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Executive Summary: New Health Insurance Solutions for Individuals, Families, Self-Employed, and Businesses
Preface
Part I
How to Better Protect Your Family While Saving $5,000+ Each Year:
Savvy and Affordable New Health Insurance Strategies
Chapter 1: You Are One Serious Illness Away From Bankruptcy:The Huge Gaps in Your Employer's Health Insurance Plan
- What Would Happen If You Became Ill and Could Not Work
- The Gaps in Your Coverage When You Lose Your Job or Change Jobs
- What Happens When You Lose Your Health Insurance
- How to Avoid Losing Your Health Insurance When You Lose Your Job
- The Other Huge Gaps in Your Employer's Health Insurance Plan
- How Employer-Sponsored Health Insurance Works
- How We Got into This Mess
- The New Health Insurance Solution: How We Are Getting Out of This Mess
- Three Trends Behind the Changes
Chapter 2: Why Buying Your Own Health Insurance Is Better, Cheaper, and Safer Than Your Company Plan
- What is Individual/Family Health Insurance?
- Obtaining Individual/Family Health Insurance
- How Much Does Individual or Family Health Insurance Cost?
- Employer-sponsored Health Insurance Is Double or Triple the Price of Individual/Family Insurance
- Why Haven't I Heard of Individual/Family Health Insurance?
- Individual/Family Health Insurance Policies in 2005-2006
Chapter 3: Your Legal Rights to Health Insurance When You Lose Your Job or Change Jobs: ERISA, COBRA, and HIPAA
- ERISA—Protects Your Pension by Not Your Health Benefits
- COBRA—A Temporary “Last Resort” If You Lose Your Employer-sponsored Health Insurance
- Summary of COBRA Rules and Eligibility
- The High Cost of COBRA
- COBRA Timeline—How to Get COBRA Coverage If You Need It
- The COBRA Loophole—How to Get Three and a Half Months of Free Health Insurance Protection from your Employer, Saving You $1,400 When You Change Jobs
- The COBRA Loophole When You Leave Your Job
- The Second COBRA Loophole—If You Are Already on COBRA
- HIPAA—Your Legal Protection When You Change Jobs or Get a New Job
- Summary of HIPAA Law and How It Affects You
- Your Rights as a HIPAA-Eligible Individual
- How to Become HIPAA-Eligible
- The HIPAA-Eligible Loophole
Chapter 4: How to Buy Your Own Low-Cost, High-Quality Health Insurance Policy
- The Two Major Components of Health Insurance
- How Medical Provider Networks Work—HMOs and PPOs
- Health Maintenance Organizations (HMOs)—More Restrictions, Lower Cost
- Preferred Provider Organizations (PPOs)—Fewer Restrictions, Higher Cost
- Indemnity Plans, EPOs, and POS Plans
- Choosing between a PPO or HMO
- How to Choose a Medical Provider Network When Buying Health Insurance
- Beware—Many Health Benefits Products Are Not “Health Insurance”
- Medical Discount Cards with No Insurance
- Association Plans with Limited Financial Protection
- Financial Protection—What to Look for in a Health Insurance Policy
- Doctor Visit Co-pay or Discount
- Prescription Co-pay or Discount
- Annual Deductible
- Out-of-Pocket Annual Maximum (OOP Max = Coinsurance + Deductible)
- Lifetime Maximum Coverage
- Premium
- HSA-Qualified
- Other Considerations
- Comparing Different Health Insurance Policies
- Estimating Your Future Healthcare Spending
- Comparing Policy Features
- Submitting Your Application—Be Careful!
- What Health Insurance Companies Look For in Your Application
- Missing or Inaccurate Information on Your Application Could Cause Your Policy to Be Canceled When You Need It Most
- How Underwriters Verify the Information on Your Application
- The Medical Information Bureau
- Telephone Verification Calls
- Requests for More Information
- After You Submit Your Application
- Application Approved as Submitted
- Application Approved with Uprating
- How I Negotiated a Better Deal with My Insurance Company
- Application Approved with an Exclusionary Rider
- Application Rejected
- Licensed Independent Health Insurance Agents: Whether to Use One and How to Choose One
Chapter 5: The Best Options for Employees with a Good Company Plan: High Deductibles, Disability, Cafeteria Plans, FSAs, and HRAs
- The Crisis in Employer-Sponsored Health Insurance
- Should You Get Your Own Individual/Family Health Insurance Policy?
- Should You Keep Your Company Plan for Yourself but Get Your Spouse and Children Their Own Individual/Family Plan?
- How to Buy Your Own Individual/Family Policy—Tax-Free
- Should You Choose a High-Deductible Insurance Plan?
- Long-Term Disability Insurance—More Important than Life Insurance
- How Your Employer's “Cafeteria Plan” (Section 125 Plan) Works
- Flexible Savings Accounts (FSAs)
- Health Reimbursement Arrangements (HRAs): A Great New Way for Employers to Fund Employee Health Benefits
Chapter 6: Health Savings Accounts: Why You Should Fully Fund Your HSA Before Putting Even $1 in Your IRA or 401(k)… and How to Build a +$500,000 HSA Nest Egg
- HSAs Versus IRAs and 401(k)s
- Why HSAs Are So Important
- The HSA Safety Net: How an HSA Can Help You Between Jobs
- HSA-Qualified High-Deductible Health Insurance
- Annual Deductible Requirements and OOP Maximums
- Checkups and Preventative Care May Be Fully Covered Regardless of Your Deductible
- Combining HSAs with Your Employer's Section 125 (Cafeteria Plan) FSA or HRA
- Transition Relief Rules
- Managing Your Health Savings Account
- Choosing a Depository Institution for Your HSA
- Making Contributions to Your HSA
- Making Withdrawals from Your HSA
- HSA-Qualified Medical Expenses
- How to Spend All Your HSA Money Tax-Free after Retirement
- The Future of HSAs
Chapter 7: What to Do If You or a Family Member Have a Major Health Problem
- Finding a Job with Good Health Insurance Benefits
- How to Become a “Friend of the Governor”: State-Guaranteed Subsidized Insurance for Those Who Are Not HIPAA-Eligible
- What Is a State Risk Pool?
- Eligibility
- Benefits
- Preexisting Conditions
- The Five Remaining States with Only State-Guaranteed Coverage Instead of a Free Health Insurance Market
- Other Substitutes or Equivalents to State Risk Pools
- State-Guaranteed Health Insurance for HIPAA-Eligible Individuals
- How States Guarantee Coverage to Their HIPAA-Eligible Individuals
- Medicaid and Other Income-Based Programs
- Medicaid
- Other Income-Based Programs
- Becoming Eligible for Someone Else's Health Insurance or Medicaid
- Purchase a Medical Discount Card or Join a PPO
Chapter 8: How to Get Affordable Medical Care When You Are Over 55: Early Retirement, Medicare, and Long-Term Care
- Health Insurance During Early Retirement—Ages 55 to 65
- Why Employers Are Cutting or Canceling Their Retiree Health Insurance Benefits
- The Government Retiree Healthcare Crisis for Taxpayers: How You Are Paying for the Health Insurance Deal of the Century
- Health Insurance Solutions for Early Retirees—Ages 55 to 64
- Negotiating with Your Employer for Early Retirement Health Insurance Expenses
- Medicare—Federally Subsidized Health Insurance for Seniors
- Medicare Part A, Hospital Insurance: Hospitals, Skilled Nursing Facilities)
- Medicare Part B, Doctor Visit Insurance: Doctors, Outpatient Services
- Part C, Medicare Advantage: The Alternative to Medicare Parts A and B and Supplemental Coverage
- Medigap—Supplemental Insurance for the Gaps in Medicare Parts A (Hospital Insurance) and B (Doctor Visit Insurance)
- Medicare Part D, Prescription Drug Insurance: A Great Deal for Everyone on Medicare
- Long-Term-Care, Assisted Living, and Nursing Home Insurance
- Medicaid-Funded Long-Term Care–Not Desirable
- Medicaid-Funded Long-Term Care–Not Desirable
- How You Can Finance Your Long-Term Care
- The Long-Term Care Insurance Market
- Choose “HIPAA-Qualified” Long-Term Care Insurance
Chapter 9: How to Save 10 to 75 Percent on Your Prescription Drugs
- Get a Drug Discount Card and Save 10 to 25 Percent
- How to Choose a Drug Discount Card
- Expiring Medicare Drug Discount Cards for Senior Citizens
- Your Insurance Company's Drug Plan Could Save You Thousands
- Shop Overseas Pharmacies
- Ask for Generic Drugs
- Use a Different Drug That Has Similar Effects
- Other Ways to Save
Chapter 10: How to be a Smart Healthcare Shopper, Stay Healthy, and Keep the Savings
- Stop Taking “Maintenance Drugs” That Treat Symptoms, Not Causes
- Change Your Lifestyle (Diet and Exercise) to Dramatically Cut Your Lifetime Healthcare
Expenses—Before It's Too Late
- Why Americans Spend So Much on Healthcare
- The Effect of Diet and Exercise on Your Prescription Drugs
- Shift from Sickness Care to Wellness Care
- Joining the Wellness Revolution
- Alternative Medical Providers
- Speak to Your Doctor about Spending Your Money as if It Were His or Her Own Money
- Medical Tests
- Surgery
Part II
How Businesses Can Fix Their Health Insurance Nightmare
and Still Hire Great Employees
Chapter 11: How Employers Can Save 50 Percent on Health Insurance by Giving Employees Tax-Free Dollars to Buy Their Own: Defined Contribution Health Benefits
- Traditional Defined Benefit Health Insurance versus New Defined Contribution Health Insurance
- Everyone Benefits, but Healthy and Younger Employees Benefit the Most
- Unhealthy Employees Also Save Money and Get Safer Coverage
- Your Company Benefits As Much As Your Employees Do
- How Much Will Your Organization Save with a Defined Contribution Plan?
- Estimate the Cost of a New Defined Contribution Program
- Designing Your Defined Contribution Health Benefits Plan
- Dividing the Savings between Employer and Employees
- Special-Purpose HRA Program(s) for Singles, Families, and Unhealthy Individuals
- Implementing Your Defined Contribution Health Benefits Plan
- Starting with a Defined Contribution Plan for Independent Contractors or Another Class of Employees
- Defined Contribution as an Optional Choice for Employees
- Perform a Census of Your Employees (or a Class of Employees) When You Are Ready to Cancel Their Group Defined Benefits Plan
- Terminating Your Group Plan and Making (Almost) Everybody HIPAA-Eligible for State-Guaranteed Insurance
- Other Considerations
Chapter 12: HSA Plans for Employers: Why Every Employer Should Encourage Tax-Free Employee Contributions to HSAs
- Three HSA Contribution Options Every Employer Should Consider: 0, 50, and 100 Percent
- Option 1: 0 Percent Employer Contribution Plan
- Option 2: 50 Percent Employer Matching Contribution Plan
- Option 3: 100 Percent Employer Contribution Plan
- HSA Plans for Employers Who Offer Health Insurance
- HSAs for Employers with Defined Contribution Health Insurance Plans
- HSA Options for Employers with Defined Benefit (Traditional Employer-Sponsored) Group Health Insurance
- The End of Health Insurance Risk for Large Employers
- How to Make Sure Your HSA Plan Is Enthusiastically Adopted by Your Employees
Chapter 13: HRAs for Employers: How to Use HRAs to Save $2,000 to $6,000 per Employee Each Year While Getting Your Employees Better Health Insurance
- How Health Reimbursement Arrangements (HRAs) Work
- Basic Rules and Uses for HRAs Today
- A Simple, Money-Saving Health Insurance Solution for Most Employers Today
- New-Employee HRAs—–Short-Term Health Insurance Coverage for New Hires (“Waiting Period Coverage”)
- Short-Term Health Insurance Policies (Waiting Period Coverage)
- Former-Employee HRAs – COBRA Alternatives (CAP) and Early Retiree Programs
- COBRA Alternative Program
- Early Retiree HRA
- High-Deductible HRAs— A Way to Encourage Your Employees to Adopt High-Deductible Insurance
- Why Don't All Employees Choose High-Deductible Plans?
- How High-Deductible HRAs Save Employers Money
- Coordinating High-Deductible (and other) HRAs with Health Savings Accounts
- Supplemental HRAs for Dental, Vision, and Other Items—Filling the Gaps in Group and Individual/Family Health Insurance
- Wellness HRAs—Programs to Improve Health and Productivity
Epilogue: The Future of Affordable Health Insurance in America—Who Wins and Who Loses?
- Employer-Sponsored Group Health Insurance—The Old Way
- Individual/Family Health Insurance—The New Way
- The Complete Reform of U.S. Healthcare
- Who Wins and Who Loses with The New Health Insurance Solution?
- Unhealthy People Lose $ and Healthy People Gain $ with HSAs
- Healthy and Especially Unhealthy Individuals Gain Peace of Mind
- Some State Governments Lose Short Term, but All Win Long Term
- The U.S. Economy and U.S. Consumers Benefit the Most
- What Should Be Done Now to Improve Health Insurance?
- Allow Health Insurance to Be Sold Across State Lines
- Make All Health Insurance Premiums Tax Deductible
- Make All Healthcare Providers Disclose Prices
- Allow International Competition for Pharmaceuticals
- Protect Bankrupt Families from 200-500 Percent Medical Bills
- End Federal Lifetime Health Benefits for Congressmen, Senators, and Government Officials
Appendix A: State-by-State Guide to Individual/Family Health Insurance Costs
Appendix B: How Americans Get Health Insurance Today…and What about the 45 Million Uninsured?
Notes
Index
Acknowledgments
About the Author
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