My Personal Finance Blog

Perhaps this is an unnecessary statement of the obvious, but the point of insurance is to give people a financial safety net. Should an emergency or disaster strike, money you would struggle to find is paid out by your insurance company. But the squeeze has been on for the last decade as medical costs and the prices of essential drugs have been rising fast. In fact, so fast that the insurers cannot pass on all the increases to their policyholders. It was hard to raise premium rates while the economy was doing well. It became impossible to raise premiums when the recession hit without there being investigations by each state’s Commissioners for Insurance and complaints from everyone else. There comes a point when the insurer cannot get any more blood from the stone and has to sacrifice profits. This has left the medical profession, the hospitals and clinics in a winning position, while the pharmaceutical industry’s profits have continued to rise despite the recession. At the other end of the spectrum, the patients are the losers. There are some who discover the small print in their policies denies cover for the very illnesses they have. There are others whose savings are not enough to pay the deductibles and co-payments. And then there are those whose policies are cancelled when they make a claim for a chronic disease or disorder.

There is a new piece of research from the Commonwealth Fund, an independent, non-profit body. In 2007, it carried out a detailed survey among 2,600 people aged between 19 and 64. When their coverage was analysed, 20% were found significantly underinsured. Why was this happening? Because they were already spending more than 10% of their income on health coverage, whether as premiums, deductibles or both. When the underinsured were added to the uninsured, this represented 42% of adult Americans. Like the uninsured, this forces the underinsured to think twice before they have treatment with more than half either refusing treatment or struggling with debt because of treatment.

In the push for healthcare reform, the focus has been on the uninsured. But this fails to recognize the injustice suffered by the underinsured. No one should be forced to choose between refusing needed treatment and potential bankruptcy. It is therefore going to be an interesting year in prospect as the reform slowly comes into force. Both the poor and the middle class need access to cheap health insurance with reasonably comprehensive coverage. This will further squeeze the insurance industry because it will be denied the right to refuse coverage to those with pre-existing conditions and will be forced to establish group health insurance for those who have struggled to find affordable plans. In all of this, the key to success will be the ability of government and the insurers to impose more control over costs. President Obama has negotiated with the pharmaceutical industry and there is some agreement to hold down prices for those in Medicare and Medicaid. The for-profit healthcare industry also sees some self-interest in moderating its price increases and has given undertakings to the Administration. If some of the pressure is removed from the insurance industry, premium rates will stabilize and the reforms should offer a more fair system to all with a health plan. We can only hope for the best while we wait and see what happens.

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.

Do you remember the Blues Brothers? They were unstoppable. They were “on a mission from God”. Seems like almost everyone standing behind the counter in the rental agency is a Blues Brother when you come into collect the vehicle. They always want to sell you something, usually additional insurance. The most common special offer is loss damage waiver (LDW). It sounds such a good idea to have complete cover against any loss caused to the vehicle while under your control. The magic word is “waiver”. You are excluded from liability even if you drive the vehicle off the end of a pier and it sinks without trace (hopefully without you still inside it). The only problem is this good idea can seriously damage your bank balance when the final bill comes in. That hourly or daily rate just got heavy. So when should you add LDW? The answer is deceptively simple. If you do not own another vehicle and have no insurance cover in place, it may be a good buy. But most insurance policies on your own vehicle cover you while driving a rental. So it all comes down to the extent of that cover on your own vehicle.

To get the maximum discount in these hard economic times, most people have been pushing up the deductibles. In many cases, the potential losses can be managed to keep to the low end. It’s your vehicle. You can talk to the repair shop and get all the work you want done at the best price. But when it’s a rental vehicle, everything is out of your hands. The rental company has no interest in protecting your bank balance. It pays top dollar to get the vehicle repaired and sends you the bill. No searching around to find the cheapest replacement parts and lowest price body shops. Everything is top of the range and then comes the kicker. It’s called the “loss of use” charge. You are expected to cover their estimated loss of profit while the vehicle is off the road. And guess what. If you are paying their loss of profit, they have no incentive to rush the repairs. They can take their own sweet time and, in most cases, you pay – most private policies do not cover loss of use charges. Some credit card companies offer limited cover, but read the small print before relying on it. Limited cover means very little actual money will ever be paid out.

If you are only renting for a few days, it’s probably worth paying for LDW. It may not be cheap car insurance, but it protects you. But if the end bill is going to be too high, trust to luck and your own insurance policy. Hopefully, your own cheap car insurance policy will give you enough of a buffer against claims Remembering, of course, that only the best private policies cover you against the dreaded loss of use charges. If nothing else, all this bad news should give you the incentive to drive like your wheels are passing over egg shells. Drive as safely and carefully as possible. If you are going to break some eggs, make sure the damage is minor and the losses are small.

The easiest way to understand how an insurance policy works is to think about gambling. You are about to drive your vehicle out on to the public roads and you make a bet with the insurance company. If you can do this without having an accident, you lose the premium. If you have an accident, the insurance company pays your losses. So, as with a field of horse about to set off round the track, the bookmakers check the records of each horse. How many times has it run and placed. This gives them a basis on which to set the odds. In theory, everyone has access to the same information so you decide whether to place the wager depending on the fairness of the odds quoted. Well, it’s exactly the same with drivers. The insurers make a risk assessment of you as a driver. What make and model are you driving? How many miles a year do you drive? How many years of experience? How many tickets and claims? This profiling gives them the odds of an accident and the company sets the premium rate to quote you. You also know your own track record and have a good basis on which to decide whether to pay the premium.

Unlike a conventional bet, you can decide to self-insure a part of the potential liabilities. This is done through the so-called deductible where you pay the nominated amount before the insurer has to contribute. So if the claim against you is for $800 and you have a deductible of $1,000, you pay the whole of the $800. But if the claim is for $1 million, you only pay $1,000 and the insurance company loves you like a brother. The majority of traffic accidents are minor fender benders and the repair costs are usually low. If no-one is injured, self-insurance is a cost-effective option, i.e. the amount you save on the premium covers the likely payments of claims. But you should consider the issues carefully before accepting the maximum deductibles. Suppose you have a bad run of luck and, in the space of a year, you are involved in three accidents where the claims exceed the deductible. Now you have to find the deductible multiplied by three as a cash sum and your premiums will go up because you have proved yourself a bad risk. Can you afford the pay this lump sum without breaking the bank? Given your premiums are going to rise, do you still want to pay the maximum deductibles in the future?

Planning is all about the worst case scenarios and hoping for the best. There are good discounts for increasing the deductible. There are also good discounts for insuring more than one vehicle or combining both car insurance with home insurance. Because you cannot guarantee you will never have accidents, you should decide what discounts you can find and how much you are prepared to pay if the worst happens. Do not simply buy the cheapest car insurance you can find. In many cases, these policies do not give a good value-for-money cover against liabilities. Shop around and buy the policy that gives you the best protection at a price you can afford.

Fee-for-Service or indemnity plans are the oldest type of health coverage out there, providing you with the greatest extent of flexibility. You are absolutely free to choose the doctor, specialist, surgeon or even the place you will receive your medical service from and it doesn’t require any approvals or referrals from other institutions. So what’s the catch?

The drawback of Fee-for-service plans is that they are quite costly and usually have higher deductibles than managed care plans. Besides, you will also have to pay a large part of your actual medical bill out of pocket. That’s the price you have to pay in order to obtain the flexibility provided by these plans. But this doesn’t mean that there are completely no restrictions with fee-for-service plans.

For instance, fee-for-service health insurance plans will not provide coverage for preventive healthcare services, meaning that any vaccinations, regular check-ups and physical exams will be paid for entirely out of the customer’s pocket. This makes fee-for-service plans quite inconvenient for families who need regular medical services and doctor consulting.

Fee-for-service plans require an annual deductible to be paid in order to receive the coverage benefits from the insurance provider. Once you do so, your medical expenses are distributed between you and the insurance carrier. You will usually pay something between 20% and 30% of the entire service fee and your insurance company will cover the rest. So it’s really important to choose a plan that has a smaller co-insurance (the part you have to pay out of pocket) before actually purchasing it.

With most fee-for-service plans you also have the so-called “caps” that are basically the upper limits of your yearly deductibles. These can be anything from $1,000 to $5,000 not taking your monthly premiums into account. So it’s better to see what your plan carries before signing it if you really want cheap health insurance with fee-for-service.

On the other hand, fee-for-service plans offer comprehensive and timely coverage when you need it, especially when there’s a medical emergency. You are completely free of the bureaucratic restrictions and setbacks of typical managed care plans that can turn down any desire to receive medical assistance in the first place. However, bear in mind that fee-for-service plans won’t be suitable and attractive for everyone. If you want to get comprehensive coverage for preventive care or have a large family with diverse healthcare needs you better investigate managed care plan options instead of indemnity plans.

And don’t forget about comparison shopping when purchasing fee-for-service coverage. Try to get as many health insurance quotes from different providers as possible and compare them in detail. You will be surprised to find out that different companies have different premiums, “caps” and co-payments that will all contribute to the final cost of your insurance coverage. So it’s always better to take some time comparing you options rather than complaining that you have a costly insurance plan after purchasing it.