What is Included And Excluded in Health Insurance Plans
Reader’s Question:
I understand very little about health insurance policies, and I constantly feel in the dark. I do not even have a clear idea of what might not be included, and this worries me. I’ve just always thought that health care insurance policies would save me from exorbitant medical expenses! Can you explain some of the limitations of a health insurance policy? I live in Louisiana.
Joy
New Orleans, LA
If you think that your health care plan includes every medical cost you might have in the future, you’re up for a surprise. Mostly, a very good health insurance plan means that you will only need to pay for a minimal amount, but certainly there are limitations to what is covered. Here are some exclusions to your health care policy.
First of these are pre-existing conditions. Many health insurance companies are reluctant to shoulder the cost of those medical conditions that you already had before you bought the health insurance policy. Insurers generally have an exclusion period of about 6 months; The state of Louisiana allows this period to be as long as one year. This means you cannot get coverage for pre-existing conditions within the first 6 or 12 months, depending on your contract.
Another is drug abuse. This exclusion assumes that you have inflicted the problem upon yourself. So, in the same way, attempts at committing suicide are excluded. So is alcoholism.
Mental illness–especially if it has already manifested before the start of your contract– will not be covered, as well. So, your psychiatric care will not be paid for by the health insurance company. The same goes for any treatment for learning and behavioral problems.
Cosmetic surgery is not vital to life or living, so looking more beautiful is something you will have to spend for on your own. Most medical procedures considered to be preventive are part of the exclusions, too. So are dental and eye care.
Of course, the best advice I could give is for you to make sure that you read your contract with any insurer very carefully and ask your health insurance company the questions that boggle you.
Tags: Health Care, health insurance, insurance
Indiana Health Insurance Options
Reader question:
I live in Indiana and don’t have health insurance. How does health insurance work in Indiana?
Rick
Here’s how.
The troubling thing about Indiana health insurance and that of many other states is that, if you are someone who is not in completely perfect health, it can often be difficult to get a health insurance plan with good coverage. In Indiana, companies get to reject you for many reasons including what your current health is and whether or not you have pre-existing conditions.
If you have a pre-existing coverage in Indiana that you developed within the last year, you may be in trouble. Some health insurance companies will cover you but exclude coverage for that condition, so you don’t have medical health insurance for what you need it for the most. Others might just not cover you at all, and you will have to look elsewhere. If your condition is from more than a year ago, it cannot be taken into account when considering an exclusion.
If you are going to get Indiana health insurane, you can either get it through the Comprehensive Health Insurance Pool, or CHIP; an individual medical health insurance plan that you buy from a medical health insurance company; or a plan provided by Indiana health insurance through the state that you can get based on income.
Cheers,
Fashun Guadarrama
Georgia health insurance for cancer patients
Reader question:
If I am diagnosed with cancer, what are my chances of getting medical health insurance in Georgia?
Abraham
Fairly good, I’d say.
Naturally, it would depend a lot on whether or not you were insured when you were diagnosed with the cancer. The main thing that medical health insurance companies have a problem with are pre-existing conditions. If you’re already under their coverage when you’re diagnosed, there’s not very much you can do. This is why it’s extremely important to get health insurance before something major happens concerning your health, because it will make it very difficult to get health insurance later, be it Georgia health insurance or any other kind. It’s possible, sure, but it’s a big hassle.
Like in the rest of the United States, Georgia health insurance plans aren’t all-covering, and there are plenty of uninsured within the state. There are some ways that the state gives to people to help them acquire whatever medical treatment that they may need.
Georgia health insurance, like insurance everywhere else, is costly, and income requirements for receiving medical health insurance from the state are set low. This leaves a lot of people who fall in the middle, both unable to afford private health insurance, and unable to qualify for state provided health insurance. Whatever they can or cannot afford, things like cancer screenings and treatments are far beyond what their pocketbook can reach.
Some of this problem is diminished by the help from the Georgia Cancer Coalition. It is not a form of Georgia health insurance, but it helps women who are not able to afford Georgia health insurance nor qualify for help. They have to be at most 200% of the poverty level, and they are provided with breast exams and cervical cancer screenings. If diagnosed, they are helped to find further treatment and are able to get it for a lower price through the Georgia Cancer Coalition.
Cheers,
Fashun Guadarrama.
Getting health insurance in Houston if you’re high risk
Reader question:
I’m from Texas and I’m having a hard time finding health insurance in Houston because I’m considered ‘high risk’. What do I do?
Marvin
There’s always something that you can do.
The health insurance business, indeed, the entire insurance business, be it life, health, or auto, functions around formulas that determine the risk of a potential customer. Medical health insurance companies provide health coverage, but they only want to provide to the people who need it least, and want to make it as difficult as possible to use. This is natural to a business, as they would much prefer to have money coming in than out. This makes it difficult for people who are more like to use medical health insurance coverage to get insured, but there are certain fall back plans set in place to help them out.
If you are looking for medical health insurance in Houston, Texas, then you should consider getting involved with the Texas Health Insurance Risk Pool. This, which makes it easier to get high risk health insurance in Houston and the rest of the state, was created as Texas’s response to the federal Health Insurance Portability and Accountability Act. It helps out poeple who find that medical health insurance companies turn them down more often than not because they have a condition or history that makes it to where they require more health care.
It works pretty much the same way as much health insurance in Houston, even down, strangely, to the fact that in the first year of your policy you aren’t covered for any pre-existing conditions. It does, however, allow for hospital stays and trips to the emergency room with small deductibles.
It may be the only option for someone who needs health insurance in Houston and can’t get it anywhere else, but that doesn’t mean that it will be cheap. As a matter of fact, with a one thousand dollar deductible, it could end up with a monthly cost of up to five hundred for a 36 year old man, and up to six hundred for a woman of the same age.
Cheers,
Fashun Guadarrama.
Individual medical health insurance: it costs a lot
Reader question:
How much does individual medical health insurance tend to cost, and what affects those rates?
Mandy
Good question.
There are many states who mandate that individual health insurance companies insure anybody who wants to be insured and can pay, but this isn’t true everywhere, and there also isn’t a set amount of what you will be paying. Most of the time, it will be a lot. Individual medical health insurance is very pricey, and it all depends on who you are, what your history is, and where you are at. Group plans are a lot cheaper because the number of people dilutes the risks of others in the group and it ends up averaging out, whereas for individual health insurance it’s always concentrated in one person.
An individual medical health insurance plan is usually underwritten so the health insurance company can judge your rates based on your medical history. There are a lot of things that can affect your rates in the end, even things that you wouldn’t think would affect it, such as having been pregnant at some point. Those things can be the difference between high prices and middling ones, being insured and being uninsured.
Individual medical health insurance coverage comes with much the same coverage as group medical health insurance coverage, except for the requirement of individual coverage that it be underwritten. Here are some factors considered by the underwriter:
- Age. If you’re over the age of sixty five, you might be out of luck when it comes to getting medical health insurance. Age is a big factor in who is or is nor eligible for medical health insurance.
- Sex. Benefits of your gender depend on how old you are. When people are longer, females tend to get injured more often and file more health insurance claims than males. Once they turn sixty, it’s vice verce.
- Health History and Physical Condition. Things like pre-existing conditions can make it hard to get decent medical health insuranc coverage. You might luck out and be able to get a different, more limited kind of coverage, but it’s often the case that you will be denied coverage completely.
- Job and Hobbies. What you do in your work and spare time may be more dangerous than what other people do and could result in higher rates or denial of coverage. If you like sky diving or work in construction, you might have trouble getting decent medical health insurance rates.
Cheers,
Fashun Guadarrama.