Sunday, August 10, 2008

Medical Insurance Overview

When shopping for medical insurance it's a good idea to choose an agent who brokers (sells) for more then one company. Obviously, if the health insurance agent works for one carrier (captive agent) he or she will "push" that one company and "sell you the sky". Now, if the agent brokers several companies they are more inclined to give you an unbiased opinion and compare rates and benefits between the top PPO (Preferred Provider Organization) in your state. One thing is for sure, you will get rate increases (premium adjustments) every policy renewal. However a medical insurance agent who sells for multiple carriers will help the consumer get the premium back down by recommending a smart carrier switch or doing a "rewrite" with the current carrier. Health insurance carriers are funny in that the longer you stick with them the worse they treat you with rate increases. Consumers can often reapply to the same exact company a couple years later and get a better rate with the exact same plan! This technique is referred to as a "rewrite" in the biz. Rewrites are a smart strategy to play the medical insurance game. Also, reapplying to the same medical insurance company is smart if you have pre-existing conditions or if riders or exclusions are unacceptable with your next policy.

In the state of Nevada for example, the top PPO players are Assurant Health (Time), Humana One, Golden Rule (United Health Care), World Insurance Company, and Anthem Blue Cross. All of these companies do rate increases every policy renewal and they are monitoring each others premiums every year to keep competitive with one another. Currently, some companies in Nevada are pricing themselves out of the market and if they don't make adjustments they could pull out of the state. Assuming the health insurance consumer is still healthy enough to switch around, a smart way to play the game is to have your agent suggest smart switches and rewrites. The medical insurance market fluctuates, so not paying attention to other PPO carriers rates every year could cost you a bundle in monthly premiums.

Years ago copay style plans made a lot of sense. These days, One Deductible PPO's and Health Savings Accounts (HSA) are a smart way to go. Pay attention to the coinsurance of your policy. 100% coinsurance means the insurance company pays 100% of the bill after the deductible. Some agents trick consumers and sell a policy with a high coinsurance because it gets the premium a lot lower. With medical insurance inflation and todays economy this is becoming more tolerable and is a good solution for some.

Key points when shopping for a PPO:
  • What is the life time max of the policy? 8 Million or 5 Million is good.
  • What's the coinsurance? 100% coinsurance is a smart choice and easy math if you have some big claims.
  • Review the doctor networks. In Nevada check out: PHCS, HRZ, UHN.
  • What is the daily ICU (Intensive Care Unit) benefit. A lot of people get burned on this benefit because the carrier has a low ICU daily limit and the insured is stuck with the remaining daily bill which adds up fast.
  • Ambulance benefit. What's the ambulance benefit...covers ground or air? Air ambulance is $1,000 a minute and if your policy has a $700 ambulance benefit guess who's stuck with that bill?
  • Organ transplant benefit. People buy insurance for things they can't afford...and organ transplants is a biggy and make sure the policy has a organ transplant benefit.

To get quotes and apply online in Nevada, Colorado or Illinois visit