With an HMO, you receive a range of health benefits for a set fee. Generally, there are no deductibles – but most plans require a small copay per office visit (around $10-25). You must choose a primary care physician from the plan's list. This doctor becomes your "gatekeeper" for all your medical needs. This is the doctor you call or see when you are sick, and he or she will refer you to a specialist or other providers within the HMO network. With most HMOs you will not receive benefits if you go out-of-network, except for emergency care.

This isn't an HMO, but it is another type of managed care. In this system, you may seek treatment from an approved network of providers, or may see other providers outside the network. Usually, you will pay small copay and satisfy a deductible before benefits are paid. Then you'll pay a set coinsurance amount. It's less expensive to visit one of the providers in the plan's list. You can go outside the plan's list, but your share of the bill will be higher.

A hybrid of the HMO and PPO is known as a POS plan. Like a standard HMO, your primary care doctors make referrals to other providers within the plan. But if you want to go to a physician outside the network without consulting your primary care doctor, the POS plan will pay a predetermined amount of the bill and your share of the bill will be higher than it would if you stay in-network. These plans usually cost more in monthly premiums than straight HMOs, but they give you the flexibility to call any doctor – within the plan or not.

Health Savings Accounts (HSAs) are a relatively new way for Americans to pay for their healthcare. Like an IRA, the money deposited into an HSA is completely tax-deductible on your federal tax return. The health accounts also are shielded from state income taxes in most of the country, but seven states have declined to provide an exemption: Alabama, California, Maine, Massachusetts, New Jersey, Pennsylvania and Wisconsin. As with all things that have to do with taxes, please rely on your tax advisor for tax advice.

These accounts, however, can be accessed whenever individuals need them to pay for qualified healthcare expenses. In the meantime, their money earns tax-free interest for future medical costs.

Some HSA Benefits Include:

• Greater control over health care costs
• Greater flexibility in choosing a physician
• Lower monthly premiums
• Tax-Free savings

No one is immune to accidents. Accidents happen and you want to make sure you and your family are covered.

Short term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs, an alternative to COBRA, temporary worker, or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. If you need coverage for longer than 12 months you should research a permanent health insurance plan. However you will need a short term health plan to cover you for the couple of months that it takes to underwrite a permanent plan.

The application process for short-term health insurance is extremely simple and can be done completely online in typically less than 5 minutes. Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, imunizations, dental or vision care.

Short-term health insurance plans do not cover pre-existing medical conditions. The definition of a pre-existing condition varies by state, but, in general, short-term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 3 to 5 years.

A "co-pay" is defined as: "An arrangement where the insured pays a specified amount for various services and the health carrier pays the remaining charges." Now, the health insurance carrier will not always pay 100% after you have paid the co pay. You will have to refer to the specific plan as to what is covered with the co pay. For example, you go to the doctor and the office visit is $55 and you get $100 worth of blood work done. Let's say you have a $25 co-pay. With some plans you pay the $25 and the health insurance company will pay the rest of your bill including your blood work. Some health insurance companies will also make you pay a separate copay for the $100 in blood work you had done so in all actuality you would have two co-pays. It's all in the policy language as to what your specific health insurance policy will cover so be sure to check on that.

Health Insurance co pays also make up a lot of cost on a health insurance program. If you cut the co pay out of your plan you may be surprised to see what you can save just by not having it on the health insurance plan. If your not one that cares for co pays you may want to check on cutting it out to save on a monthly basis.

A health insurance deductible is a fixed amount you pay before the health insurance company begins to pay benefits on a policy. Depending on the type of policy you have the health insurance deductible can apply to different procedures and admissions. It's always a good idea to look through your policy and see which services and facilities are applied towards your deductible. Some health insurance deductible plans have co pays for certain services and facility charges that are per occurrence. A health insurance deductible is generally a fixed amount per calendar year.

Co-Insurance is a cost or "risk" you agree to share with the health insurance company before scheduled benefits are paid at 100%. Most health insurance policies on the market today have co insurance but it's how the co insurance is set up that determines your share of the costs. For example, a typical co insurance percentage is 80/20 to $5,000. So, this means that typically you will have to pay your deductible plus 20% of $5,000 which is $1,000 before the insurance company will pay benefits at 100%. With some health insurance companies you can actually choose to have a higher co insurance to save money on monthly health insurance premiums.

The average person on Medicare could wind up spending thousands per year out of their own pocket.* These costs include deductibles, co-insurance and more

Medicare is a federal program developed to help Americans over 65 and some disabled Americans pay for the high cost of health care. There are different parts: Medicare Part A (hospital insurance) is free if you paid Medicare taxes while working. There's a monthly charge for Medicare Part B (medical insurance). Medicare Part D (prescription drug plan) is a Medicare benefit that offers a choice of prescription drug plans (PDPs) to anyone enrolled in Part A or Part B.

Medicare pays for all but $992.00 of your hospital stay during each benefit period for reasonable and necessary care in the first 60 days of confinement. For the next 30 days, it pays all but $248.00 a day for covered services. Medicare pays expenses in excess of $496.00 a day during the 91st through 150th days. These are Lifetime Renewable Days and may be used only once. If you are hospitalized more than 150 days, Medicare pays nothing.

A benefit period begins the first day of hospitalization and ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. It is possible to have more than one benefit period and more than one hospital deductible in a calendar year.

Charges for skilled nursing facility stays may be paid by Medicare if the facility is a Medicare-certified facility. To qualify for this benefit, you must have been hospitalized for at least three days and have been admitted to the nursing facility within 30 days of discharge from the hospital. The first 20 days are covered at 100 percent provided you are receiving skilled care. The next 80 days Medicare pays amounts more than $124.00 a day. Beyond the 100th day, Medicare pays nothing.

Under certain conditions, home health care is available for homebound beneficiaries. This coverage includes skilled nursing services, occupational therapy, and physical and speech therapy if provided by a Medicare-certified home health service and if determined to be medically necessary. If your physician establishes a care program that requires durable medical equipment, Medicare will pay 80 percent of the Medicare-approved cost of the equipment.

Medicare provides coverage for hospice care for patients certified as terminally ill. This benefit is divided into two 90-day hospice benefit periods and one 30-day benefit period. A subsequent extension also may be covered. You pay for the first three pints of blood and Medicare pays for any additional blood.

Medicare Advantage Plans offer an alternative to "traditional" Medicare plus a Medicare Supplement policy. Medicare Advantage plans will act as a single servicing point for Medicare for Medicare Parts A & B billing functions. These plans can operate as PPO (preferred provider organization), Managed Care Plan, HMO, Private Fee for Service plan, or as a Specialty plan as approved by Medicare.

Under a Managed Care, PPO or HMO type plan, you may have to use doctors and hospitals that are in that plan network or you may have to pay a larger co-pay or other charges if you choose a medical provider that is not a member of your plan. A company that offers Medicare Advantage plans may offer coverage with a national, regional or local service area. Medicare Advantage Plans may include a prescription drug plan equal to or better than a standard Medicare Part D plan or they may require participants to enroll in a separate Medicare part D plan.

All people with Medicare are eligible to enroll in plans that cover prescription drugs. The premium for this coverage will range from less than $5 per month to about $99 per month and there may be an annual deductible of up to $250. All plans must offer at least the minimum standard benefits as set forth by Medicare but may offer significantly more coverage.

The Medicare "standard" benefit states – after your $250 deductible is met, you will pay 25% of your prescription drug costs and Medicare will pay 75% until your total prescription drug cost reach $2,250. You will then pay 100% of your prescription drug costs until your total prescription drug costs reach $5,100. After your total prescription drug costs reach $5,100 you will pay a 5% co pay per prescription and Medicare will pay the remaining 95%.

The Medicare Prescription Drug benefit will include additional assistance for people with lower incomes. Most significantly, people with Medicare who are also eligible for Medicaid will receive full premium subsidy, full subsidy of the deductible and minimal co-pays, usually between $2-$5 per prescription. Other people with Medicare with lower incomes may receive premium and deductible assistance and/or have limited co-pay from their Social Security.

In January of 2006, there were 2 new Medicare Supplement Plans made available. These Plans are titled K & L.

Plan K: A person who chooses a Medicare Supplement Plan K will have a 50% co-pay for Medicare eligible expenses including your Part A deductible, skilled nursing co-insurance, your first three pints of blood, hospice care, and Part B deductible until such time as your "Out of Pocket" expenses reach $4,140 (for 2007). After a person reaches their out of pocket expense threshold, Plan K will pay 100% of Medicare eligible expenses.

Plan L: A person who chooses Medicare supplement plan L will have a 75% co-pay after their deductible is met until their "Out of Pocket" expenses reach the Plan L threshold of $2,070 (for 2007). After out of pocket threshold is reached, Plan L will pay 100% of Medicare eligible expenses. The 75% co-pay applies to Medicare Part A & B deductibles as well as skilled nursing care co-insurance, your first 3 pints of blood and hospice care. Both Plans K & L include coverage for an additional 365 days of inpatient hospital care after other Medicare benefits are exhausted. The "Out of Pocket" thresholds for both plans K & L are indexed to inflation and may increase over time.

It's designed to help pay some of the medical expenses that Medicare does not pay. For instance, you can choose a Medicare supplement plan that pays the $992 Part A deductible for you.

Generally, your six month "Open Enrollment" period is the best time to buy a Medicare supplement plan, particularly if you are no longer working or covered by an employer-sponsored health plan. This period begins the first day of the month in which you turn age 65 or enroll in Medicare Part B. During this time, as long as you have Medicare Part B, you can buy Medicare supplement insurance without answering any health questions.

A benefit period begins on the first day of a Medicare-covered inpatient stay. It ends when you have been out of the hospital or skilled nursing facility for 60 consecutive days. A new benefit period begins and the beneficiary must pay a new inpatient hospital deductible. There may be as many as five benefit periods in a calendar year.

No. Medicare only covers a portion of health care costs. A Medicare supplement helps with expenses not fully paid by Medicare.

No. Supplements will not cover expenses if Medicare doesn't pay a portion of the bill, with some exceptions.

If physicians recommend a procedure that they are (or should be) aware is not covered by Medicare, they are required to notify you in writing that Medicare will not cover the service. Similarly, if a surgeon does not accept assignment for elective surgery, the physician must give you a written estimate if the charge will exceed $500.

It is the acceptance of the charges allowed by Medicare as payment in full.

Physicians who do not accept assignment are limited to charging 115 percent of the fee schedule for nonparticipating doctors.

The premium is established when you buy your policy. You continue to pay the premium required of a person who is the same age you were when you bought your policy. For example, if you buy a policy at age 65, you always will pay the rate that the company charges people who are 65, regardless of your age.

The premium is based on your current age and increases automatically as you grow older. Typically, these plans are less expensive for younger individuals, but may cost considerably more in later years.

A person can qualify for Medicare under age 65 if they meet certain criteria for disability. If you receive continuing dialysis for permanent kidney failure or need a kidney transplant you could be eligible for Medicare. If you are disabled and have been receiving Social Security Disability payments for at least 2 years or if you have Amyotrophic Lateral Sclerosis (ALS - Lou Gehrig's disease) you could also be eligible for Medicare.

It is important to know how to assess your need for insurance in every type of coverage you buy. With a Medicare supplement policy, you should review your medical care costs for the preceding year, assess your current health status and choose a plan that is affordable. You may want to consider enrolling in a Medicare Part D plan if you currently are taking medications. The cost of prescription drugs has increased dramatically in the last few years.

Long term care insurance policies are not standardized, so the services covered by different companies vary greatly. Each policy has its own eligibility requirements, restrictions, costs and benefits. Services generally covered include: nursing home care (skilled, intermediate and custodial), care in your own home and in adult day care centers, assisted living, personal care, hospice care, and care for people with cognitive disorders like Alzheimer's disease. Services generally excluded include: psychological disorders, such as anxiety or depression, alcohol or drug addiction, illness or injury caused by war, attempted suicide or intentional, self-inflicted injuries.

Insurance companies also offer policy holders a choice of daily benefits (how much the company will pay per day for care). This usually ranges from $40 to $250 a day for care in nursing homes. To decide what you need, it is important to know how much nursing facilities in your area charge. Home care benefits are usually one-half of that for nursing home care and only pay up to a fixed amount per hour of service. For example, $60 a day or $20 per hour. Keep in mind that your policy usually does not pay for your needs in full, so you will have to pay the balance out of your own pocket.

In addition to the daily benefit, you will have to choose a benefit period, meaning how long you want the insurance company to pay your long term care bills. Benefit periods may run one, two, four, six, ten years or, sometimes, for the rest of your life. Naturally the higher the daily benefit and the longer the benefit period, the more expensive the long term care insurance plan is.

As one ages, in the event that you cannot keep your independence, there are plenty of options available: nursing homes, home health services, adult day care centers, assisted living facilities. The money to pay for such services, however, is the problem.

Currently, the average cost in a nursing home for a private room is $181 per day, or about $66,000 per year, in a nursing home. These numbers come from a 2003 survey by Prudential Life Insurance Co. When today's 60-year olds might need such care in the year 2021, the average rate will rise to about $480 a day, or $175,200 annually if the room rates have the same inflation rate that is currently occurring in nursing home costs.

The government is unlikely to pick up the tab. The question is who has this amount of money? The obvious answer is the long term care insurance, an insurance policy that it is designed to pay for these catastrophic predictable events. Predictable in that for large group of people a certain number of people will eventually enter a nursing home, etc. People entering nursing homes or needing other forms of long term care will be financially "taken care of" by the long term care policy.

A long term care policy is designed to help cover long term care costs caused by a nursing home stay, in-home care, custodial care, assisted living residency, informal care, care provided in Alzheimer's facility or hospice care. There are insurance companies will even pay benefits for care provided by family.

Long term care insurance sometimes even pay for home and community-based care services, such as physical, speech, and occupational therapists; home health aides and visiting nurses, hospice care or adult day care. (Skilled care generally refers to 24 hour treatment by registered nurses under doctor's supervision. Intermediate care is occasional nursing and rehabilitative therapy and care under the supervision of medical personnel. Custodial care deals with activities of daily living such as help in dressing or eating.)

When the member of the long term care insurance plan requires supervision to protect themselves from threats to their safety and health as well as due to severe cognitive impairment in addition if the policy holder is unable to perform without substantial assistance from another individual at least two out of six of the activities of daily living (ADLs) the long term care insurance plan will pay a set amount of an insured's costs.

Benefit triggers can vary by policy. In a qualified policy these activities of daily living are: transferring, continence, bathing, toileting, eating and dressing . When the benefits of a long term care insurance plan are triggered, the policy will pay up to a preset maximum daily benefit for a specified time period, till the policy holder no longer needs a long term care insurance plan, or until the policy holder has exhausted their benefits.

A long term care insurance plan holder must also fulfill the waiting elimination/period period before collecting any policy benefits. The "elimination period"/"waiting period" is the deductible. Waiting periods vary in time frame. There are numerous options available on most long term care insurance company contracts, but 90 day waiting periods are most commonplace. An insured is liable for all costs related to their long term care expenses during the waiting period. The policy provider will begin paying benefits as soon as the long term care insurance plan holder has met the requirements for a claim and the waiting period is fulfilled.

Medicare will not take care of long term care needs. It is a tremendous mistake to believe that Medicare will cover the long term care bill. This is an undisputed fact. Medicare is government health insurance for people over the age of 65 and the disabled. Long term care is custodial care that many people may need, especially as they get older. Medicare does not pay for long term care as a general rule.

Medicare provides limited long term care coverage. Medicare is limited in scope and in some limited situations, will pay some of the costs for Medicare beneficiaries who require skilled nursing or rehabilitative services for a limited amount of days. To receive these payments for a limited amount of days for rehabilitation, the Medicare beneficiary must receive services from a Medicare certified nursing home after a qualifying hospital stay.

Medicare will provide skilled nursing facility care for up to 100 days. Medicare will only pay for care that requires professional medical care. Medicare is designed to cure or medically improve a person's life. Long term care is to take care of a person. In the skilled nursing benefit of Medicare the patient must be admitted into a nursing facility within 30 days of a three-day hospital stay.

One must meet Medicaid's income and asset eligibility requirements for the government to cover the cost of certain types of long term care. Medicaid is a state and federal government joint welfare program designed to care for the indigent. Medicaid was not designed to act as a governmental long term care welfare fund. The charter of Medicaid states "jointly funded Federal, State health insurance program for certain low-income and needy people." Medicaid covers approximately 37 million individuals, including children, the aged, disabled and/or blind, and people who receive federal income maintenance payments."

Certain people have simply reduced their assets in order to meet Medicaid's requirements. Once a person has depleted their assets, they have lost control over their receive care. Recently, because government budget cutbacks, eligibility to the Medicaid program has become more difficult for those that have "given away" their assets. As well, the quality of care that one should want to receive at the golden years of ones life should not be dependant on a ever more stringent government welfare program.

In order to be considered tax qualified, the long term care insurance policy must contain certain provisions. These provisions pertain to the manner in which future benefit payments can be triggered. If the policy contains the required language, it can be considered a qualified long term care (qualified long term care insurance) insurance contract for tax purposes.

Here are some provisions. The long term care insurance company can only cancel the policy for non-payment of premiums. The policy must be guaranteed renewable. The long term care insurance company, however, may increase premiums on a group or class basis. The long term care insurance policyholder must be certified as a "chronically ill" person within the prior 12 months and must have a written plan of care, provided by a licensed healthcare practitioner.

Long term care assistance must be expected to last for at least 90 days. A chronically ill certification is required to be based on one or both of the following criteria: The inability to perform, without substantial assistance, at least two of six activities of daily living (ADLs). The ADLs are eating, bathing, dressing, toileting, continence and transferring. Substantial supervision needed in order to protect the individual from threats to health and safety due to a severe cognitive impairment. Benefit increase options (inflation protection) and nonforfeiture benefits must be offered to the applicant at the time of sale, but are not required as part of the policy.

Benefits under a qualified long term care insurance policy cannot duplicate Medicare benefits. Individuals who have large medical expenses and low adjusted gross income may find that the premiums they pay for a qualified long term care insurance insurance policy are deductible from their federal taxes. Taxpayers who itemize may deduct the cost of eligible qualified long term care insurance premiums as a medical expense on Schedule A. There is an age based limit on the amount of premiums for purposes of this deduction, which may be less than the actual policy cost. The age based limits for 2005 are:

(maximum deductible premium)
Insured ages 40 and under $270
Insured ages 41-50 $510
Insured ages 51-60 $1020
Insured ages 61-70 $2720
Insured ages 71 and above $3400

These limits are adjusted annually for inflation. When allowable medical expenses, including qualified long term care insurance premiums, exceed 7.5% of the taxpayer's adjusted gross income, the excess over 7.5% may be deducted. The age based limits above apply only to the premiums paid for the long term care insurance policy and do not reflect the maximum total deduction that may be taken by the taxpayer.

Long term care insurance is less expensive if it is purchased many years before it is expected to be used. Long term care insurance coverage can be purchased much less expensively if the long term care insurance policy is bought while the insured younger and is not to be reasonably expected to need long term care. Younger applicants who are healthy should expect to be accepted easily by long term care insurance companies.

An individual should purchase a policy twenty to twenty five years before they expect to use their benefits. Purchasing the long term policy as a "youngster" is wise and the long term care insurance company will provide the client the option to that will enable benefits to increase over the life of the policy. The reasoning is long term care costs are expected to rise in the future.

Benefit Increase Riders can be the difference between a policy that provides expected benefits when and if care is needed, and a long term care insurance policy that is "not what you expected.". The long term care insurance policy should have a benefit increase rider to your policy as an optional benefit. There are long term care insurance companies that allow policyholders the option of a benefit increase as many times as they like on an annual basis. Benefit Increase Riders offer to raise benefits on an annual basis, using one of the following methods:

Simple Interest Benefit Increase rider
In this scenario, benefits can increase by a preset percentage on an annual basis. 1%, 2%, 3%, 4% and 5% and 6% increases are common. The daily benefit percentage increase is always based on the original benefit.

Compound Interest Benefit Increase rider
Compound interest benefit increase rider causes benefits to increase by a preset percentage on an annual basis. A 5% compound increase is common. The percentage increase in this case is always based on the current daily benefit. A much more rapid increase of the daily benefit amount will acrue in later years.

Reasonably healthy people who are not afflicted with a terminal disease usually can obtain long term care insurance coverage, but different companies have different underwriting guidelines. A minor health problem such as a bum knee, for example, would probably not cause an applicant to be declined but may put the applicant in a higher rate class for long term care insurance with certain insurance companies.

It is extremely wise to have one of QuoteRetriever.com's knowledgable long term care insurance specialists shop the market for you to find the policy that is the best value for you specifically. Alzheimer's disease, for example, would preclude one from obtaining long term care insurance for every long term care insurance company, but if a policyholder developed Alzheimer's disease, they would be able to collect benefits from the long term care policy.

Reason #1: 22.4 million families provide care to a person over age 50. By 2020, the General Accounting Office estimates that 10-12 million people will need long term care.

Reason #2: 52 million family caregivers provide care to someone aged 20 or older who is ill or disabled.

Reason #3: The average cost in lost wages and benefits is around $109 per day for a caregiver who must quit his/her job to care for a family member.

Reason #4: 94% of all Americans are without long term care insurance.

Reason #5: Approximately 40% of long term care policies will be used for people aged 18-64.

Reason #6: About one third of the 700,000 stroke victims each year in the United States are under 65.

Reason #7: The younger you are when you purchase long term care insurance, the less costly it is likely to be.

Reason #8: In most cases, you can't get long term care insurance once you have a problem that requires long term care.

Reason #9: After the age of 65, Americans have more than a 70% chance of needing some form of long term care.

Reason #10: One out of five American households is providing care to an adult family member.

Reason #11: In 2004, the average hourly rate for home care was $18 per hour.

Reason #12: The average annual cost for a private room in a nursing home is $70,080.

MYTH: I'm young and healthy, so why do I need long term care insurance?

• FACT: Currently almost 1 in 2 people will require some sort of long term care assistance over the age of 65. Forty percent between the age of 18 and 65! There is also a 1 in 3 chance you will have to assist a family member with such care.

MYTH: If I do need long term care, the federal government will pay the escalating costs of long term care.

• FACT: The federal government can not afford to pay for long term care. Medicare only reimburses some, if any, costs for the first 100 days of care?nothing thereafter. Medicaid is for the people who are most in need. Qualifications for this program require a substantial spend-down of assets.

MYTH: My children will take care of me.

• FACT: Long term care situations can create great emotional strain for family members. As a result, maintaining independence and future peace of mind are the main reasons people purchase long term care insurance today.

MYTH: Long term care insurance is not a good value.

• FACT: The average annual cost for a private room in a nursing home is $70,080. This is why 72% of those admitted into nursing homes are impoverished within a year.

MYTH: I cannot afford long term care insurance.

• FACT: If you wait until later, that may be true. The younger you are when you purchase a long term care policy, the less you'll pay. Waiting until later also means there is a chance you may not even be eligible for coverage, due to a change in your health.