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Health Insurance

Overview

Health Insurance can best be described as any policy, or group of policies, that pays for medical care and expenses. These medical expenses cover, but are not limited to, preventative, diagnostic, surgical, therapeutic, pharmaceutical, disability and even long-term nursing or custodial services. The sources of medical insurance can be government based, social programs, employee provided and individually purchased.

The LaBorde Agency LLC specialized in employee provided group insurance plans, family & individually purchased plans and some products or policies that works with or compliment government based plans. The scale of coverage and premiums for these different types of health insurance plans are typically based upon a blend of factors uniquely determined by each separate insurer. Great attention should be given by any purchaser of medical health insurance because price is only one factor in the overall scope of coverage and although similar types of policies can seem the same - in actuality they may be very different. The buyer should focus his or her attention on two distinct considerations; (1) the “value of coverage per unit of cost” and (2) the “financial stability and reputation of the insurer”.

Types of Health Plans

There are essentially two types of health insurance plans: indemnity plans (fee-for services) or managed care plans. The differences include the choice of providers, out-of-pocket costs for covered services and how bills are paid. There is no one “best” plan for everyone. Some plans are better than others for your or your family’s health care needs, but no one plan will pay for all the costs associated with your medical care.

Indemnity Plans

Cafeteria/Flexible Spending Plans are employer-sponsored plans that allow the employee to design his or her own employee benefit package, choosing between one or more employee benefits and cash. Several types of Flexible Benefits or Cafeteria Plans are used by employers, including a pre-tax conversion plan, multiple option pre-tax conversion plan, medical plans plus flexible spending accounts, and employer credit cafeteria plans.

Indemnity Health Plans allow you to choose your health care providers. You can go to any doctor, hospital or other provider for a set monthly premium. The plan reimburses you or your health care provider on the basis of services rendered. You may be required to meet a deductible and pay a percentage of each bill. However, there is also often an annual limit on out-of-pocket expenses, so that once an individual or family reaches the limit, the insurance covers the remaining eligible medical expenses in full. Indemnity plans sometimes impose restrictions on covered services and may require prior authorization for hospital care or other expensive services.

Basic and Essential Health Plans provide limited health insurance benefits at a considerably lower cost. When buying such a plan, it is extremely important to read the policy description carefully because these plans don’t cover some basic treatments, such as chemotherapy, certain prescriptions and maternity care. Furthermore, rates vary considerably because, unlike indemnity plans or a managed care option, premiums are community rated and are based on age, gender, health status, occupation or geographic location.

Health Savings Accounts (HSA) are a recent alternative to traditional health insurance plans. HSAs are basically a savings product designed to offer individuals a different way to pay for their health care and usually part of a larger major medical plan with a high deductible. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. Instead of paying a premium, you establish a tax-free savings account that covers your out-of-pocket medical expenses. This means that you own and control the money in your HSA. You make all decisions about how to spend the money without relying on a third party or a health insurer. You also decide what types of investments to make with the money in the account in order to make it grow.

High-Deductible Health Plans (HDHP) are sometimes referred to as catastrophic health insurance coverage. An HDHP is an inexpensive health insurance plan that kicks in only after a high deductible is met of at least $2,500 for an individual or $5,000 for a family.

Managed Care Plans

Health Maintenance Organizations (HMOs) offer access to an extensive network of participating physicians, hospitals and other health care professionals and facilities. You choose a primary care doctor from a list provided by the HMO and this doctor coordinates your health care. You must contact your primary care doctor to be referred to a specialist. Generally, you pay fewer out-of-pocket expenses with an HMO, but you are often charged a fee or co-payment for services such as doctor visits or prescriptions.

Point-of-Service (POS) plans are an indemnity-type option in which the primary care doctors in the POS plan usually make referrals to other providers within the plan. If a doctor makes a referral out of the plan, the plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service is covered by the plan, but you will be required to pay co-insurance.

Preferred Provider Organizations (PPO) charge on a fee-for-service basis. The participating doctors, hospitals and health care providers are paid by the insurer on a negotiated, discounted fee schedule. Costs are lower if you use in-network healthcare services, but you have the option of going out-of-network. If you choose an out-of-network provider, you are generally required to pay the difference between what the provider charges and what the plan pays.

Medicare is a federal government program for people 65 and older, or those with certain disabilities, that pays part of the costs associated with hospitalization, surgery, doctors’ bills, home health care and skilled-nursing care. The LaBorde Agency provides a wide range of choices for Medicare supplement coverage.

Long Term Care

If a person has a cognitive impairment or the individual can not perform two or more of these six actions referred to as “Activities of Daily Living” (ADL) - eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed) then they are in need of long term care.

The period of care, i.e. four weeks, six months, a year or even for life is usually prescribed by the attending physician and can change for better or worse as time goes by. History of this type of care has proven the sooner one is in receipt of this type of care the better the outcome.

At one time this coverage was referred to as a “nursing home” policy. Today Long Term Care plans include both “skilled care” utilizing a team of medical professionals and “custodial care” provided in nursing homes, day care facilities, assisted living facilities and as their first choice – the patient’s home.

Disability Insurance

Disability insurance is;    income protection or replacement insurance.

When an individual, family or business prioritizes its needs; income from employment, including self-employment, is usually at or around the top of the list.

Life insurance replaces or provides desperately needed financial resources in the case of an untimely death. Health insurance provides for immediate and pro-longed care as well as reducing financial exposure to massive loss. But in a case of temporary or permanent disability neither will replace loss income.

There are many different types of plans and they are diverse in their types of coverage, benefits and cost. Just call us today to get specific information on a plan that would suit your unique situation.