"Americans brag about their healthcare" from Mikheala.netJohn and Joe ask the basic question (be sure to read the comments section - I'm finding more-and-more sites in which the best-of-the-web stuff is tucked into the comments!).
Here are three follow-on questions:
1. What do you do with the information, if you can get it?
Even if you can find out in detail what a policy that you own covers (which you cannot, typically) - let alone a policy that you and thinking about purchasing or comparing to your existing one - what do you do with the information?
Example: Lifetime coverage cap of, say, $1 million and per hospital limits and everything else.
Is that enough to cover two serious illnesses in your lifetime, maybe one involving surgery and recovery for yourself, after a complex and costly diagnosis period and, say, a long illness for your spouse, including, say, palliative care at the end?
In other words, even if you know what you have, it's not so easy to figure out if it is "enough".
What's more, you have to guess that the "caps" are there for a reason, right?
2. What is your "hurdle rate" or the cash you need to be 'protected'?
That $1 million might look like "a lot" of protection, right?
Well, consider that many plans are 80/20 coverage, in which you pick up 20% of usual-and-customary.
That may mean that you have to have $200,000 in the bank, before you can access your $1 million in protection, right?
3. For the fun of it, try to find out who is running your health care insurance.
If you are in a managed plan (and perhaps others), try to find out who (name, rank, serial number) is on the board that is making the medical decisions about what is covered and what is not.
I'd be interested in the percentage of people who got that information with "no problem".
Here are questions from a health-insurance broker:
Let’s see how many YOU can answer without looking at your policy.
- 1. What Insurance Company are you with and what is the name of your plan?
- 2. What is your deductible?
- 3. Do you know what your coinsurance percentage is and what dollar amount (stop loss) it is based on? (e.g. 80/20 coverage means you pay 20% of some dollar amount, what is it?)
- 4. What is your maximum out of pocket expense per year? (e.g. deductibles + coinsurance + other fees)
- 5. What is the Lifetime maximum benefit the insurance company will pay out if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. the plan has a $5 million lifetime maximum, but only pays out $1 million per illness. This means that you would have to develop FIVE separate and unrelated life-threatening illnesses costing $1 million or less to qualify for $5 million of lifetime coverage)
- 6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, a.k.a. National Association of the Self-Employed NASE)
- 7. Does your plan have doctor copays and are you limited to a certain number of doctor copay visits per year? (e.g. Can only go to the doctor 2 times a year for a $20 copay?)
- 9. Does your plan offer outpatient prescription drug coverage and if it does, do you pay a copay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits?
- 10. Does your plan have any reduction in benefits for organ transplants and if so, what is maximum the plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants, but the procedure actually costs $250-$400K)
- 9. Do you have to pay a separate deductible for each hospital admission or for each emergency room visit? (e.g. Some plans have a separate $750 hospital admission fee for each hospital admission which is separate from your deductible. Others have a separate $100 E.R. deductible that may be waived if you are admitted to the hospital.)
- 10. Are there any restrictions, benefit “caps” or “access fees” on out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc.? (e.g. Some plans pay a $500 maximum for each out-patient treatment and others require you to pay a $250 “access fee” per treatment. This is usually separate from your plan deductible. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000)
