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1 CHAPTER 9 Health and Disability Income Insurance Pssst. Here are a few words to the wise: Don’t Get Sick. More Americans Wanted the Health Care Bill to Do More 2 Health Care Costs The United States has the highest per capita medical expenditures of any industrialized country in the world Predicted over $9,000 per person in 2011 This amount is over twice as much as the average for the 24 industrialized countries in Europe and North America 6% of the GDP in 1965, but expenditures rose to over 17.6% of our GDP in 2010 – $2.5 trillion! And it is growing fast − 21½% by 2018? Health expenditures jumped 5.7% in 2009 National Coalition on Health Care “Americans want too much of a very good thing.” Health insurance rose dramatically in 2011 3 Why Does Health Care Cost So Much? High administrative costs – Insurance companies! 26% of health care dollar vs. 1% in Canada Use of sophisticated, expensive technologies Duplication of tests and technologies Increases in the variety and frequency of treatments Increasing number and longevity of elderly people From ages 60 to 70, the average person uses more health-care resources than they did from ages 0 to 59 These are the most significant reasons, especially the first and the last reasons. Malpractice insurance is often used as a scapegoat for spiraling costs but it is a very small amount. What is Being Done About the High 4 Costs of Health Care? Careful review of fees and charges Establish incentives for... Preventive care Services provided out of the hospital where medically acceptable Community health education programs to get people to take better care of themselves Preventive care is almost always cheaper than allopathic care Medical “vacations” 750,000 in 2007; 6 million by 2010? The real answer to this question is, “Not much.” Are you willing to forego medical care? 5 Which Would You Choose? You are 50 years old. Recently, you have been experiencing severe abdominal pain and a nagging cough. You go to your family doctor who sends you immediately to the hospital. After a few tests, the specialist asks you to sit down with her and tells you that you have stage 4 liver cancer that has spread to your lungs and spine. She tells you that you probably have three to six months to live. She gives you two choices: Choice 1: You decide to forego radical Choice 2: You decide to undergo treatment. Instead, you are given pain radical treatment. You have surgery, medication and placed in hospice care radiation treatment, and several after two months. Your chances of rounds of chemotherapy. Your living 5 years are 1 in 1,000. chances of living 5 years are 1 in 85. You die in four months. You die in nine months. Total cost: $45,000 Total cost: $1,250,000 How Can You Reduce Your 6 Personal Health Care Costs? Stay well – focus on prevention Eat a balanced diet and keep your weight under control Learn to deal effectively with Don’t smoke – Don’t drink to excess Get enough rest, relaxation, and exercise “Yeah, sure, Mom. Right.” Do financial health and medical health have any correlation? Disability Income Insurance 7 and Financial Planning Disability income insurance protects your most valuable asset – your ability to earn an income One of the most neglected forms of insurance No matter what your age during your working years, you are more likely to become disabled than to die Young, healthy people don’t think about the risks related to all their future earning potential Provides regular cash income lost by employees as the result of an accident, illness or pregnancy If you become disabled your income drops but your expenses usually go up Disability Income Insurance 8 and Financial Planning (continued) Carefully read a policy’s definition of disability May (will!) only pay if you can not work at any job Look for a policy that pays if you are unable to work at your regular job (You will not be able to find any!) Aim for a benefit that when added to your other income will equal 60-70% of your gross pay I have never seen more than this How long do benefits last? To age 65? For life? How long is the waiting period? 90, 180 days? Look for a policy that is... Non-cancelable Guaranteed renewable 9 Four Sources of Disability Income Employer-sponsored disability insurance Group disability policy may be short or long term but usually not enough by itself Individual disability insurance Good Luck! It is very hard to find and, if found, is expensive and restrictive What a deal, huh? Social Security Covers total disability that lasts more than one year Workman’s Compensation If you are injured at work Health Insurance and 10 Financial Planning Health insurance alleviates the financial burdens people suffer due to illness or injury Part of your overall risk management plan to safeguard your family’s economic security A week in the hospital can literally kill you (financially, that is) 47 million Americans have no health insurance Two-thirds are full-time workers and their families Older college students can now be covered by their parent’s policy until age 26 under the new law This number was climbing as more and more smaller businesses claimed they can no longer afford the cost of health insurance for their employees. The new health care law is supposed to reduce this number to just below 20 million. Health Insurance and 11 Financial Planning (continued) Medical Savings Accounts (MSAs) (HSAs) Allows small businesses and self-employed workers to place pre-tax money into an account set aside solely for medical expenses Health Savings Accounts (HSAs) Are replacing the MSAs (less restrictions) Anyone is now eligible if they have low-cost (?), high-deductible comprehensive major medical insurance The major problem is “low-cost” insurance ain’t so low-cost anymore! We used to have an MSA/HSA but we switched to Southwestern’s HMO 12 Types of Health Care Coverages Comprehensive major medical insurance Low or high deductible offered without a separate, basic plan Hospital indemnity Pays a fixed amount for each day you are in a hospital Cheap and not very useful Dread disease and cancer insurance policies Focus on unrealistic fears, and only pay out for very specific conditions Often sold by people working on commission Expensive and not very useful 13 Types of Health Care Coverages (continued) Dental expense insurance Group coverage for exams, cleaning, x-rays, fillings, oral surgery Vision care Some group plans include exams and glasses Long-term care insurance Virtually unknown 20 years ago, but now is growing faster than any other form of insurance Oversold, especially to younger adults who could easily start an investment plan to self-insure their long-term care 14 A Good Health Insurance Plan Should… Offer basic coverage for hospital and doctor bills Cover at least 120 days hospital room and board Provide at least $1,000,000 lifetime maximum per person (still plenty of coverage) Impose no unreasonable exclusions Pay at least 80% of out-of-hospital expenses after the yearly deductible is met Limit your out-of-pocket expenses to no more than $4,000 to $5,000 in a year, excluding dental, optical and prescription costs – a.k.a. “stop-loss” 15 Health Insurance Policy Provisions Eligibility Varies with age, marital status and dependency Internal limits Fixed amount/day for hospital room Co-payment Cost sharing in the form of a flat dollar amount you pay, such as $15.00 per office visit or Rx Exclusions and limitations Pre-existing conditions for the first year Coordination of benefits If more than one insurance company is covering you, they will not together pay more than the total cost of medical bills 16 Health Insurance Policy Provisions (continued) Guaranteed renewable / Cancellation & Termination Can only be cancelled if you don’t pay premium Premiums can only go up for the entire group Can convert to an individual policy if you leave group Sources of Health Insurance and 17 Health Care Group plans comprise close to 90% of all health insurance issued Most group plans are employer sponsored, and the employer pays part or most of the cost The Health Insurance Portability and Accountability Act (HIPAA) provides some protection If you changes jobs you need not lose your health insurance Individual health insurance policy Typically (but not always) cost more than group policies Mangled care, uh… Managed care Two of the prime examples are HMOs & PPOs … Sources of Health Insurance and 18 Health Care (continued) Health Maintenance Organizations (HMOs) Contract with care providers Fixed monthly premium Focus on prevention and wellness Preferred Provider Organizations (PPOs) Several providers to choose from Costs more than a HMO, but you have more choice and fewer restrictions If you go to another provider it costs more 19 “Catastrophic” Health Insurance Low-cost / High-deductible insurance It is really a comprehensive major medical plan Choose your own health care providers Pay out of pocket Can usually negotiate lower fees Just mention this magic little four-letter word, “Cash” Protected against large losses Great for small businesses, the self-employed and employees with cafeteria plans that allow employees to opt-out Example: Southwestern Community College But our Administration wants out of it! (It is expensive) 20 Medical Information Bureau (MIB) The MIB operates much in the same manner as the credit reporting agencies Used by the life insurance in much the same manner as the credit reports and the C.L.U.E. reports Protected by the same laws as the credit agencies Fair Credit Reporting Act MIB must correct any inaccurate information or allow you to report your side of the story Allowed one free report each year (like credit reports) 866-692-6901 www.mib.com 21 Government Health Care Programs Medicare – Federal program for those age 65 and older, and certain disabled persons Part A – compulsory Covers hospital costs including doctor Part B – voluntary Doctor’s office visits & prescriptions Now being “means tested” More about this later when we get to retirement… Medigap – Will pay what Medicare does not Medicaid (MediCal in California) Low income people of all ages State administered with Federal guidelines 22 Bottom Line on Health Insurance BOHICA That’s right – it is pretty much the bottom line on all insurance… Oh, Yeah. Don’t Forget. Don’t Get Sick.
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