Health Care Debate Should Spur Insurance Review

February 28, 2011 | Posted By: Chris Birk
The nationís recently passed health care form act is nearing a Supreme showdown.

A Florida judge struck down the law in late January, agreeing with the attorneys general of 26 states who sued to block its implementation. The decision out of Pensacola came just weeks after a Virginia court found the lawís insurance mandate unconstitutional.

The looming reality is that the Supreme Court of the United States will have the final word on key provisions of the landmark piece of legislation, if not the entire act.

Regardless of where U.S. citizens stand on the issue, the debate should encourage everybody to review their insurance. Scores of employers offer their workers health insurance, but not everyone enjoys these prized benefits.

Not all employed people get insured either. In those cases, itís up to them to find an insurance plan that meets their financial constraints. The key is understanding what to look for.

Read the Fine Print

Thereís no question that checking a planís deductible and premium is vital. After all, these tell you when the insurance starts paying if youíre ill and if you can afford the plan at all. When looking for health care plans, itís best to find one that looks like insurance rather than a plan where you pay a monthly premium and get the care you need, which is more of a prepayment plan.

ďWhether youíre employed by a large company, self-employed, or unemployed, you want to read the fine print,Ē said Mitch Redmond, a manager with Free Insurance Quotes. ďA quote is a quote, but your final plan and its details can vary.Ē

Paying the Out-of-Pockets

Consequently, the out-of-pocket maximum and policy limit are equally as important as the premium and deductible. The out-of-pocket maximum is the limit you pay after the insurer pays its share of the bill. So whatever is left on the bill falls on you, but youíre off the hook once you hit the maximum.

Consider Policy Limits

Policy limits can help consumers gauge whether their health care is a prepayment plan or real insurance. If you can pay the out-of-pocket maximum without going belly up, then you have insurance. If paying it would run you dry, then you have more of a prepayment plan.

Itís also important to determine whether this maximum applies to out-of-network coverage. The maximum seldom applies here, which means you could be held responsible for paying your entire share of the bill.

Health insurance is like other insurance, meaning there is a policy limit. This is the maximum that the insurance company will pay. Insurers use the limit as a way to determine what premiums to charge. If an insurer denies coverage simply because the cost was too high but didnít come close to the policy limit, the insured can take courses of action, if need be. (Appeals, lawsuits and arbitration are not uncommon.) However, once the insurer reaches the policy limit, there is no legal obligation for the insurer to pay any more.

Regardless of your opinion on a public option for health care or on the governmentís right to mandate insurersí policies, the debate is a good reminder that we should all look over our health insurance.

For those without health insurance, itís time to look for a plan, paying close attention to the out-of-pocket maximum and policy limit in addition to the deductible and premium.
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