Health Plan Pitfalls
Posted by ilhealthquotes on October 21, 2009
When choosing an Illinois health plan the details of the coverage matter. Make sure you read all the fine print on any health plan brochure so you understand exactly what is covered and, more importantly, what is not covered. Watch the following video which discusses some of these issues:
Insurance companies use many different techniques to limit there financial liability and increase yours:
(1) Percentage copays. Many plans being sold in Illinois have percentage copays that never end, even after you meet your deductible for the year. Example: Let’s say you have a health plan that provides coverage for prescription drugs with a 35% copay for brand name drugs. If you develop MS you will likely require a medication that cost $2,800 per month. On this plan you would pay $980 per month out of pocket for drugs or $11,760 per year out of pocket. In this case it would be better to have a high deductible plan (say $5,000) that includes prescription drugs in the deductible. After the first two months of the year you will hit your deductible and the insurance company will pay 100% for your drugs for the remainder of the year.
(2) Higher Co-insurance. Historically plans had a 20% co-insurance. Insurance companies have created plans with 30%, 40%, or even 50% co-insurance which can cost you tens of thousands of dollars. You can find more affordable high deductible plans with no co-insurance that have lower annual out of pocket maximums.
(3) Unreasonable benefit limits on procedures. For example one limited benefit plan sold in Illinois had a maximum benefit of $1,000 per chemotherapy treatment. This sounds reasonable until you find out each chemo sessions costs $10,000 to $15,000. Limited deductible plans should be avoided unless you have a pre-existing condition and can not get a standard major medical policy.
(4) Unreasonable benefit limits on prescription drugs. Look out for plans that have low dollar limits on prescription drug benefits. There are some Illinois health plans that have an annual drug benefit limit of $2,000. If you need a high cost prescription drug this type of plan could require you to pay thousands of dollars out of pocket for your drugs.
(5) Low plan maximum benefits. Your plan should have at least a $2,000,000 lifetime maximum benefit. If not you are not truly protected against the cost of developing a major medical condition.
Illinois Health Plans is a small family run agency specializing in health insurance in Illinois. Give use a call at 1-630-518-5979 or visit our website for your FREE Illinois health insurance quote.
