How HIPAA Trained Employees Can Help In Safeguarding Patient Information

The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 with the primary objective of protecting confidential patient information. There are various circumstances due to which this protected information is accessed by employees in hospitals, clinics and insurance companies. There is always a danger that this protected information could be used for commercial reasons. This is one of the primary reasons as to why it needs to be protected from unauthorized access.

There are also restrictions on the number of times that confidential information of individual patients can be accessed and it is important that people who access it are aware about it. Employees who work in "covered entities" as specified in the Health Insurance Portability and Accountability Act need to be properly trained so that they are able to access this confidential information carefully. The regulations of HIPAA are quite stringent and any unintentional or intentional violation attracts many penalties. The penalties could include fines or imprisonment depending on the nature and extent of the violation.

What Are The 5 Issues That You Need To Be Aware About In HIPAA Training?

It is important that all employers of health care service providers (covered entities) arrange for a HIPAA training session for their employees so that they become aware of the various rules and regulations that are stipulated by the Act. The HIPAA training can be done by just a section of the employees who handle this protected information or all employees of the covered entities. The training sessions can usually last for a couple of hours and employees should be encouraged to ask questions so that they are able to get a better understanding of HIPAA and its various rules and regulations. The training will also provide information to employees about the various penalties for non compliance of Health Insurance Portability and Accountability Act. The penalties can be civil and criminal depending on the extent of the violation. The training will also ensure that all provisions of the Act are complied with and there are minimum unintentional violations. There are various physical and technical safeguards that need to be implemented to keep the protected information safe and secure and the training will provide employees with the guidelines to do so. This will also help prevent any unauthorized access to the protected information of the patient. After the training period is completed, employees will need to take a test to check whether they have understood all the concepts of HIPAA clearly. Employees who have successfully completed the test will be awarded a certification. The certification would mean that these employees are proficient in the privacy and security rules of Health Insurance Portability and Accountability Act.

There have been several modifications made in HIPAA since its introduction in 1996. The training should be a continuous process for employees as Health Insurance Portability and Accountability Act can get updated at regular intervals. The covered entities can have specific policies that are related to HIPAA and this should be in compliance with the overall act.

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How to File a Health Insurance Claim

There are two methods for getting a claim under a health insurance policy in India:

1. Cashless Hospitalization

2. Non-cashless Hospitalization

In case of Cashless/planned Hospitalization

1. In case of planned hospitalization inform the Third Party Administrator/insurance company about the date of admission in the hospital quoting your policy number and health ID card at least 4-5 days in advance.

2. The form for intimation to Third Party Administrator and obtaining previous authorization for cashless claims services is available with the admission counter of the hospitals.

3. The patient must fill up the form carefully as any incorrect information may lead to rejection of previous authorization.

4. The medical condition of the patient or the requirement of any surgical procedure is filled up by the doctor attending the patient. Be sure that the doctor is briefed correctly about the patient's history, otherwise it may again lead to rejection of previous authorization by Third Party Administrator.

5. In case of new policies all previous existing diseases are excluded. At the time of signing previous authorization form check that doctor has not mentioned anything about condition which may lead to assume it for existing previously.

6. The filled up form is then sent by the hospital authorities to the respective Third Party Administrator of the company for granting of previous authorization of amount for hospitalization.

7. The Third Party Administrator carefully scrutinizes all the details such as policy number, validity of policy, Sum assured, waiting period, preexisting diseases etc and after being satisfied sends the authorization of amount directly to the hospital.

8. After satisfying itself the Third Party Administrator will issue a previous authorization letter/ guarantee of payment letter to the hospital/nursing home mentioning the sum guaranteed as payable and also the ailment for which the person is seeking to be admitted as a patient.

9. The Third Party Administrator has the right to deny the previous authorization if he is not satisfied with the documentation.

10. Unless the Third Party Administrator gives the previous authorization letter to hospital, the hospital will not treat it as cashless claim. So the insured must vigorously follow-up with the Third Party Administrator for giving the authorization letter.

11. If the letter from Third Party Administrator is not received or if they deny then the insured must first pay for the expenses from his pocket and then lodge a claim to the Third Party Administrator/insurance company.

12. In case of planned hospitalization it is easier to get previous authorization since the insured has ample time to followup with the Third Party Administrator. The problem comes in emergency hospitalization.

Here time is of essence. The hospital will not start treatment unless he receives authorization from Third Party Administrator or cash from the insured.

13. This creates a panic situation and many times the insured are forced to pay from their

pocket and thereafter claim the amount from Third Party Administrator/Insurance Company in normal course due to emergency. In many cases it has been seen that Third Party Administrator's delay the process of authorization so that the customer pays from his pocket and then claims reimbursement.

14. Generally the Third Party Administrator's grant authorization for a particular amount. If the cost of treatment exceeds that amount the patient must give it from his own pocket and then claim reimbursement from the Insurance company if it is within the policy limits.

In case of Non-Cashless Hospitalization/Emergency Hospitalization:

In case of Non cashless Hospitalization the insured must give preliminary intimation about the claim within 7 days of hospitalization (The intimation period may vary from company to company) to the Third Party Administrator/Insurance Company.

The notice would include the following:-

1. Particulars of Policy number

2. Health ID card number and copy

3. Name of Insured Person

4. Address

5. Name of attending doctor

6. Name of Hospital

7. Nature of illness/injury

After the insured is discharged the final claim must be submitted to the company within 30 days from the date of discharge. The period of intimation may vary in insurance companies.

The following documents must be attached along with the prescribed claim form of the company:-

1. Original prescription of Doctor

2. Prescription of doctor advising for hospitalization/tests.

3. Original reports of all diagnostic tests along with the original bills like X-rays, ECG, Scan, MRI, Pathology etc.,

4. Detailed itemized bill from the hospital for bed charges, OT charges, medicines, and details of any other charges that the hospitals have levied.

5. Surgeons certificate stating nature of operation along with bill.

6. All bills for medicine purchased during the previous 30 days before hospitalization and

after discharge.

7. Hospital Receipts / bills / cash memos in Original (Copies of charge slips if payment is made by credit card) duly stamped.

8. Discharge certificate from hospital

9. Certificate from the doctor that the patient is fully cured and is able to resume his work

10. In case of domiciliary hospitalization a report from qualified nurse who attended the patient in his residence supported by a certificate from medical practitioner.

11.Copy of current insurance policy and previous policy.

12. F.I.R. in the case of accidental injury and English translation of the same, if in any other language.

13. The claim form must be filled correctly and there should not be any overlapping of information otherwise it may lead to rejection of claim.

14. Since all the original documents are submitted along with the claim form the policyholder must keep a copy of the claim form and all the original documents submitted along with the claim form. At the time of submitting the claim form he must obtain an acknowledgment from the insurance company about the receipt of the documents to serve as a proof of submission.

15. The policyholder must followup with the insurance company about the status of the claim after some time as the insurance company may require some other documents or clarifications from the hospital about the charges.

16. The insurance company if finds everything in order shall make payment for the claim. Many times it deducts some amounts from the bill which are not authorized under the policy or which may seem to be in excess.

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How Does Medicare Work? Understanding Medicare

Medicare is a federal program open to seniors 65 years or older or to certain disabled Americans. It has various component programs that cover a number of people.

Generally speaking, Medicare recipients are in the low middle income to low income levels. Because they have limited means, these recipients often find it hard to pay for all their medications so they will either skip taking the medicine or skip on groceries or other life's essentials.

To help alleviate this particular problem, the federal government has several resources available to Medicare recipients. For example, the Social Security Administration says,

"Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia."

There are links at the end of this article you can use to read the full details about this program. Take advantage of all the information they provide.

Believe it or not, the federal government wants each recipient to get all the benefits they deserve. They encourage people to find and enroll in federal, state, local and private programs that help pay for prescription drugs, utility bills, meals, health care and other needs.

For example, people who need help paying for food can enroll if the Supplemental Nutrition Assistance Program (SNAP). The federal government has renamed the former federal Food Stamp Program. SNAP helps low-income individuals and families buy the food they need to maintain good health.

Their opening paragraph sums up their mission this way:

"There are programs that help millions of people with Medicare save money each year. States have programs for people with limited income and resources that pay some or all of Medicare's premiums and may pay Medicare deductibles and co-insurance."

Visit this site and click on your home state and see what is available to you. Hopefully, you hit the jackpot and get all the aid you deserve.

Simply because you are a low income or poverty level income individual doesn't mean you are without means or resources. The above programs are in place to benefit you and hopefully make your life a bit easier.

Another excellent resource is on Medicare.gov, the official US Government site for Medicare. The specific program is called Medicare Savings Program (MSPs). Its web address is:

http://www.medicare.gov/contacts/staticpages/msps.aspx

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Value Your Own Loved Ones' Wellness By Getting Health Insurance Plans

Probably one of the most essential things folks just ignore is health and wellness. As we say, health is wealth. On the other hand, they just recognize its relevance should they become ill and need to pay a large amount on their medical costs. This is exactly what injures your bank account the most. Whenever you are unwell, you have to spend unexpectedly something you must have well prepared for at the start.

That is why it is essential to make health a high priority. Keeping yourself healthy makes it possible to steer clear of forking over big medical costs and other related expenditures. On the other hand, accidents could happen out of nowhere. That is why you'll want to stay one step ahead of the game. Each time unanticipated situations have an impact on you and your loved ones, you have to be equipped for the inevitable. For this purpose alone, family health insurance plans undoubtedly are a must.

These days, most people find getting health insurance plans the best way for you to cope with any kind of health issue or accident. To make the best from obtaining one, you ought to select the right family health insurance plans. Here are some elements you need to know prior to getting started.

First thing will be to understand the medical expenses needed. You will need the best idea of what form of medical expenditures you own family must have. Since members differ in age and gender, it's always best to generate a comprehensive plan for every one. The listing should also contain all planned expenses and also the ones that may possibly occur at any time.

Immediately after figuring out the coverage essential, the next thing is to find a reputable health insurance organization which may offer this. It is important to pick a company that's legitimate and offers top quality service. It will be helpful when you speak with friends or relatives to get some kind of idea. Doing your search on the internet will also help save your time. Visit sites of the insurance agencies and look at testimonials. Ensure that you go over your choices cautiously prior to making any kind of selection.

One more thing to take into consideration is price. Choose amongst major medical insurance plans which come on this category. When you search on the internet, always evaluate the costs. While doing this, you must be mindful too. A few sites offer unbelievably affordable costs which are fraudulent so you should always be mindful all the time. Don't end up being easily blinded by these unusually low rates and add-on special discounts. Being nitpicky helps you save from making the wrong choices.

Family health insurance plans help you provide protection for your family. Being a concerned loved one, you need to spend much focus on this. Being equipped will let you handle unpredicted instances that involve their health. Most importantly, owning insurance coverage will give you peace of mind.

There are lots of plans offered. All you have to do is choose the one which matches your requirement.

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Make Sure You're Covered Before It's Too Late

It's been a few years since you've had your last physical and you have this insurance plan through work that takes a monthly sum out of your paycheck-so what the heck, why not get a check up? You find a doctor in your insurance provider's network, make an appointment, and check that task off your things-to-do list.

If this is all you've done to make a doctor's appointment, you haven't adequately protected yourself against a surprise bill from the doctor's officer following your visit. Just because a doctor is in your insurance provider's network does not mean that same doctor is covered under your plan. The previous hypothetical is one of several ways ordinary people get hit with big medical bills due to a lack of due diligence on their part and a false sense of security that they're covered. Ensure that you're fully covered before seeing a doctor or specialist by asking yourself the following questions.

Is the doctor or nurse familiar with my plan?

Doctors and nurses want to make sure that you're covered just as much as you do. They're much more comfortable getting paid by your insurance provider rather than by you. That being said, don't hesitate to ask in a straightforward manner whether your policy covers a specific doctor or procedure. Additionally, to be absolutely certain that your visit is covered speak with an insurance claims manager in the officer either in person or by phone. These managers will work hand-in-hand with you to make sure you understand what is covered and what is not. Insurance claim managers are often Certified Medical Assistants (CMA) so they have a wealth of knowledge about health insurance. The more questions you ask them, the better off you'll be.

Is the doctor covered under my plan, not just in the insurance provider's network?

Similar, to the hypothetical, don't be fooled into thinking that a doctor is covered under your plan just because that doctor is in the insurance provider's network. It's common for plans to not include all the network doctors.

Is my name on the claim the same as it appears on my insurance card?

Avoid any unnecessary headaches by confirming the correct spelling of your name on the claim and your insurance card. Insurance providers will deny or reject a claim for such an administrative error. Sure, you can probably appeal the denial or rejection and get it reversed, but why bother going through red tape that could take months to resolve?

Is this medical bill accurate?

After doing your homework you still may receive a medical bill if a procedure was only partially covered or you went into a procedure knowing that it was not covered. That doesn't mean you should not closely look at the bill. Believe or not, medical providers and insurance companies make mistakes. Be sure the charges are accurate and if you're not sure about a few charges contact the appropriate entity for clarification.

Remember the adage, it's better to be safe than sorry. That applies when finding a doctor under your insurance provider. Save yourself time and money by asking yourself, your insurance provider, and healthcare providers the right questions.

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Concerned Over Gaps in Medicare Plans? Choose Suitable Medical Supplements

Obviously, health comes first. If you are not in good state of mental and physical health, your work, leisure, productivity, relations...all of the things get affected.

As individuals are careful about their well-being, so is the government. This is the reason many health insurance plans are run by governments of different countries. Here I am going to discuss about one such plan... Medicare plans.

This is a plan administered by U.S. Government for people over 65 years of age. Younger ones but affected from any disability are also covered under it. If you are in search of health insurance plans, Medicare well deserves your attention but you also need to know about Medicare supplement plans as Medicare doesn't cover everything.

For the things not under its purview, you can opt for Medicare supplements health insurance.

Here are some aspects you need to consider while selecting Medicare supplemental

• An estimation of medical cost is the first and foremost thing. Make a list of any regular checkup, test you are undergoing, doctor's visit and similar other things. However, this may become difficult as all Medicare plans A,B,C provide different coverage. Also, don't forget to include the premium of Medicare policies while making n estimation.

• Check state insurance departments to know about the companies providing supplement health insurance legally. Not all policies are offered by all companies. So, if you skip this step, you may end up in wasting time as your selected insurance coverage may not be applicable in your state.

• Similarly, not all companies are operating legitimately. So, while finalizing the insurance company, Its better to take guidance from friends, family other sources as well.

• Once you are through with company selection, start comparing their plans and policies. You can narrow down your choices by restricting to your needs. Don't look for unnecessary coverage. Stick to only what you require. It will help you out in making good selection.

• If you are a travel freak, make sure that the plan includes nationwide coverage because all policies don't include the same.

• Don't forget to inquire about the customer service of the company. However good it is, if customers are not satisfied; it's of no use. You can visit the website of the company and read customer's testimonials. Personally contacting them will also solve your purpose. By any means, make sure to get convinced by the services before taking a final decision.

• If you enroll for supplement plans within 6 months of enrollment in Medicare part B, it will be best for you as you will grab comprehensive coverage. The more time you take, the higher will be the premium.

So, these were some of the points you need to take care of while opting for supplement plans!

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Insurance Exchanges

The Patient Protection and Affordable Care Act, passed by Congress in 2010, addressed the inability of individuals and small employers to obtain affordable health insurance in the existing markets. With the intended goal that every American has a basic level of protection, the new law mandated that each state create an insurance exchange in which individuals and small employers can purchase coverage. In order to ensure that the system is properly financed, the law also mandated that nearly everyone must purchase health insurance. This law will affect an estimated 27 to 33 million Americans who currently do not have health insurance.

In 2014, most Americans will be required to obtain coverage through their employer, a state insurance exchange, or an individually procured insurance policy. (A limited number of exemptions apply, including illegal immigrants, prisoners, Indian tribe members, and religious objectors.) Failure to obtain the mandated coverage will result in a fine that will be collected through individual's income tax returns.

Concurrently, employers with 50 or more full time employees must provide a basic level of coverage for their employees or be penalized for failure to comply. Fines will range from $166 to $250 per employee, per month and will be used to subsidize the cost of private insurance for lower income purchasers.

PPACA specifies that exchanges are to be available to individuals and small employers by January 1, 2014. States are required to create an exchange for which they will have control and responsibility, or cede the responsibility to the federal government. According to a Kaiser Family Foundation recent report, "Focus on Health Reform," 12 states have established exchanges: California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Nevada, Oregon, Utah, Vermont, Washington, and West Virginia. Of the remaining states and District of Columbia, 10 have not proposed legislation for the formation of an exchange and 16 have proposed legislation that failed to pass.

For those states that do create the mandated exchange, there are several oversight options. An exchange may be created within a new or existing state agency, as an independent public entity, or as a non-profit organization. Once the entity is created, a form of governance must be selected. At this point, it appears that most states have chosen to have a governing board with appointed stakeholders who are not elected officials. Stakeholders will be drawn from health economists, actuaries, organized labor, health care providers, small business owners, consumer advocates, and insurance brokers. These individuals, viewed as subject matter experts in their particular field, will be responsible for overseeing the creation of the exchange as well as serving on the governing board.

The structure of the exchange will also need to be determined through state legislation or the governing board. There are two options. With a clearinghouse model, the exchange acts as an aggregator of the open market, asking private insurance companies to offer coverage that the consumer can choose to purchase based on individual needs. In the active purchaser model, the exchange exerts more control by conducting reviews of the benefits and rates offered by providers and actively filtering out plans that do not meet specified standards.

PPACA stipulates that any plan offered by an exchange must cover "Essential Health Benefits." While the list is not completely defined, the benefits will certainly include preventive, physician, prescription, hospital, maternity, and rehabilitative care. The law also requires that exchange plans pay a minimum of 60% of the actuarially-based health costs that fall under these "Essential Health Benefits." Consumers will be able to choose a level of coverage ranging from Bronze at 60% to Platinum at the 90% level.

Assuming that the individual mandate remains intact and Americans are required to purchase insurance, substantial decisions still need to be made for implementation of an effective insurance exchange. What will the infrastructure needs be for customer service, software systems, connectivity with insurance companies, and reporting to small employers? How will individuals be supported in their decision making? How will the subsidies be administered?

While the intent of the law is clear, it is also clear that the formation, design, and implementation of an effective exchange by January 1, 2014 will be a challenge for many states. Politics will continue to shape the evolution of the exchanges, but for now the states have a significant amount of latitude in the formation of their exchange and each state could have a dramatically different outcome.

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Getting International Health Insurance? Consider These Points

The international health insurance industry is a multibillion dollar market and as customers we can expect to get great coverage all across the globe. It is a big decision, who to go with, and there are a lot of options out there so research is key. Before taking the plunge consider the points below, often over looked issues or recent developments in the market, they may make all the difference and get a great deal with comprehensive coverage.

Flexible coverage. We're not talking about tiered coverage here, we're talking about how flexible the coverage is within each tier and how far your international health insurance provider will go to accommodate you and anyone else on your package. For example currency flexibility is fairly new as a feature and can make the world of difference for customers. When making a claim for an accident that happened in Europe, what use are Euros when you're in South East Asia? It's far more convenient for the customer to get their payout in the currency of the country they currently located and a good provider will offer this.

Where is the company based? Many companies rightfully allow the nature of their business to direct them geographically so international health insurance providers will often have offices in most of the major cities, which is comforting for expats and travellers. If this isn't the case then the recent advancements in communication technology should allow you to contact them (and vice versa) with ease. Services such as Skype as well as iPhone apps and the World Wide Web makes it fast than ever to get in touch to customer services departments, and your provider should have a 24/7 customer hot line.

User reviews. These are good to research but only use them as a bench mark. Read as many as you can to get an overall wider sense of the company you are considering. Don't let a few ultra negative reviews put you off instantly. The internet is full of trolls and disgruntled customers and with high speed broadband they often vent their frustrations as soon as there is a hitch in their cover, without allowing fair time to resolve any issues so be aware of this before abandoning a health insurer based one bad review.

An international health insurance package that provides good coverage for you and anyone travelling with you, is essential to a smooth relocation, holiday and backpacking trip. So when you're signing on the dotted line, take a minute to consider the above points and hopefully you'll get the best cover possible with the most accommodation provider.

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The Importance of Your Health Care Deductible

Health insurance plans are complicated. This used to be the problem of the Human Resources department. However, today more Americans then ever are sharing the responsibility of making decisions for their employer based health care coverage. Millions more are on their own, purchasing health insurance in the private market. While many decisions are centered on the monthly premium, the level of your health insurance deductible can greatly impact the overall cost of your plan and even your level of care.

What Is A Deductible?

A deductible is the amount of health care that the insured must pay before the health plan provider begins to make payments. The deductible applies only to medical care that has been billed directly through the insurance provider. It does not apply to any medical care paid for outside of the health plan.

Deductibles can vary widely from just a few hundred dollars to over $10,000 a year. Some will vary based on in-network versus out-of-network medical care. The deductible is wiped clear once a year, usually on January 1st.

Growing Influence

Most people have typically received health care coverage through their employer. Under such plans, the worker generally paid very little for actual medical care used. There might be a co-pay for a visit to the doctor and perhaps a small yearly deductible, but for the most part, benefits meant you did not pay much, if at all, for the health care you used.

But that's often no longer the case. The reality is that health care costs have been on a steady, high growth rate over the past two decades. The cost for an employer to provide health benefits has reached a critically high level, in many cases well over five figures. In response, many employers have pushed some of the costs back on the employee. This is often seen directly in an increased share of the monthly premium paid by the employee, but also an increase in plans with high deductibles, most or all of which will be the responsibility of the employee.

High or Low?

When selecting a health care plan, many people focus on the monthly premium. When it comes to budgeting, many people think in month-to-month terms. Low premium, high deductible plans can look attractive. However, with such plans, the insured will have to spend a lot of money out of pocket, in addition to the premium, in the event that they use medical care. Plans such as these are best paired with a health savings account, so that money can be saved tax-free towards the deductible. Otherwise you may be stuck with a very large medical bill you are unprepared to pay.

Many people are used to low-deductible plans, and often prefer them. Its nice to know your medical care has been largely taken care of in a standard monthly payment. Part of why people have insurance is to have predictable costs. However, the cost of high premium plans has risen dramatically over the years, often beyond what a car payment is and in some cases rivaling a house payment. This has made high premium plans less attractive.

What Is Best For You?

In general, a high deductible plan will have a lower total yearly cost then a high premium plan. This is because many people do not use as much medical care as they think over the course of a year. What they have to pay towards a deductible is often offset by their monthly savings with the lower premium.

If you are someone who uses a lot of health care year in and year out, a high premium plan may be a better solution. High premium plans can also be a good decision for people who have a hard time saving. A high deductible plan can be a major hardship for people who do not have much in savings and who typically do not save a lot of money. A high premium plan is somewhat like a forced savings plan.

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Deciphering Medicare Eligibility

Questions arise all the time about Medicare. Eligibility, cost and coverage are the three topics of conversation that are talked about the most. Eligibility is a topic all in its own. Most people are under the assumption that the only requirements to qualify for Medicare benefit is that they have turned sixty-five. That however is not the case. This article will help layout guidelines on eligibility so that it is easy to determine if you fall under the guidelines to qualify for the Medicare benefits and Medigap supplement insurance.

The first group of people we will look into is the group of adults that are sixty-five and older. Sixty-five is a qualifying age however there are other requirements that must be met to receive Medicare aid from our government. It is a must that you are a United States citizen or legal resident. You must also have proof that you have lived within the United States for at least five years. It is also important to note that you receive Medicare from working at least ten years in Medicare covered employment.

If you find you meet all three of these guidelines it is most likely that just prior to your sixty-fifth birthday you will receive a Medicare card and packet in the mail. This will detail what Medicare is, what it offers to you and how you start using it for your health care needs. You are automatically given both Medicare part A and Medicare part B. Part B can be declined as it is optional and does require a monthly premium.

If you are under sixty-five you can also qualify for Medicare benefits under certain circumstances. One is if you have End Stage Renal Disease. Kidney disease does allow you to qualify for Medicare benefits if you are under sixty-five. Another reason qualifications for Medicare are considered under sixty-five is if Social Security Disability Income has been received for twenty-four months.

Medicare is not the perfect coverage. It will not cover all of your medical expenses. This is why it is so important when you finally do qualify for coverage that you look into different Medigap supplemental insurance plans. Medicare does not cover prescriptions and does require you pay premiums and co-pays. Additional coverage through the supplemental insurance will help to fill in gaps left by Medicare coverage.

There are multiple items that Medicare part A and part B do not cover. Below is a sample list of items that are not covered and that additional coverage should be sought out if they are important for your well being both financial and health.

Acupuncture is a type of alternative medicine is not covered. Acupuncture is a treatment that works through the insertion of thin needles strategically placed throughout the body to help cure ailments.

Dental care is an incredibly important part of the aging process and is not part of Medicare. It is advisable if your dental history has been anything less than stellar that you seek out additional insurance to fill the gap left by Medicare.

Chiropractic care is also something that many older people rely on that is not covered. Often time's doctors of chiropractics will offer discounted rates to seniors. This is something to think about however when seeking out gap insurance if your doctor is not one that does.

Obviously the list of covered versus not covered is detailed in great lengths through handbooks, websites and pamphlets. Supplemental insurance providers are a great source of knowledge as they can review your past history with you and based on the pattern that has developed guide you into the right combination of plans. This way you are not purchasing additional coverage that is not ever going to be utilized.

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Don't Let Switching Health Insurance Plans Scare You

Even though the old platitude goes the only constant in the universe is change, sometimes changes is a good thing, especially when you have become complacent with the current state. You have developed a current monthly budget based off of your bills: rent or mortgage, power bill, phone bill, cable bill, etc. and you've come to a place where you expect to have to pay out X dollars every month to keep those bills current. Even though this is comforting in one respect, it makes sense to take a look at your subscriptions plans and programs to see if making changes will save money. This even applies to your health insurance plans.

While it's easy to be satisfied with what you've got, if your policy is over a couple of years old, it may be an idea to see what's new. Taking the time to sit down with your health insurance provider to see if there are better options or other ways to structure your policy to improve your coverage at a better price can be very beneficial. With the changes that have occurred in the last couple of years and with the changes still to come, you may be over spending on health insurance.

New offerings like HSA's (Health Savings Accounts) enable you to have a higher annual deductible which reduces your monthly premium dramatically. These are especially handy if you (and your family) are pretty much healthy and you rarely if ever meet your yearly deductible anyway. The money you save on monthly premiums can be kicked into an HSA to take care of the deductible if you need it. The best part on your health insurance package is that the HSA funds roll over each year. Once you've saved the money for your deductible, you can use the extra money for whatever you want.

Also, looking at changing companies may be a viable option. Not only can companies offer incentives to new clients who may save you money, their health insurance programs may actually be less expensive than your current plan. Changing over companies can be a little tedious but the health insurance agents are more than capable of handling the details so if you can put together a better package with a different company, you may come out ahead.

This is especially true if you have your health insurance plan with the same company you have your homeowner's and auto insurance plans with. A lot of companies now offer significant discounts when you combine programs. That's because they get more of your business each month on one bill that covers all your insurance needs at a lower price. This can actually save you the most money overall.

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What Will Tennessee Health Insurance Do With Health Care Reform?

A study by Blue Cross Blue Shield of Tennessee takes an in-depth assessment of the possible effects that national health care reform could mean for Tennessee residents. The study estimates that 683,000 Tennesseans will get new Tennessee health insurance coverage under health care reform. It also focuses on possible changes in access to medical care, as well as the shift from employer-provided TN health insurance to the state exchange.

Dr. Steven Coulter, president of the Tennessee Health Institute, conducted the study entitled "National Health Care Reform: The Impact On Tennessee." According to Coulter, the study explores how the expansion of Medicaid and the establishment of the TN health insurance exchange in 2014 will affect the residents of Tennessee.

Coulter says that since the advent of Medicare in 1965, the Patient Protect and Affordable Care Act has been the largest expansion of entitlement programs. "With the expected increase in consumers eligible for Medicaid expansion coverage and an estimated 1.5 million qualifying for subsidies in 2014, there is a great deal that needs to be addressed to ensure a smooth transaction," he says. Coutler also noted that people who already have access to health care might have to wait longer when more people can afford to see a doctor unless there are basic changes to the health care system.

What's Happening With The Shortage Of Doctors In Tennessee?

Long before health care reform, an appalling shortage of doctors was noted in Tennessee, and the situation has improved dramatically in some counties. On October 26, 2011, The Jackson Sun reported that the situation had improved in rural West Tennessee. Specifically, the doctor-patient ratio in Hardeman County went from one doctor per 4,675 people to one doctor per 2,229 people from 1992 to 1999. Chester County saw similar improvement with the ratio of one doctor per to 6,409 people falling to one doctor per 2,505 people.

What's Happening to Tennessee Health Insurance Prices?

Coulter also notes the possibility that young adults will have to pay more for Tennessee health insurance by 2014. That's because health care reform tends to level the playing field, so to speak. Groups, like the long living, have been paying high premiums, while young people have been paying low premiums. To average out the price of TN health coverage for all residents, some will likely end up paying more, but those who have been paying high rates, will get a break.

Who Stands To Gain The Most From Health Care Reform?

Overall, the people with the greatest economical disadvantages stand to benefit most as access to health care is extended to more state citizens. People who have been barred from getting TN health care coverage based on medical conditions will also get greater access to health care when they can finally get coverage.

Employers are also expected to have financial gains when they can encourage employees to get Tennessee health insurance through the exchange because not providing coverage will improve the company's bottom line.

Will Everyone Directly Benefit From Health Care Reform?

It remains to be seen whether people who currently have TN health insurance will have longer wait times for health care, with more doctors and clinics coming to the state. For example, a federally-funded clinic opened in Hardeman county in 1993 and in Hardin county in 1995. In East Jackson, West Tennessee Healthcare opened a clinic in 1996, and federally-funded clinics have been operating in Fayette and Lake County since the 1970s.

Tennessee health insurance companies will have to navigate new price regulations and could see their profit margins decreasing over time. Insurers selling individual TN health insurance plans are already required to spend 80 percent of the premiums they take in to pay for policyholders' care. That reduces the amount of premiums they have been permitted to keep as profit. Group plans have been managing regulations that require they spend 85 percent of premiums for policyholders' care, though.

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Medicare Part C

What is Part C?

Medicare Part C is also referred to as "Medicare Advantage." Medicare Part C is offered only by private companies with a Medicare contract. If you join a Medicare Advantage Plan, the plan will provide Part A (Hospital Insurance) and Part B (Medical Insurance).

What Does Part C Cost?

Today, many Medicare Advantage Plans are eliminating their monthly premiums. Complementary to the removal of premiums, the out-of-pocket costs for these plans are typically lower than the out-of-pocket costs in Original Medicare (4). There are different out-of-pocket costs associated with different Medicare Advantage Plans, so it's important to do your research. Your out-of-pocket costs for Medicare Part C are dependent on (1):

If the plan charges a monthly premium. If the plan pays any of your monthly Part B premium. If the plan has a yearly deductible or any additional deductibles. The fees for each visit or service (copayments or coinsurance). The type of health care services you need and how frequently you receive them. If you follow the rules of the plan, like using network providers. If you need extra benefits and if any costs are associated to these benefits. The plan's yearly limit on out-of-pocket costs for all your medical services.

If the Plan pays any of your Part B premium, also known as Part B Premium Reduction:

The Medicare Part B premium is covered for full Dual Eligible members Premiums, co-pays, co-insurance, and deductibles may vary based on the level of help received for Dual Eligible SNP members

What Does Part C Cover?

Remember, everything that is covered by Part A and Part B is covered with a Medicare Advantage Plan. If you are covered by a Medicare Advantage Plan, you receive coverage for all medically necessary services, including emergency and urgent care. Private companies that offer Medicare Part C usually have networks of doctors, and this may mean that you will have to see your plan's doctors in order to receive care. When making your decision on Medicare Part C, it's a good idea to ask if the doctors near your home are included in their network.

With the exception of hospice care, Medicare Advantage plans are required to cover all of the services that Original Medicare covers. Original Medicare covers hospice care even if you're are enrolled in Medicare Part C. Medicare Advantage Plans are not supplemental coverage.

When Can You Enroll in a Medicare Advantage Plan?

Each year, there is a specific time when you can enroll in a Medicare Advantage Plan called the Annual Election Period. Get your daily planner and Google Calendar ready; the 2012 Annual Election Period is scheduled for October 15-December 7, 2011. With the exception of those beneficiaries that become eligible for an Initial Enrollment Period or Special Enrollment Period, this is the time period that applies to you. The time frame for the Annual Election Period is subject to change from year to year, so make sure to check for updates!

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Need Insurance? Choice Is Vital

Do you need health insurance? Choice in the matter is a vital part of making sure that you and all citizens are able to make the decisions that make the most sense for you and your family. Your health, like your shoes shouldn't be viewed as a one size fits all proposition. We all have different health needs, different budgets and different degrees of comfort with risk. Being able to choose a plan that fits you as much as possible is the first step to making sure you continue to lead a life of good financial and physical health.

What are some of the things that make a difference when searching for health insurance? Choice in providers is one of the big factors. You need to be able to compare plans from several different insurance firms and go with one that you feel comfortable with. You should be able to choose a provider who you trust and whose reputation gives you a sense of comfort and stability. Being forced to go with one insurance provider is a major drawback of many employee sponsored plans. Of course, the group rate discount is very attractive but it can be frustrating to feel trapped with a provider who you do not trust or who doesn't provide you with excellent customer service.

Health insurance in the United States has been inextricably tied to employment for many for many decades. Many people can't imagine it another way and are scared to go off on their own to find insurance. The truth is, it is more than possible to purchase insurance privately for yourself and your family but the premiums will almost certainly be higher. On the other hand, if you do provide your own health insurance you might no longer feel chained to a job that you do not enjoy. It could be very worth your time to at least research the possibilities and expense involved in purchasing a private health insurance policy just so you know what your options are.

Imagine no longer feeling trapped in the corporate world, knowing that you can get health insurance that can insure you get the treatment you need without breaking the bank. Or feeling like the provider you've been given is not your only option and that you can go with one you like and trust. Do your homework because when it comes to health insurance, choice really is yours.

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Will Tennessee Health Insurance Rate Hikes Be A Thing Of The Past?

U.S. Department of Health and Human Services Secretary Kathleen Sebelius has announced that the Affordable Care Act grant will provide $3,979,002 to Tennessee to combat unreasonable TN health coverage premium increases. Sebelius also released a report called "Rate Review Works" to show how previous rate review grants have helped to mitigate insurance premium hikes and increase transparency in the marketplace.

While Sebelius says, "States continue to have the primary responsibility for reviewing insurance rates and these grants give them more resources to hold insurance companies accountable, the grants are just the most recent federal action to increase access to health insurance for Tennessee. Almost $250 million in grant money have been distributed to different states to facilitate health insurance rate reviews.

Tennessee Health Insurance Changes Follow Health Care Reform

As of September 1, 2011, health care reform requires Tennessee health insurance companies that plan to increase individual and small group insurance premiums by more that 10 percent to submit a request. If the rate increase is deemed to be unreasonable, the insurance company will need to publicly justify it. Federal authorities hope that this will improve health insurance accountability and lead to significantly lower costs for individuals, families and small business owners who buy coverage through the individual marketplace.

This May, Governor Haslam signed a bill into a law that expands the TN Department of Insurance's scope of review and gave the Department an approval authority regarding proposed rate increases on individual and small group policies. Currently, the department is working on regulations regarding its new approval authority.

As of July 1, 2011, all individual and small group Tennessee insurance rates needed to be filed in advance for this approval from the commissioner. The department is exploring how to incorporate the Tennessee's All Payer Claims Database in order to enhance the rate review process.

Tennessee Health Insurance Has Not Yet Met All Of The Affordable Care Act Provisions

The state is one of four granted a temporary one-year waiver to slowly transition from policies available prior to health care reform to those that meet new national standards for increased coverage. The waiver was deemed necessary to prevent some Tennesseans from losing their existing coverage, even if it was below national standards.

Certain fast food restaurant chains implied they would end insuring workers completely if required to offer more substantial health coverage for Tennessee. These companies, along with Tennessee health insurance companies, are still required to meet federal standards after the waivers expire.

While marginal health coverage is better than none at all, some of the policies available in Tennessee have been criticized as leaving policyholders exposed to major medical costs that could ultimately force bankruptcy. One of the most critical elements of any insurance policy is the maximum out-of-pocket annual limit. That's a fancy way of saying the total amount of medical costs that you could be responsible for paying in a single year.

Since policies contain co-payments, co-insurance and sometimes multiply deductibles, confirm what you'd end up spending in a worst-case scenario. Why don't Tennessee insurers just say what they will pay and what you'll have to pay? Perhaps someday the pressure to increase transparency will make that possible. For now, there are online resources that can help you decipher what insurance terms mean in terms of how much you'll actually be paying for health care with a particular policy.

What To Look For In The Right Medicare And Medicaid Attorney   Comparing Healthcare Plans   Health Insurance - Benefits of Private Care   Average Cost of Health Insurance   Will More Tennessee Health Insurance Access Lead To Delayed Treatment?