What to Do When You Lose Your Health Insurance

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Losing your job is stressful. Losing your health insurance on top of that is even worse. And whether you have health concerns now or want to safeguard yourself and family for the future, you might be worried about how to cover medical expenses if you’re out of work. Find out what to do when you lose your health insurance because you lost your job.

Ask About COBRA

COBRA is a health insurance continuation option that many employers offer. It allows you to voluntarily extend the health coverage you have under your former employer’s plan. If you qualify for COBRA, you must be given the option to extend your coverage up to 18 or 36 months, depending on what event qualified you for COBRA.

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However, your employer does not have to continue
contributing to cover the premiums of this plan as they did when you were
employed. If they elect to not offer contributions to the premium, COBRA
coverage can be fairly expensive.

Check the Health Care Marketplace

Job loss that causes you to lose employer-sponsored or provided health insurance counts as a qualifying event. That means you’re eligible for a special enrollment period.

Normally, you can only sign up for insurance plans through
the health care marketplaces during open enrollment periods, which typically run
from November to January. Exact dates for enrollment depend on the state.

Special enrollment periods occur for people who have a
qualifying event, such as a change in marriage status, a death in the family or
job loss. You qualify for this special period whether you were fired, laid off
or quit your job.

You must apply within 60 days of losing your insurance coverage. If your employee gives you notice and you know you’ll be losing your insurance, you can apply proactively up to 60 days before that happens.

Purchase Short-Term Coverage

Short-term insurance policies are meant to bridge the gap when you’re between jobs. Not all states allow for short-term insurance—eleven states currently prohibit their sale. But, depending on your state, short-term insurance could cover you for up to 364 days. These aren’t qualified plans under the ACA, which means they don’t offer all the benefits that the ACA requires by law. Typically, these are major medical plans meant to help cover the costs of a catastrophic illness or accident and not routine health care.

Make
sure you understand what benefits are included and how the plan works if you
opt for short-term coverage.

See If You
Qualify for Medicaid

A man holds the hand of a young child while they walk down the street.

If you have lost your job, that probably means your income has been reduced. That could mean that you’re eligible for Medicaid or the Children’s Health Insurance Program (CHIP). The income requirements vary by state, but you can find out more about eligibility from the Department of Health and Human Services.

You
can apply for Medicaid and CHIP at any time, but remember that you can lose
your Medicaid benefits if your income changes. Have a plan in place to budget
for health insurance if you get a job that doesn’t offer benefits or has a
waiting period before benefits start.

Go Without Health Insurance

You can choose to go without health insurance until you find another job or until open enrollment happens again. This can be a risky move because a health emergency or accident could lead to mounting medical expenses that leave you in serious debt.

But if you’re healthy and think there’s a good chance you’ll get a new job with coverage soon, you might decide to take the gamble. If you do, it’s a good idea to set aside some money in savings to help cover the cost of doctor’s visits or other necessary medical care should the need arise. For example, during COVD-19, you might use your stimulus check for this purpose.

You Have Options

Losing your job and your health insurance is scary, but you’re not alone. Credit.com has resources to help you through. Check out our additional resources below—and if you need more help, you can reach out to tipswithtiff@credit.com for help from Credit Tips with Tiff.


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Source: credit.com

4 Ways Health Insurance Can Save you Money

December 26, 2019 &• 6 min read by Alice Stevens Comments 0 Comments

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Many health insurance shoppers will consider premium costs when purchasing health insurance. The full cost of a health planalso includes your out-of-pocket expenses, like the deductible, copays, and coinsurance.

As important as it is that your health plan is affordableand that the monthly premiums fit into your budget, it’s also important to consider the value health insurance offers. If you’re considering opting out of health insurance next year, evaluate the value of the following health plan offerings before you finalize your decision:

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  • It’s settled; I’m getting ExtraCredit tonight. Totally unrelated, but any suggestions for my new fear of sharks? I watched that documentary too.
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  • Discounted rates
  • Cost-sharing
  • Preventive care coverage
  • Additional features

While everyone has a different financial situation with varying constraints, health insurance is a worthwhile investment.

1. Discounted Rates 

Health insurance companies negotiate costs directly with hospitals and other medical care providers. These rates are then included with the health plans offered by the company. 

Some plans only have negotiated rates for in-network providers. Others have different negotiated rates for in-network care and out-of-network care. All health plans offer coverage for emergency services when a patient is admitted—whether or not the care was received from an in-network provider.

The amount the hospital or clinic usually charges is higher than the negotiated rate. The differences between the negotiated rate and the standard rate varies depending on how the insurance company has negotiated. 

However, when you receive an Explanation of Benefits (EOB) with the breakdown of costs, you’ll see:

  • What the hospital or clinic usually charges
  • What the negotiated cost actually was
  • What portion of the bill your health insurance company paid
  • The amount left for you to pay

2. Cost-Sharing 

Health insurance plans come with an annual deductible and annual out-of-pocket maximum. The deductible is the amount of money the insured must pay in cost-sharing over the course of the year before the insurance company takes on a greater responsibility for the costs. The out-of-pocket maximum is higher than the deductible. Once it is reached, the insurance company is responsible for the remainder of your covered medical expenses.

Health insurance plans often have separate deductibles for prescriptions and medical care. Health insurance plans that offer out-of-network coverage will have a different deductible and out-of-pocket expenses maximum for out-of-network care and in-network care. 

Health insurance companies determine cost sharing in a few different ways depending on how your plan works. With a traditional plan, you’ll have copays and coinsurance. Coinsurance means that the insured pays a certain percentage of the discounted medical bill.

Copays are a set amount that the insured pay when they receive health care services. There are usually set amounts for prescriptions, primary care visits, specialist visits, and emergency services. Payment may also be required beyond the copay after the bill is processed by the insurance company. The copay contributes to this payment.

High-Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs) work differently. Instead of having copays and coinsurance, you pay for your medical expenses as you receive medical care. You can use the funds in your HSA to pay these costs.

Funds in your HSA roll over year to year and can be invested. The money you put into your HSA is tax-free. The monthly premiums for HDHPs tend to have lower premiums because a greater cost responsibility is on the policyholder. Some people take advantage of these plans while they are healthy and save funds for medical expenses later in life.

The specifics of cost-sharing differ from plan to plan, so carefully reviewing your plan before signing up will help you understand how the cost-sharing works.

3. Preventive Care Coverage 

Because of the Affordable Care Act, health insurance plans cover preventive care fully. While the future of the Affordable Care Act is uncertain, coverage for preventive care is an important way that health insurance protects your finances.

Doctors can detect some health problems early on and implement treatment plans to prevent the issue from developing further. Regular visits to the doctor go a long way in avoiding expensive bills later, especially for preventable issues.

It’s especially important for people with some diagnoses and conditions to visit a specialist regularly as needed because some health issues can be managed successfully and future complications can also be avoided.

4. Additional Features 

Health insurance companies also offer the following helpful features with their plans:

  • Telemedicine
  • Nurse help lines
  • Care management

These additional features are helpful resources for people. Telemedicine allows plan members to work with a doctor over the phone or through video chat in non-emergency situations. Some companies offer this service to plan members for free, like Oscar. Other companies also offer it as an a la carte supplement to health insurance, like GoHealth.

Others may charge a fee when you use the telemedicine service. The fee for the telemedicine service may vary based on your plan and your insurer and can be cheaper and faster than setting an appointment with your doctor or visiting an urgent care.

Nurse help lines are another common offering among health insurance companies, including Cigna. This hotline gives people quick access to a nurse without needing to leave their home. In non-emergency situations, the nurse can answer questions and give advice on scheduling appointments. 

While these benefits are nice and do not require you to establish care with a doctor, you can always call your doctor’s office with questions to get similar assistance. If the doctor can’t take your call, one of the assistants can take a message and get back to you with a response in a non-emergency situation. Even after hours, there’s usually a doctor on-call. 

Another benefit some health insurers offer is care management. These can be helpful to people who want support with improving their health. Companies like Kaiser Permanente offer this with many of their plans to help members with chronic conditions.

Is the Investment Worth It? 

It’s easy to see how much your health insurance plan saves you on medical care when you review the EOB.

It’s trickier to determine if the cost of monthly premiums is worth the savings. If you have health insurance, you can keep track of how much you are spending on medical care, prescriptions, and premiums. Evaluate you EOBs over the course of the year to understand what the costs would have been without insurance.

Medical procedures, surgeries, and emergency medical treatment are more expensive than preventive care. Some of these events can be planned for in advance, but many cannot. 

Because of the high financial cost of these services, not having health insurance is a risk for your financial stability.


Alice Stevens loves learning languages and traveling. She currently manages content for BestCompany.com, specializing in personal finance, health insurance, Medicare, and life insurance.

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Understanding Long-Term Care Insurance

  • Health Insurance

A lot of us don’t like to think about this, but inevitably there will come a time where we will all need help taking care of ourselves. So how can we start preparing for this financially?

Find the Right Health Insurance for You!

Attention: Still Open During the Financial Crisis…

Tip: Act now to see if you qualify for lower rates!

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Many people opt to purchase long-term care insurance in advance as a way to prepare for their golden years. Long-term care insurance includes services relating to day-to-day activities such as help with taking baths, getting dressed and getting around the house. Most long-term care insurance policies will front the fees for this type of care if you are suffering from a chronic illness, injury or disability, like Alzheimer’s disease, for example. 

If this is something you think you’ll need later on, it’s crucial that you don’t wait until you’re sick to apply. If you apply for long-term care insurance after becoming ill or disabled, you will not qualify. Most people apply around the ages of 50-60 years old. 

In this article, we will discuss long-term care insurance, how it works and why you might consider getting it.   

How long-term care insurance works

The process of applying for long-term care insurance is pretty straight forward. Generally, you will have to fill out an application and then you’ll have to answer a series of questions about your health. During this point in the process, you may or may not have to submit medical records or other documents proving the status of your health. 

With most long-term care policies, you will get to choose between different plans depending on the amount of coverage you want. 

Many long-term care policies will deem you eligible for benefits once you are unable to do certain activities on your own. These activities are called “activities of daily living” or ADLs:

  • Bathing
  • Incontinence assistance
  • Dressing
  • Eating
  • Getting off and/or on the toilet
  • Getting in and out of a bed or other furniture

In most cases, you must be incapable of performing at least two of these activities on your own in order to qualify for long-term care. When it’s time for you to start receiving care, you will need to file a claim. Your insurer will review your application, records and make contact with your doctor to find out more about your condition. In some cases, the insurer will send a nurse to evaluate you before your claim gets approved. 

It’s very common for insurers to require an “elimination period” before they start reimbursing you for your care. What this means is that after you have been approved for benefits and started receiving regular care, you will need to pay out of pocket for your treatments for a period of anywhere from 30-90 days. After this period, you will get reimbursed for your out-of-pocket expenses and from there.

Who should consider long-term care insurance

Unfortunately, the statistics are against our odds when it comes to whether or not we will eventually need some type of long-term care. Approximately half of people in the U.S. at the age of 65 will eventually acquire a disability where they will need to receive long-term care insurance.  Of course, the problem is, long-term care can be really expensive. Unless you have insurance, you’ll be paying for your long-term care completely out-of-pocket should you ever need it.

Your standard health insurance plan, including Medicare, will not cover your long-term care. The benefits of buying long-term care insurance are that:

  • You can hold on to your savings: Many uninsured seniors have to dip into their savings account in order to pay for their long-term care. Because it’s not cheap, many of them drain their life savings just to be able to pay for it.
  • You’ll be able to choose from a larger variety of options: Being insured gives you the benefit of being able to choose the quality of care that you prefer. Just like with anything else, you get what you pay for when it comes to healthcare. Medicaid offers some help with long-term care, but you’ll end up in a government-funded nursing home. 

How to buy long-term care insurance

If you’ve recently started thinking about shopping for long term-care insurance, you’ll want to keep a few things in mind:

  • Do you mind being insured on a policy with an elimination period?
  • Can you afford all of the costs including living adjustments?
  • Are you interested in a policy that covers both you and your spouse, otherwise known as “shared care”?

There are a few different ways to go about getting long-term care benefits. You can either buy a policy from an insurance broker, an individual insurance company, or in some cases, your employer. Obtaining long-term care insurance through your employer is probably going to be cheaper than getting it as an individual. Ask your employer if it’s included in your benefits. 

Many people also opt to shop for hybrid benefits insurance policies. This is when a long-term care policy is packaged in with a standard life insurance policy. This is becoming a lot more common in the world of insurance. Keep in mind that the approval process may be slightly different for a hybrid insurance policy than of that of a stand-alone long-term care insurance policy. Make sure to ask about the requirements before you apply. 

Best long-term care insurance packages

There are not very many long-term care insurance companies that exist as there once was. It’s hard to wrap our heads around purchasing something that we don’t yet need. However, here are a few examples of companies that offer competitive long-term care packages:

  • Mutual of Omaha: This company offers benefits of anywhere between $1,500 and $10,000. While the main disadvantage of this company’s packages is that they do not cover doctor’s charges, transportation, personal expense, lab charges, or prescriptions, you CAN choose to receive cash benefits instead of reimbursements. This company also offers discounts for things like good health and marital status. This company’s insurance policies offer a wide range of options and add-ons so you can make sure that all your bases are covered.
  • Transamerica: This company’s long-term policy, TransCare III, is good if you don’t want to hassle with an elimination period. If you live in California, this may not be the best choice for you because California’s rates are a lot higher than the rates in other states. Your maximum daily benefit can be up to $500 with this program, with a total of anywhere between $18,250-$1,095,000. 
  • MassMutual: Popular for their SignatureCare 500 policy which comes in both base and comprehensive packages, is a long-term care and life insurance hybrid. This is very appealing to many seniors wanting to kill two birds with one stone. This company also has a 6-year period as one of their term options, which is pretty high.
  • Nationwide: This program sets itself apart from many other programs available because it allows you to have informal caregivers like family, friends, or neighbors. You will receive your entire cash benefit every month and it is up to you to disperse the funds as you would like. Currently, this company does not have their pricing available online, so you will need to speak with an agent to discuss prices.

Source: pocketyourdollars.com

What is a Health Savings Account (HSA)?

  • Health Insurance

A Health Savings Account (HSA) is a convenient way to store funds specifically for medical expenses. If you qualify for an HSA, you will get to enjoy a few tax advantages as well. While this might sound like an ideal setup, not everyone is eligible for a health savings account. To qualify for a health savings account, you must be enrolled in a high-deductible health insurance plan (HDHP). The details of these plans are revised every year by the Internal Service Revenue (IRS), which sets the bar for:

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  • The minimum deductible a plan must have to be considered a HDHP.
  • The maximum amount that a customer who purchases a plan is able to spend out-of-pocket.

The benefits of a health savings account

Here are some of the key advantages of having a health savings account:

  • It covers a large variety of medical expenses: There are many different kinds of medical expenses that are eligible, such as medical, dental and mental health services.
  • Pretty much anyone can make contributions: Contributions to your health savings account don’t have to be made by you or your spouse. Employers, relatives, friends or anyone who would like to contribute to your account can do so. There are limits, however. For example, in 2019, the limit for individuals was $3,500 and $7,000 for families.
  • Pre-tax contributions: Since contributions are generally made at your employer pre-taxes, they are not considered to be part of your gross income and are not federally taxed. This is usually the same case when it comes to state level taxes as well.
  • After-tax contributions are tax-deductible: Any contributions made after taxes are deductible from your gross income on your tax return. Doing so minimizes the amount you would owe on taxes for that year.
  • Tax-free withdrawals: You can withdrawal money from your account for approved health care costs without having to worry about federal taxes. Most states do not tax, either.
  • Annual rollover: Any unused HSA funds that are left over by the end of the year get rolled over to the following year.
  • Portability: Even if you change health insurance plans, employers, or retire, the money in your health savings account will continue to be available for qualifying health care expenses.
  • Having a health savings account is convenient: Most of the time, you will receive a debit card that is connected to your health savings account. This way, you can use your debit card to start paying for eligible expenses and prescription drugs on the spot.

The drawbacks to having a health savings account

While there are many advantages to having a health savings account, there are a few things to consider. For one, in order to qualify for an HSA, you must hold a high-deductible health insurance plan. The tax benefits might entice you to purposely sign up for insurance coverage under one of these health plans but think before doing this. Here are some of the disadvantages to having a health savings account:

  • The High-Deductible Health Plan: These types of health plans can end up being a lot more expensive in the long run, even with an HSA. If you have other options for health insurance that offer lower deductible, definitely consider those and don’t only choose a High-Deductible plan so that you can open an HSA.
  • You need to stay on top of your spending: If you have an HSA, you need to be willing to hold yourself responsible for recordkeeping. Keep track of all of your receipts so that you can prove you spent your HSA funds on eligible expenses.
  • Taxes and penalties: Using money from your HSA on other expenses that do not qualify as eligible health care expenses could result in you owing taxes. If you do this before the age of 65, you will have to pay taxes with a 20% penalty tacked on. If you are 65 or older, you will be responsible for paying taxes, but the penalty gets waived.
  • Fees: Sometimes, health savings accounts will charge additional fees, either per month or per transaction. Check with your HSA institution for more information on extra fees.

How an HSA works

In many cases, if your employer offers high-deductible health plans, they probably offer health savings accounts as well. Talk to your employer to find out what they offer. If your employer doesn’t offer HSAs, then you can sign up for a separate one through a different institution.

You get to decide how much you would like to contribute to your HSA annually, but keep in mind that you cannot exceed the HSA contribution limit. Once you are set up with an account, you will either receive a debit card or a series of checks that are linked to your HSA. Right away, you will be able to use the funds in your account for:

  • Deductibles
  • Copays
  • Coinsurance
  • Other eligible health care expenses that your insurance does not cover.

Generally, you cannot use HSA funds to pay your insurance premiums.  HSAs are not the same as flexible spending accounts, because HSAs rollover. Once you turn 65, you are no longer eligible to make contributions to your account, but you can still use the available funds for eligible out-of-pocket expenses. If you use the funds for non-eligible expenses, you will owe taxes on these amounts.

Investment Opportunities

Another benefit of HSA that you may or may not have heard of is that you can invest the money in mutual funds and stocks. If this is something that you are interested in, seek advice from a financial advisor for more information.

Source: pocketyourdollars.com

How Much Does Long-Term Care Insurance Cost?

How Much Does Long-Term Care Insurance Cost? – SmartAsset

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A 55-year-old can expect to pay a long-term care insurance premium of $2,050 per year on average, according to a 2019 price index survey of leading insurers conducted by the American Association for Long-Term Care Insurance (AALTC). That will cover $164,000 in benefits when the policyholder takes out the insurance and $386,500 at age 85. (Policies often include an inflation rider.) However, long-term care insurance costs vary widely, depending on factors like your age, health condition and the specific policies of your insurance carrier. The AALTC estimates that a single 55-year-old can pay around $1,325 to $2,550 a year for a policy. That’s why it’s important to shop around to find the best rates and terms. You should also speak with a financial advisor who can help you plan the future.

How Much Does Long-Term Care Insurance Cost?

The AALTC provides the following estimates of annual premiums based on its 2019 study of different long-term care insurance carriers.

Annual Premium Estimates
Single Male 55 $2,050
Single Female 55 $2,700
Couple 55 $3,050 (Combined cost)

Keep in mind, though, that these are only averages based on a pool of data gathered from leading insurance carriers. The costs of long-term care insurance can vary widely,  depending on several key factors. We explore some of these below.

Health: Some medical conditions will disqualify you from even being able to purchase a policy, including muscular dystrophy, cystic fibrosis and dementia. That’s because insurers will likely lose money on those policies. Generally, the healthier you are, the less likely you’ll ever need to file a claim – and so the lower your premium.

Age: In general, you’ll pay more in long-term care insurance if you take out a policy when you’re older, since you’re probably less healthy and you’re closer to needing the assistance the policy covers. This is why the AALTCI recommends you begin shopping for long-term care insurance between the ages of 52 of 64.

Marital status: When combined, premiums tend to be lower for married couples than they would be for individuals paying for a personal policy.

Gender: Because women tend to live longer than men and make claims more frequently than their male counter parts, women tend to pay more for insurance premiums. The AALTCI study showed that a single female pays an annual premium of $3,050 on average while the single man that age paid $2,050.

Carrier policies: Each insurance carrier sets its own rates and underwriting standards. In fact, costs for the same services can vary widely from one company to another. This is why you should gather quotes from various carriers. You can also work with an experienced long-term care insurance agent who can gather these for you and help you understand the differences between insurance policies. They can also help you determine the kind of coverage you’re likely to need, so you don’t over-insure.

Should I Get Long-Term Care Insurance?

The average 65-year-old today has a 70% chance of needing some kind of long-term care eventually, according to the Urban Institute and the U.S. Department of Health and Human Services. Of those who need it, most would use it for about two years, but around 20% would require it for more than five years.

The smart money, then, would prepare for this significant cost. To give you a sense of how much bills can run, below are the estimated annual costs of different types of long-term care services, according to Genworth Financial, which has been tracking them since 2004.

Estimated Annual Costs
Private room nursing home $102,000
Assisted living facility $48,612
Home care aide $52,624
Home care homemaker $51,480

What’s more, costs have been rising faster than even inflation. Genworth found that the average cost of home-care services increased about $892 annually each year between 2004 and 2019. The average cost for a private room in a nursing home jumped by about $2,468 each year during the same time period, currently putting the average cost of a semi-private room in a nursing home at $89,297 per year. As noted before, about 20% of Americans will require more than five years of care.

Unfortunately, with these costs, many retirement nest eggs will come up short. And contrary to popular belief, Medicare covers only limited medical costs, e.g., brief nursing home stays and narrow amounts of skilled nursing or rehabilitation services. The scope for Medicaid is even smaller. On average, it covers about 22 days of home care services if you meet very low income thresholds.

Of course, there’s no way of knowing how much long-term care coverage you’ll need. But knowing what long-term care insurance does and doesn’t cover is key to making sure you’re not over- or under-protected.

What Does Long-Term Care Insurance Cover?

Long-term health insurance typically covers services not provided for by regular health insurance. This can include assistance with completing daily tasks like eating, bathing and moving around. In the industry, these are known as activities of daily living (ADLs). Long-term care insurance policies generally would reimburse you for these services in such locations as:

Some policies also cover care related to chronic medical conditions such as Alzheimer’s disease and other cognitive disorders.

But keep in mind that these are generalizations. There is no industry standard that sets ADL requirements for claim eligibility or what kinds of illnesses long-term care insurance will cover. Each insurance carrier makes its own rules.

So it’s essential to understand when coverage kicks in – and for how long. Policies used to provide coverage for life, but now most cap benefits at one to five years. If possible, some experts recommend extending the initial period when you are not compensated for costs (it’s often 90 days) in exchange for a longer period on the other end of receiving benefits. You also will want to know how premiums may increase over time and whether the cap on benefits will, too. Some carriers allow you to place an inflation rider that increases your daily benefit every year. That increase can be up to 3%.

How Does Long-Term Care Insurance Work?

After you apply for long-term care insurance, the insurer may request your medical records and ask you some questions about your health. You can choose the type of coverage you want, but the insurer must approve you.

When the company issues you a policy, you begin paying premiums every year. Once you qualify for benefits, which is often defined by not being able to perform a set number of ADLs, and the required waiting period has passed, you can file a claim. The insurance company then reviews your submitted medical records and may send a nurse to perform an evaluation before approving a payout. Once approved, you will be reimbursed for paid services, up to the cap on your policy.

Ideally, you’ll stay healthy and your long-term care needs will be minimal. Though your premiums will add up over time, this is one situation where you hope not to get your money’s worth. On the bright side, to lessen the hit to your wallet, the government may give you a tax break.

Tax Relief for Long-Term Care Premiums

Some or all of the long-term care premiums you pay may be tax deductible at the federal and state level. But you must make these payments toward a tax-qualified insurance policy. Also, you must meet certain income thresholds.

Maximum Deductible Premium

40 or under $420
41 to 50 $790
51 to 60 $1,580
61 to 70 $4,220
71 and over $5,220

How to Buy Long-Term Care Insurance

You can purchase long-term care insurance directly from carriers or through a sales agent. The agent can help you shop around for comparable rates. This professional can also help you understand how different policies work and what they offer.

Also, you may be able to get long-term care insurance through your employer. Some allow you to purchase policies at discounted group rates. However, you should get quotes from multiple insurance companies. In some cases, you may find better rates for more suitable policies that aren’t through your employer.

How to Calculate Your Long-Term Care Insurance Costs

Some websites such as Genworth Financial provide interactive calculators that can estimate what long-term care premiums may be like in your area. Prices and policies can vary, depending on the state.

Tips on Paying for Long-Term Care 

  • If you have a health savings account (HSA), you may want to start socking away more money in it for long-term care. Also called health IRAs, these plans allow your money to grow tax deferred. (But you have to have a high-deductible health plan to open an HSA). To find out more, check out our report on the best HSAs.
  • Don’t go it alone. A financial advisor can help you devise an insurance plan and figure out how you’re going to pay for it. If you are in the market to buy insurance now, some advisors are also licensed insurance agents. Use our matching tool to find the right advisor for you.

Photo credit: ©iStock.com/FangXiaNuo, ©iStock.com/tumsasedgars, ©iStock.com/syahrir maulana

Javier Simon, CEPF® Javier Simon is a banking, investing and retirement expert for SmartAsset. The personal finance writer’s work has been featured in Investopedia, PLANADVISER and iGrad. Javier is a member of the Society for Advancing Business Editing and Writing. He has a degree in journalism from SUNY Plattsburgh. Javier is passionate about helping others beyond their personal finances. He has volunteered and raised funds for charities including Fight Cancer Together, Children’s Miracle Network Hospitals and the National Center for Missing and Exploited Children.
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Health Insurance Myths Debunked

  • Health Insurance

A health insurance policy is essential for anyone seeking to safeguard their future and avoid the catastrophic consequences of high medical bills. Whether you’re buying coverage for yourself or a health plan for your family, it’s important to get complete coverage. But despite this fact, millions of Americans remain uninsured, often because they believe one of the following health insurance myths.

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Myth 1: I’m Young and Healthy; I Don’t Need Health Insurance

You’re never too young to start shopping for health insurance plans because you don’t know what’s around the corner. Medical expenses can be astronomical at any age and anyone can have an accident, fall ill or be diagnosed with a serious disease. 

It’s not pleasant to think about and many people prefer to bury their heads in the sand and live as if they are invincible, but they’re not. No one is.

Health care is very expensive in the United States, there’s no escaping that fact. This is one of the few developed nations in the world where being the victim of an accident or attack could lead to insurmountable medical expenses and essentially ruin your life. You can’t rely on luck and you can’t assume you’ll be safe just because you’re young, fit, and healthy.

In fact, buying at this young age has many benefits, including the fact that you’ll likely clear all exclusion periods by the time you actually need to start claiming.

Myth 2: The Benefits are Lost if I Don’t Renew by the Due Date

You should always try to pay your monthly premium on time, thus avoiding any issues and ensuring you are covered at all times. However, your health insurance coverage does not end the minute you miss a payment.

Insurance companies have a grace period, during which time your policy will remain active. This period allows you to gather the funds needed and to pay your monthly premium, thus keeping your policy active. 

Typically, this grace period lasts for between 7 and 15 days, but it differs from provider to provider. Check your policy for more details but try to avoid playing fast and loose with your payments as they could be the only thing protecting you.

Myth 3: It’s All About the Deductible

The deductible is the amount of money you pay before the health insurance policy takes over and to many consumers, it is the single most important part of any health insurance policy. However, while it is important to consider the deductible, you should not choose your policies based solely on which one has the lowest deductible.

Look for the sort of cover that they provide and whether this will suit your needs or not, and then focus on the deductible. 

It’s also important to find the right balance between a deductible that is cheap enough for you to afford when the time comes, but is not so cheap that it sends the premiums through the roof. To do this, avoid focusing on how much your first monthly payment will cost and ask yourself what you would do if you had to pay for a medical expense today.

Would you have an issue paying the deductible? Would it require you to borrow money from friends or family? If so, it’s too high and it’s time to go back to the drawing board.

Myth 4: I Have Insurance from My Employer so I Don’t Need any Additional Cover

If your employer offers any kind of group health insurance cover, take it, but don’t assume that it will cover you for everything you need. Read the small print, look for gaps, and seek to fill those gaps with your own cover.

With your own policy, you’ll also be protected if you lose your life. If anything happens in the time it takes you to find a new job, you could be left to foot the bill, making this an even scarier and more stressful time. But if you’re covered, you can take your time as you search for a suitable role.

Myth 5: It’s Not a Pre-Existing Condition if I Didn’t Know About it

If you have any pre-existing medical conditions you will be subject to an exclusion period, one that may last for up to 48 months. During this time, your insurance company will not pay out for any issues related to this condition and contrary to popular belief, not knowing about the condition is not enough to avoid this exclusion period.

If, somehow, it is proven that you had a medical condition that was simply not discovered at the time you applied, it will still be subject to an exclusion period. The good news, however, is that you can no longer be refused because of pre-existing medical conditions, which means that everyone can benefit from health insurance.

Myth 6: I Don’t Need Health Insurance If I Have a Life Insurance Plan

A life insurance policy can cover you for critical illness, which could be used to cover health care costs. You can also purchase accident and dismemberment insurance to cover you in the event you lose a limb. However, life insurance is designed to pay out a death benefit when you die. It goes to your loved ones, not you, and is therefore not a viable replacement for health insurance.

For complete cover, you should look into getting both life insurance and health insurance. You can find low-cost options for both.

Summary: Common Myths Debunked

If you don’t have any health insurance coverage, it’s time to change that and start looking for coverage today. Take a look at our guide to choosing a health plan to get started. We also have guides on everything from life insurance (term life insurance, whole life insurance, and other life insurance coverage) car insurance and pretty much all other insurance products.

By purchasing all of these together you could even save some money while getting essential coverage! Just remember to do your research, plan ahead, and never settle for less than you need as you may live to regret it in the future.

Source: pocketyourdollars.com

A Guide to Coinsurance and Copays

A Guide to Coinsurance and Copays – SmartAsset

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Having health insurance makes it possible to receive medical care while only paying a fraction of that care’s true cost. Insurance doesn’t cover everything, however. Some of the cost of your care is still up to you to pay, and that cost comes in two primary forms: copays and coinsurance.

What Is a Copay?

A copay is a flat amount of money that you’re responsible for paying for a health care service. Copays typically apply for things like a doctor’s appointment, prescription drug or medical test. The amount of your copay is dependent on your specific health insurance plan.

You can typically expect to pay your copay when you check in for your service, be it an annual physical, dental cleaning or blood test. Copays are typically lower amounts ranging from $10 for something like a generic drug prescription to around $65 for a visit to a medical specialist.

Depending on your insurance plan, copays may not take effect until after you reach your deductible. Your deductible is the amount of money you must pay out-of-pocket before your insurance provider starts to pitch in. Deductibles reset at the beginning of every year.

When you are reviewing your plan information and you see the phrase “after deductible” or “deductible applies” in reference to your copays, that’s an indication that the copay is only in place once you meet your deductible. On the other hand, if you see “deductible waived,” that’s a sign that your copay is in place from the beginning. It may go without saying, but the latter situation is vastly preferable to you.

What Is Coinsurance?

Coinsurance is another method of splitting the cost of medical coverage with your insurance plan. A coinsurance is a percentage of the cost of services. You pay the percentage, and your insurance company foots the rest of the bill. So, if you have a $8,000 medical bill and a 20% coinsurance, you would be on the hook for $1,600.

Coinsurance typically only comes into play after you hit your deductible. Further, you may have differing coinsurance percentages for the same services depending on your provider network. If you have a preferred provider organization (PPO) plan, your coinsurance could be a higher percentage for providers outside your network than it is for providers in your network.

Similarly, your coinsurance may not apply to providers outside your network if you have a health maintenance organization (HMO) plan or an exclusive provider organization (EPO) plan. That’s because these plans typically don’t provide any out-of-network coverage.

Copay vs. Coinsurance

Copay and coinsurance are very similar terms. They both have to do with portions of the cost of your health care that’s under your responsibility. Because of that, and their similar names, it’s easy to confuse the two. There are a couple of important distinctions to keep in mind, however.

The most notable difference between copays and coinsurance is that copays are always a flat amount and coinsurance is always a percentage of the cost of the service. Another difference is that some copays can be in place before you hit your deductible, depending on the specifics of your plan. With coinsurance, you have to hit your deductible first.

Bottom Line

If you’re choosing between health insurance plans, make sure to examine the provided copays and coinsurance for each option. While they may not be the most important factor to consider, a high copay can be quite a pain, especially over the course of years of appointments and procedures.

Tips for Staying on Top of Medical Expenses

  • One of the best ways to stay ahead of surprise medical expenses is to have an emergency fund in place for just such a situation. If you can manage it, have three to six months worth of expenses stashed away in a high-yield savings account. That way, if you’re dealing with medical bills or have to step away from work, you’ll have a bit of a cushion.
  • If you’re not sure how an unexpected medical expenses would fit into your finances, consider working with a financial advisor to develop a financial plan. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.

Photo Credit: ©iStock.com/DuxX, ©iStock.com/SARINYAPINNGAM, ©iStock.com/Aja Koska

Hunter Kuffel, CEPF® Hunter Kuffel is a personal finance writer with expertise in savings, retirement and investing. Hunter is a Certified Educator in Personal Finance® (CEPF®) and a member of the Society for Advancing Business Editing and Writing. He graduated from the University of Notre Dame and currently lives in New York City.
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Deducting Health Insurance Premiums When You’re Self-Employed

  • Health Insurance

In this day and age, health insurance is something that we all need to have but have different ways of getting it. Health insurance is expensive. If you work for a company that offers insurance, you won’t have to worry about deducting it from your taxes, but if you have been paying out-of-pocket for your health insurance and living on a self-employed income, you might be able to deduct the total dollar amount from your taxes. There are specific criteria you will have to meet in order to be able to make this deduction. In this article, we will discuss what the self-employed health insurance is and how you can deduct your monthly health insurance premiums. 

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What is the self-employed health insurance deduction?

Because it doesn’t require itemizing, the self-employed health insurance deduction is considered an “above the line” deduction. If you are able to claim it, doing so lowers your adjusted gross income (AGI). 

This tax deduction gives self-employed people an opportunity to deduct the following medical expenses:

  • Medical insurance.
  • Dental insurance.
  • Qualified long-term care insurance. 

One benefit of this tax deduction is that it’s not only useful for your own health insurance expenses. If you are paying for health insurance for dependents, children or your spouse, you may also deduct these premiums at the end of the tax year. 

How to claim the deduction if you are self-employed

If you are self-employed such as a freelancer or an independent contractor, you can deduct any health insurance premiums that you paid for yourself, your dependents, and your spouse. If you are a farmer, you would report your income on Schedule F and if you are another kind of sole proprietor, you would report on Schedule C. You may also be able to take this deduction if you are an active member of an LLC that is treated as a partnership, as long as you are taking in self-employed income. This same rule of thumb goes for those who are employed by S-corporations and own 2% or more of the company’s stock. Self-employed people who also pay supplemental Medicare premiums, such as those for Part B coverage can also deduct these. 

You won’t be able to take the deduction if:

  • You or your spouse were eligible for health insurance coverage through an employer and declined benefits. If you have a full-time job and are running your own business on the side, this could be a situation you face. Alternatively, perhaps your spouse works a regular full-time employer and had the option to add you to a health insurance plan through their job. 
  • Your self-employment income cannot be less than your insurance premiums. In other words, you must have earned an amount of taxable income that is equal to or greater than the amount you spent in healthcare premiums. For example, if your business was to earn $15,000 last year, but you spent $20,000 in health insurance premiums, you would only be able to deduct $15,000. If your business lost money, then you won’t be able to deduct at all. 

One of the major differences between the health insurance tax deduction and other tax deductions for self-employed people is that it’s not taken on a business return or a Schedule C. It is considered an income adjustment, in which case, you must claim it on Schedule 1 that is attached to your Form 1040 federal income tax return. 

Final Thoughts

Self-employed people, such as freelancers, independent contractors and small-business owners, might have the opportunity to deduct their health insurance premiums from their taxes. As long as your business made a profit for the previous tax year and you were not eligible for a group health insurance plan, you should be able to take this deduction. If you’re not sure whether or not you meet the criteria, you may seek advice from a tax professional. You will need to fill out all of the necessary forms to qualify for a deduction. To make this process as seamless as possible, it’s important to keep track of all your business records.

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Choosing a Health Plan

  • Health Insurance

In a lot of cases, our health insurance coverage comes from a group plan that is offered to you by your employer or by your spouse’s employer. For individuals who do not have insurance through their employer, individual policies exist as an option as well. 

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Of course, you can also opt for having no coverage at all, but in the case of an emergency, this could be detrimental to your financial health. No matter your age or marital status, it’s worth looking into your options for a good health care plan to protect yourself from a medically-induced financial struggle. 

No matter what kind of plan you choose, there will always be some out-of-pocket expenses, which means you’ll have some decisions to make. Deciding what type of healthcare plan to choose can be stressful, but it doesn’t have to be overwhelming. In the sections below, we will discuss the key factors that play into choosing the right health insurance plan. 

Types of health plans available 

There are a lot of different terms to learn when sorting through health insurance plans, and each of them come with their own set of distinctions. Before we discuss the difference between HMOs, PPOs, POS Plans and Indemnity plans, it’s important to start with the most common types of health insurance categories: 

  • Indemnity of Fee-for-Service Plans: Health insurance plans that enable you to go to any doctor or specialist that you want without a referral are called indemnity, fee-for-service, or point of service (POS) plans. The insurance company will cover a predetermined amount of your medical expenses, and you will be responsible for the remaining balance. These plans tend to be the most flexible since there are no set restrictions on the medical providers you’re allowed to use, and you are usually not required to choose a primary care physician. 
  • Health Maintenance Organizations (HMOs): A Health Maintenance Organization (HMO) is a band of healthcare professionals and medical facilities that offer a set package of medical services at a fixed rate. This plan does require that you have a primary care physician (PCP), who would serve as the middle-man when it comes to health care. Your primary care physician would then decide whether or not seeking out a specialist is necessary. If your PCP finds it necessary for you to see a specialist, they will then issue you an in-network referral. 
  • Preferred Provider Organizations (PPOs): A Preferred Provider Organization (PPO) has the same organized care characteristic that you will get from an HMO, but with the benefit of more flexible options. A PPO allows you to seek healthcare outside of your network if you feel the need to. Keep in mind that doing so will usually cost you more in out-of-pocket expenses, but a PPO would still cover some of the cost, unlike an HMO. If having a wider variety of options is important to you, then a PPO might be a good option for you. 

Pros and cons of each health plan

Each type of plan comes with their own implications. Ultimately, you’ll have to figure out what is most important to you in order to make your decision. Let’s compare the pros and cons of each plan.

Indemnity Plans

Pros: The major advantage of this type of plan is that you are able to choose where you get your medical care from and which doctor to go to, without the need for a referral or a pre-approval. 

Cons: Indemnity plans will usually come with much higher premiums and deductibles, making them more expensive than perhaps an HMO or PPO. Another area where these plans fall short is the route you may have to take to get coverage. You may have to pay for your medical services out of your own pocket, and subsequently submit a claim to get reimbursed by your insurance company. There’s no telling how long this could take, and you also face the risk of not getting reimbursed at all. 

Health Maintenance Organizations (HMOs) 

Pros: The best thing about getting an HMO insurance plan is that your out-of-pocket medical expenses are usually pretty affordable, and you can expect to pay the same amount for each visit, depending on whether it’s a primary care physician or a specialist.

Cons: In most cases, any services that you receive from a medical professional outside of your healthcare network will not be covered with an HMO plan. Another drawback is that you have to get referred by your primary care physician in order to see a specialist. This may not be seen as a disadvantage to some, but for others it could be seen as an unnecessary extra step in the process if you already know what you need. 

Preferred Provider Organizations (PPO)

Pros: This type of plan offers customers much more flexibility than they would have with an HMO with a lot lower rates than one might experience through an indemnity plan. 

Cons: The main drawback with a PPO is that the out-of-pocket costs are generally less predictable.

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HIPPA (Health Insurance Portability and Accountability Act)

  • Health Insurance

With the growing use of paperless forms, electronic information transfers and storage has become the norm. This is true about our medical information as well. So, how do we know that our sensitive medical records are being kept private? Thanks to a federal law entitled Health Insurance Portability and Accountability Act (HIPAA), health plans, health care providers, and health care clearinghouses are required to abide by a set of standards to protect your data. While this law does offer protection for certain things, there are some companies that are not required to follow these standards. Keep reading to find out where the loopholes are and how you are being protected by this law. 

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What is the HIPAA Law and Privacy Rule?

Although HIPAA and Privacy and Security Rules have been around since 1996, there have been many revisions and changes over the years so to keep up with evolving health information technology. HIPAA and the HIPAA Privacy Rule set the bar for standards that protect sensitive patient information by making the rules for electronic exchange as well as the privacy and confidentiality of medical records and information by health care providers, health care clearing houses, and health plans. In accordance with HIPPA, Administrative Simplification Rules were created to safeguard patient privacy. This allows for information that is medically necessary to be shared while also maintaining the patient’s privacy rights. The majority of professionals in the health care industry are required to be compliant with the HIPAA regulations and rules. 

Why do we have the HIPAA Act and Privacy Rule?

The original goal of HIPAA was to make it easier for patients to keep up with their health insurance coverage. This is ultimately why the Administrative Simplification Rules were created to simplify administrative procedures and keep costs at a decent rate. Because of all the exchanges of medical information between insurance companies and health care providers, the HIPAA Act aims to keep things simple when it comes to the healthcare industry’s handling of patient records and documents and places a high importance on maintain patients’ protected health information. 

HIPAA Titles

The Health Insurance Portability and Accountability Act, a federal law which was designed to safeguard healthcare data from data breaches, has five titles. Here is a description of each title:

  • Title I: HIPAA Health Insurance Reform: The objective of Title I is to help individuals maintain health insurance coverage in the event that they lose or change jobs. It also prevents group health plans from rejecting applicants from being covered for having specific chronic illnesses or pre-existing conditions. 
  • Title II: HIPAA Administrative Simplification: Title II holds the U.S. Department of Health and Human Services (HHS) responsible for setting national standards for processing electronic healthcare transactions. In accordance with this title, healthcare organizations must implement data security for health data transactions and maintain HIPPA compliance with the rules set by HHS. 
  • Title III: HIPPA Tax-Related Health Provisions: This title is all about the national standards regarding tax-related provisions as well as the general rules and principles in relation to medical care.  
  • Title IV: Application and Enforcement of Group Health Plan Requirements: Title IV elaborates further on issues related to health insurance coverage and reform, one key point being for patients with pre-existing conditions. 
  • Title V: Revenue Offsets:  This title has provisions regarding company-owned life insurance policies as well as how to handle situations in which individuals lose their citizenship due to issues with income taxes. 

In day to day conversations, when you hear someone bring up HIPAA compliance, they are most likely referring to Title II. To become compliant with HIPAA Title II, the health care industry must follow these provisions:

  • National Provider Identifier Standard: Every healthcare entity is required to have a 10-digit national provider identifier number that is unique to them, otherwise known as, an NPI. 
  • Transactions and Code Sets Standard: Healthcare organizations are required to follow a set of standards pertaining to electronic data interchange (EDI) to be able to submit and process insurance claims.  
  • HIPAA Privacy Rule: This rule sets national standards that help to protect patient health information.
  • HIPAA Security Rule: This rule establishes the standards for patient data security. 

What information is protected by HIPAA?

The HIPAA Privacy Rule safeguards all individually identifiable health information obtained or transferred by a covered entity or business associate. Sometimes this information is stored or transmitted electronically, digitally, on paper or orally. Individually identifiable health information can also be referred to under the Privacy Rule as PHI. 

Examples of PHI are:

  • Personal identifying information such as the name, address, birth date and Social Security number of the patient. 
  • The mental or physical health condition of a person.
  • Certain Information regarding the payment for treatments.

HIPAA penalties

Health industries and professionals should take extra caution to prevent HIPAA violations. If a data breach occurs or if there is a failure to give patients access to their PHI, it could result in a fine. 

There are several types of HIPAA violations and penalties including:

  • Accidental HIPAA violations could result in $100 for an isolated incident and an upward of $25,000 for repeat offenses.
  • Situations in which there is reasonable cause for the HIPAA violation could result in a $1,000 fine and an upward of $100,000 annually for repeat violations.
  • Willfully neglecting HIPAA can cost anywhere between $10,000-$50,000 and $250,000-$1.5 million depending on whether or not it was an isolated occurrence, If it was corrected within a specific timeframe. 

The largest penalty one could receive for a HIPAA violation is $50,000 per violation and $1.5 million per year for repeated offenses.

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