5 Tips to choose a Right Healthcare Plan

October 14th, 2010 Vijaianand No Comments »

In the last post, we saw the recent Health Act law changes went effect from Sept 23,2010 and more such changes are going happen for the year to come. Whether full health care bill takes effect in 2014 or not, these small changes really helps many families to maintain their health insurance coverage.  If you are individual who don’t work for any big companies that offers group health coverage and been contemplating about taking individual coverage, this may be right time before the premiums go up as many expects.

For the household which has group insurance coverage, open enrollment is right around the corner. That mean’s it’s time to start thinking about choosing your health plan for next year. Some of you might have option to select from different providers and plans but some might not have lot of wiggle room except choosing from two different plans. It all depends on your employer. But if you are individual/family without an option for getting group plan and looking to carry individual insurance you have all the options in the world.



1. What’s your status?

First, think about your current status. Are you single or married? Do you have dependents in your household who needs medical help. It matters because it determines whether you need a plan for one or a family member. Also the status will affect your cost and your health coverage. So be careful to see which plan options best suit your situation.



2. What’s the cost?

Secondly comes the cost. There are a few big things to consider about cost. Do you or your family go to the doctor often? Then you might want a plan with a lower deductible and out-of-pocket cost and a higher monthly premium. If don’t use your health plan or go to the doctor much? It might be better to choose a plan with a lower monthly premium and higher deductible. I like to categorize them as, Pay first Plans and Pay later plans.

You either pay ahead as premiums if you need lot of medical help and save money on deductibles or pay later when things happen and save money on paying high premiums.  It depends on your situation. I prefer to go with Pay later plans that way you have more flexibility but you need to plan for those expenses and put away the money aside for deductibles/coninsurances.

If you’re not sure what might be best, look at what you spent last year and how often you or your family went to the doctor. By doing your analysis and then you can choose a plan that fits your needs.



3. Who’s in the Provider network?

Third comes the provider network. Check out whether your favorite doctor is “in network” for the plans you are looking. How about specialists and hospitals nearby your area? Some don’t want to lose their favorite doctors or pediatricians while changing the plans but most of the PPO plans from different providers are pretty flexible and coverages well know doctors and clinics. But it is always better to make sure by calling the doctors office before you deciding on a particular plan.



4. Are there other benefits?


Many providers offers plan with paid preventive coverages with certain limitation and also offers wellness programs like reimbursing for fitness clubs memberships, covering certain weight loss programs. This will be the fourth step in your plan selection process.  It is common belief that one lives healthier avoids getting sick often and will have less medical problems, that reduces number of visits to hospitals and doctors and insurance companies can reduce their cost. At the same time, as a person it is important to get support to lose weight, eat healthier or stay fit. It is a win win for both insurance companies and individuals. So make sure you take a look at the wellness options.



5. Is a healthcare fund (FSA/HSA) right for you?


Finally comes some many saving options. If you currently have healthcare insurance through your employer, you might have heard about FSA cafeteria plan(FSA). This plan is offered seperately apart from your Health insurance. If you have the option to enroll in this funds, please consider it. It could help you save by paying for care with pretax dollars. Similary, HSA (Health Savings Account) also helps save money by paying premiums and deductibles from Health Saving account where the contributions to them are tax deductible and also has flexibility to earn some interest which can be withdrawan tax free when used for medical expenses. You can learn more about these plans at planforyourhealth.com.

Health problems/issues can be devastating at times and has the power to wipe out your full assets in matter of months. It is wise to have a Health insurance with reasonsable coverage to cover you and your family both for the physical and financial well being.

Some content courtesy: Aetna Newsletter

Health Care Act Update: Good Changes are in effect

October 5th, 2010 Vijaianand No Comments »

Around 10-15 million Americans are without job and around 45 millions don’t have any Health Insurance coverage as per reports. So we cannot be sure about how the new Health Care Act is going to help achieve its set goal of making the not insured count go down when it takes effect starting in 2014. With Mr. President opponents(republicans) grapling about Health Care Bill and doing everything possible to repeal the act. It is not sure whether major changes of health care act will ever effect. So it is encouraging and good news to hear some part of the act is taking effect as of Sept 23rd, 2010.

Being self employed and carrying Individual Health insurance, I always look out for changes in health care to see whether it makes our life easier and save some money. The changes which took effect on Sept 23, 2010, seems to really add value to the consumer and makes good sense.  Here are the details about changes so you can apppreciate it. If you are group health plan holder, you won’t be thrilled about since everything is covered in group coverage.


What Insurance companies can’t do anymore:

  • Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma. This is a big blessing for many parents who already suffereing because of their kids pre-existing conditions. Now Insurance companies have to cover them. It might be expensive but alteast coverage gives discounted price on the services provided.

  • Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer. With medical cost skyrocketing these days, any person with serious medical condition, this is big bonus so they don’t have pay from their pocket after lifetime benefits are finished. 

  • Cancel your policy without proving fraud. Health plans can’t retroactively cancel insurance coverage – often at the time you need it most – solely because you or your employer made an honest mistake on your insurance application.

  • Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer. This makes sense because you have the right to appeal or review which many times helps to get the cliams paid. Many insurance carriers already provide this opportunity but making it a compulsory in the agreement would force them to do proper claim service.

What consumers get when they renew or buy new Health Plans:

  • Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you. Many insurance carriers already provide this option with limitation on the expense like $300/year. I am not sure whether the new law changes and takes away the limitation or not.

  • Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now most likely add or keep your children on your health insurance policy until they turn 26 years old if they don’t have coverage on the job.  This might e a burden to many parents but kids without insurance is bad compared to having them in your plan until they can financially support themselves.

  • Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan’s provider network and let you see an OB-GYN doctor without needing a referral from another doctor.

  • Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network – and they can’t require higher copayments or co-insurance for out-of-network emergency room services.  This change is a big plus for many elderly and many with serious medical conditions who use emergency a lot.


Overall, these new changes seems to add value to the insurance policy but Insurance carrier are sure to shove the expenses related to these changes to the consumer. Because of that, you are going to see some big jumps in the insurance cost in coming years. Check out more details and webcasts about this change from healthcare.gov

Source: healthcare.gov

Generic Drugs – Safe & Save

September 22nd, 2010 Vijaianand No Comments »

In the last post, we saw how Store or private band products helps to save tons of money instead of buying national brand products. I got lot of enquires about Generic brand drugs and want to address that topic too.

What are Generic Brand Drugs?

According to FDA(Food and Drug Administration), Generic drugs are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.  Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name (or reference) product.  Generic drugs do not need to contain the same inactive ingredients as the brand product.

Are they safe?

As per FDA, today 7 in 10 prescription filled are generic drugs. Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs. And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.  You can check more facts and Myths about Generic drugs at generic drug section of FDA.gov

Why Generic drugs are cheaper than brand names?


When a drug company introduces their new drug to the market, they have to go thru lot of process starting from research, innovation, development, testing, approval, marketing and other costly affairs to get their drug out to the market. With more scientific advancement comes more cost associated with the research. Like every other business, money spent on research and other process by the drug company gets transferred to the product price and to the consumer in order for the company to make profit.

During the patenting and approval process, innovators/drug companies are restricted  to use the patent for specific period of time which should allow them to set their price in order to get their return in investment and make some profit. After that period, drug chemical composition is open to any other company to manufacture the same drug in similar manner and make it available as Generic. Those companies don’t have to spend money on research and approval except they need to get FDA approval on their generic drug. That’s why brand names cost more than the generic brands.


Are all generic brand drugs same?


Yes, very much. Whether you buy the generic drug in Walmart or Kroger or CVS or Walgreen, it will have the same chemical composition. May be their manufacturing site might differ but all site has to go thru approval process to get the product out to the market. So it doesn’t matter where you buy but buying the right generic equivalent to brand name matters.

How to save on buying Generic brands?


Independent research has shown that total prescription drug expenditures in the United States only increased by 4.0% from 2006 to 2007, with total spending rising from $276 billion to $287 billion. This is a sharp decrease from the 8.9% growth rate observed in prescription drug expenditures in 2006. One factor cited as a reason for the slowdown is an increase in availability and use of generic drugs.

Generic drugs helps save tons of money and it is your choice to take advantage of the savings.  How? It is easy and simple. Here are some tips.


1. Many group and individual medical policies pay either full or 80% of the cost of generic drugs compared to only 25% on national brands. They support and encourage buying generic brands which saves them money as well. Also preordering 3months worth of supply in advance saves another 10% or more depending on the pharmacy service.

2. Buy generic over the counter medicines for headache, cough, fever etc., I save atleast $1 – $3 dollar on purchase of CVS or Walgreen generic over the counter medicines instead of brand names, sometimes even more when I get coupons.

3. Lastly, don’t fight over for a penny of savings on generic drugs. If the generic brand only saves a dollar or two compared to brand name and your partner prefers brand name, just let it go. Fighting is not worth it for the small amount of saving.

In conclusion, Generic drugs have become more popular these days and many people are starting to realize that they are safer than ever. It is always good to buy generic drugs which are safe and saves you money.

Some content source: fda.gov
Image courtesy: trustpharma.net

« Older Entries
Newer Entries »