The Pre-Existing Conditions Conundrum

There are times that finding an Illinois health insurance plan suitable for a pre-existing health condition is difficult, if not next to impossible. What do people do about that?

The first thing to understand when dealing with Illinois health insurance is what the definition of a pre-existing health condition happens to be. To simplify a sometimes long and drawn out description, a pre-existing condition is one where a person has seen a doctor and has been diagnosed with a “condition or illness,” and has been treated prior to applying for Illinois health insurance.

The tricky situation then becomes the fact that many Illinois health insurance companies use the application questionnaires to implement an exclusion period to defend themselves against people with pre-existing health conditions. It is often used as a loophole to deny insurance, rider it or accept it, but with a higher premium.

The conundrum in Illinois is that if a person is looking for individual Illinois health insurance and they have a pre-existing condition, the insurance company can turn them down unless the person happens to be eligible for an Illinois Health Insurance Portability and Accountability Act, HIPAA. Without getting too technical, HIPAA protects Illinois health coverage for workers and their families if they change or lose their jobs and provides protection for those with pre-existing medical conditions by limiting their exclusion period.
While it’s a good thing to have that law in place to protect people who need Illinois health insurance, the unfortunate thing is that the law hasn’t gotten rid of the ability of insurance companies to deny health insurance to those with pre-existing health conditions or even excluding medical conditions. What this boils down to is that there’s only guarantee issue in State sponsored plans and in insurance company funded plans. If an applicant for Illinois health insurance meets six HIPAA criteria, they are eligible for guaranteed issue HIPAA. In a pinch, this may be the only route those with major pre-existing health conditions are able to take.

Illinois health insurance companies all tend to handle pre-existing health conditions differently, so it’s best to do some serious research online and in person to find out what company and policy will be applicable. It’s a given that individual plans have more exclusions and are more expensive than group plans. When in doubt, ask a local insurance agent what is available and what the requirements are to apply.

Some of the most important insurance companies in the state of Illinois handle pre-existing conditions a little bit differently, because of this it is important to do some research and actually shop around for a policy before deciding to apply. Individual plans have more exclusions than group plans and that is why they are quite a bit less expensive, because they are more restrictive.

To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com

How to Get Competitive Health Insurance in Illinois

Getting competitive health insurance in Illinois is a whole lot easier that you might think.

How easy is easy? Really, it is a lot easier to get competitive health insurance quotes in Illinois by doing smart surfing online and finding a site that offers side-by-side competitive quotes. Not just a few things side-by-side, but a site that offers customers the best bang for their buck.

Keep in mind that not all the things one sees on an online insurance website are always applicable to your particular situation. For instance, you may find a totally outstanding quote and note that it is the “preferred” rate. That means you have to meet certain criteria in order to be eligible for that particular Illinois health insurance policy. This is one of the major reasons you will want to talk to the agent who owns and runs the website you are surfing, to clarify any questions you might have about the quotes you will receive.

Sometimes just reading quotes side-by-side online, or side-by-side comparisons made by an expert health insurance broker after you have provided your information makes sense and sometimes there are unanswered questions that can be cleared up by an insurance expert. Always take the time to carefully compare the health insurance plans you see online, paying particular attention to two things – what is included in the plan and what the price happens to be.

There are various choices of health insurance plans that may be tailor-made to suit your circumstances with some tweaking. You will definitely have a wide variety of carriers to choose from when you find an Illinois health insurance website with up-to-date information.

You might be wondering why you have a good chance of finding a “deal” on Medicare supplements. This happens because each private insurance carrier has the option to offer Medicare (if they do offer Medicare, as not all insurers do) at a rate they choose. So it makes a lot of sense to have a health insurance expert provide you with side-by-side comparisons after providing your information. Of course you will want to make sure that the Medicare supplements you want will dovetail with the Medicare plan you ultimately choose.

If at any time you have questions while getting your competitive Illinois health insurance quotes, reach for the phone and make that personal call to the expert. It goes without saying that you only want the best in Illinois health insurance for you and your family.

Randy Gillespie is with Illinois health insurance agency, Focus Insurance Group. To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com

Keeping Networks Is a Good Thing

Sometimes, the more things change, the more they remain the same. This seems especially true when talking about Illinois health insurance.

It wasn’t too long ago that Blue Cross and Blue Shield of Illinois told their members that one of their hospitals, St. John’s, was making the decision to discontinue its status as a Medicare Select contracting network hospital. That decision, which caused a lot of pandemonium, was supposed to kick-in on the 17th of June, 2009.

Of course the implications for a decision like this that affected Illinois health insurance echoed far and wide, with the major complaint, aside from what people would do to replace the service they were getting, was having to change to another type of plan that was more expensive. An agreement was ironed out where Blue Cross Blue Shield helped people who’d lost their original Illinois health insurance plans to get reinstated and credited for premium increases that arose due to changing plans.

This kind of thing raises the very specter of changes coming to the health care system over the next few years. And along with the changes come the questions of whether or not the changes will be beneficial. This is one of the toughest questions to answer with any degree of certainty.

It would involve having a crystal ball and a system that would address everyone’s medical needs; a system that would be affordable and accessible to all. Comprehensive health care reform is supposedly coming, and likely won’t come any too soon given the current state of the health system. In the meantime we muddle along with what works the best at any given time, and that includes Medicare Select.

Medicare Select is basically an Illinois health insurance Medicare supplemental insurance plan that provides you with choices. They also have the advantage of being priced at an even more reasonable level than the usual versions of Medigap insurance policies. The one major difference that you might want to be aware of is that Medicare Select acts like a managed care plan. That simply means that you’d have to use doctors and hospitals that are in an Illinois health insurance network. In addition, your insurance company will only pay full benefits if you got your medical care from a preferred health provider who is, once again, a part of the insurance company’s designated network.

Let’s take a quick look at an example. If you go to see a preferred provider physician, Medicare pays the approved charges. Your supplemental insurer pays the full benefits under your policy. However, if you choose to use services outside the plan network, the plan may deny the claim entirely or only pick up a very limited portion.

So really, there are three things you need to know and remember about a Medicare Select plan. The first thing is that it is considered to be an Illinois health insurance supplemental product, just about the same as Medigap insurance. In other words, when you buy a Medicare Select policy, you’re getting a standard Medigap plan. And, as we already pointed out (but it’s worth mentioning again) pretty much the only difference between a standard Medigap policy and a Medicare Select policy is that the Select policies are managed care plans. To get full benefits from the Select plans, you will need to use designated hospitals, clinics and even certain doctors. This will explain why these plans are priced lower than similar Medigap policies.

Something else you also need to know about Medicare Select plans is that they are typically only offered in larger cities in Illinois. If you live outside a large city, you may have other options. To find out what those options are, contact an expert Illinois insurance agent in your area.

Randy Gillespie is with Illinois health insurance agency, Focus Insurance Group. To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com

Insurance Buyer Beware

While it's a good thing to be able to access lots of Illinois health insurance quotes online, it doesn't always mean that what the consumer sees online will suit them.

It's a smart choice to find health insurance quotes online because it saves time. However, saving time and finding out what a person really needs to know doesn't always work when surfing the Internet. There's definitely a plethora of information about various Illinois health insurance plans, but is "all" the information there?

People may even apply for insurance online in the convenience of their own home, thinking they will avoid speaking to an Illinois health insurance broker. This is where people begin to fall through the cracks. Even if they are offered multiple Illinois health insurance quotes to compare online, no online insurance quote is able to completely answer all the questions a health insurance shopper may have.

Furthermore, even if an online shopper uses the single engine quoting technology, it doesn't mean they will get quotes on all the plans that are actually available. This largely depends on the state where the consumer lives, who the insurance carriers are, and which plan options that particular Illinois health insurance agency offers. Since these Illinois health insurance quotes can't give everyone every last plan they have online, most carriers will ask for contact information.

Once personal information is given, then in most cases, insurance companies are able to directly contact the consumer, if they want that kind of contact. There is an understandable reluctance to provide personal information by this method (quoting software) as there are some companies (even though they do provide quotes) that really only want the personal information to re-sell it.

A person who suddenly gets a whole slew of emails and phone calls from businesses vaguely related to Illinois health insurance will know their personal information was passed on. This is highly frustrating to people just wanting a quote and to talk to an agent for further clarification.

The other insurance marketing reality on the Internet is the tech companies who work it so their websites specifically gather names and contact info. The thing is that insurance agents or agencies do not own these sites; they belong to a company who sells leads to Illinois health insurance agents. The lesson is that if someone is searching for health insurance information, check the authenticity of the site by placing a call to the agent listed on the site.

To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com

For Those Who Need Insurance Now

When it comes to denying Illinois health insurance for pre-existing conditions, or having to sit out a waiting period, Americans are wondering what's the point in having insurance.

If someone does have a pre-existing condition and gets declined by an Illinois health insurance company, or in the alternative, gets told they could have coverage, but only after sitting out a waiting period, what good is health insurance? "People in these situations need Illinois health insurance now, not later. The plain facts of life are that if an individual is forced into a waiting period before getting coverage, it might be too late," said Randy Gillespie of the Focus Insurance Group in Liberty, Illinois.

It's downright amazing the kind of creative excuses that some Illinois health insurance companies use to not pay claims. While this is somewhat amusing, those who are currently pregnant might not be so thrilled with the fact that pregnancy is classified as a pre-existing condition. That means some insurance companies may deny you coverage if you are pregnant when you apply for insurance.

As unfortunate as this kind of behavior may be, it is the result of a free market populated with private health care companies. All of these private health care companies also have one thing in mind – the bottom financial line. If they think someone will cost them money, they may try and find a way to not offer Illinois health insurance. However, that does leave some people in a major bind.

There is a way around situations like this and that is to shop for guaranteed issue Illinois health insurance. "This means a person won't be denied health insurance – period. It means everyone gets approved, no matter what their medical history happens to be, whether or not they have pre-existing conditions, or are a higher risk for certain diseases or conditions. It's definitely possible to find guaranteed issue health insurance for those with pre-existing conditions," added Randy Gillespie of the Focus Insurance Group in Liberty, Illinois.

To find out more information about guaranteed issue health insurance for pre-existing conditions, contact an experienced Illinois health insurance broker who will not only explain how guaranteed issue works, but what its benefits are and how to sign up for it, if that is the decision.

To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com

Would Someone Please Explain Co-Insurance?

There aren't too many people who really understand the concept of co-insurance.

This isn't to say that some people "do" get the idea of what co-insurance really involves. There are, however, many more that get a nasty surprise when they leave a company for which they worked and had a group plan, a low deductible and a low doctor's office visit co-pay. Co-insurance has actually been around for quite a long time; it's just that managed care began to take over in the form of PPO and HMO plans.

In order to tackle the rising costs of health care, co-insurance came into being and varied by company and the plan they chose. It's used to be the good old standby of 80% and 20% for the next $10,000. This isn't to say that doesn't still exist, but there are now newer options to cut Illinois health insurance premiums. The low-end co-insurance range is 50% / 50% to the upper end of 100% with the co-insurance coming in at zero dollars to $50,000.

Would you want a 50/50 split? That depends on how you feel about taking risks and also takes into consideration one's budget and how healthy they happen to be. To be on the safe side, most savvy Illinois health insurance brokers will recommend the 80/20 or 60/40 percentages of the next $10,000 to $15,000.

So, to get to the meat of the matter, just what is co-insurance? Co-insurance is the amount of money you pay for medical services after you meet your deductible in a calendar year. A co-payment is a fixed dollar amount and co-insurance is a percentage. Let's look at a quick example: there are quite a number of insurance plans with a 20% co-insurance of the next $10,000 "after" the deductible for hospital expenses, diagnostic tests, x-rays and lab work. This means "you" pay the 20%. Remember however, that the amount is capped per calendar year.

So let's just use the example that you happen to have a $2,000 deductible in your calendar year with an 80% / 20% of the next $10,000. If you do the math, you will see that out-of-pocket expenses for that year would be $4,000 (for an individual) for covered services. Since a lot of this insurance lingo may be confusing, contact an Illinois health insurance expert to help you make some sense of co-insurance and what will work for you.

Randy Gillespie is with Illinois health insurance agency, Focus Insurance Group. To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com

COBRA and HIPAA Save the Working Day

If you've lost your job, then you're likely worried about medical coverage.

Losing a job these days in this recession seems to be far more common than we would like it to be. Those who still have jobs may even be thinking about quitting to work somewhere else with more stability, but are scared their health insurance provider won't take them on because of a pre-existing condition. In either of these situations, you can rely on COBRA or HIPAA. Both of these protect coverage if you are switching workplaces.

For those of you not familiar with the acronyms COBRA and HIPAA, they stand for Consolidated Omnibus Budget Reduction Act and Health Insurance Portability and Accountability Act. In terms of COBRA it will let workers extend health coverage when their employer's policy ends.

There are a number of reasons why that may happen, including your job is terminated, if you were covered but coverage is stopped because of legal separation or divorce, and in the event of a disability. There are other reasons as well, but it is best to speak with a qualified health insurance broker and have everything laid out in plain English.

Generally speaking, in most states, this kind of coverage is limited to workplaces with 20 or more workers. Having said that, there are states that have the minimum amount of employees, two. You need to ask an insurance expert what is applicable where you live.

Let's say you're out of a job. You now have 60 days to continue coverage under COBRA. If you choose to go that route, you then you have 45 days to pay your retroactive premiums. Once the premiums are caught up you will have coverage unless and until you cancel it, you stop paying premiums, become eligible for another policy or Medicare, or the COBRA continuation period has maxed out. Again, you really need to check all this out with an expert insurance agent who will be able to outline what you need to do and what will happen in various situations.

On the other side of the coin, HIPAA lets people switch companies and get approved whether they have pre-existing conditions or not. It's pretty straightforward and simple. The company you go to must accept you. Again, there are a multitude of things you will need to know about HIPAA protections; e.g. pregnancy/prenatal health problems are not pre-existing conditions.

Also speak to your insurance broker about acknowledging credit for prior insurance polices in the previous 12 months, etc. Rather than be confused, take the time to consult with a knowledgeable health insurance agent who can help you keep your health coverage while switching employers.

Randy Gillespie is with Illinois health insurance agency, Focus Insurance Group. To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit Focusinsgroup.com