Kentucky Health Insurance

Kentucky health insurance

The Kentucky Health Issues Poll (KHIP) conducted in December 2010 shows that about a quarter of the state’s population does not have health insurance. This means that health insurance has a big gap to fill.

Though Kentucky’s strengths include a comparatively low prevalence of binge drinking, low violent crime rate and ready access to early prenatal care, the state faces challenges in terms of the high percentage of smokers in the population and high rates of obesity prevalence, cancer deaths and preventable hospitalizations. Also, according to the 2010 America’s Health Rankings® by the United Health Foundation, Kentucky fell a few spots from last year’s #41 ranking, taking over as the 44th healthiest state to live in.

The main findings of the Kentucky Insurance Poll are:

• Households with lower incomes have higher rates of being uninsured. About 46% of adults in households with an income level that is below 100% of federal poverty guidelines (FPG) were uninsured compared to 16% of those living above 200% of the FPG.

• Over one third of people age 18-29 (young adults) are twice as likely to go without Kentucky medical insurance when compared to people over 45.

• About 1 in 4 Adults age 18–64 do not have Kentucky health insurance. As seen in previous KHIPs, age, education level, and income are factors that had a positive influence on the percentage of Kentucky adults who were insured.

• More than a third of Kentucky residents age 18-64 did not have health insurance at some point in the last year.

Having coverage continuously for one year signifies that a person has stable insurance. This is a measure of the ability to utilize healthcare services. This KHIP survey showed that the majority of insured Kentuckians had stable insurance coverage over the past year.

It is also expected that under new federal law, 261,000 Kentuckians will benefit from Medicaid expansion. Nevertheless, there will still be many Kentucky residents who are uninsured and who need to take an informed decision on purchasing an appropriate plan so that they can be ready to face a potential healthcare crisis. Contacting a licensed insurance agent it the best way to learn about various Kentucky health plans, get quotes, compare them and make the right choice.

With the nation’s debt crisis looming large, much attention is on cutting Medicare spending. Medicare shoulders the highest expenses in the U.S. healthcare system, and tax dollars pay for most of the annual increase in the cost of care for the elderly and disabled.

The Medicare cut proposal is causing a lot of concern. President Obama and Congressman Paul Ryan are taking opposite approaches to the Medicare dilemma, though their goals are the same – to rein in Medicare costs and to limit the amount of taxpayer money going into Medicare. However, the proposals that both the President and the Republicans are making to tackle long-term Medicare debt have come under fire.

President Obama says he is determined not to leave “seniors at the mercy of private insurance with shrinking benefits to pay for rising cost”. Physicians express the fear that the various committees and federal agencies that President Obama visualizes to set up, to look into the matter, will decrease the services that doctors can order for their patients. The Independent Medical Advisory Board that will kick off by 2018 will decide whether too much is being spent on medical services, and will decide whether one service or treatment is better than another. This has come in for much criticism:

• First, it places the onus of judgment in the hands of a few bureaucrats and vested interests.
• Doctors feel that such judgments on the ‘comparative effectiveness’ of treatments or services are not wise, as they could affect the physician-patient relationship, especially when a patient needs a particular treatment. There is a view that way too much is being spent on seniors aged 65-70. Individuals in this age group are much healthier than they used to be. Some doctors feel that a better alternative to saving money that is being spent on medical services would be to cut Medicare benefits for those in the 65-70 age group so that there is enough to pay for a life saving operation when they reach, say, age 80.

As for Congressman Paul Ryan’s suggestions, doctors think that they could work well for younger people but not the elderly. Paul Ryan recommends that health insurance companies should be brought in for people who have a serious illness. His long-term “budget-cutting plan” proposes a drastic restructuring of Medicare that includes the creation of health insurance exchanges, which he claims would drive down prices through free market competition.

Doctors also came out in criticism of Paul Ryan’s views, especially when it comes to dealing with older patients. As a result, the House GOP plan, to replace Medicare with a voucher-like system, has been rejected. Some of the issues raised are:

• The general feeling was that it does not make sense to give a voucher to an 80 year old with medical problems and tell him to buy private insurance, as it is tough to get private health insurance companies to pay for patients who are very old and very sick.
• President Obama points out that this plan will leave old and sick people at the mercy of private insurance companies.
• Private insurance works better for patients who are young and have less medical issues. It is pointed out that Medical Advantage has not worked well for older patients even in the past.

Suggestions Put Forward to Cut Medicare Spending:

• Medicare access should be cut down. For instance, people shouldn’t be using Medicare or Medicaid to treat issues like a common cold. Treatment should be restricted to high tech solutions that work.

• There is too much money being wasted internally in the Medicare system. This should be dealt with and such waste should be cut.

• Obama care talks about ‘preventive medicine’. Doctors feel that lifestyle changes like diet, and exercise are the crux of preventive measures. Federal medical spending should address such measures to ensure that seniors stay healthy. This would contribute to lowering the nation’s overall health bill.

• Reassessing the retirement age can also help. With greater awareness about health issues and improved medication, today’s senior citizens are quite healthy even at age 65. Reassessing the retirement age can bring down the number of people becoming eligible for Medicare.

• The use of electronic medical records can bring down health care costs and improve the efficiency of hospitals and practices. Computerized medical records will help prevent waste and reduce the time needed to repeat expensive medical procedures and tests. Doctors are now eligible to get more than $40,000 in extra Medicare payments, if they upgrade to electronic records. They would face reduced Medicare payments and even a penalty if they don’t do so by 2015.

To sum up, there is no doubt that Medicare must operate more efficiently, especially as the generation of baby boomers is all set to enter its rolls. Additional revenue must be found. The government should take care to prevent false billings and ensure that Medicare reimbursements are made only for authentic claims.

There is general consensus on an enforceable limit. Such a limit would see a future with less Medicare payments for healthcare service providers like hospitals, doctors, drug companies and others, more out-of-pocket expenses for many senior citizens, and smaller role for tax dollars in Medicare payments.

Health insurance providers in Kentucky offer a wide range of plans for individuals and businesses. Most people are covered by an employer-sponsored plan. If you are not, you would have to buy a policy directly from an insurer. This means looking at various options and choosing the right Kentucky health insurance plan.

Compare Kentucky Health Plans

Health insurance plans comprise managed health care plans and indemnity plans. Managed care comprises HMO, PPO and POS plans. Managed care means fewer out-of-pocket costs, a small co-pay per visit, and no deductibles or insurance claims to file.

With HMOs, members must choose a primary care physician. This physician handles all your healthcare and treatment and refers you to a specialist if necessary. Each plan allows a certain number of wellness visits and checkups. A HMO is the least expensive of healthcare plans.

PPOs are flexible in that they let you see anyone you want, even out-of-network doctors and specialists. The doctor or healthcare provider is under contract with the insurance company to provide services at a discounted rate. However, if you go in for outside network care, you would be reimbursed for only up to a certain percentage of your expenses.

POS plans combine features of both HMOs and PPOs. Premiums are higher than HMOs, but POS plans offer greater freedom of choice with doctors and hospitals. In-network care involves a small copay and no deductible. If you go outside the network, you have to pay as in a fee-for-service or indemnity plan.

Making the choice between plans depends on what your priorities are. Choose a HMO if you are looking at low premiums and preventive care. But this plan would not be right for you or a family member have a pre-existing health condition that needs the attention of a specialist. If the coverage is for you and your spouse, see if having two individual plans is less expensive than having family coverage. A PPO is ideal if you can stay within the network and see the doctor you want.

One of the most important things to remember when buying medical insurance is that cost should not be the only concern. It is important to consider the needs of your family, range of benefits offered and the quality of the plan.

Points to Consider when Buying Health Insurance in Kentucky

When you compare plans, consider the following:

• The copay or discount for doctor visits
• Number of doctor visits
• Coverage for children
• Coverage for prescription
• Inpatient care and what the policy covers
• Emergency care
• Lab tests covered
• Annual deductible
• Total amount of co-insurance and deductible
• Premium
• Lifetime max coverage
• Whether the plan is HSA-qualified. A High Deductible Health Insurance Plan combined with a Health Savings Account (HSA) and can save you tax dollars

Other relevant considerations:

• If you are considering a new plan, review your past medical claims to understand how much of your expenses were not reimbursed
• See if your doctor or specialist is enrolled in the plan
• Choose the right doctor by checking out educational qualifications, credentials and experience. Ask friends to recommend a doctor, do online research to find good doctors and hospitals and choose a plan that has them as members
• Read the fine print before you sign

Benefits of Expert Guidance

The first step in choosing the right Kentucky health insurance plan is to get quotes from leading providers. Browse the web to find a reliable insurance agent who can help you. An experienced agent would answer all your queries and offer expert guidance to help you find affordable health insurance to suit your needs.

Leading insurance companies offer various kinds of Kentucky medical insurance plans. All health insurance in the state is monitored by the Kentucky Department of Insurance. The health insurance offered include indemnity and managed health care plans. The best way to buy a suitable plan is to look at the various options available, compare them, get quotes and apply online.

There is a greater choice of health care providers with indemnity plans. The insurance company fixes the amount that it will pay for medical services that you are provided. You have to pay up front and your health insurance company will pay their share of the cost on receiving the bill.

With managed care, the insurance company contracts with a network of doctors and hospitals to offer you services at fixed rates. You choose a suitable primary care physician who is responsible for your health care.

Make an Informed Decision

To make an informed decision on Kentucky medical insurance, consider the following:

• Your priorities
• Your medical condition
• Future healthcare needs
• Your budget
• Services paid for by the plan
• Your primary care physician and whether he is nearby
• How much you have to pay as premium and other costs

To make an informed decision on health insurance, it is important to look at various kinds of plans. You need to select a plan that is within your budget and offers the maximum benefits for the amount you pay.

Seek Professional Assistance

Browsing the Internet takes you to the websites of various insurance companies offering different kinds of Kentucky medical insurance plans for individuals, families, businesses, students and much more. Looking at these plans and making the right choice can be quite confusing with professional help. You have to understand the various terms, guidelines on premiums, out-of-pocket costs, and more, compare plans and select a suitable one. An ideal way to go about all this is to get help from a reliable insurance agent. You can get free instant quotes from leading insurance companies from the websites of these agents. They can answer all your queries on Kentucky health insurance plans, help you choose one to suit your needs, and guide you through the whole application process.

Kentucky medical insurance fall under various categories such as family and individual insurance, group, short-term medical insurance, student health insurance, and Medicare. Understanding all these categories and the benefits they offer is the key to getting affordable health insurance.

Kentucky Medical Insurance – Various Categories

Individual: Individual Kentucky health insurance plans are for the self-employed, or those without employer-sponsored health insurance. Individual health insurance is underwritten. Medical insurance underwriting is a process through which medical insurance companies consider factors such as age, health status and history, occupation, hobbies, personal habits, and lifestyle to evaluate their risk in issuing the policy.

Group: With group health plans, the insurance company has to cover all qualified applicants. New employees may have to wait for health coverage. Medical insurance company can refuse coverage for those with preexisting conditions only the first 12 months. By 2014, most employees will be able to buy individual policies at much lower prices than employer group coverage.

COBRA: If you lose your job, COBRA (The Congressional Omnibus Budget Reconciliation Act of 1985) ensures that you can stay on the employer-sponsored plans for a certain period.

Student medical insurance: Kentucky schools and colleges offer student medical insurance policies that usually cover x-rays, lab work and minor emergencies. School health center visits are free and many other services come at low cost. Students need to check the extent of plan coverage and conditions. New law permits children to stay on their parents’ medical insurance plan till age 26, which could mean that fewer students may opt for student medical insurance.

Medicare: This is government-administered medical care available to persons aged 65 and over. New reform aims to strengthen Medicare. Check with the Kentucky Department of Medicaid Services to understand eligibility criteria, plans and benefits.

High-risk pools: New reform ensures that Americans denied coverage because of a preexisting medical condition are covered in high-risk pools until 2014. After this, they will have access to coverage through health insurance exchanges. In KY, 45% of the total cost of plans purchased through the high-risk pool is paid by premiums.

Rely on Expert Assistance
Kentucky health insurance companies offer different kinds of plans covering many categories. Getting a quote and applying for a policy is now a relatively easy process, though it is advisable to rely on professional help to understand your options and choose a suitable health insurance plan.