Limited Medical Plans -- What You Should Know

You've probably seen the signs for low-cost prescription drug cards, discount dental/vision programs, subsidized doctor's office visit, or $500 hospital benefits. These same flyers and ads also tell you your acceptance is guaranteed. They promise great savings on all kinds of medical services.

The signs and flyers and marketers are everywhere - on telephone poles, in your company mail, on your desk when you get back from lunch, under your windshield wiper blade, or stuck in your front door when you get home.

Are these plans for real? Are they a good idea?

First of all, keep in mind most of these plans are not insurance. You need to read the fine print to see what services are excluded from coverage, and whether your service provider is included in the benefit plan. Once you are comfortable with any limitations, here's the next thing to check out.

Contact your local Better Business Bureau (BBB) and the national BBB (at www.bbb.org) to see if there have been complaints about or issues with the company. Then find out what state the company is “domiciled” in and make sure it is in good standing. Ask around to see if others know about the company. Check the plan out with your state Division of Insurance to make sure there are no outstanding issues or complaints. Finally, do an Internet search on the company name to see if there's any news headlines or information out there you should know.

What do these plans cover? Who offers them? Are the coverage types and limits going to meet your needs and address your concerns?

Most of these plans are the result of negotiated discounts with groups of service providers, and may even be offered by the service providers themselves.

An example of a provider-offered plan is a dental plan with a chain of offices where you pay an annual fee to cover one or two complete check-ups and exams and x-rays, and then also get significant discounts on other services such as fillings and crowns.

Other plans offer you a set amount of coverage for a number of services each year, up to a fairly low maximum amount. For example, you may get 2-4 office visits per person, with a participating doctor, included for your monthly fee. In addition, you may also get $500 per day for a few days toward hospital stays. The maximum coverage amount is chosen by you, but is usually between $2,500 and $5,000 per year, and may only apply to accidents, not illness or maternity, for example.

If your employer does not offer health insurance and you cannot obtain it (or afford it) on your own, these discount or pre-pay programs may be worth looking at, but tread carefully. Many are legitimate, but some aren't. Always check the plan out before sending money, and never give your social security number or checking/banking/credit card information out to get the plan in place.

Let Your Uncle Sam Help with Medical Costs

Your health insurance, no matter how good the plan, will not cover all of your medical costs. Travel, meals, and lodging may play a part in the costs associated with a serious acute or chronic illness. Or, a doctor may recommend a pain management program, massage or other 'quality of life' procedures not typically covered by insurance.

That doesn't necessarily mean you'll have to shoulder the entire burden. You may be able to deduct some of those costs from your IRS bill. For this purpose it is essential to maintain correct and substantial records to back up the claim for all deductions the IRS allows.

Keep the following in mind when creating your medical records, so you can take all the deductions available to you. Before assuming any deduction is allowable, however, be sure to consult the appropriate IRS tax publications or your tax advisor. Most medical related expenses must exceed 7.5 percent of your annual adjusted gross income in order to be deductible. Still, that may well happen in the case of chronic conditions or very serious acute medical problems.

Always retain these documents:

• All medical bills, paid or unpaid, by you or your insurance company
• All claims you have filed
• All vouchers for reimbursements
• A log of all conversations with insurers and medical personnel, including names, dates and brief descriptions
• Receipts for meals, lodging and gasoline or other travel costs - airplane or railway tickets (one of the most overlooked expenses)
• Long-distance telephone calls for medical discussions
• All prescriptions and also over-the-counter drugs recommended by a medical professional

Making sure you have all the documents you might need requires some thought and attention, too. So:

• Decide who will be responsible for collecting and filing documents, and at what intervals. (If you are a single head-of-household, you may want to ask a friend, relative or neighbor to help, especially during acute illnesses or conditions.)
• Create a file system in a filing cabinet or document file box available at office supply stores.
• Create a system for incoming documents for your review or action before they are filed.
• Keep a calendar on which you designate days for filing to be completed, bills paid or letters written/phone calls made.

If you use your own car, you can claim actual costs of gas and oil for the trips, or use the current standard mileage rate. In either case, you can also deduct parking fees and bridge or highway tolls. The standard mileage deduction for medical treatment car use is not the same as for business car use; it is far less, almost two-thirds less, at 15 cents a mile for 2005. Still, it's something.

The mileage deduction can apply to a wide range of medical needs, including:

• Driving a wheelchair-bound patient to school.
• Driving to Alcoholics Anonymous or Narcotics Anonymous meetings.
• Trips to visit a child at an institution if the visits are deemed essential to the child's treatment.
• Trips to visit family members in the hospital when a weakened condition makes your presence indispensable to care/recovery.
• A trip to bring back a family member who becomes ill abroad and cannot travel home without help.
• Trips to accompany ill or injured family members who cannot speak due to permanent or temporary medical conditions.

Other deductions you can use

There are other deductions for which you might also qualify, so keep those receipts, as well. Some are:

• Installing ramps.
• Widening doorways to accommodate wheelchairs.
• Bathroom railings and support bars.
• Modifying height of cabinets or equipment.
• Altering electrical outlets.
• Installing porch or stairway lifts, but not elevators (which could be used by anyone, not just the person in need of assistance ascending or descending).
• Modifications to stairways.
• Hardware alterations on doors.
• Installation of other grab bars and handrails.
• New landscape grading to accommodate specialized vehicles.

If you're in doubt about whether a purchase or trip is deductible, keep the receipt anyway, and mark it with a question mark. Then bring it up with your tax advisor, or research the expense with the IRS through its website at www.irs.gov.

New Health Insurance company in Florida

The first new fully-insured health plan available to employers and individuals statewide in more than five years has been approved by the State of Florida Office of Insurance Regulation (OIR) and is now available, announced the Company's co-founder and Chief Executive Officer Charles O'Neill. Florida based Avalon Healthcare, Inc. (Avalon) offers consumer driven health plans (CDHP) on a preferred provider organization (PPO) platform with the option to add Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).

"There is a dynamic change taking place in the health insurance industry with the movement of healthcare plan designs away from first dollar coverage options like HMOs to consumer directed PPO plans with health savings options like HSAs attached," O'Neill said. "These plans will have a tremendous impact on how Florida employers and consumers purchase, use and manage healthcare for years to come."

Avalon Healthcare was founded by O'Neill and Drew Cassidy in August 2004 in anticipation of changes expected in health insurance products and as an answer to the diminishing competitive healthcare landscape in Florida. Within the past 10 years, a large number of health insurers have left Florida leaving only a few carrier options in the small group and individual healthcare markets.

Company facts

New college grads enter insurance maze

In the next month or so, college graduates will step on stage to pick up their degree--and frequently step off as another member of the uninsured.

The reason: Most health plans drop coverage for dependents once they are out of school. If you lack a job with benefits, you'll have to buy your own insurance.

"Young adults probably have the weakest connection to employer-based coverage," said Sara Collins of the Commonwealth Fund, a non-partisan foundation that focuses on health-care issues. "They're more likely to get jobs that are low wage, part time or with small businesses that can't offer insurance."

Individual insurance has its bonuses, mainly that it stays with you no matter what job you have.

But it can get confusing and expensive.

In Columbus, Ohio, for instance, a 25-year-old woman who opts for a $5,000 deductible would pay $40 a month, according to eHealthInsurance, an online marketplace for individual and family plans. For a $1,050 deductible, she'd pay $23 more.

But in other cities, the difference is far greater. The same woman would pay $35 a month for a $4,000 deductible in Los Angeles. For a $1,100 deductible, the premium catapults to $524 a month, in part because of less competition for certain types of plans in California.

"This shows that carriers will price insurance quite differently," said Emily Fox, a representative for eHealthInsurance.com. "You really need to do some homework and consider what you need and can afford."

One thing is clear: You shouldn't skip on health insurance altogether. Several studies have found that medical expenses are the leading cause of personal bankruptcy.

So to minimize the cost, especially with such other expenses as housing and student loan payments competing for your paycheck, consider these options.

-- Get a temporary policy

If you'll be without health insurance for only a few months, opt for high-deductible, short-term coverage. You often can become insured within one day and stay covered for up to 12 months.

And since it's a temporary policy, you don't need to pay for all-inclusive coverage.

Doctor shopping? How to find the best match

Changing doctors is an increasingly common fact of American life. Sometimes, you force the change—if you switch jobs, or insurance plans, for instance. Other times, the change is forced upon you—your doctor moves or retires.

Whatever the source, there is a lot you can do to smooth the transition and boost the chances of finding a doctor with whom you can forge a beneficial relationship, experts advise.

Finding a good doctor is good for your health. It increases the chances you'll get quality care and decreases the likelihood that you'll be hospitalized, research shows.

If you're like most people, you'll find a new doctor by first asking around.

"Most people find a doctor by getting a referral from a friend or relative," said Dr. Caroline Rudnick, an assistant clinical professor of family medicine at St. Louis University, and a family physician who often counts as her patients all members of a family. "Usually, they don't know anything about our background when they come to see us."

Get basic info
When doctor-shopping, experts suggest you start by checking your potential doctor's credentials. This is no time to be shy, Rudnick said. She encourages prospective patients to inquire about the doctor's medical training—where he or she went to medical school, did his or her residency.

You should also ask about the scope of their practice. Does the doctor care for patients of all ages? And if you have a chronic condition like diabetes, you should ask if the doctor has a lot of experience dealing with patients with the disease, Rudnick suggested.

At Blue Cross and Blue Shield of Florida, prospective members can find this information and much more right on our website by searching our online provider directory. We also offer members Physician Selection Advisor^®, an online tool for helping you search for the doctor that’s right for you. The tool links to Hospital Advisor, another tool that provides vital information about the hospital(s) at which the doctor has admitting privileges.

"You should also feel free to ask about the mechanics of the practice," said Dr. Mary Frank, president of the American Academy of Family Physicians, and a family physician in Rohnert Park, Calif. For instance, you'll want to know what would happen if you get sick on a weekend, or who would cover the practice if your doctor is out of town.

Also, try to determine if your new doctor's philosophy about preventive health meshes with your own, experts advise. Ask about views on complementary and alternative medicine, for example, if that's important to you.

If you rely on acupuncture, for instance, and your new doctor doesn't see a role for it, you should probably keep looking for a new physician, Frank said.

Give basic info
Once you feel like you've found a good match, you should provide accurate, thorough information about yourself so your new doctor can care for you in the best way possible, Frank and Rudnick said.

Start by covering four topics during your first visit:

• your medical history
• your family history
• your lifestyle
• medications you take

Knowing which health problems you've had in the past can help your new doctor assess your current health status and be on the lookout for potential problems, Rudnick said.

And learning about your family's medical history can also help your new doctor help you, Rudnick and Frank said. Certain diseases and conditions—cancer, diabetes, heart disease, mental illness, high blood pressure and high cholesterol, for instance—often run in families, Rudnick said.

Lifestyle factors can also have an enormous impact on your health and are another great source of information. Tell your new doctor if you exercise, smoke or drink alcohol, and whether you have a pet. Owning a pet, for instance, can mean the difference for some people between being sedentary and getting some exercise.

And instead of telling your new doctor which medications you're on, Rudnick advises that you bring prescription bottles so the physician can examine them. If you can't bring them to an appointment, make a list of the drugs, including dosages, she said.

Staying with a doctor is good for your health
Staying with the same doctor can also pay health benefits, Frank said. "A trust builds up," she said. "The patient feels comfortable talking to the physician."

And the physician feels comfortable doing a bit of gentle nagging, Frank added. For instance, she said, if she had a patient who smoked, she would encourage him to quit. "And every time I see him, I am going to say, 'What's going on with the smoking?'"

Research suggests that keeping the same physician is good for your health. In a study published last year in the Journal of Family Practice, researchers reviewed the results of 18 studies examining "continuity of care" and patients' outcomes.

They found that those patients who stayed with one doctor had better care, were less likely to be hospitalized or go to the emergency room, and were more satisfied with their care.

More information
To learn more about choosing a doctor, visit the American Academy of Family Physicians.