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"Real" Major Medical Plans
Personal health insurance—referred to as "major medical" is not
"cheap," but a savvy, well informed shopper can find coverage that
is reasonably priced and dependable. A quick study of three major
issues will help you determine if a particular type of coverage
is right for you. They are (1) your own health and coverage needs;
(2) types of coverage available; (3) recognizing reputable companies.
Analyze your own needs
Freedom to choose your own lifestyle is one of the plusses of living
in America. However, your lifestyle, physical fitness, and health
history will play an important part in not only your health insurance
premium but also in the level of coverage you can purchase. For
example, those who do not smoke and who maintain a healthy weight
will get lower premiums. In fact, simply being able to report an
active lifestyle can lower your premium. Also, if you take a lot
of prescription drugs, talk to your doctor—or consider visiting
a naturopathic doctor who is educated in supplements and nutrition
and can direct you in ways of eliminating prescription medicines.
Prescriptions scream "chronic condition" to an insurance company.
Vitamins and supplements, which most doctors are not prepared to
talk about, however, are not regarded as underwriting factors in
health insurance even if taken continuously and for a single cause.
You may find yourself
needing insurance without having had much warning. In that case,
you might have to take an insurance with a higher premium, but you
can get begin a healthier lifestyle, and once needed changes have
been accomplished, you will be able to change to another company
and possibly lower the premium.
Types of Coverage
The coverage most people look for is "major medical." It is traditional
coverage that pays for office visits—with either coinsurance or
a copayment from you—as well as hospital care, emergency room and
outpatient services, and may even include some vision and dental
coverage. It is also the most expensive, although the cost can be
reduced if you take a higher deductible. Healthier people today
often take a deductible high enough to qualify for a Health Savings
Account (HSA). The HSA is a special type of IRA account that you
set up at your local bank. Money is deposited (according to government
limits) "before taxes," allowing you to lower your reportable income,
and then is withdrawn tax free to pay applicable health-care related
Other forms of coverage
are the HMO, which requires you to seek care from within a network
of caregivers; the PPO, which still involves a network but does
not require the recommendation of the "primary care" physician in
order to visit another doctor; and catastrophic coverage which only
pays for a major illness which requires hospitalization. Catastrophic
coverage will have a higher deductible and will usually not pay
for office visits, maintenance prescriptions, or vision or dental
Hundreds of organizations that promise some sort of health insurance
exist in today's marketplace. However, the worst thing that can
happen—other than the illness itself—is to submit health insurance
claims, only to find out that the company doesn't pay the way you
thought it would, or that it is no longer in business, or is just
a discount plan that pays "per illness" according to a limited schedule.
The number one cause of bankruptcy in America, especially among
seniors, is catastrophic health care costs that an individual is
unable to pay. Lawsuits involving health insurance policies generally
do not solve the problem as such companies know how to word the
policy so that they actually cover far less than you expected. Regardless
of the type of insurance you want, the first step in choosing a
company is to see what is available with the companies that have
an established track record. Then, talk to a health insurance agent
who can explain the policy fully and who is willing to deliver the
policy and take time to go over the various clauses.
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