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 lisa@writtenarts.com. Follow Lisa on Twitter: Twitter.com/lzam

by Lisa Zamosky

Drug prices, like everything but your salary, are going up. According to a 2009 article in the Wall Street Journal, the prices for about a dozen of the most popular brand name drugs increased by double digits in the first quarter of 2009 from just one year before – this, in the midst of the worst economic crisis we’ve seen since the Great Depression!

As a result of growing pharmaceutical costs, which have outpaced inflation, the Kaiser Family Foundation found in a survey conducted last year that 30 percent of Americans did not fill a prescription for medicine and 20 percent were cutting pills in half or skipping doses.  I expect those numbers are even higher today with unemployment rates topping 10% and health insurance benefits going away for so many people.

Many people delay a trip to the doctor or a medical procedure out of a need to save money. Not great, but most often not life threatening. However, skimping on doses of medication you take to manage a chronic condition can quickly become dangerous. Still, so many people today are faced with steep drug prices and diminishing wages, making it very difficult to continue to pay for needed medications.

Times are tough, but fortunately there are a number of ways to cut costs on prescription drugs, including accessing programs aimed at offering those in need free or reduced cost prescriptions. If you’re struggling to pay for your medications, here are a few ways you may be able to catch a break.

1. Shop Around Prices for prescription drugs vary widely among pharmacies, which means comparing prices can make a big difference in your out-of-pocket expenses. A great way to make sure you’re getting the best price on your medications is to check sites like www.pharmacychecker.com. You can compare prices from one pharmacy to another, and the site offers a system that rates each pharmacy on a number of criteria.

2. Wal-Mart $4 Prescriptions If you take generic medications you can pick-up a 30-day supply of your prescriptions at Wal-Mart for just $4 (the program doesn’t apply to brand-name drugs). Wal-Mart offers more than 350 different types of generic medications with this program. You can call your local store or check online at: http://www.walmart.com/4prescriptions to make sure the drug you need is on the list.

3. TogetherRx Access Individuals earning less than $45,000 a year and who do not have Medicare or insurance coverage for prescription drugs may be eligible for the TogetherRx Access program, which can save you as much as 25 to 40 percent on brand-name drugs. You can sign up for this program online at: http://www.togetherrxaccess.com/Tx/jsp/about_how.jsp, or by calling 1-800-444-4106.

4. Prescription Assistance You’ve likely seen Montel Williams on television advertising this program offered by the Pharmaceutical Research and Manufacturers of America. PhRMA brings together big pharmaceutical companies, doctors and community groups to help people in financial need fill prescriptions for free or at low cost. If you’re eligible, you’ll be connected to a public or private drug plan program that will meet your particular needs. Check out the details at www.helpingpatients.org or by calling 888-477-2669.

5. Pharmaceutical Company Help If you don’t already know, it’s worth finding out which pharmaceutical company makes the particular medication you take. Many of the big pharmaceutical companies, such as Merck, Abbot and Pfizer, offer programs to make the medications they manufacture available to patients at either no or low cost. Check the website of the company producing your prescription medication to determine your eligibility and to fill out an application.

Good luck!

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 lisa@writtenarts.com. Follow Lisa on Twitter: Twitter.com/lzam

Take Advantage of Health Benefits Before the Year Ends

by Lisa Zamosky

As the year comes to a close, so does the chance to use health insurance benefits that run on a calendar year cycle. In order to get the most for your money, it’s important to evaluate where you are with items like your annual deductibles, preventative services, and health savings accounts before the year is over to make sure that you’ve used all the services and benefits to which you are entitled.

In order to take full advantage of your health plan and save money, consider closely reviewing three main health benefits before 2009 comes to a close.

#1 Free Annual Screenings

Most health plans offer a range of free services that are well worth taking advantage of, yet millions of Americans each year let these freebies pass them by.

Among the free services offered on an annual basis by insurers are tests and screenings such as physicals, pap smears, mammograms, eye and dental exams, as well as prostate screenings. These services are often fully covered or require only a small co-payment. If you haven’t yet taken advantage of these benefits and aren’t certain about what your policy offers, pull out your benefits book, go online to your insurer’s Web site, or call the customer service number on the back of your benefit card to find out what’s available to you. Do it quickly so you can get in for an appointment before the year ends. It’s a good idea for your health and your wallet. 

#2 Paid-Up Deductable

If you’ve met your annual deductable and are in need of a medical procedure, see about scheduling it within these final weeks of 2009.  Once your deductable is paid up, you can expect in most instances that your insurer will pick up a bigger share — sometimes 100% — of the cost.

Surgeries, medical tests, dental work, along with mental health counseling and physical therapy, which usually have set limits on the number of sessions allowed in a year, are just a few examples of the services you want to use by year’s end so that you don’t lose the coverage.

If your plan has limits on the amount it will pay toward a particular service during a calendar year, talk with your health care provider about breaking up the work between the end of this year and the beginning of next. Dental benefits are a prime example. It’s common for dental programs to cover a set dollar amount for services in a given year, say $1,000 to $2,000. In order to get maximum coverage, ask your dentist if you can begin work now and start up again in January to finish.

#3 Flexible spending accounts

If you have a flexible savings account (FSAs) through your employer, make sure you have a plan in place to use the full amount you’ve deposited before year’s end. These tax-sheltered accounts are a great way to pay for office visits, prescription co-pays, over-the-counter medications, dental care, eyeglasses for you and your dependents, and a host of other health-related items and services. If the money isn’t spent within the year, however, you’ll lose it.  Many employers offer a grace period until March 15, but don’t just assume yours is one of them.

If you need some ideas about how to spend the money in your FSA, you can go to the IRS’s web site for a list of eligible medical expenses: http://bit.ly/1C0j5X

Good luck!

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 lisa@writtenarts.com. Follow Lisa on Twitter: Twitter.com/lzam.