Does Healthcare Reform help me get coverage if I have medical issues?

Presently Healthcare Reform is in the implementation stages and to a large extent is not fully implemented. It is also facing a decision of constitutionality by the Supreme Court of the United States. These two factors mean we have a long way to go before we have a fully functional law if ever.

The timeline for the law does not call for major changes such as implementing guaranteed issue for all major medical health plans until 2013. Thus for those who currently have major medical issues they must still meet all underwriting criteria for a plan to be issued by the insurance carrier.  Thus, if you have serious medical conditions it is possible there will be no coverage offered.

Presently, in Texas you can always go to the Texas High Risk Pool for help with coverage when you are declined by other carriers.  Many other states have similar programs for those who are otherwise not insurable with traditional health insurance for individuals.

In 2014 if the law stands, you will be able to get coverage, however ratings can be applied so those with major health issued will still likely pay more.  Some of those details are still not fully worked out.  There is a 3:1 ratio that is to be implemented that one person does not pay more than 3 times what anyone else pays in the same geographical are. I expect but have not been told explicitly, that age as well as medical conditions will warrant the differentials in rates.

Ultimately yes, if the healthcare reform act stands, it will help you get coverage, but it will not necessarily make the coverage any less expensive for you.  There are still issues with how the law is structured that allows healthy people to opt out and pay a minimal fine thus making for a riskier pool of folks buying insurance thus higher premiums for those individuals.

What are the different variables in a Long Term Care Policy?

Long term care insurance policies are built around the promise to pay for care needed when you meet the eligibility requirements to go on claim. However, with long term care it’s not as simple as paying for a doctor office visit as care is rendered in many different ways and in many different settings.  To meet all of these different needs, the plans are designed with flexibility to make selected parts of the plan design best work for the insured’s needs.

Long Term Care Insurance Plans are designed with the following key components set based on insured input about needs. The daily or monthly benefit; percentage of benefit available for in home care; elimination period; inflation protection level; length of total coverage; and in some cases establishing if the payments are based on daily or monthly benefit levels.  These together create the policy and dictate how benefits are paid out during the time of a claim.

The daily or monthly benefit level is one of the most key elements in designing a policy. Also, the decision to take a daily or monthly benefit is also part of what will affect these amounts of payments as well.  Generally when in a facility it is easier to live on a daily benefit basis, but during the use of home care often different amounts of care happen on different days which lends itself more to using the monthly benefit for in home care.  Home care often ends up shared between paid care givers and family and/or friends who help out some. With this you may see spikes on some days where costs for care are greater than on other days.

The costs some days could be more than the daily benefit, but when averaged for the month may fit within a monthly benefit. In order to choose the level of coverage it’s best to look at facility costs in your area, or the area where you would want to live if needing institutional care.  Also assess how much does in home care cost. With these numbers you can more easily pick a number that gets the coverage level you want. You do not have to cover all of the expenses you may incur. Some people do opt for lower levels of coverage to help pay for care but don’t worry about covering the costs fully.

The elimination period, which serves as a deductible, but is expressed in terms of the number of days services are received or since the designation care is needed is another moving target, you set as the policy gets set up. You can have one elimination period for both the institutional and at home care. You can also have separate elimination periods, where typically the at home care payments kick in more quickly than do payments for institutional care.  You can get anything from zero day elimination for home care up to 180 days elimination. Typically there are no zero elimination periods for institutional care, but the 180 days is one way to help cut the cost of the care.  Know that whatever period you pick, is a time frame in which you are paying for the care, hence my comparing it to a deductible.

Inflation Protection is another key element. Setting up a plan for a set amount of benefit today is great if you end up needing care soon. However many of us will have many years before we need to get care. To that end, you will always want to have the level of coverage grow to keep pace with the rising costs associated with the care.  Most of the carriers even require you to consider as part of the application process how you would pay for care if the cost increases with or without inflation protection. In fact to have a partnership eligible plan it must contain inflation protection in most cases.  The inflation protection will on either a simple or compound interest method increase the daily/monthly benefit limits typically annually on the anniversary date. The most I see offered is usually a 5% compound interest.  At this time, that is helping keep pace with medical inflation, which is key for this kind of care.

Length of coverage is the last key component where you have multiple choices. You can get as little as two years of coverage to as much as lifetime coverage. Two years is fairly short, unless you only seek care when you are nearing the end of life. Statistics indicate there are three points where we see spikes in the length of stay with institutional care. They come around six months, two years, and five years. Of course nobody fits right on those spikes and you can’t know ahead of time which spike is yours.  Thus, you have to look at how much care you may want to have covered by the insurer. 

In addition to standard lengths of coverage couples can get shared coverage where one can use most of the shared coverage leaving some for the other member of the couple. This is how my own policy is set up with my wife. We are both guaranteed a minimum amount of care but if one were institutionalized for many years the shared coverage allows for that coverage to kick in and ensure we both get care. This is a very useful provision in many plans and beyond that is one that is especially useful if one partner is placed into institutional care to deal with organic brain disease.

Ultimately the use of a professional agent is key to building a policy that best fits the client’s needs. A good professional agent understands the market and how the policies fit together. This allows guidance towards designing a plan that provides the benefits most important to the client, not just pushing a cookie cutter plan on all who desire coverage.

We enjoy working with clients on finding and implementing the right Long Term Care Insurance Solutions.

Does my health insurance cover care outside the USA, such as the discount surgeries in India?

Health Insurance varies from policy to policy. Some will cover emergency care outside the USA while other plans will only cover care inside the USA. Almost none cover international medical evacuation though. Thus, there is no simple answer to will your policy cover international care.

International care is broken down into a couple of different care categories. First there is emergency care, which if any care is covered internationally, usually it is emergency care. Routine care is something almost no policies cover on an international basis. The reason emergency care is covered on many policies, is that it is an emergency endangering life and limb. Also, frequently the emergency care outside of the USA is far less expensive than that received in the USA.

Another break point in getting an idea of if your care is covered or not has to do with the kind of payor (insurance company) involved. Medicare, for those 65 and over who have paid into the system long enough or the disabled who were granted Social Security Disability and Medicare for the Disabled, and Medicaid are the two big government payors.  The government generally does not pay for any care outside of the USA. Other insurance comes thru employer sponsored group plans and yet one other source is individual health plans. These private insurance plan are where you really have to check will or won’t they cover emergency care outside the USA.

Virtually all Indivdual major medical health plans will cover emergency care outside the USA. Group plans more often than not will cover emergency care outside of the USA. The plans where coverage is fully insured by the insurance company generally do cover emergency care around the world however self insured groups (those plans where the employer puts aside money to cover care) have more liberty in how they define covered services. These plans are ones where there is a higher probability you may not get emergency care covered outside the USA, especially if the company does not require any international travel for business reasons. They way you know for sure is to ask the employer or review your certificate of coverage.

In the event your health insurance does not cover emergencies outside of the USA, you should definitely get travel insurance where they provide adequate emergency care coverage while on the trip. You can pick a plan here. Without insurance you can be out of pocket and often the providers will require payment before treatment, especially outside the USA. This could be financially devastating to most travelers.

Of course some people want to travel internationally for lower cost good quality care. There are several areas in the world where US quality care is available at facilities and providers all trained in the West. More often than not those seeking care of that nature are paying cash for the care. Insurance generally does not cover care of that nature. There are a few facilities that have achieved JCAHO certified facility status and that is a critical step towards being able to get US based insurance companies to agree to pay for care like this. Because there are travel costs and follow up care is a bit more difficult, the insurance carriers are a bit timid to rush into paying for this care. 

As we see more facilities and programs around the world get the JCAHO certification, we will likely see a growing list of programs where you can travel for your care. Of course the care involved is typically extensive surgical procedures which for most people take several days from initial diagnosis thru completion of treatment. Of course often these programs include hotel accommodations and sometimes airfare as part of the overall program. The price for many of these programs is a small fraction of what would be paid at a hospital near home, so that is why some carriers do agree to pay for these packages.

As you can see coverage for international care is limited and tends to be by private insurance companies and only for emergency care. Always keep in mind that the government does not pay for care outside the USA so you need to have travel insurance if you have coverage thru the government and plan international travel.

Is Travel Insurance a Good Idea?

Travel insurance is one of those add on costs when you are booking that exciting well deserved vacation (holiday).  To many it seems like it is just wasted money because nothing ever goes wrong or if it does they roll with the punches and take it in stride.  Others swear by it because they know the costs associated with things going wrong.  Also, they understand that when things go wrong it is not always someone else’s responsibility to cover their additional costs, which can mount rapidly depending on circumstances.

There are so many reasons in favor of having travel insurance and so few legitimate reasons not to have it. For most folks a vacation represents one of the most major purchases for a specific year.  When folks buy a new car or new house they definitely insure it.  Thus when sinking a few thousand dollars, which in many cases are non-refundable, into a vacation is a huge investment. If for some reason the trip had to be cancelled most people would want their money back or at least most of it back. Also, if they have problems along the way to or from the trip again they want help with the extra expenses.

In a worst case scenario on a foreign trip if you or a family member traveling with you were to become ill or injured you want help picking care and ensuring it is paid for. If you need medical evacuation you want to have that paid for as well. This is one of the key features many people cite as their key reason for adding coverage.

With travel increasing in cost and vacations growing as an expense for most, the invested dollars are becoming more important to most families.  Thus a missed vacation and lost dollars are also more important to families. The extra costs associated with things going wrong can easily kill the budget for their trip. A medical evacuation not paid by any insurance could easily put most families in serious financial trouble when often they cost $15,000 or more depending on when, where, and how far they have to fly. 

Travel insurance covers so many different situations that may come up that causes problems for your trip. It typically covers things such as cancellation of trip for medical reasons of travelers and their immediate family members. Death of family of the travelers also tends to be a covered situation. In some policies work related cancellations are possible, but you have to really watch the exclusions there as business owners typically can’t cancel for business reasons. You can buy a rider on some policies that allow cancellation for any reason.

Once the trip starts you usually have coverage for many things that come up such as missed connections and other delays. This helps you catch up with your ship, pay for a hotel room and extra meals on the trip due to issues that come up. (You do have to check exclusions to know when coverage will not occur.) Should your luggage not arrive with you on the flight, most travel insurance providers will keep watch on the location process and ensure the bags get to you timely. They will also offer different levels of coverage for replacement items and in the event the bag never found and returned they will pay you for the lost goods, at least up to the limits of the policy.

Should you have to break away from the trip in the middle of vacation there are typically trip interruption provisions that will help cover the cost of returning home early if that should be necessary.  Thus, if you get sick and need to go home for care not requiring a specific medical evacuation this is where that can come into play.  If a family member dies or becomes seriously injured or ill the trip interruption provision may come into play.

Another feature of the travel insurance is that they have folks well versed in helping arrange alternative travel when things go wrong. Thus, if your flight gets cancelled you can call them and they will work out new travel plans for you keeping in mind various aspects of the trip important to you. If you are on the way to a ship and need to be at the port by a specific time that can be the guideline in getting the trip reworked.  They can also go and find a hotel when the airport is backing up with tons of stranded travelers. These specific items really can make a big difference when you are already under the stress of missing part of your vacation.

Before the trip you can get concierge services from the insurance company. For instance on a recent trip I had them find me internet café’s near to each of the ports of call we stopped at so I would have a list before I even arrived at the ports. The can arrange special meals for you and even help get limited show tickets. They are there to help you make the trip an even better experience for your travels.

Those who say that travel insurance is an expense not worth it to them, offer up that they never have a need for any of the covered things and will suffer the loss of the non-refundable trip fees. This may work for some, but unless you live near the port and can dive there or to the resort you plan to use, you may well find that air travel offers many troubles at unexpected times. If you are on Medicare and travel out of the country you have NO medical coverage so assuming that just because you are healthy and nothing has ever happened is not a good idea. Some can afford to self insure but very few are in that club. 

Airlines and cruises are not required to cover costs associated with missing flights or ships and in many cases every issue that comes up falls into a category where the expense is yours to cover. Thus, things you may expect other vendors to cover for you, really are not going to be covered so the idea that the airline or cruise line will take care of me is outdated and one you should not fall back on.  Thus, there is more reason again that getting coverage is important.  This is even more true when traveling internationally where if you have health insurance other than Medicare you may have emergency coverage but almost never have medical evacuation coverage.

We work with several travel insurance carriers. For help picking the right travel insurance plan give us a call. For an immediate quote check out these policies and rates.