5 Signs That it Might Be.
by Lisa Zamosky
When does having health insurance offer you no greater protection against financial ruin than having none at all? This isn’t a riddle or some joke with a witty punch line. This is a serious question that all health care consumers need to ponder. The sad truth is that any health insurance – even a “good” plan — can leave you high and dry when you are most in need. But there are at least five insurance plan characteristics that are almost sure to fail you every time. The only thing worse than not having health insurance when you really need it is to find out you’ve been paying your hard-earned money for a plan that never had much of a chance of helping you in the first place.
If you’re considering buying into or currently have a plan with one of the following five features, consider looking for another insurer or policy:
#1 Health plans with no out-of-pocket limits: When you review a new health plan, determine your maximum out-of-pocket costs. A good plan will show exactly how much money you’ll have to pay toward your medical bills before the insurer begins covering services. If your plan doesn’t specify any limit, walk away, because if you become ill and need serious medical care, the situation could potentially become catastrophic – both for your finances and your health.
#2 Hospital coverage that doesn’t begin until day two of your stay: Most consumers would never consider that a health plan that offers to pick up all hospital charges beginning on day two of your stay would be a problem. The fact is, however, that the bulk of hospital costs – ER visits, diagnostic tests, surgeries — are incurred on the first day of admission, which could leave you with huge bills to pay. Any policy that won’t cover your costs starting from the moment you enter the hospital is not worth the paper it’s written on.
#3 Caps on certain types of potentially costly care: Be very careful about dollar limits placed on particular medical services. If, for example, you end up in the hospital after an accident that requires three different surgeries, a daily spending cap of $1,000 would leave you with a hefty bill. While you can expect most health plans to place limits on services like mental health, rehab and home health, it’s important to confirm that your plan does not place dollar limit on inpatient hospital care, prescription medications, diagnostic tests and outpatients visits to your doctor. Such limits can become extremely costly. Also, be aware that most plans have a lifetime spending cap on each kind of service, and some have annual caps as well – a surprising fact for too many patients. Once the limit for a particular service has been reached, you are no longer insured for that service. And don’t be lulled into complacency by 100 or 500 thousand dollar limits. The cost for cancer treatment can hit six figures faster than you can say “chemotherapy.”
#4 Selective coverage that excludes the services you need the most:Medical insurers are not always mandated by law to cover certain services. In some states, insurers can exclude people with pre-existing conditions. In fact, if you’re in the individual market, pre-existing conditions that are excluded from coverage or any waiting periods for coverage of pre-existing conditions can pose a problem. The very malady for which you’re most likely to need healthcare may not even be covered. Check your policy for coverage of the medical services you need most. If you don’t see what you need, don’t assume you’re covered. In fact, you’re probably not.
#5 Low premiums with little coverage: Who isn’t tempted by a bargain? And with the cost of health care continuing to rise, a cheap plan is certainly appealing. But beware. Super low insurance premiums often translate to super poor coverage with important benefits left out. Research fair pricing for insurance plans at reputable sites like Ehealthinsurance.com, which will outline a series of plan options based on the information you provide.
Lisa Zamosky is a writer specializing in healthcare, and a former executive who worked for years in the health insurance industry. Visit her online at Writtenarts.com. E-mail Lisa at firstname.lastname@example.org. Follow Lisa on Twitter: Twitter.com/lzam