Health Plan Definitions - Six Coverage Alternatives

Posted by Ty Sect

You want health coverage, but want to know what your options are? You know your options, but want to know the difference among the various plans? If you answered "yes" to either of this questions, the six Health Plan definitions below will be of significant help as you decide upon health care alternatives.

1. COBRA: COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It's a policy that gives you the option to continue your current healthcare plan (i.e. the health insurance plan provided by your former employer). Here's the catch: With COBRA, you now pay for 100% of the cost! You have 60 days after your departure to "elect" COBRA coverage. COBRA coverage lasts for up to 18 months.

2. Fee for Service: A health insurance plan where you pay a fixed percentage of the cost for any service received. As an example, you pay 25% of the cost for any doctor's visit, hospital stay, or prescription, and the insurance company pays the remaining 75%. Fee for service health insurance plans have largely been replaced by managed care plans in the United States. Fee for service health insurance is also referred to as indemnity health insurance plans.

3. High-Risk Pools: Health insurance provided by states that cover individuals who have been denied health insurance because of a pre-existing medical condition. High-risk pools generally take the form of an HMO or PPO, and premiums are capped at a certain level. Over 30 states offer high risk pools. High-risk pools can be tricky, because many states offering these programs use different names to describe them.

4. Managed Care: Managed care "plans" (also referred to as "organizations," insurance," or "companies") are the most common type of health coverage in the United States. There are actually three health plan definitions included within Managed Care: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. Managed care plans employ the concept of a network, which refers to a group of doctors, hospitals, and other healthcare providers. When insured under a managed care plan you'll be referred to as a "member" of the plan. As a member, you are entitled to seek medical service with doctors and facilities that are part of the managed care network. If you require care outside of the network, you will pay a premium for this service. In addition, managed care companies may require prior approval for certain types of medical care (e.g. seeing a specialist or undergoing expensive procedures). In doing so, these groups are able to "manage" the care that patients receive, thereby reducing overall costs. Collectively, managed care plans currently account for the vast majority of private health insurance in the United States.

Health Maintenance Organization (HMO): A type of managed care insurance plan. Services are provided by doctors who are employed by, or "contracted with," the HMO. In contrast with other managed care plans, HMOs require that you seek a referral from a primary care physician prior to seeing a specialist. In addition, HMOs do not provide insurance coverage for you to see out-of-network doctors, meaning that if you need to see a doctor who is not contracted with the HMO, you will have to pay 100% of the cost. The HMO network of doctors will likely be large enough to have a doctor that meets your needs. Because of these limitations, HMOs are typically the most affordable healthcare option.
Point of Service (POS): A type of managed care insurance plan that combines some the features of an HMO and a PPO. A point of service plan enables you to see out-of-network doctors and receive some insurance coverage. Think of a point of service plan as having more flexibility than an HMO, but less than a PPO.
Preferred Provider Organization (PPO): A type of managed care insurance plan offering the most flexibility. As a member of a PPO, you can see in-network and out-of-network doctors, and may seek the care of a specialist without the referral of a primary care physician.

5. Self Insurance: Going without health insurance. Technically, self insurance refers to setting aside an appropriate amount of money to pay for both expected and unexpected medical care.

6. Temporary Health Insurance: Short-term health insurance plans that last anywhere from one month to twelve months in duration. Temporary health insurance plans offer limited healthcare coverage relative to traditional health insurance plans, and the insurance companies that provide these policies have the option to prevent you from renewing the plan at expiration. Because of their limited scope and unfavorable renewal provisions, temporary plans are typically priced at a discount compared to traditional healthcare plans. Temporary health insurance plans are also referred to as "short-term policies."

Welfare Health Plans

Posted by Ty Sect

If you are on welfare and need health care, there are welfare health plans that can help accommodate your needs. In general, the welfare system is set up to help assist people and families who don't have the income to adequately support themselves. This definitely includes your health care options.

There are certain situations where you can receive a welfare Health Plan. Medicaid is set up by the federal government and supported through the state to help people in certain situations. For example, Medicaid supports people who are pregnant, need nursing home care, are 65 and older and or are a child.

Are you interested in getting welfare medical aid and exploring all the welfare health plans available to you? Contact your state's Department of Health and Welfare to get more information about eligibility and the programs that are available to you.

Have you determined that you are eligible for welfare medical assistance but don't know where to go from there? Again, contact the nearest Department of Health and Welfare for more advice. They can help you apply and assist you through the entire process. You will most likely need to fill out an application to receive the health care benefits.

You may also want to consider signing up for the welfare program to help with other aspects of your life. This may make the process of signing up for one of the welfare health plans easier, because you will already have a feel for the system. The program is designed to help you through tough times and make sure you have adequate nutrition by offering grocery assistance and health benefits.

State's hospitals see impressive growth spurt from nearly $1 billion in capital investment

Posted by Ty Sect

Kentucky’s major hospital systems are going big, making high-profile, technology-forward capital investments across the commonwealth. Josh Shepherd of The Lane Report writes that every sector of the state is part of the hospital boom. The state's cumulative total of investment since 2010 is roughly a billion dollars, notes Shepherd, and has meant hundreds of construction and, soon, medical and other hospital-related jobs. Here's the list of the most notable construction projects now under way:

  • Owensboro Medical Health System,  $385 million, a new complex (pictured, above) that will allow expansion for the next 50 years, completion date: summer 2013.
  • Norton Healthcare System, Louisville, converting Suburban Hospital into Norton Women's Hospital and Kosair Children's Hospital, $120 million, completion date: 2013.
  • Pikeville Medical Center, new office building and parking facility, $130 million, completion soon.
  • Baptist Health, Lexington, expansion of Central Baptist Hospital medical services complex with parking structure, $200 million.
  • University of Kentucky Healthcare, Chandler Medical Center, $750 million, includes new plans for Shriners Hospital for Children.
  • Frankfort Regional Hospital,  $8 million expansion, emergency department.
  • Trigg County Hospital, $7 million, surgery and rehabilitation unit.
  • Lifepoint Hospitals-owned Clark Regional Medical Center, $60 million, 79-bed hospital. (Read more)
  • Covington police chief: New prescription drug law has unintended consequence of encouraging pain pill addicts to move on to heroin

    Posted by Ty Sect

    Black tar heroin
    Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets but could be forcing those very same addicts into transitioning to heroin. That's the view of Covington Police Chief Spike Jones who took his case to the Kentucky Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

    The drug law passed in April 2012 -- known in some circles as House Bill 1 -- was written such that Kentucky doctors are required to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

    Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

    Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

    First lady speaks out on behalf of domestic-violence victims; Ky. is one of four states without protection for date-violence victims

    Posted by Ty Sect

    First Lady Jane Beshear pointed out the accomplishments of the anti-domestic violence movement in Kentucky this week, and spoke the names of 26 women who had died at the hands of their abusers this year. With that, she then announced that October would again be Domestic Violence Awareness Month in Kentucky.

    “Nearly one-third of all American women report being abused at some point in their lives. Abuse affects more than just individuals -- families and communities suffer, too,” said Beshear. “Domestic Violence Awareness Month is the opportunity for all Kentuckians to learn how to recognize the signs of domestic abuse and to show support for victims as they work to regain control of their lives.”

    Kentucky is one of only four states that do not provide protection for victims of dating violence. “In celebrating the successes of the Violence Against Women Act, we must acknowledge the work still left to do,” said KDVA President Anne Perkins, who also serves as executive director of Safe Harbor, a regional domestic violence program in Ashland.  She called on state legislators to pass a new dating violence bill during the next legislative session. Research shows that young women between the ages of 20 to 24 are at greatest risk of intimate partner violence.

    Annual report for Cincinnati-Northern Kentucky region shows employee health care costs there will go up about $400 next year

    Posted by Ty Sect

    In an continuing effort to move health costs off the shoulders of employers and onto employees, workers in Greater Cincinnati and Northern Kentucky will likely pay an average $4,775 out of their own pockets for health care in 2013 -- about $400 more than this year. That's nearly $2,000 more than they paid in 2007. The payments include premiums through their employer, as well as office co-pays and deductibles, said Aon Hewitt, the consultant that produced its annual cost report. These payments are slightly less than the national average of $4,814.

    The trend toward "more employee accountability" means that nearly all companies are adjusting the designs of their employee plans, adding wellness programs and moving more employees to high-deductible plans with health savings accounts, reports Cliff Peale of the Cincinnati Enquirer. Penalties are now common for workers who smoke or who don’t take required health screenings.

    The report notes that companies continue to bear most of the cost of their employees’ health insurance. It also predicts that, counting the portion paid by both companies and workers, the cost of a health care policy will increase 6.4 percent next year to $11,566. That should return the region to numbers more aligned with the national average. About half of all Americans still get benefits through their employers, and there are nearly 50 million without health insurance at all. (Read more)