Friday, February 20, 2015

Advantage Medicare

It is no secret that the cost of healthcare in the United States, is very high and people who are at a disadvantage like the elderly, the disabled, the poor, those without a steady job find it particularly hard to pay for hospitalization, medication, and any form of treatment. Privately subscribed Health Insurance Plans are not a solution for everybody, as primarily many people in the above categories would not be eligible for the plans. Secondly, all private insurance plans are customized to the individual person’s risk profile, who is under the plan.

On the contrary. Medicare is a Federal Government instituted Social Insurance program. Being a social program, it guarantees certain benefits to every single citizen of the country and is funded by taxes paid as well as Federal grants.

Benefits of Medicare

Medicare has four parts to it:
  1. Part A: Hospital/Hospice insurance
  2. Part B: Medical insurance
  3. Part C: Medicare Advantage plans
  4. Part D: Prescription drug plans
Part A: Hospital/Hospice insurance
  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Blood (under certain conditions)
Part B: Medical insurance

This pays for a whole lot of services and procedures that are not covered by Part A as long as they are regarded as outpatient treatments. Working professionals who have a group health insurance at the workplace can defer the Part B plan for themselves and their dependents. The services covered include all services that require specialists like physicians, nurses or lab technicians. This includes diagnostic services like Blood tests and X-rays, all laboratory and diagnostic procedures, vaccinations, dialysis, blood transfusion, chemotherapy, organ transplant, hormone replacements, ambulance service etc. Additionally, medical equipment (DME) required by the patient is also provided under Part B. This includes walkers, wheelchairs, artificial limbs, special eyeglasses, canes, collars, etc.

Part C: Medicare Advantage plans

Medicare Advantage health plan evolved in line with better affordability for the financially well endowed. Such members pay an additional monthly premium, over and above the premium paid for Part A and Part B. This includes certain prescription drugs, dental care, eye care, periodic checkups, coverage while traveling outside the United States, health club memberships, health camps, gym and spa treatments etc (under certain conditions). However, a much larger benefit is that it reduces the 20% co-pay condition, and the high deductible charges associated with the Original Medicare.

Part D: Prescription drug plans

Although these plans are part of the Medicare program, they are administered by private health insurers. This means, there is no standardization here and the private insurer can choose the class of drugs and level of drugs to cover.

Part A and Part B are plans were designed several years ago and these plans offer a fee-for-service kind of coverage, and are often called the Original Medicare plans. People who have only subscribed for Part A and Part B, can take additional coverage such as Medigap or go in for a private Medicare Advantage plan offered by a Medicare HMO.

This includes Part A also covers rehabilitation or convalescence in skilled nursing facilities, as long as it is for short durations and under certain conditions. For terminally-ill patients who have 6 or fewer months to live, hospice benefits are extended under Part A under certain conditions and based on the recommendation of the physician.

Medicare provides tremendous benefits in standardizing cost, coverage, access and information about the plans. However, to ensure that you are on the right plan and are adequately covered, it would be wise to talk to experienced brokers / advisors available at the insurance companies before finalizing on a healthcare insurance plan for you or your family. Allied Brokers, a renowned and decades old insurance company, located in the Bay Area, can help you to understand and subscribe to the right Medicare plans and coverage.

Monday, February 9, 2015

Individual and Family Health Insurance

Diseases and ailments are on the rise, around the world. Scientists attribute this to pollution, junk food, excessive alcohol consumption, stress, and lifestyle in general. And when illness strikes, the focus is less on getting quality healthcare or recovering quickly, and more on fretting about the cost of treatment or how to foot the medical bills.

It is shocking to know that, in the last three decades, more and more citizens in North America are able to ill-afford the cost of much needed medical treatment, as they do not have healthcare coverage of any sort. In 2011, a report published by the Commonwealth Fund showed that as many as 26% of US citizens in the working age-group have gaps in their health insurance coverage.

Not having adequate health insurance coverage can be risky from various perspectives.
  1.  Penalties to be paid: From January 2014, US citizens who do not have healthcare coverage, must pay a tax of $95 per adult or 1 percent of annual income, whichever is greater, with this amount gradually increasing to $695 per adult or 2.5 percent of annual income, whichever is greater, by 2016. 
  2.  Financial ruin: It may be disquieting to know that one of the most common reasons for people filing for personal bankruptcy is their having to foot costly medical bills after the onset of a serious illness. The consequences of such action has led to destruction of an individual’s career, marriage and has even ruined their creditworthiness.
  3. Reduced access to healthcare: Federal law requires the insured to undergo mammograms, vaccinations, colonoscopies, or prostate cancer screenings frequently. These examinations help detect these ailments in the early stages, thereby enabling treatment and cure. Not having coverage means people tend to defer such screenings and expose themselves to health risks and the increased cost of treating them.
  4.   Limited to none follow-up care: Though, all hospitals treat emergencies, even if the patient has no healthcare insurance, this however, does not apply to follow-up care. So when a patient who needs follow up care, does not have healthcare insurance cover, they are putting themselves at a risk for consequences such as a relapse and other complications.
  5.  It may be a while before you get coverage: As per Federal laws (Obamacare), consumers can purchase health insurance cover only at prescribed intervals of time every year, or shortly after a life-altering event like immigration, marriage, death of a family member, birth of a child, a new job, etc.
That is why it is imperative to have a reasonably good health insurance cover. This begs the question. Does one go for an individual health insurance or a family health insurance plan? Needless to say, these two types of cover are suitable for different situations, and have their own benefits and disadvantages.

Family Health Insurance
Family Health Insurance is less expensive than Individual Health Insurance and covers all the family members, who share a fixed cover. This means, if a family has a cover of 100,000 USD, the entire family can claim up to 100,000 USD as a combined entity. The most common configuration for these policies is two adults and two children to be covered. This is ideal for younger families whose members have a low health risk.

Individual Health Insurance
Here, each member of the family has a separate cover amount, and they claim this entire amount over one or more claims in a year. This is ideal for older families and when the health risk is more. 

Regardless of the type of healthcare insurance coverage you desire, at Allied Brokers, we primarily analyze your / your family’s profile, before making our suggestions. We offer the most flexible plans and we function on a consultative style. Our plans are easy to assimilate and they also ensure that the coverage we afford keeps you in good general health, without having the stress of paying huge hospital / medical bills.