagnostic tests; days in the hospital stated as “$X per day”. This type “policy” is offered without underwriting or medical questions and can be sold over the Internet. The better companies offering a policy of this type clearly state as the law requires, “This is NOT medical insurance and is not intended to take the place of a full major medical policy”.

However, for many people, it does. One reason is lower costs. But a policy like this is not as subject to state regulation and monitoring and while there are many long term, well established indemnity companies in the market, it seems as if every day a new firm pops up to capitalize on the current economic situation. The buyer of this type policy should be extra careful and see if the company has been around long enough to have established a good practice of paying claims! While this is obvious, it’s not done as often as it should be.

Another check that should almost always be done is the future insured should call their state insurance commission and see if there are any reports on this company.. either good or negative. Mainly in claims payment.

But to return “to theme” this is one type of “policy” that can be purchased on the Internet.. but again, it is not truly medical insurance.

True individual medical insurance will have these characteristics: First, it is “underwritten” or based on individual circumstances such as age, ht, wt, smoking or tobacco use, and current medical conditions. Most policies will not immediately cover pre existing conditions, or will rate up if they do. Pricing is based on these factors.

A policy of this type will generally have first a deductible amount which is what the insured pays first on a major medical bill. The deductible generally has to be satisfied before many other policy benefits kick in. There is an inverse ratio between deductible amount and total monthly costs. The lower the deductible, the higher the monthly cost, called a “premium”. Now in many policies, one can at least see their doctor at some “paid for” rate before having to satisfy the deductible. Many prescription plans are also written this way.

Now here’s the problem and a two sided dilemma: First, there are so many variables and options that the future buyer just looking at the Internet, and then being contacted by an agent, is not aware of all the choices they might normally have. Most people.. maybe you, the reader.. are not even aware the choices exist. One example: Your deductible. Does the deductible apply for a calendar year or a policy year? If you entered the hospital in Nov, you’d have to pay the same deductible as if you entered in Jan.. and when you’ve satisfied it, if you went back in Jan, even for the same problem, you’d be starting a whole new deductible. Not always.. but this is just one example of what you might not know.

Now let’s say you went on one of the Internet sites. You did a search engine look for “health insurance” and you got 25 listings to pop up from the search engine you used. You went to the first site and did not find a policy application, so you went to another. Next thing, usually within minutes, your phone starts to ring.

The call you are most likely getting is from what is known as a “captive” agent. He or she works for just one company, and has just one major product line to offer you. Do you think they are going to tell you the options you might have if you looked at a competitor? Of course not! They know you will be getting many calls; they know you are probably not educated in the selection process, and they know if they don’t get you to “buy” (which is really to put in an application), they will never talk to you again. As trained sales people, they know one first rule of selling it “give the prospect what they want’. Never mind if you don’t really know ALL you want or could have.. so they hear your buzz words of “deductible”, “Copay” and “Monthly amount”. It’s offered; it’s what you asked for, and you bought.. or actually only put an application in. The fact is that your application is far from guaranteeing you will be issued the policy you apply for. It can be modified with waivers or rate ups, but you won’t know for at least 5 work days in most cases. In the meantime, you tell future callers, “Thanks, I’ve taken care of it”. Little do you know!

There is some hope however. Another category of person or company who will call you is an independent broker. They do not work for any one company. They don’t have to sell or be fired for any one company. They have no vested interest in a certain and special company, and they have to know the competition. This kind of agent or broker can and will search for the company that suits you best. Their call may tend to put you to sleep because they are going to teach you and ask and explain the questions. Now as your author, I’ve been involved wearing both hats.. captive and broker.. and I’ll tell you this: More than half of my prospective clients are more interested in how many pixels their next HDTV will have than the finer points of this policy they are looking for. If this describes you, accept you are only going to get what you ask for. Pay attention; go buy a good book on buying health insurance. Get educated and be proactive.

So as we conclude the answer to the article title: One is you should not buy health insurance on line and one reason is you can’t. You apply for it through a good broker. You can buy an indemnity policy, but it is not true health insurance.

Meet the qualified vendors on line. After you have evaluated their offerings, then you can apply on line and use the tools such as PDF versions of their official brochures. This is not buying on line. If you consider that buying, this part is ok.

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Tips You Should Know Before Choosing Health Insurance

Monday, August 3rd, 2009

Making a wise decision on which Health Insurance Policy to buy may seem like a confusing task, but if you consider just these five most important items you and your agent will both find that you are a Savvy Buyer! These items are your KEYS to picking a policy that’s right for you:

1. The Insurance Company’s Rating

Ask your agent for the Company’s A.M. Best rating. If the company is highly rated at this national rating registry, then the company will have literature showing their rating with an explanation of what it means. Choose only companies that have an A or A+ rating.

2. The Insurance Company’s Record of Complaints at your State Board of Insurance

Every large company will have some complaints. Avoid companies that have a high number of unresolved complaints. Ask your agent for the phone number for your State Board of Insurance. If he will not give it to you, this is a warning signal! You can also look up the number in any directory of your state’s agencies. No matter what your agent says, CALL your State Board of Insurance and ask them for the record on any company you are considering.

3. The Limits Shown On Your Health Insurance Quote

Check your quote to see if you are comfortable with the benefit levels. You can usually change several levels to fit your needs and budget. For example, a higher deductible will cost less each month. Also, many plans give you a choice to split your medical bills with the Insurance Company either 50/50 or 80/20 (with them paying 80%). Then they will have an amount (your stop loss) where they will take over at paying 100% of your covered bills for the remainder of the year. These deductibles and other levels start over every year in most plans. Some plans, though, have a “per cause” deductible. Such a deductible means that you will be responsible for bills up to that deductible for each accident or illness. Make sure you are aware of this distinction, so you can choose a plan that’s right for YOU!

4. The Limits Revealed Within The Policy

Ask your agent for a sample policy, and then check two sections: The Benefits and The Limitations and Exclusions. Many of your benefits are actually limited in the Benefits section. For example, diagnostic testing or outpatient treatment may be severely limited. These days, you could have a serious disease such as cancer, and never go into the hospital for it. You could rack up thousands of dollars in medical bills for the diagnostic and follow-up lab tests and MRIs, and then have surgery, chemo, or radiation therapy all on an outpatient basis.

Other items that may be limited are your hospital room rate and intensive care. Your hospital room rate should be at least average semi-private and your intensive care benefit should NOT be tied to your room rate, but should, instead, be covered as whatever is an average ICU rate for the area of the hospital, also. Some policies limit the ICU benefit to 3 times the regular room rate, when ICU can cost you 10 or 20 times the room rate each day. A short hospital stay with a limit like this in your policy can cost you literally thousands of dollars. A long hospital stay with a limit like this in your policy could drive you into bankruptcy. Even if your policy says it takes over at 100% after $5,000 of covered medical bills, the important term here is “covered” medical bills. If the policy only pays three times the room rate for ICU, then the rest of the ICU bill is considered an “uncovered” charge!

Look out for these types of limits!

Also, be sure to check the Pre-Existing Conditions Limitation if you already have any medical conditions, and ask your agent if the Company will be excluding your conditions permanently on your policy.

5. Pay the Insurance Company, Not the Agent, & Follow Up!

And lastly, make your check payable to the Insurance Company, and then follow up to make sure it was received. When you get your policy, check the Schedule of Benefits to verify you got the coverage you ordered, and then check to see if any special Amendments were added to your policy to exclude any of your conditions. If an Amendment exists, these conditions will always be excluded from this policy, even after the Pre-Existing Conditions Limitation expires.

Following these five tips will help you choose a health insurance policy which will protect you from catastrophic medical bills. You may think, “Isn’t that what any health insurance policy is for?” Yes, that is the reason for buying any health insurance policy, but, unfortunately, many policies fall short of actually providing this protection! Be sure to take the time to choose wisely when it comes to your health insurance!

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