Use this Guide to Find the Type of Healthcare Coverage that You or Your Organization Needs.

Note: By Publishing This information The Dove Center, LLC is neither endorsing or defaming any particular health-plan, rather we are simply trying to present all possible alternatives to those seeking information.

To find the proper health insurance for yourself, your company or your ministry;  it is important to understand a few basic terms and concepts surrounding the insurance industry.  Insurance is a component of RISK MANAGEMENT, which is the process of (1.) accessing the RISK of an EVENT happening, (2.) analyzing if, with the assets available, the person or organization can afford to pay for the cost associated with the EVENT and (3.) the REASSIGNING of the unaffordable or undesired risk to someone else.  This REASSIGNING is what we call insurance or "INDEMNIFICATION," which is a fancy word for "paying you back for what you've lost."  This "pay-back" principle affects the cost of insurance; here's how.  

Insurance companies spend lots of money studying the health habits of individuals.  They can tell you for your given age, habits, weight, height, and socio-economic background what your probable health outcome will be.  They have RISK RATIOS  associated with these. They also know that 90% of all your health care dollars are spend in the last 30-90 days of your life.  That means that usually they only have a 10% chance of paying for a health claim on you and probably won't have to pay a claim on you at all if you only have CATASTROPHIC health insurance. You see, there are several types of health care insurance:

You will notice that as the risk to you is lowered the cost to you is increased. 

 Look at it from the Insurance companies perspective.  You'll probably live until you age 77 as a man and 85 if you're a woman.  So, under our system of insurance you only need health insurance between the ages of 1 and 65.  After age 65 your on Medicare!  So the only period that you'll buy insurance is typically the most healthy period of your life!  For healthy individuals, this period only leaves the insurance company open to cost of pregnancies for women as a risk and injuries from accidents as risk for men.  That is actually is a very low risk!  As insurance companies insure people which are in a "HIGH-RISK" group, like those that are severely obese, smokers, have high blood pressure, those with hereditary predispositions to health problems (like diabetes, heart problems, etc) or dangerous occupations (like the ministry...the highest disability among ministers is emotional disability) they take on RISK FACTORS which could potentially raise the cost of insuring the whole RISK POOL. 

 You see, insurance companies are restricted from discriminating against a high-risk person who is a member of a group policies in most states.  Therefore, the healthy low-risk people have to pay the risk for the high-risk people.   Now, this isn't true on individual policies.  Insurance companies are allowed to discriminate on individual policies, and can refuse to take the risk (issue the policy) but if they're going to raise the monthly premium rate due to the risk, they have to do it for a whole CLASS of people across the entire state.  So many times, especially in group policies, insurance companies are forced, by law, to accept risk which cost them and the other policy holders a lot of money.

An Issue here is that Americans see Health Care as a Right not as a Privilege.

The fact of the matter is this: ALL Americans have access to health care.  Yes!  If you're in emergency need of health care there is some hospital in your town that must, under penalty of law, provide you with emergency health care at the public's expense, if you can't pay. Is it the best care...not necessarily...but it is care.  The health care industry is a $750,000,000,000 (750 Billion) per year industry.  That's 13% of our Gross National Product (the value of everything we produce in the USA each year).  Out of every $100 dollars spent on health care last year nearly $35 dollars went for COST SHIFTING.  Cost shifting occurs when some person, agency or group either won't  pay the required cost or can't pay the cost of the health care at all. 

 The federal government (HCFA-Health Care Finance Administration) will only pay doctors and hospitals a CAPITATED (fixed) amount for a given service covered under Medicare or Medicaid, likewise with HMO's.  Then there are the situations of the 35 million Americans which have no healthcare coverage and are given it anyway--who picks up these costs?  First the hospital and doctors; they then shift it to the Insurance companies, then the insurance companies shift it to the companies and individuals paying the premiums.  That's why your premiums are so high.  Is it a broken system? Probably, but its about the best one on earth, so maybe we shouldn't complain.

First, Determine how much risk you can afford to take and how much you can eliminate.  If you ask the insurance company to take almost all of your potential loss from a potential illness (low deductibles: $500 or less), then your premium will be on average around $400 per month per person.  By being willing to pay for all your yearly checkups, medicine and routine visits you could raise your deductible and possibly cut your monthly premium by as much as 50%.  Here's typical insurance works:

You have a Deductible: $250, $500, $1000, $1500, $2000, etc.
You have a Co-pay amount: 50/50, 70/30, 80/20 (insurance pays 80% you 20%)
You have an Out-of-Pocket Limit: usually $1500-$2500
You have a Lifetime Maximum Benefit: usually $1 million or $2 million

Now here's the "Kicker:" almost every insurance salesperson sells, and therefore almost everyone asks about, the "Deductible" amount on a policy.  This is the wrong question! What your health care provider is worried about is: what is the most you are insured for not the least!  Start thinking like your healthcare provider!  You see, the hospital and doctor are not worried about the "little-ol'-bitty" deductible--they'll let you pay that amount by the month if necessary; what they're worried about is that "great-big-ol' " balance on your bill for services which could be as high as a million dollars! So, you may want to consider buying health insurance Only for catastrophic losses not regular/routine healthcare.

Consider this: The dollar amount of your part of your healthcare risk is equal to is the Out-of-Pocket Limit not the deductible. Here's what I mean.  Let's say you have a $40,000 open heart surgery operation and you're ready to go home.  You go by the business office of the hospital and tell them you want to pay the amount you owe them.  They'll call your insurance company and find out that you have a policy with a $250 Deductible, an 80/20 Co-payment, an Out-of-Pocket Limit of $1500, and a Lifetime Maximum Benefit of $1million.  Now, they're not asking you to pay, you understand, you're offering.  Here's how they'll calculate your amount.  They'll see your Out-of-Pocket Limit equals $1500 and your bill equals $40,000--they'll tell you to pay them $1500.  If your bill had been, say, $10,000 they wouldn't have been so sure, here's how they would have calculated it:

Your total bill of ...........................$10,000
Minus Deductible.........................$    250
Balance Due................................$ 9,750
20% Co-pay(.20 times $9.750).......$ 1,950

Since Co-pay is greater than Your Out-of-Pocket Limit you would pay $1500 total

Here's the thing though, you paid the Out-of-Pocket Limit amount not the Deductible amount! What insurance companies look at is this: are you wanting a lower deductible so that they will be at risk for even your routine medications, doctors visits, etc...if you are you'll pay a much higher premium. 

Second, Work on lowering your responsibility for the risk.  Do you smoke, drink, engage in activities that are potentially harmful?  Are you taking care of your mental/emotional health?  Do you get regular check-ups? Are you eating a well-rounded, balanced diet?  Are you severely overweight? Are you exercising?  Are you examining and learning what your body needs, in terms of vitamins and minerals, to keep it healthy as you age? Most of all, are you praying--are you neglecting your relationship with God? There are a lot of things you can do to lower your risk of health problems.  Once you successfully lower these risk factors you might look at how much insurance you need. 

Here are a few tips for getting the coverage you feel you need

 Example: Hospital coverage only
         Hospitals are the largest percentage of Healthcare costs

Or: Major Illness Coverage Only
This coverage is usually 25% lower than Full Major Medical Coverage and covers most debilitating illnesses.  These Policies are usually for $50,000 to $100,000 life-time maximums

Warning:
 While Hospitals account for two-thirds of all healthcare costs,  you could still owe an enormous amount to Doctors if you use Hospital coverage only.

Remember, if you're self-employed you can now deduct more than 50% of your health insurance cost!

If you're still at a loss!...

If you just can't afford or qualify for any type of healthcare insurance, apply for Medicaid at your State Department of Social Services.  This will allow you to access an array of healthcare services.  Below are the average guidelines for qualifying: guidelines change slightly from state-to-state. 

Maximum Cash Assets (bank accounts, stocks, bonds, cash in life insurance): $2,000
Maximum Monthly Income: $900 - $1500
Maximum Fixed assets allowable: Your Home and One Car
Some health disability or uninsurable condition is usually required

Last but not Least!
Virtually every state has County health clinics!
County Health clinics can be of tremendous assistance to you.  Almost all of your non-hospital healthcare needs can be met at these centers...and you're already paying taxes for these services.  You probably won't be able to see your own family Doctor, but it's very affordable and if your income is low enough, it's FREE!

You don't have to go without Healthcare in America!
God has really blessed us! 

Why? 

Because Healthcare is not a right.

I pray this guideline has been Helpful.

 

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Page Last Updated Tuesday, April 17, 2007 07:10:54 PM