What are those benefits and features? How do they work after a hospital stay? When you begin to find the answers to those questions then you begin to understand what makes up the total premium. When you receive your first benefit statement after a hospital stay then you will begin to understand how the deductible is applied and how the coinsurance works.

Simple claims analysis

1. Total inpatient expense for 4 days in the hospital including physician services amounts to $4000.

2. Your policy has a $500 deductible with an 80/20 coinsurance clause with a maximum out of pocket $2000.

3. You must pay the first $500 for your stay leaving a balance of $3500.

4. You will pay 20% of that $3500 or $700 and the insurance company will pay $2800.

When your 20% reaches $2000 then the insurance company pays 100% of the remaining costs up to a million dollars (or 2 million etc).

The health insurance buying trends indicate that people are purchasing health insurance with higher deductibles. Deductibles bring down the premium dramatically. There are some plans with deductibles as high as $5000. This is called self-insuring because in essence that is what you are doing for the deductible amount.

Health Savings Accounts are also starting to become very popular. These savings accounts are tax deductible. They are like medical IRA’S. Contact your tax advisor or accountant for more details.

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Know Your Options

• Married couples in situations where both spouses are offered health insurance through their jobs should compare the coverage and costs (premiums, co-pays and deductibles) to determine which policy is best for the family.

• Always stay in-network when possible, making sure to get referrals and pre-certifications as required by your plan.

• Keep all receipts for medical services, whether in- or out-of-network. In the event you exceed your deductible, you may qualify to take a tax deduction for out-of-pocket medical bills.

• Consider opening a Flexible Spending Account (FSA), if your employer offers one, which allows you to set aside pretax dollars for out-of-pocket medical expenses.

• If you lose or change jobs, be aware of your rights to continue your group health coverage from your old employer for up to 18 months (though you have to pay the premiums), as provided under COBRA (the Consolidated Omnibus Budget Reconciliation Act).

Health Insurance Tips for

Different Life Stages

The NAIC’s consumer Web site, Insure U, (www.InsureUonline. org), explains the different types of health insurance and gives focused tips to consumers based on their likely needs in different life stages. For example:

• Young singles who may not yet have a full-time job that offers health benefits should be aware that in some states, single adult dependents may be able to continue to get health coverage for an extended period (ranging from up to 25 to 30 years old) under their parents’ health insurance policies.

• Young couples expecting a child should make sure they register their newborn with their health insurance provider within the deadline required.

• Established families with children should consider Flexible Spending Accounts if available to help pay for common childhood medical problems such as allergy tests, braces and replacements for lost eyeglasses, retainers and the like, which are often not covered by basic health insurance.

• Empty nesters/seniors who are under 65 and no longer employed, but whose COBRA benefits have run out, should research high-deductible medical plans. At this life stage, consumers may want to evaluate whether long-term care insurance makes sense for them.

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