Today's Healthcare Insurance Options

Article submitted by Sharon Weatherhead, MBA / BDR with Housecall Home Health.
For more information, she can be reached at 239-218-9547 or 239-275-8883.

Medicare Part D? Co-insurance? Managed Care? HMO? What does this alphabet soup mean? What are my options? If I don't understand it, how can I decide what's best for me?

Insurance choices are numerous and keep changing to meet the demands of society. Your best bet is to speak with a knowledgeable insurance professional regarding all the available options in order to make the best decision for you. You will need to balance the benefits vs. acceptable risk, vs. costs to you.

I will try to give you an abbreviated summary of healthcare insurance options available today.

Government Programs:
The most common healthcare insurance programs are those where the US government is the insurer. Those programs, also called social insurance, are Medicare and Medicaid. These programs are either partially (Medicare) or completely (Medicaid) subsidized) by the government. They are available to people based on age, income, disability or chronic illness.

Managed Care:
Managed Care refers to health plans that have contracted arrangements with a defined system of healthcare providers. You must use the providers they have contracted with to receive maximum financial coverage. Examples of providers are: hospitals, physicians, home health agencies, skilled nursing/rehab facilities, etc If you go out of the referral network your out-of-pocket expenses increase dramatically.

The most common Managed Care Organizations are: HMO'S (Health Maintenance Organizations), PPO, (Preferred Provider Organizations), and POS (Point-of-Service Plans). It is important to note that there are Medicaid and Medicare Managed Care plans also. If you have a Medicare Managed Care plan (such as Medicare Complete, United Healthcare, Humana Gold, etc) you do not have Medicare. You have a plan that has different benefits. In general, a Medicare Managed care plan will have lower premiums and some prescription drug coverage. On the other side you may have different deductible and co-pays along with limited provider choices. You need to speak with an insurance professional to determine what's right for you!

Medicare Part D:
Just a few notes on Medicare Part D, or Medicare's new drug benefit program: It is a voluntary drug benefit program that provides some coverage. Although it is voluntary, there are penalties if you do not enroll when you are first eligible to do so and you decide to use the benefit later. It is not available to those with Medicare Managed Care plans. It provides subsidized coverage beginning in 2006. Premiums will be about $35/month. Drugs are formulary based choices. The standard package provides 75% coverage for the first $2000 of drug spending beyond the deductible (based on your income). Coverage stops completely for the next $2850 of costs (this is called the "gap" or "donut hole". The purpose of this gap in payment is to limit the federal costs of this benefit). Those at the lowers income levels (including those on Medicaid) will pay nothing.

Although there is much more information available, this is just a brief summary of available options.

Home Health Care is a benefit that is paid for by all providers. Home Health is very valuable to those coming home from a hospital stay, a rehab or nursing home stay, or for those with chronic conditions that leave them home bound. Certain criteria must be met for continued care.

Most Home Health Agencies accept only Medicare (government insurance) payment. This may make it difficult to find a provider if you have private or Managed Care plans. Housecall Home Health (an Amedysis company) accepts Medicare and most insurance and Managed Care plans. They are dedicated to be socially responsible to the people in their community.