Health - Health Insurance's New Limitations

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Everyone in America is looking for a low cost health insurance plan that will cover every medical expense we may incur.  Fact is you may have a better chance finding a winning lottery ticket on the side of the road.  With today's ever rising healthcare costs, if a plan is very cheap and appears to cover everything, you should probably read the brochure again.

Insurance companies often snip away at benefits to achieve a more affordable premium.  While there is nothing wrong with this, the problem is that some people purchase the plans without being made aware of which benefits are lacking.

Here are some typical ways an insurance company will alter coverage to create a more affordable health insurance premium.

Prescription drug coverage: People are used to having a simple drug co-pay plan.  Insurance companies are now offering a variety of prescription drug co-pay plans.  Here are some ways that the insurance companies are making prescription drug cards a little more complicated:

• Add a deductible which needs to be met before the co-pays can be utilized.
• Add a co-insurance amount which will be over and above the regular co-pay amount.  For example: If you have a brand name prescription co-pay of $30 plus a 20% co-insurance you would pay a total of $50 for the brand name drug which original price was at $100.  This includes $20 for your share of the co-insurance at 20% plus the co-pay of $30.
• Excluding certain brand name drugs.
• Placing an annual maximum benefit amount on prescription drugs.

If you tend not use prescription drugs much, and feel that your health is in a state that you can continue not to use prescription drugs, utilizing these sorts of options may work to your advantage.

Outpatient Coverage: Typically health insurance plans treat outpatient care as any other illness, allow the medical expenses to work toward the deductible and have few limitations.  Insurance companies are starting to limit the benefits to reduce monthly premium.  Some ways of doing this are:

• Placing a separate deductible on outpatient expenses.
• Limiting daily or annual outpatient benefit amounts
• Waiving all normal doctor visits and lab expenses.

These outpatient limitations are a great way to save money if you are able to self-insure you and your family for smaller expenses.  Keep in mind though, some outpatient expenses can become costly, such as MRIs and CAT scans.

Inpatient and Outpatient facility charges: Usually once your deductible has been met, the only thing you would have to pay is your co-insurance amount, whatever that may be.  Co-insurance generally has a stop-loss amount.  Once the stop-loss amount has been met, there are no more expenses to come out of your pocket.

Insurance companies have started adding inpatient and outpatient facility fees to some plans.  The plan may state that if admitted to a hospital for an inpatient stay, there will be a fee of $500 per occurance.  If an outpatient surgery facility is used, there will be a fee of $250 per occurance.  These charges can be compared to co-pays.  The charges will not work toward the health insurance deductible and will be over and above your out-of-pocket stop-loss.

These fees provide the insurance company with a little less risk and in turn can save your money on your health insurance premium.  The only time you will notice that the fees are there is if you have a rare occurance of an inpatient stay or outpatient surgery.

Please keep in mind, there is no one health insurance plan out there that will suit everyones needs.  In effort to make more affordable health insurance, companies are coming up with new plan types constantly.  You can get creative and use these "optional limitations" to your advantage and save money on your health insurance premium.