Health insurance coverage is important because one never knows when one will become ill. Granted, health insurance can be costly. Also, there are life circumstances which can make it seem impossible to get adequate health insurance coverage or payment of costs. For instance, denial of claims, reduced retirement benefits, job layoffs, and pre-existing conditions can be burdensome. Fortunately, there are ways to deal with these challenges.
Health Insurance Enrollment Choices and Subsidies
If working for an employer who offers health insurance coverage, during the open enrollment period, sign up to get a flexible spending account. The benefit of this is that one can use up to $5000 tax free to pay for out-of-pocket medical expenses. Also, participate in a mail-order prescription opportunity which enables payment of half of what one normally might pay for prescriptions at a drug store. In addition, purchase generic prescriptions when possible.
Until 2014, purchasing low cost group health insurance coverage via a professional association is one option to reduce health insurance costs if one is self employed or if an employer has suddenly cut health insurance benefits. However, in 2014, individuals with low income or middle income will be able to get subsidies that will enable them to purchase health insurance.
Stick With Medicare for Health Insurance as a Senior Citizen
If one has an illness and wants to be able to see any physician of choice, it is better to stick with traditional Medicare coverage. Also, most likely, getting Part D coverage for prescriptions along with Medigap can be a helpful choice to cover deductible costs and co-insurance costs.
Of note, some senior citizens have been signing up for private Medicare Advantage plans rather than the typical Medicare coverage. However, the fees to the plan administrators are going to be cut and there are concerns that some of these administrators will cut benefits or leave the health coverage market totally. That is why staying with Medicare coverage could be the best bet.
If Health Insurance Claims are Denied Keep Trying
If a claim is submitted and it gets denied, try again. In fact, chances are strong that the claim could get paid if one is very exact in going through the process described in the denial note. Always appeal in writing and send it via certified mail. In a formal letter, include documentation and be specific in the response to the reason that was given for the rejection of payment of the claim.
Also, include discussion of what the illness was, previous treatments that failed, consequences of not being able to receive care, medical records, and also put into the packet a note from the doctor. If the medical procedure was experimental, attach a copy of a medical journal article which says that the treatment can be an effective treatment. Or, if all else fails, go to the state insurance department and ask to get a patient advocate.
If things go far enough, the case will likely be reviewed by an independent review board. The review board may get involved through an employer’s health insurance plan or through the state insurance regulatory board. In the meantime, also negotiate with the physician and work out a payment plan which stretches payments out over time and makes treatment more financially affordable.
Health Insurance Options If Laid Off Work or If You Have A Pre-Existing Condition
Joining a health insurance group plan that one’s employed spouse is already a member of is an option for health insurance coverage if one has no job. Or, thanks to Consolidation Omnibus Budget Reconciliation Act (COBRA) requirements, one could remain in the group health insurance policy provided by one’s employer for 18 months after the job was ended although companies with fewer than 20 workers might be exempt from having to provide this.
Having a pre-existing condition or having a condition which is not included in coverage means that it might be necessary to be a part of the state high risk health insurance pool. In addition to the state high risk pools, there is also now a national high risk coverage pool that one can join as a result of health reform law.
Also, healthcare such as medical tests and medical exams are available at Walgreens or other drug stores these days. Medical evaluation may be done by a nurse practitioner instead of a physician. However, the medical care is available. Also, going to a community health care center is an option because community healthcare centers in many urban areas provide free medical care for those without health insurance or those who have low income.