Florida Health Insurance Blog

Misunderstanding health insurance

In viewing the healthcare system it is helpful to step out of it and then view it.  If we compare it to the care, maintenance and insuring of a car or home, then it makes more sense.  Let’s say a person takes a job.  Let’s say the employer in this imaginary example gives their employees a car benefit.  The employer’s car benefit includes providing the employee’s car insurance to cover accidents and the other things auto insurance now covers.  Now, let’s say this employer’s benefit plan also includes a warranty.  The warranty will pay for the repairs the employee’s car will need.  Let’s also say the plan also pays for maintenance costs.  Now finally the employer’s plan will pay your car to have all the nicks and dings taken out of it.   This is what people expect of their health insurance plan.  Health insurance is no longer insurance, it is insurance with a warranty, a preventative maintenance plan and covering old damage. 

The Role of the Government

A way of seeing the role of a government plan is like the role of a big city’s public transit system.  Cities develop around their modes of transportation.   Cities that developed before cars look different than cities that developed around the automobile.  Cities such as New York and Chicago invested in transit systems before automobiles became the primary mode of transportation in the US.  Public transportation means that everyone has access to transit, but does not eliminate other modes.  People can walk, take taxis or drive cars if they choose.  With my healthcare plan, the government’s healthcare option would play a role similar to the role of public transit.  It is there for everyone, but everyone still has choice.  Our cities would not have grown and prospered without having a public transit system and supporting all other forms of transportation as well. 

The government would have a national public HMO that everyone could have.  It would be available to every citizen and legal resident no matter their age, health or financial situation.  The government plan would focus on primary care.  The government public HMO would becomes the payor for healthcare services under $5000 or $10000.  The government only pays up to $5000 or $10000 maximum per person per year, no more.   Each person would select a primary care physician.   There would be emphasis on regular care, checkups, testing, prevention and wellness.  

The plan would be offered at very little or no cost.  There may be a sliding scale based on income.  The idea is that everyone will have access to primary care.  There would be no reason for anyone to put off going to the doctor or going to the emergency room for a non emergency situation.   Some people would continue to use emergency rooms as this has been the habit for a couple of generations.  Controls would need to be implemented so that people would go to their primary care physician when that is the proper medical treatment.  With this plan, there would be no advantage for a person going to the emergency room for a non emergency.

As this is an HMO, costs could be controlled.  People that would prefer to have more freedom, such as not needing to have a primary care physician or need a referral to see a specialist could take private health insurance just like that do now.   In this plan, everyone has access to primary care either with the government public HMO or with their own private health insurance plan.   Private health insurance would be like now, either by being on an employer sponsored group health insurance or on individual health insurance.   

Since the burden of unpaid healthcare and abuse of the emergency room would be lifted off the hospitals, then there would be no passing on these expenses.  Currently, unpaid medical expenses are passed on to those that do pay.  This raises the costs of healthcare and health insurance.  This should lower healthcare costs and health insurance costs or slow the rise of healthcare costs.

Florida Health Insurance and Medicare Website
www.floridahealthinsurance.com
International Health Insurance Website
www.insurance-network.com

We need to address the following topics to implement effective healthcare reform in the US. 

• Access to primary care
• Misunderstanding health insurance
• Role of the government
• Public Plan
• Private Health Insurance Plans
• Education of the Public

     Access to Primary Care is the Answer to Healthcare Reform

The healthcare problems in the US are caused by the lack of access many Americans have to primary care physicians, physician assistants and nurse practitioners.    This creates problems on many levels.  The US falls below other countries in the treatment of chronic illness.  People use the emergency room as their only form of healthcare.  This raises the cost of healthcare for everyone.  The costs are distributed over the people that do pay by higher costs of services and health insurance rates. 

Lack of access to primary care causes:

• Use of emergency rooms for non emergency healthcare such as urinary tract infections, minor injuries and upper respiratory infections
• Chronic conditions such as hypertension, high cholesterol, diabetes, heart disease, arthritis related conditions and asthma do not get treated
• Lack of treatment leads to health situations with much higher costs
• Many persons needing treatment, when treated, cannot pay and the costs are then passed on to persons, insurance companies and the government as increased costs
• Hospitals bear the burden of treating people which do not need to be in the hospital or might not have needed to be there if they had received ongoing primary care
• Chronic health conditions do not receive sufficient care or sporadic care
• People do not go to the doctor when they should for fear of the costs
• The healthcare system becomes clogged

I believe that healthcare costs can be brought under control by making primary care accessible to everyone and encourage people to use it.  We need to educate people so they feel comfortable seeing their primary care physician.  We need to make emergency rooms for real emergencies.  We need to have more primary care physicians, physician assistants and nurse practitioners.  This also means teaching people new 21^st century ways to relate to our new healthcare system

All discussions seem to be about people being uninsured.  This leads to all proposed solutions focus on finding ways to get people insured.  Yes, this is important, however if we focus on people not having access to primary healthcare then proposed solutions will be about ways to get people access to primary healthcare.   We need to also focus on ways to encourage people to use primary care providers as much of the US culture uses healthcare for acute care or waits until the really need emergency care.  We need to encourage prevention and wellness supported by access to primary care.  Even if people have access to primary care, they need to use it.

Healthcare Reform – A Plan That Works For Everyone

Here is how to end the deadlock on Healthcare reform.

This covers everyone and will actually work.  I have experience in domestic and international health insurance so please read.

Here is how to do this very simply.The government becomes the payor for healthcare services under $5000 or $10000.  The government only pays up to $5000 or $1000 per year, no more.

Everyone is covered. 

Health insurance companies are the insurer with plans having $5000 or $10000 or higher deductibles.   They can vary the benefits after the deductible.  Insurance companies need to be able to underwrite applicants as they have been doing.  

They can offer different plan benefits and rates will vary based on the market as it is now.  Plans are marketed as they are now by insurance companies and insurance agents. 

This will mean everyone can have routine exams and preventative healthcare.   It will mean health insurance will look like insurance which is protecting against a large risk. 

Everyone’s needs get addressed with this plan. 

In my plan, the government plan is a form of national HMO.  It takes what works best about foreign country healthcare which is that primary care is accessible to all.   The US handles major care such as advanced technology testing, surgeries such as for heart problems and other major healthcare issues faster and better than it is handled in other countries.  That is best served by private health insurance plans.

I would also suggest we give people the right to choose what they want to have.  This means they could have the government HMO plan at little or no cost or opt-out and choose private health insurance.  The private plans would be similar to plans we have today.

Primary healthcare is the biggest need we should address.  The US lags behind other countries in this area.  My plan will give everyone access to healthcare.  It supports universal healthcare, a government and private insurers working together for a healthier America. 

Finally, agents, such as myself, that have spent decades working with people are a tremendous resource.  We are the only ones that work with all the pieces.   We are the ones that can implement this plan best.

This plan would mean we would need more primary care physicians as well.

If you are taking a trip, studying, working, visiting or living outside of your home country, is there a need to have international travel health insurance or permanent international health insurance.

First, travel insurance and travel health insurance is not the same thing.   The purpose of travel insurance is to protect your trip in case something happens that causes you to either not be able the take the trip or the trip is cut short.   For example, you have booked and paid for a cruise and the cruise employees go on strike.   The travel plan would pay you the cost you paid for your trip. There are many other situations that could cause you to miss your trip.  Travel insurance is important, but it the health coverage is only incidental.   It is trip protection.  This type of insurance is typically offered by travel agents.

Travel health insurance is international health insurance with some trip coverage, but it is primarily health insurance.    Travel health insurance is only sold by licensed insurance agents.   It is a specialty in the insurance and so it is best to work with an agent who has a lot of experience in this area. 

Some International travel health insurance plans are only offered to US citizens or have benefits that only apply to US citizens.   There are plans that are offered only to non US citizens and only covering them in the US.   There are restrictions on these plans as to who qualifies based on citizenship, countries being visited, length of coverage and age of the insured.

 In general, travel health insurance plans do not cover existing or pre-existing health conditions.  There is coverage for US citizens that do have coverage for the acute onset of a pre-existing condition.     If you have a health condition it is important to know how your plan handles pre-existing conditions.  There are plans for US citizens that will cover all pre-existing conditions if you have a US primary health insurance plan. This includes individual health insurance, group health insurance and Medicare.  These plans are available for trips up to 6 months and must to be taken out prior to leaving the US.

So, you have your US health insurance plan, why would you need something else?   If you check your US health insurance plan you will mostly likely see that if you are out of the country then your plan has emergency only or maybe no coverage at all.   Domestic, meaning US health insurance plans are setup with US healthcare providers.   They are not setup internationally.   Customer service for US health insurance plans usually is open from 8 or 9 to 5 Monday thru Friday in whatever time zone your are in.   International travel health insurance customer service is open 24 hours a day 7 days a week and they handle situations in many languages.   Their business is international and they are used to working in many countries.  

If you are sick or injured in another country, you may find yourself in a very uncomfortable position.  This is not because there is any issue with their healthcare.  It may be due to your not speaking the language.   Each country has a different system.  In some countries they want payment immediately, in fact, in the worst circumstances; people are not allowed to leave without payment being made.   International insurance companies have relationships with foreign hospitals and providers.   They can talk with them.   They can wire money to the hospital.   They have customer assistance.

Does this mean that every claim will be paid for you to the provider just by showing your ID card?  Not necessarily and doctors and clinics tend not to want to deal with insurance from other countries.   You do have the option of calling the insurance company and asking them for advice and guidance.   Sometimes they have provider relationships established that you can use.   In case they do not and the bill is relatively small, under $1000, you would pay the bill and submit a claim.

 One of the great things about travel health insurance is that you can have deductibles as low as $0 or no deductible.   Let’s say you need to see a doctor because you are sick.   The sickness is new and not connected to any existing condition.   The visit costs $50 and the medication is another $50.  You would pay for that, keep copies of the bill and submit them.   If the country where you saw the doctor is not an English speaking country, the bills are in the language of the country.   Imagine submitting that to your US insurance company.  

If you have a $0 deductible on your travel health insurance, then you would be reimbursed from the first dollar spent.    Most US plans today do not have out of network deductibles less than $1000.   Instead of quickly being reimbursed, you would be under your deductible, so no reimbursement and they would have to translate your bills which they may not be able to do.

Some countries require that you show proof of insurance to visit there.   European countries have this requirement.  Plans have to meet the Schengen Treaty requirements.   Some countries such as Italy and France also require special letters that verify insurance.  These have to written as the consulates require.   Proof of qualifying insurance is provided by the international carriers at no cost and immediately.

International travel health insurance costs a lot less than most people expect.  There are some reasons why.  The plans are for a certain period of time, not indefinitely.   Healthcare costs outside the US are less than in the US and can be considerably less.   When the claims amounts for services are less, then premium cost is also less.  

Most international travel health insurance plans can be done right online over the internet.   International insurance companies have been leaders in the use of the internet.  It makes sense as business is happening globally all the time and what better place than online.  ID cards are issued immediately after the online application is completed.    The ID card will have the person’s name and all contact information.    It can be printed out from your computer.  

So, as part of any trip of any length, international health insurance needs to be on list.  Pack yours pants, shirts, underwear, socks and other items and keep your insurance card in with your other valuables like passport and ID.  

You can find plan descriptions, get quotes, apply and be immediately issued right online at www.insurance-network.com  Have a great trip.

You have been working at a job that has an employee benefits including a group health insurance plan.  You might have the insurance plan for yourself, for yourself and your spouse, for yourself and your children or for your entire family.   Then you find that you are losing your group health insurance.

 This could happen for a variety of reasons.  Maybe you lost your job.    Maybe you quit your job to take another job.  The new job either does not offer health insurance or you have to wait before it starts.    You might lose your employer group health insurance because the company you work for decides to discontinue or reduce their employee benefits.  Maybe your hours were reduced and so you no longer qualify for the group health insurance.   Maybe you are getting divorced and you were covered as the spouse on his or her insurance.   Any number things can happen with result being, you have lost your employer group health insurance.  

So, what now?   The easiest situation is the person that is changing jobs and the new job has health insurance and employee benefits.  You just have to wait until the new benefits start.  Often there is a 90 day waiting period before benefits start.  In this situation, where you know you will be getting new benefits at a certain time, there are couple things to consider.   The first is your current health.  If your health is good or if you or a family has health issues helps determine what is the best way to handle the gap in insurance between when the prior employer’s insurance ends and the new employer’s insurance begins.   If there are no problem health issues, then a temporary health insurance plan is a good choice.  You can find those at www.floridahealthinsurance.com/hpa  if you or a family member has some health issues, where a break in coverage or having those conditions would be a problem, and then you need to seriously consider taking COBRA benefits during the gap between plans.

COBRA, the Consolidated Omnibus Budget Reduction Act was passed in 1985.   COBRA is the federal legislation that governs health insurance continuation for employer’s having 20 or more employees.  It applies to most businesses. There are few exceptions to this.    If your employer is governed by COBRA, and you have lost your employer group health insurance and the employer still has their group health insurance plan in force, then COBRA legislation governs what is available to you and for how long. 

The most basic benefit period is 18 months.  This means that you and anyone in your family that was on the group health insurance plan could continue with their health insurance for up to 18 months from the time they lost health insurance.   Other longer benefit periods would apply if the person was disabled or lost their insurance due to divorce.   COBRA is the responsibility of the employer and there are strict guidelines for notification.   The insured has time periods to make a decision and to pay.   It is important to know what these are if COBRA is the only health insurance option.   The COBRA legislation can be found at www.floridahealthinsurance.com/cobra.htm

If you qualify for individual health insurance, then that might be the best option.  The reason is the individual health insurance plans generally cost less than employer group plans.   This comes as a surprise to many people.   Group health insurance plans have to include all eligible employees and family members.   They qualify irrespective of their health.   This is good for people that have health problems that would not qualify for a medically underwritten group health insurance plan.   It does mean that the cost of the group plan has to be higher to cover the costs of guaranteeing insurance to everyone.    Employer group health insurance plans also include many mandated or required benefits.   Every mandated benefit increases the cost of the insurance.

Finally, we have the situation where you have lost your employer health insurance due to the employer going out of business or discontinuing their group health insurance.   In this case COBRA is not an option as there is no longer a group health insurance plan.   If you are insurable, then individual or temporary health insurance is a good choice. If you are uninsurable then you would need to consider a HIPAA guaranteed issue plan, CoverFlorida or if your state has a state high risk pool then see if you qualify for that.   The same applies to people that have left a job from an employer that is not governed by COBRA.

COBRA is for businesses with 20 or more employees.  States have their own legislation to govern insurance continuation for businesses with less than 20 employees.  You should check in your state.  In Florida we have mini-cobra for groups with less than 20 employees.

In summary, your choices are temporary health insurance, COBRA continuation, individual health insurance, HIPAA, CoverFlorida or your state’s high risk pool.   You can find detailed information on all of these options at www.floridahealthinsurance.com