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Monthly Archives: July 2017

You Need Health Care Insurance

Provision of peace

With the changing times, the penalty for not having a health care insurance increases at a great percentage every year. For your own peace of mind and benefit, it is good to avoid these repercussions. Accidents or illnesses do not knock; they just budge in without an invitation. When this happens, a sigh of relief follows in knowing that you have it all covered. If not insured the medical bills will always seem unreasonable and devastating.

Protection for your family

If you do not have your health or that of your family covered, this could cause you stress. Medical needs at times are unpredictable and they are mostly accompanied by high costs that end up accumulating to large medical bills. Retirement savings are meant for the period after your retirement and having your family’s health insured is an assurance that you will not start digging deep into those savings to pay for the medical bills.

Health tools and resources

There is an added advantage of going for regular medical check- ups as well as screenings, which are covered by the insurance policies annually. Discounts on other programs exercised and treatments come in handy.

Health Insurance Shopping

Platinum plans – Typically less than $3,000 max out-of-pocket per person ($1,500 max on some plans) with co-pays for first dollar coverage. This is very rich and the premium will be unaffordable to most.

Gold plans – Roughly $3,000 out-of-pocket maximum per person including your deductible (this can vary based on personalities of the insurance companies). Your deductible could start as low as $500 or be at the max at roughly $3,000. This plan will also typically includes co-pays at the doctor, specialist and prescription drugs at the pharmacy. The amount of the co-pays will vary by carrier and service and/or tiers.

Silver plans – Roughly $6,000 out-of-pocket maximum per person including your deductible (this can vary based on personalities of the insurance companies). Your deductible would typically start around $2,500 and go up to the max of $6,350 per person. This plan will typically include co-pays similar to the Gold plans.

Bronze plans – Some refer to this as a low-level plan. There is nothing wrong with this plan. It’s similar to the old Health Savings Account (HSA) plans. It is a high deductible and everything you do applies towards your deductible. All except for Preventive or Wellness exam (check policy for details). If someone is comfortable just know what their maximum out-of-pocket is without worries of co-pays and take a premium reduction for it, this is a great alternative to the other plans. This plan will be a maximum out-of-pocket of $6,350 for individual and $12,700 for a family. This will vary depending on the personalities of the insurance company you are reviewing.

Catastrophic plan – This plan is for the young. It’s basically mirrors the Bronze plans but it will have a doctor co-pay attached to the plan. It’s an alternative for the young to get something more affordable with a co-pay for first dollar doctor visit coverage. There are age limits to this plan. However, with certain financial hardship, those over the age limit may qualify.

Fix Obamacare

First we need to realize that there is a difference between being uninsured and not being able to qualify medically for insurance. While we need to find a way to insure those, insuring six to eight million is a different strategy than insuring fifty million. I have studied what some other states did prior to the enactment of the Affordable Care Act, and I think I have found the answer.

If I were in charge of reform in this country this is what I would do. First I would keep an open enrollment period every year, however, I would make this only for the people who cannot medically qualify for insurance. I would force every insurance carrier in the stat to participate in this enrollment, but have a cap on how many they could take. I would guess about 5% of the company total number of policyholders could be in this category so once a carrier got to 5% they were closed for the open enrollment. I would also say you need to have a slight rate increase on the non healthy block of business, but have a cap of 30% of what the standard rates are. This would offset some, but not all of the medical expenses incurred by this block of business.

The rest of the business is written year round and underwritten. This will keep the rates down for two reasons, one no one is getting bombarded with the chronically ill, also you could offer a more affordable rate to the “young invincibles.” Allowing people to change plans during the year if they can pass underwriting, is beneficial as if you get a rate increase you can look around, if you have a bad experience with your carrier you can move.

The next part would be to extend HIPAA to the individual market so if you have had insurance for eighteen consecutive months, you could not be denied or rated and have the ability to change plans outside of open enrollment. That really solves a lot of issues on the uninsured market. I have always kind of believed the reason we had pre-existing conditions in the first place was due the way that part of the law was written.

File A Medicaid Claim

Once determined to be eligible, an individual or family can receive medical care from providers who are enrolled in the Medicaid program. These providers are the ones who bill Medicaid for services rendered.

Billing at the local or state level, so it is also at the state level that program administration is determined.

Can an Individual File a Medicaid Claim?

The question of how to file a Medicaid claim is one that can confuse both individuals and medical care providers.

Each state has its own application and claim forms. The application is submitted by the eligible individuals or families. In the case of minor children, these are normally submitted by their primary caregivers. In the absence of primary caregivers, state institutions or agencies may handle the application process.

As for the claim forms, this is ordinarily taken care of by the medical service providers or the health care providers, the ones who will submit the claims.

Individuals or families may only fill out and submit a Medicaid claim by themselves, under two circumstances:

1. if or when specific health services required by the patient are not covered by the health provider, or,
2. then the health care provider states that it does not submit claims to Medicaid

How Does the Submission Process Go?

If you are a non-provider, and are the actual patient eligible for Medicaid that is filing a claim, follow these basic steps:

1. Go to your local Medicaid office to get the appropriate claim forms. You might also try getting the forms online. There are states with websites that have sections for downloadable forms of many kinds. In case your state does not have such forms for download, you need to visit your local Medicaid office and fill out the forms yourself. If you are still too weak to do so, authorize a relative in your behalf to ask your local Medicaid office how to go about filing a claim. Remember that each state may have its own rules, so never assume a procedure. Always check it out.

2. If you are able to get a Medicaid claim form, you need to put in the correct service codes on the forms. Be careful about the service codes as they are the one that identify the exact type of treatment you are referring to for claiming. Correct service codes are fundamental to correctly process the Medicaid claim form.