My Personal Finance Blog

There’s much debate around the healthcare system reform proposed by President Barack Obama. And while there are many people who protest against it, and those who support it, it is important to know what it is all about in the first place. Here is a short overview of the reform, which is comprised of three essential parts:

1. Assure all American citizens with access to comprehensive and affordable health coverage

The main features of this part are:

• New Public National Health Plan, which will be very close to the current health coverage provided to federal employees. The main difference is that the new plans will be available to all US citizens for a reasonable price no matter of their financial situation. Deductibles and co-payments will be reduced to minimum, while low-income persons will have the possibility to use additional subsidies.
• National Health Insurance Exchange, which will allow US citizens to look for private health plans. It will set regulations on private insurance providers in order to make sure that private plans are not too different form public ones.
• New business mandate requiring national enterprises to pay for the Public National Health Plan.
• Individual mandate aimed specifically at children.
• More support provided to existing programs like Medicaid and SCHIP.

2. Improve the quality of healthcare services and lower their costs

This initiative presumes federal financial assistance for improving the quality of the services and lowering the costs, with additional assistance to enterprises that cover high-risk employees.

To President’s belief the following actions may also contribute to lowering cost and improving services:

• Special disease management programs for improving chronic care.
• Improving transparency in what concerns quality and costs of healthcare offered by providers.
• Lowering the rates of medical errors.
• Introducing financial incentives to stimulate substantial improvements.
• Providing support for researching new and alternative healthcare technologies.
• Eliminating ethnic disparities in access and quality of healthcare services.
• Popularizing health IT.
• Stronger regulation of insurance and drug markets in order to lower medication costs and allow cheap health insurance.
• Preventing Medicare private plan participants from overpaying.

3. Wellness and healthy lifestyle promotion

This initiative is to be supported through the following actions:

• Special wellness programs at working places.
• Eliminating child obesity with school activities.
• Better education for present and future healthcare workers.
• Promotion of healthy lifestyle in communities.

Saving possibilities with the new initiatives

President Obama estimates that in average a typical American family will be able to save about $2,500 on an early basis after the plan will be implemented. These are the possible sources for such savings:

• Health IT introduction and implementation.
• Improved quality of services.
• Limitations on health insurance provider profits.
• Federal funding of catastrophic coverage that will lead to cheap health insurance.
• Universal coverage availability.

As you can see the Plan requires significant federal funding and that is one of the major points of those who are against it. Other arguments include direct implication to health insurance market, which of course is not quite welcome by the insurance companies. But is the idea of cheap health insurance for everyone that bad?

One of the more annoying features of the insurance world is its habit of distilling options down to simple sets of letters and then failing to clearly explain what the letters mean. In other words, insurers hide behind jargon and prefer not to explain clearly what you are buying. You are expected to assume the insurer has your interests at heart and pay over your money without a second thought. In many cases it works. Over the years, we have given up the unequal struggle and just say prayers we never fall sick. But, as premium costs have risen and the recession has cut back our spending power, trying to understand the options is back on the menu. So let’s start with an explanation of HMOs and PPOs. In fact, they both rely on a network of physicians, clinics and hospitals, but they differ significantly in the detail of how they deliver healthcare to you and your family.

A Health Maintenance Organization (HMO) is a network of healthcare professionals that enters into a contract with an insurance company. The insurer offers a captive group of people to refer to the network and, based on the expected volume of business, the network agrees a fixed fee for all the main services on offer. In theory, this works well for everyone. The fees are discounted because of the volume of business, so the insurer saves money and charges lower premiums. This is usually the cheapest form of health plan with very low copayments and, often, no deductibles. But there are problems. HMOs are very reluctant to accept people with existing conditions requiring expensive treatments. They prefer most of their patients to be reasonably healthy. The reason is basic economics. Every physician has to meet a quota of patients in a day. This means spending the shortest possible time on each consultation. Long diagnostic sessions disturb the quota and can result in penalties to both the doctors who miss their numbers and the patients who have slowed down the queue. There are also significant restrictions on patient choice. A nominated primary care doctor decides what referrals shall be made and to whom. HMOs are the cheapest form of care, but you have little control over the treatment you or your family receive.

A Preferred Provider Organization (PPO) uses the same basic approach but, because you pay more, you buy greater control over the treatment. The copayments are around 20% and there are usually deductibles. But, you have freedom to choose your own doctors. So long as you go see a physician in the network, you are covered. If you want to see someone outside the network, you usually only pay the difference between the network rate and the actual fees your choice collects.

So, when it comes to cheap health insurance, an HMO is the better option. But if you have the money and a health problem likely to need more extensive treatment, you should opt for a PPO. It always comes back down to your own personal needs and what you can afford. Cheap health insurance always comes with limitations. Read the small print before you buy into any plan and see exactly what you can and cannot do before you agree to buy the policy.

Well, after all the excitement and the best efforts of the GOP to say “No” loud and long enough to make a difference, the President signed the healthcare reform into law. The partisans are now into the equally exciting game of trying to decide whether this is the greatest victory since Abraham Lincoln, with a little help from General Ulysses S. Grant, won the Civil War or the greatest disaster since Hurricane Katrina reminded us Nature can be devastating. Allowing for the fact this is a complicated piece of legislation, this is a little difficult to predict because so much of it is not designed to take effect for years. Calling for immediate repeal does not seem helpful when no one can say how the future will turn out. As time passes and we dig ourselves out of the recession, it is entirely possible this may turn out to have been a good “thing” on balance. If “things” do not look quite as good, a little tinkering may set matters to right. History has a way of judging “things” rather differently than we expect. This leaves us with the next twelve months during which there are elections and an opportunity for voters to have their say. What is due to happen and will this make the reform look good enough to keep?

1. There will be a payment of $250 to people in Medicare. This is designed to close the Part D donut hole. In 2011, there will be a 50% discount on the branded drugs in the hole with the hole closing by 2020.

2. Starting on January 1, 2011 there will be no co-payments for preventative medical care. This care will also be exempted when calculating the deductible.

3. Starting in three months, there will be a temporary re-insurance program for employers to cover retirees in the age range 55 to 64.

4. Starting in six months, insurers shall not cancel a policy if a claim is made nor discriminate against children with a pre-existing condition. There are also to be new controls to prevent insurers from imposing caps on coverage.

5. Before the reform, the majority of people were insured by their employers. Starting immediately, small businesses can claim, tax credits of 35% of premiums if they decide to buy a health plan. This rises to 50% in 2014. Up to now, small businesses have always claimed they were the victims of discrimination, priced out of the market by the insurance industry. With a government subsidy, this argument looks less real.

Whether this will be enough to sway public opinion is anyone’s guess. Health insurance has provoked some seriously extreme reactions and it will take time for people to take a more calm view of what the reforms offer. The reaction of the insurance companies is also difficult to predict. Some may react to the new controls by increasing their premiums. Insurers are, after all, for-profit organizations and they have never shown themselves slow in coming forward with premium hikes. This makes it even more important to get the maximum possible number of health insurance quotes before deciding on which policy or plan to buy. When midterm elections come in November 2012, 36 seats in the Senate and all the seats in the House are up for grabs. Experts predict the Democrats will lose seats. But, with President Obama in the White House, no repeal will be signed into law.

Many people are complaining about their health insurance costs, having a dramatic increase in rates over a short period of time. Some policyholders have noticed that their rates increased by 30% over the last two years and that definitely rings a bell, when a good portion of your income is spent on health insurance. In this time when every spare dollar counts, people are looking for ways to minimize their expenses and insurance, whether health, car or homeowners, is the first thing that comes in mind when cutting costs. Some people choose to drop health coverage altogether, ending up with astronomic bills for any medical service they get. Others are more careful with their decisions and first investigate what other types of health insurance can bring to the table. Here are some things to consider if you want to minimize your insurance costs.

Should I get individual or group health insurance plan?

There are a lot of questions about group and individual health insurance. Of course, group plans are very convenient in the sense that you can insure your entire family and pay out a single premium rather than have multiple separate policies, which only multiply the annoying paperwork. However, group health insurance usually has higher rates as it should guarantee that even high risk customers within the group have adequate coverage. This, of course, makes the healthier group members pay for the risk they share with the less healthy members. Such a situation can be acceptable if there are different health issues among different members. But if your family is healthy in general it would be more cost effective to purchase separate individual policies for each member, because the rates in individual plans are based on your particular health situation and if it’s OK then you will get much lower rates than with a group health insurance plan.

Outline your exact insurance needs and get an appropriate plan

If you are looking for cheap health insurance you first have to determine what your exact insurance needs are. Analyze your conditions, see how often you go to the doctor and what particular services you are using most frequently, and choose a plan that gives you the base rates for your exact needs. With so many different plans out there on the market you should definitely find the one that will give you cheap health insurance and will address all of your needs to the proper extent.

Finding cheap health insurance while self-employed

Those workers who are self-employed often find it hard to get adequate coverage for a low price. The group health insurance benefits that an employer can give their workers don’t apply here, and in most cases self-employed specialists have to go with independent individual health insurance plans that can sometimes be quite expensive. However, if you are leaving a workplace with good group health insurance benefits, you may fall under COBRA regulations in certain circumstances and continue receiving group health benefits while already being self-employed. If your previous employer didn’t have any group health benefits, it would be better to go independently.

If you have been asking questions about healthcare coverage you have definitely heard about health savings accounts (HSAs). Some people advocate that they are the next step in the domain of health coverage, while the others believe that only healthy and rich citizens can benefit from such plans. Before answering these questions it is better to learn what HSAs are in essence and how do they work.

What is a HSA?
A typical health savings account is comprised of two elements:

1) Savings account with interest bearing:
– Yearly deposits of up to $2,900 ($5,800 in case of a family) introduced to the savings account are to be taxed. The money deposited will usually roll over on a yearly basis. However, the money you withdraw from the account for healthcare purposes are tax-free. So are any withdrawals after you officially retire.

2) Healthcare coverage plan with a high deductible
– The minimum deductible amount should be not less than $1,100 ($2,200 in case of a family). That is the amount of money to be paid out-of-pocket before getting the actual benefits.

– When the annual deductible is paid the actual coverage kicks in. You will have to pay all the specified co-insurance and the plan will cover all that remains.

– The overall amount of money to be paid out-of-pocket is limited to $5,600 ($11,200 in case of a family). In other words, after you have spent $5,600 on healthiness services your insurance company will pay for all health costs exceeding that amount.

What are the pros of health savings accounts?
– Because of the fact that any money withdrawn for healthcare use is not taxed, HSAs are a good way of saving more money in your pocket.
– In case you keep the funds without withdrawing them from the account you will have more money after you retire. And since you can freely withdraw the money for any reason after you turn 65 it is a good additional source of retirement money.
– Cheap health insurance plans with higher deductibles have lower premiums than typical plans.
– HSAs don’t depend on your working place and you will keep it the same no matter what.

What are the cons of healh savings accounts?
– Those who have substantial needs in healthcare services will find little use in HSAs since they provide main benefits when the money is kept in the account for an extended period of time.
– People with serious health issues will find it hard to get high-deductible insurance plans, especially if they were already denied of typical plans.
– Some HSAs have additional fees that in sum can make the plan quite costly for the customer.
– Because of high out-of-pocket expenses people tend to go without care, which usually results in complications and more serious and expensive health concerns.

Will a HSA be useful for me?
In case you have no serious health problems and are able to pay the required out-of-pocket expenses than HSAs will definitely be a good option for you. However, you must understand that HSAs require you to be more conscious about your medical costs and the coverage provided by these accounts is much less comprehensive and diverse than with typical health insurance plans. Having an active position in managing own healthcare is a must with HSAs, so if you’re not ready for that then it will be not of a much use to you.