Q. I am a non-US citizen and need this information to do a case.
Specifically:
1) Is health insurance compulsory for everyone?
2) What happens if someone cannot afford it?
3) In the event that a medical procedure needs to be done, does health insurance cover all the bills? Does the patient need to pay anything extra?
4) Does the patient have any say over what kind of procedure he can take? Say if 2 treatments are available for his condition, can the patient choose the more expensive treatment? And if so, is it covered by the insurance?
Thanks for reading this. Your help in answering any part of the questions would be greatly appreciated!
Thanks to those who have responded so far.
I would like to further ask:
Does a health insurance contract state that it will only cover the "normal" rates for a procedure? For eg. if there are 2 possible treatments for a disease, 1 of which is more expensive but more effective than the other, will the patient only be covered by the LESS expensive one?
Or is it a case in which the patient can opt for the more expensive one and "top-up" the difference?
This is a crucial question to my understanding the case. Thanks!
Specifically:
1) Is health insurance compulsory for everyone?
2) What happens if someone cannot afford it?
3) In the event that a medical procedure needs to be done, does health insurance cover all the bills? Does the patient need to pay anything extra?
4) Does the patient have any say over what kind of procedure he can take? Say if 2 treatments are available for his condition, can the patient choose the more expensive treatment? And if so, is it covered by the insurance?
Thanks for reading this. Your help in answering any part of the questions would be greatly appreciated!
Thanks to those who have responded so far.
I would like to further ask:
Does a health insurance contract state that it will only cover the "normal" rates for a procedure? For eg. if there are 2 possible treatments for a disease, 1 of which is more expensive but more effective than the other, will the patient only be covered by the LESS expensive one?
Or is it a case in which the patient can opt for the more expensive one and "top-up" the difference?
This is a crucial question to my understanding the case. Thanks!
A. You've asked a very broad question. There is no simple answer.
In truth, health insurance works a little differently in each state.
To answer your specific questions:
1) No, health insurance is not compulsory for everyone. If you're lucky, you are able to join a group policy at work. (If you're really lucky, it's a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that's such a recent change that there's no clear cut answer yet for how that's going to work.
2) What happens if someone can't afford it is... they don't get it, usually. Except if your income puts you below the "poverty level", in which case you qualify for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)
3) Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you're really, REALLY lucky, you don't have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you're in Congress.)
4) Yes, the patient has some say over procedures. However, if the patient opts for an "experimental" procedure, or one that isn't deemed "medically necessary", then health insurance may refuse to cover any charges at all.
In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)
** Edited to add:
It's not ALL about the money when a procedure is involved. If it is, the state keeps track of complaints filed on behalf of consumers with "managed care" (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations -- also known as PPO, HMO, and POS) and may very well revoke a company's charter to do business in the state should the company be turning down too many legitimate claims.
However, insurance companies are sticklers for following the "standard" for medical care. This is what makes it difficult to answer your question. Because they should not deny anything that's considered standard for care in the given circumstances (should not and will not being two completely different things, of course.) And there may be several options that would be considered "standard." If the patient wants treatment that isn't yet considered "standard", they would balk. Period.
In truth, health insurance works a little differently in each state.
To answer your specific questions:
1) No, health insurance is not compulsory for everyone. If you're lucky, you are able to join a group policy at work. (If you're really lucky, it's a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that's such a recent change that there's no clear cut answer yet for how that's going to work.
2) What happens if someone can't afford it is... they don't get it, usually. Except if your income puts you below the "poverty level", in which case you qualify for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)
3) Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you're really, REALLY lucky, you don't have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you're in Congress.)
4) Yes, the patient has some say over procedures. However, if the patient opts for an "experimental" procedure, or one that isn't deemed "medically necessary", then health insurance may refuse to cover any charges at all.
In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)
** Edited to add:
It's not ALL about the money when a procedure is involved. If it is, the state keeps track of complaints filed on behalf of consumers with "managed care" (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations -- also known as PPO, HMO, and POS) and may very well revoke a company's charter to do business in the state should the company be turning down too many legitimate claims.
However, insurance companies are sticklers for following the "standard" for medical care. This is what makes it difficult to answer your question. Because they should not deny anything that's considered standard for care in the given circumstances (should not and will not being two completely different things, of course.) And there may be several options that would be considered "standard." If the patient wants treatment that isn't yet considered "standard", they would balk. Period.
What is the difference between health insurance and travel insurance?
Q. I have a health insurance plan that covers me overseas in ANY country at ANY hotel. What would be the benefit of adding medical travel insurance, if any? I only found one link pertaining to this and it said travel insurance covers personal items and what not, but not any that I could afford.
Does anyone have any experience with this?
Does anyone have any experience with this?
A. Really. It pays for medical services at a HOTEL? What are the limitations?? Because they ARE there.
You will need to go to your health insurance broker, who's READ your policy, and can tell you what is NOT covered under your health insurance overseas.
You will need to go to your health insurance broker, who's READ your policy, and can tell you what is NOT covered under your health insurance overseas.
Where can i get individual health insurance for me and my daughter that also covers pregnancy in connecticut?
Q. I need to get health insurance for me and my 1 year old daughter. I am planning on becoming, or possibly already am pregnant but need insurance for us. Any help? This is in CT, so it is a state that does not require individual policies to cover pregnancy.
A. There are many web sites online that offer health insurance quotes you can compare with no obligation.
Some health insurance plans may include coverage for pregnancy. You want to check with the plan when requesting your quotes.
Ask about pre-existing conditions coverage in the health plan and how your coverage and deductibles are applied to pregnancy - What exactly is covered. This way you won't be surprised when you need the coverage during your pregnancy.
You want to make sure you understand the coverages offered, coverage limits, deductibles, co-pays, and exclusions for any pre-existing conditions. Try this site
http://free-health-quote.blogspot.com/
Here you can get quotes from different health insurance companies in your area, its the best way to find an individual health insurance with a reliable company.
Best Wishes,
Some health insurance plans may include coverage for pregnancy. You want to check with the plan when requesting your quotes.
Ask about pre-existing conditions coverage in the health plan and how your coverage and deductibles are applied to pregnancy - What exactly is covered. This way you won't be surprised when you need the coverage during your pregnancy.
You want to make sure you understand the coverages offered, coverage limits, deductibles, co-pays, and exclusions for any pre-existing conditions. Try this site
http://free-health-quote.blogspot.com/
Here you can get quotes from different health insurance companies in your area, its the best way to find an individual health insurance with a reliable company.
Best Wishes,
How would health insurance businesses be able to stay viable if the Senate bill is passed?
Q. As I understand it, the bill forces all Americans to have health insurance. However, I think that the fine for having no health insurance is around $750. But after the year 2014, health insurance companies will not be able to turn customers away for preexisting conditions. Why wouldnt someone pay the fine or buy low end coverage until they got ill and supplement the coverage or buy an extensive plan?
A. You almost understand it - Americans will have a choice - they can either pay $500 a month for insurance, OR, they can pay $300 a year in extra tax, and wait until something goes wrong before buying that $500 a month insurance, and then buy it and still get it covered.
Obviously, there's a huge "adverse selection" issue written into the current law, which means that it's highly unlikely that "all Americans will have health insurance". Normally the way things work, laws passed by the government have the exact opposite result of the stated intent, and even now, we have fewer people with health insurance today, than when the bill was passed. As the rates skyrocket to counteract the preexisting conditions exclusion deletions, even fewer people will be insured.
Plus, basic math. How, exactly, is a family of 4 making $50,000 a year before taxes, supposed to carve out $1500 a month, UP FRONT, for a full year, until they can get their income tax credit the following year to "subsidize" them? I really don't see it happening.
This bill will tighten the insurance marketplace even further, as far as individual policies go, and the smaller companies will be going out of business. That, to me, is the REAL intent behind the "Obamacare" legislation.
So you're right. Only people who are really, really bad at math, will pay for insurance up front, when they don't need it, when for way, way WAY less money, they can buy it AFTER they need it, and still get covered.
Obviously, there's a huge "adverse selection" issue written into the current law, which means that it's highly unlikely that "all Americans will have health insurance". Normally the way things work, laws passed by the government have the exact opposite result of the stated intent, and even now, we have fewer people with health insurance today, than when the bill was passed. As the rates skyrocket to counteract the preexisting conditions exclusion deletions, even fewer people will be insured.
Plus, basic math. How, exactly, is a family of 4 making $50,000 a year before taxes, supposed to carve out $1500 a month, UP FRONT, for a full year, until they can get their income tax credit the following year to "subsidize" them? I really don't see it happening.
This bill will tighten the insurance marketplace even further, as far as individual policies go, and the smaller companies will be going out of business. That, to me, is the REAL intent behind the "Obamacare" legislation.
So you're right. Only people who are really, really bad at math, will pay for insurance up front, when they don't need it, when for way, way WAY less money, they can buy it AFTER they need it, and still get covered.
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