Find the Best Health Insurance: Expert Tips

In the last article we compared our medical team to our own sportsteam. the goal of our medical team is for us to experience the best health.

In this article we will take our first step into the world of health insurance. Before we set up our healthcare team, usually we will select our health insurance plan. In most cases, our health care team will fall within the network of our health insurance provider.

Illness is not always well defined, especially when it comes to ageing and chronic disorders such as diabetes, anemia or headaches.

There are many factors that affect our health. Last week we spoke about our work and the environment in which we live as contributing factors to health. Our stress levels, the amount of sleep and exercise are also factors in our health coupled with our food choices and the quality of our relationships.

Health insurance is not a guarantee against being ill or even recovering from illness. You will want to assess the many factors that affect your health, and address them as you see fit. This is where your healthcare team comes in. Discuss your various needs with them.

Health insurance helps with the cost of medical care. It is designed to prevent unpredictable, costly medical bills. For example, when I awoke in the hospital, more than 90% of the expenses were covered by my health insurance. That saved me more than $90,000.

Many people enjoy sports, personally I ran track in high school and middle school in addition to playing the flute. For this reason, I will continue our sports analogies to help us understand the benefits of health insurance.

Subscriptions

These days it is popular to have subscriptions. Many of my friends who are fur parents participate in bark box. They say their furry family members always know when the bark box arrives for them and their fur family members look forward to it.

For men, there are shave clubs and for many of us, we participate in gym memberships.

Rather than set aside space in your home and purchase expensive gym equipment, tanning beds, saunas, swimming pools and massage chairs, we opt instead to take a gym membership or membership at the YMCA.

A massage chair can range from $300 to more than $3,000. Tanning beds, saunas and swimming pools need special placement in rooms and also require regular maintenance.

In gym membership you are able to have access to these items when you need them it addition to access to the treadmill, free weights, cable machines, workout classes and fitness instructors.

The gym may also include specialty classess such as kettlebells, yoga, pilates, exercise bikes and more.

The gym pools all of these activities in one place. If we were to purchase these items individually we would be out of pocket several thousands of dollars and probably would not have the space to house all of the equipment, nor would we have the ability to maintain the quality of the equipment.

For these reasons, the gym is a great option. It provides a wide range of activities and allows us to connect with like minded people.

Health insurance gives us access to a wide range of facilities from knowledgeable doctors, xray, lab and mri specialists, urgent care, er, physical therapists, gynecologists and more.

In addition to this, health insurance negotiates the costs before hand on our behalf so that we don’t have to go from office to office to find the best rates.

Brief History of Health Insurance

Believe it or not, health care plans date back as far as 1798. In the 1900s it quickly became a part of the benefits packages that employers used to lure in employees.

The benefit of the health insurance that we provide access to at Health Solutions Today is that you can be self employed and have health insurance for yourself and your family and if you work for a company that does not provide health insurance benefits then you are able to enroll as well.

Many of us limit our joy of life and our potential income simply to work at jobs that provide health insurance benefits. Many employers pay a portion of health insurance benefits. Some employers may pay as much as 50 to 80% of the monthly premium of health insurance and offset the rest of the cost to the employer.

But is it really worth limiting one’s earning potential simply to have the cost of health insurance subsidized by an employer? I hope not, especially when there is a better choice available. It is far better to simply pay the full price of health insurance and free up your earning potential and your time by properly managing your business and your expenses.

The Great Depression brought together workers and hospitals, this further entertwined employment with health insurance. We will always have dips in the economy, it is best to prepare for this as an aspect of business and as an opportunity for increased creativity coupled with an opportunity to better service the needs of the cust base that you service.

During the Great Depression employees joined the first prepaid group plans. These group plans later developed into HMO’s. In a few moments I will explain HMO’s, PPOs and EPO’s. First I want to lay the ground work to understand how we came to health insurance as we know it today.

After World War II health insurance was officially used as a recruitment tool by employers. Rather than receive higher wages, they were offered more expansive and generous health benefits. In the 50’s employers were allowed to contribute to health insurance premiums without having to pay taxes. This benefit for employers continues to this day.

It was in the 50s that the Blue Cross and Blue Shield plans began to compete at the commercial level.

The Blue Cross represented prepaid plans for hospital insurance and the Blue Shield represented physician insurance. Together, the Blues set pace for community ratings and experience ratings.

Community ratings set premiums based on an entire geographic area and experience ratings based premiums on specific groups and individuals. Some areas are more healthy than others, this resulted in low spending areas due to increased health. This is referred to as experience rating.

Community ratings favored groups of people who were already sick.

Indeminities were started by early commercial plans to pay a fixed amount per hospital day and the insured was later reimbursed for these payments.

Managed Care

Right now I want to get into managed care before we come to a close of our discussion. As we move forward to the 60’s and 70’s the federal government began programs such as medicare and medicaid.

These programs provided health insurance for the aged and families with dependent children. This is also known as welfare. During this time, the economy was sluggish. For example, the GDP only grew 3.2% from 1966 to 1973 but health expenditures more than doubled this at 7.2%.

HMOs were created during this time in 1973. The term HMO stands for Health maintenance Organization. All employers were required to offer at least one HMO with their health insurance plan in order to receive tax exemptions.

HMOs were similar to prepaid programs created by the Blues discussed earlier. They received a fixed fee to providers per patient each month. In other words they received a budget or allowance.

Enrollees in HMOs selected a primary care provider and the provider decided if the enrollee was allowed to visit a specialist. In otherwords to see a specialist you would have to be preapproved by your pcp. They would write a note that you could provide to the specialist to show that you had approval to see them. In 1970 there were fewer than 2 million people enrolled in HMOs by 1992 there were 39 million.

There are two more managed care plans to discuss, PPOs and EPOs.

PPOs stand for Preferred Provider Organizations. They were started in the 80s. In this plan, the services were not prepaid as in HMO. Instead contracts were created with preferred providers to pay a negotiated rate for services. This resulted in a less restrictive plan than the HMO where you had to see your pcp in order to see a specialist.

In a ppo if they are in network you can see them, even if they are a specialist, you do not have to see your pcp first and get approval. From a healthcare perspective, this gives the enrollee a wider perspective for their health condition because they can have multiple people provide a diagnosis.

If the services were not contracted beforehand with the PPO then the service was referred to as out of network. This meant you would pay more for the service and it provided an incentive to look for a provider who accepted the insurance offered by the EPO.

EPOs were created to be an in between for both HMOs and PPOs. They are not as restrictive as HMOs. Still, in an epo, the enrollee is assigned a pcp but they are able to use an out of network provider, but they pay more out of pocket in exchange.

EPO stands for exclusive provider organizations. An epo has a restrictive network and a very limited if any out of network benefits. But they do not require you get prior approval from your pcp to see a specialist.

Today we discussed the beginnings of health insurance in 1798, how it became deeply ingrained as a benefit for employment.

We also managed to squeeze in the diff between HMO’s, PPO’s and EPO’s. Phew, that was alot. Eventhough I may implore you to step out and start your own business there are those who walk the tight rope and opt to go without health insurance.

In the next article we will explore the uninsured and the impacts of this risky lifestyle.