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What a Self-Employed e-Patient Needs to Know about Choosing Health Insurance

For more than 50% of employed workers who get health insurance through their  company and the 29% of workers who are employed by the government,there is a trained individual who investigates the best health plan choices and presents those options to their workforce. For those of us who are self-employed, and under the age of 65,(therefore not eligible for Medicare), what to do about health insurance is a real dilemma that raises such questions as:


Do you really need health insurance or do you take your chances and hope you will not end up bankrupt from a serious illness?


How much of a deductible can you manage in your budget and how do you calculate the risk regarding how much debt you can incur for medical expenses?


How do you evaluate a policy’s overall coverage?


Can you get help from a state agency or get into a pool where your premiums are lower and your coverage more extensive?


What if anything will the Affordable Health Care Act provide for you?


Regarding whether or not you sign  a health insurance policy or take your chances, you need to know that going without coverage is risky.  More than 60% of bankruptcies in the United States are the result of medical bills. The lack of insurance has even led to  the death of individuals who, because they lacked insurance. sought medical help when it was too late. With no insurance you will tend to put off preventive health measures, wellness check ups and other important screenings as mammograms and colonoscopies that will detect problems before they become life threatening. Thus, ignoring this issue and pretending it will never surface is not an option so  you need to do your homework and find a healthcare insurance program that will work for you.


How much of a deductible can you manage in your budget and how do you calculate the risk regarding how much debt you can incur for a more serious medical illness? This is obviously an individual thing based on your weekly income, your set expenses and the amount that is left over that can be applied to paying for medical expenses, prescription drugs and other healthcare needs.


If you have an  insurance plan that comes with a $5,000 deductible and a 20% co-pay across the board, are you protected beyond the initial $5,000 outlay?  If you can manage the $5K , and the other upfront costs, than  your plan will work for you. If  not, you will have to look at options that lower your deductible but will  increase what you must pay monthly.   Whatever formula you choose, do not assume that for an indefinite period of time you will never face a medical issue, because it typically does not happen that way. So decide how much debt you can manage should a serious illness occur and weigh that against an insurance plan with its  premium cost-sharing requirements including  deductibles, co-payments or co-insurance. If you can do it, opt for the higher deductible policy, budget for all your normal medical bills out-of-pocket, and rely on your insurance only in the event of a catastrophic illness.


How do you evaluate a policy’s overall coverage? You must carefully read the fine print and understand how your policy explains: hospital care, surgery coverage, office visits to your primary care doctor and to specialists, emergency room visits, maternity care, immunizations, medical tests, well-baby care, dental care, vision care and prescription drugs costs, particularly any medications that you use on a regular basis.


You also need to be very specific on your insurer’s view of pre-existing conditions. There are a few states  where companies doing business in the state must guarantee all subscribers the opportunity to purchase health insurance regardless of pre-existing conditions. Most states do not offer those options. Furthermore,  there are no regulations, currently, on how much the insurance company can charge to cover you for those pre-existing conditions.


The Patient Protection and Affordable Care Act mandates that by 2014 every state in the nation must establish state health benefit exchanges that provide qualified individuals with access to insurers and qualified health plans.  In these exchanges, qualified individuals can receive premium assistance credits to help them pay for health insurance.  The premium assistance guidelines are based on the Federal Poverty Level guidelines  and provide coverage regardless of pre-existing conditions. More information on who qualifies and how this works can be found in a report issued by the Congressional Research Service.


Other provisions in the Affordable Health Care  Act that will assist self-employed individuals includes a mandate that enables you to deduct the cost of your  health insurance premiums from your federal taxable income (not to exceed the amount of your  annual income). Additionally, beginning in 2014, no American can be denied coverage or be subjected to an extended waiting period, or be charged significantly higher premiums due to pre-existing conditions.


For more assistance in understanding your rights and benefits regarding health insurance including;finding insurance options, getting help obtaining health insurance, understanding the laws and comparing providers,here is a link to a government site that will clarify some of these issues.



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