Getting the most out of your Health Insurance
Real, genuine Long Term Risk Protection
Just about everyone agrees, health care in America, as we know it, is in deep trouble and needs reformed. Short of that, how do you protect yourself at the least possible cost, for the long term?
The problem with much health insurance, is most people look at it as a fringe benefit that comes with employment. They take a short term view to get it to meet current needs, often overlooking the long term need. The way it is sold and the way people buy it is foundation to the problem.
To find the right answers, we need to be asking the right questions. Question #1 for all should be: "Why do I buy/want health insurance?" Other questions should include: "What do I expect my insurance to do for me long term as well as short term?" "What do I expect my health insurance to cover?" "How do I want to use my insurance, under what conditions?"
There are many other questions that may be asked, but lets focus on the foundation. Once you have a solid foundation, most of the rest is details. Why do you want health insurance anyway?
The correct answer is insurance is to protect your family health and wealth by providing protection against catastrophic costs in the event anyone under your care becomes sick or hurt and requires extended care. Basically it is Risk Management to limit the amount of your liability when medical treatment costs spiral out of control.
The concept of insurance is to put a large number of people into a group with each contributing what is deemed to be a ‘fair' amount based upon the statistical risk they represent to the group as a whole. Premium is determined by number crunching statistics which insurers are constantly compiling and refining. Of course, you need to understand that insurance companies aren't in business with the primary objective of helping people, they are in it for the money, just like everyone else does whatever business or service they do to make money. Profits are made when risks are strictly defined, claims stay limited, and premiums exceed costs. When the collected premiums fail to cover costs, the plan fails and all within the group have to go elsewhere.
Like banks, insurance is a confidence game. If people really understood what was going on in the background, they would choose who is insuring them more carefully. What happens in real life is they try not to publically bankrupt a plan. But what companies do is to ‘roll over' group plans every 2-3 years into new plans that may or may not be with the same company. This is really an ‘out' for the company to revise plans often, limit benefits and manage their risk better. They are able to rate or exclude those who have developed expensive conditions and remove them from the entitlement group.
The net result of this is to deny those who have become sick continued benefits at a reasonable cost. This is one reason we have so many uninsured and outside the system. Many of these people are also railroaded out of the work force because even on group plans, the insurance company rates them as individual risks. That makes those who use the benefits cost the employer more. Often their conditions put them lower on the productive/profit rating scale that eventually moves them out because of cost/efficiency formula used by most employers and they soon become unemployed.
Few really understand this process because it is individual in nature and there are always other reasons given for termination. This methodical process is one that takes place over a period of months and years, thus it appears to be more of a ‘hard luck' situation rather than a circumstance that has been created by the employment societal environment.
So, if you, the consumer of insurance, buy health insurance to limit and control your risk and protect your assets long term, why do you play this game? It looks like a guaranteed Lose – Lose proposition to me with most companies the way they play the game. If you get sick, you get covered for that illness and it works well for limited or one round things. But if it is anything catastrophic or long term, you end out uninsured. If you don't use it, you are also out all the money paid as it is spent on the care of others.
Is there an acceptable answer to this dilemma? Yes. I've shopped around and can say that I've found one company that is at least attempting to address these basic problems. They cater to self employed and independent people who qualify for a quality health insurance plan once and then they are able to keep and maintain it up to age 65 when all coverages terminate and medicare takes over.
This plan is available through an association that provides a number of member benefits that can save most people chunks of money over and above membership costs. It's like a Sam's Club for insurance, but also covers lots of ordinary, everyday things. The company is national in scope, ‘A' Rated, publically traded, financially secure and even provides an option that will let the subscriber receive a refund of all monies paid that have not been used to pay their own insurance claims at time of retirement.
This in essence, makes health insurance work much like Universal Life insurance where cash values accrue and eventually the value of the policy is equal to the price paid for it. As far as I know, this kind of coverage is not yet available from other carriers but if and only if people demand it, will insurance companies change and start catering to the real needs of consumers and insurance buyers.
The bottom line is that you must ask the right questions to get the right answers in regards to health insurance. If you only accept what is offered and then conform your life to follow the rules in order to use the benefits, you support an established money cartel. If you buy insurance through an association that has been formed and created to stand up for your interests and it demands the insurance company that covers its members to do things differently, then you are helping bring change to a process that is broken.
Some people understand this problem and have come up with a solution. The insurance company is one that is able to keep premiums affordable by reason that they are always adding new, healthy members to an ever growing group that is never closed off. Therefore it doesn't shrink in numbers as costs go up and doesn't require people to rotate into different plans as time progresses. If conditions develop, they can't kick you out or rate you individually as other plans do. The large group absorbs these greater risks and you continue to pay normal rates until retirement.
By having an advocate in your corner, via the association, insurance premiums can stay affordable long term, you can maintain coverage to manage your risks long term and come out protected from financial disaster regardless of what happens to your family health wise. I think its an idea whose time has come.
For more information, please email me and I can share contact information. In time, there may be more than one source for this, but for now, I have found only one.
About the Author
T L Walker is a self employed business person. He began representing a national association when he found that most insurance companies rated and excluded many of his friends who had developed medical conditions like asthma and diabetes. In all his searching, he found only once company that didn't play what he now terms, ‘the health insurance game' where they cycle consumers around from one plan to another every few years until they are able to systematically eliminate all the poor risks. This article was written to help people realize the game they play and that now there is another alternative out there. Contact T L at: tlwa@swbell.net
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