8 Health Insurance Terms You Need To Know

Tuesday, September 1st, 2009

There are plenty of medical terms that govern health insurance that everyone has heard – yet they may not really know. Some terms are easy to understand, while others are downright odd. Before you start to read too much into your health insurance policy, there are some main medical and insurance terms that you need to be aware of. Here are 8 that you should know so you can properly understand your insurance:

Premium – for many people, this is what your employer, or sponsor, will pay each month for your health insurance. Sometimes, individuals pay this amount to their employer or directly to the health insurance company. This, in turn, covers you under their insurance.

Deductible: This is the amount that you have to pay from your own pocket before the insurance will take care of their part.

Copayment: This is the amount that you have to pay at the time of service (such as doctor visits, hospital stays, etc), that comes out of your pocket before your health insurance will pay the remainder. This is normally a small amount, usually under $50.

Coinsurance – many people have this, especially seniors that are on Medicare. This just means that you have one main health insurance plan and then another, smaller plan (coinsurance) that covers the remainder of the bill. Many people that are on fixed incomes have coinsurance so that they aren’t stuck with massive unexpected expenses.

Coverage Limits: There are some health insurance policies that will only pay for a specific set amount of different types of coverage. For example, they may only pay up to $1000 a year on basic physicals for your entire family. This is one area where you need to check your health insurance plan well so you aren’t caught with payments that you thought we covered.

In-Network – this is the term that is used to cover the doctors and other medical professionals that accept that specific health insurance. When you sign up for health insurance, you will normally get a book with a list of “in-network” providers that have already made an agreement with the health insurance company.

Prior Authorization – normally, health insurance companies will require that you have prior authorization either from them or from your primary care physician before you see a specialist. So, when you need to go to an OB/GYN or surgeon (or other specialized medical professional) you will need to check and see if you need to get a prior authorization to ensure that their services are covered.

Capitation: This is the overall amount that your health insurance company will pay to your medical professional (i. E. Doctor, surgeon, dentist) to ensure that they will see anyone covered under their health insurance plan.

While there are thousands of other health insurance terms that you should get to know, you should also take the time to read through your insurance plan so that you will be familiar with what is covered and what is not. There are so many different health insurance plans and different things that are covered and aren’t, so you need to be aware exactly what you have coverage for and what you might need in the future.

Dawn Enstruthe writes for website DS Health Insurance which info on topics like dental insurance for low income people and cheep dental insurance for seniors.

Who Will Pay Your Long Term Care Bills?

Thursday, May 14th, 2009

I always like to ask my clients, “Will your financial planner be willing to pay your long term care bills, will they have access to good quality Home Health Care Providers?” Many lawyers and advisors are now reluctant to recommend against Long Term Care Insurance for fear of law suits later on, from children, when hundreds of thousands of dollars were required to pay for their parents long term care bills. Planners who fail to recommend coverage are more times than not, unaware of the real RISK of needing care one day.

The senior has now become the GREATEST financial risk that Americans face today. The majority of them are unaware of it because let’s face it: No One wants to think about needing Long Term Care. It is going to happen to someone else! Long term care bills are the biggest reason for financial failures among seniors today. Yet there are a lot of Financial Planners and Investment advisers who will say that you don’t need Long Term Care Insurance.

If you already have a lot of money, perhaps you don’t! The question is: Would it be a smart decision to have this coverage? What we are seeing today are many Financial Planners split on the subject of LTC Insurance. You will hear some say that if you have any resources you should not be without it, that it is an integral part of financial planning, while others think if you have enough money you should self-insure. Who is right?

Every financial adviser I talk with would recommend long term care coverage if he knew in advance that his client would need several years of long term care. Do the math. In a state where long term care bills are averaging $170 per day, and the average premium is $4000 a year for a couple, aged 60, and they live another 20 years, they have paid out $80,000 in premiums for the peace of mind that they will not go broke. Without the insurance, they could end up paying over $80,000 in less than two years for ONE OF THEM on the advice from a Financial Planner telling them that they DON’T NEED IT! It must be concluded that Financial advisers who recommend against LTC Insurance figure you are not going to need care since they would recommend you obtain coverage if they knew you were going to have to spend several hundred thousand dollars. You should find out from the adviser what is the BASIS for their prediction? Also, be aware that advisers are sales people. They are in the business of making you money.

If you purchase Long Term Care Insurance, you have less money for them to manage! The decision is yours. At this point in your life, are you more interested in making a few more thousand dollars a year or are you more interested in protecting what you have already earned from the most DEVASTATING financial risk that people face in America today? One of the biggest financial mistakes a person can make today is needing Long Term Care and having no coverage! Is this a mistake you want to take a chance on making? Seek out a LTC Insurance Specialist to help you make the best informed decision for you and your family. Remember, your Financial Planner or adviser is not going to pay your long term care bills. You will!

About the Author:

Understanding LTC Insurance Company Rating

Thursday, May 14th, 2009

Companies are like people, and just like people, they can fall on financial hard times and suffer through bankruptcy. This is especially true for long-term care (LTC) insurance companies, who have to deal with an expensive and complex insurance system. As a result, some companies end up going into bankruptcy because they are unable to afford to pay out benefits due to a variety of factors. This means it is very important for individuals to look at LTC insurance company ratings so that they are not left with nothing to show for the premium payments.

One of the best ways to determine if a company is going to head into financial difficulties is by looking at LTC insurance company ratings, which come from several companies including Standard & Poor’s, Moody’s and A.M. Best. The rating system was created to ensure that insurance companies were financially sound when issuing a policy.

Currently, Standard & Poor’s publishes a rating on thousands of insurance companies, while A.M. Best publishes 50 different reports about insurance companies and has been in business for over 100 years, as well as being one of the largest insurance rating companies in the world.

The credit ratings provided by these evaluation companies can give a clear indication about the risk potential of putting your money into a company, however this is not an endorsement of that company, as many individuals think.

The rating system will differ, but the results are generally the same. While Standard & Poor’s best rating is AAA, Moody’s is Aaa and Best’s is A . This signifies an excellent record of financial stability and an ability to meet the demands of policyholders.

Low ratings are generally universal in how the insurance evaluators rate them, with F being the lowest of the low. You will not want to be a part of a company with an F rating because they are nearly bankrupt, or they have begun bankruptcy proceedings. In terms of companies with a C or a D rating, you should avoid taking out long-term care insurance with them because their LTC insurance company rating is not that great. Try and only go through companies with a high rating. Remember, it is your money and you don’t want to pay into something you won’t be able to benefit from later on down the road.

Conclusion When you pay money into a policy that will keep your head, as well as your family’s heads, above financial water when you are in need of long-term care, you want to make sure that the company you pay to is going to be around in 30, 20 or 10 years.

You should just ask for help from an insurance representative who specializes in long term care insurance to answer any questions.

About the Author:

What you should know about Long Term Care Insurance

Thursday, May 14th, 2009

If you want to get a long term care insurance quote, it is essential that you know some of the factors involved. This particular article will give you six essential factors to take into consideration. If you want an ltci quote, there is so much information you will want to know about so that you can make an informed decision. This information is based upon factors such as what type of benefits you want to receive when using your policy.

A long term care insurance quote is contingent upon many factors and following are some of the points to consider. Your age and what type of benefits will cause your quote to vary.

The types of benefits you receive will help determine your cost of long-term care. These types of benefits can include whether you will receive in-home services, care at a nursing home or from services based in your community.

The cost of your ltci quote is contingent upon age so the younger you are when you purchase ltci will cause your premium to be lower.

Different costs for quotes can be based upon what company you request a quote for. You should ask your employer if they offer ltci.

Your quote can be contingent upon how you want benefits to be paid out. Some policies allow you to spend a certain maximum in whatever way you want while others offer a maximum based upon a daily, weekly, or monthly time frame.

You have the option to choose when you are able to start using benefits and this will cause a change in your insurance quote.

You will want to think about what kind of daily benefits you will receive. Your quote will be higher when you want higher daily benefits.

This article should have opened your eyes to a greater degree to what to expect when receiving a long term care insurance quote. You want to have as much information out and on the table when talking about this because it is important to know what to expect with your policy.

About the Author:

LCTi Myth: I Cannot Afford Long-Term Care Insurance

Thursday, May 14th, 2009

As the title of this says, the belief that you cannot afford long-term care insurance is nothing more than a myth. The truth of the matter is that everyone can afford long-term care insurance, and everyone who is interested in retirement planning should. The premiums are not high when they are compared with the long-term care cost that families, or the individual, will have to incur over the course of the long-term care life.

If you are worried that you cannot afford long-term care insurance, then start getting the premiums as early as you can. There is nothing wrong with a 30-year-old doing retirement planning. In fact, the younger you are, the lower your premiums are. Often, a 30-year-old will pay $100 or more less than a senior citizen will in their monthly insurance premiums to pay for their long-term care insurance. The types of young individuals who take the initiative to start retirement planning understand the long-term care cost they may have to pay for without the insurance, and they understand that nearly half of all those who use long-term care services are not over the age of 65.

Long-term care is incredibly important and an individual should make the effort to afford long-term care insurance because it will make things easier, financially speaking, on their family and themselves. Costs can run as high as $5,000 per month for long-term care, and without long-term care insurance, an individual’s savings can disappear very quickly.

For the cost of cable television or monthly payments on that exercise machine you bought but never use, you can afford to pay your insurance premiums on your long-term care plan. There is no reason you cannot afford long-term care insurance when you make the effort to cut back on non-essentials. There is nothing more essential than making sure you have the money to get the long-term care you need in case you need help with your day-to-day activities.

Do not think that you will only need it when you are 80. Your life can change in an instant, and even at the young age of 40 you can require long-term care because of an accident, surgery, or illness. Christopher Reeve was healthy and fit at the age of 41, at the age of 42 he was paralyzed from the neck down because of a fall from a horse. He required long-term care for the rest of his life. If it can happen to Superman, it can happen to anyone.


If you believe the myth that only some can afford long-term care insurance, then you need to give your head a shake. Everyone, even if they have to cut back on that latte every day, can afford long-term care insurance when they make the initiative. Retirement planning for long-term care cost is an effective way of taking your future by the horns and ensuring your family does not have to pay for your care, thereby putting financial stresses on them as well. Everyone can afford long-term care insurance, it is just a matter of whether or not they want to take the initiative and pay for it.

About the Author: