Posted : 02/26/2009
"Let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year."
President Obama made this bold promise to hopeful Americans in his recent address to Congress. Few listeners debate the importance of health care, but providing quality affordable health care for every American will clearly challenge Democrats and Republicans to work together to meet this goal.
As unemployment rises, even fewer Americans will have health insurance through an employer. And, rising medical costs are forcing small and large businesses to reduce coverage, increase co-pays and deductibles and raise the amount that employees must pay each month. Some small business owners have even converted traditional health insurance plans to high deductible plans.
Insurance.com offers these tips for evaluating your health care options and saving money on your medical bills.
My employer offers an HMO and a PPO. How do I decide?
Both provide excellent care, but you may want to choose an HMO if its network of doctors and hospitals matches your needs. Health insurance with a Health Maintenance Organization (HMO) is generally less expensive. You're required to select an HMO physician to be your primary health care provider. This doctor will coordinate all of your medical care, including referrals to specialists within your HMO network. If you seek treatment from a non-network physician, you will generally pay most of the cost yourself.
A Preferred Provider Organization (PPO) is more flexible than an HMO plan, but it still operates with a list of physicians and hospitals that are "within the PPO network." You may visit an out-of-network provider, but you will pay the difference between the PPO network and out-of-network prices. Both plans usually offer a prescription drug benefit, as well. Some companies are offering options that allow you to combine features of both HMO and PPO plans.
I can't afford full health insurance, but I want coverage for major emergencies.
A high deductible health insurance plan or catastrophic health insurance offer coverage for major illnesses or accidents. For example, a plan with a $5,000 deductible requires you to pay all of your medical expenses up to $5,000 before your insurer begins to pay. If you choose a high deductible plan, try to save a small amount of money each month in a Health Savings Account (HSA) so that you're not overwhelmed by routine medical expenses.
I have health insurance, but it seems like I'm always paying for something.
Sad but true. You may owe a co-payment for doctor's visits or a trip to the ER. Usually, this is a flat fee, but it can get expensive if you don't stay within your plan network.
Secondly, payment for expenses is subject to your annual deductible, which is the amount you pay toward your medical expenses before the insurance company begins to pay claims. Some HMO plans do not have deductibles but do have co-payments.
Lastly, there's co-insurance, which is the percentage of your medical costs that you pay after you reach your annual deductible. 80/20 co-insurance is a common option, and that means that your insurer pays 80% of your bills and you pay 20%—after your deductible. So, anything you can do to reduce your medical bills will help you reduce your out-of-pocket expenses, too.
I don't have health insurance. What can I do?
Almost every hospital has a financial aid office that will evaluate your personal situation and determine your ability to pay for required care. Generally, a hospital will provide sliding scale fees if your income is 400% or less of federal poverty limits and may eliminate bills entirely if your income is 200% or less of federal poverty limits. But hospitals have to make money, too, so they may not publicize these programs or provide much assistance in applying. Be prepared with recent copies of your tax returns and W-2's to prove your need.
We agree with President Obama that all Americans deserve quality affordable health care and look forward to the details of its delivery. What do you think? Looking for different information? Have questions or feedback? Please let us know.
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