Many Americans are concerned with insuring the everyday mishaps like bodily injuries and emergency room coverage. Of course, insuring things like Cancer and Heart Attacks are important, but for younger adults and especially kids, emergency room visits are far more prevalent. Unfortunately, a trip to the emergency room isn't cheap and the healing process from a serious bodily injury can be exhausting. Damaged body parts often need to be surgically corrected and the post operation Physical Therapy sessions feel like a Sylvester Stallone Rocky Movie. I'm not going to lie, the Rocky Four soundtrack got me through my Physical Therapy workouts post ACL Knee surgery.
Health insurance for the self-employed is especially complicated when it comes to emergency room visits. To qualify for a Major Medical PPO plan one must go through underwriting and medically qualify. Assuming you get approved, you'll need to select a deductible and plan style. The most cost effective PPO policies in the individual health insurance market are the HDHP (High Deductible Health Plan) plans. Deductible is the out of pocket expense the insured has before the health insurance policy picks up the bill. PPO stands for Preferred Provider Organization and is the type of health insurance that lets you choose any doctor. Choosing any doctor isn't necessarily true, theirs a lot of gray area with "being in network or out of network" with PPO's.
Deductible options for individuals in the PPO market are $1,500, $2,500, $3,500, and $5,000. Typical family deductible options are $3,000, $5,000, $7,000, and $10,000. You'll want to choose a co-insurance of 100%. Co-insurance is the shared expense between you and the insurance company after the deductible. Most people are familiar with 80/20 % co-insurance. 100% co-insurance is popular because you won't need to understand Calculus to figure out any future hospital bills. Insurance plan picks up 100% of the bills after deductible with this option. On a side note, it's a good idea to set up a Health Savings Account. HSA's have some decent tax advantages and you can set up an account equivalent to the deductible amount. So a $10,000 HDHP can have a $10,000 health savings account attached to it. The yearly max contribution to the health savings account is determined by your HDHP deductible. Ask your CPA about health savings accounts if your self-employed.
Higher deductible health insurance plans have lower monthly premiums. However, with that high deductible comes risk of having to owe that deductible amount if you use the health insurance. A $5,000 dollar deductible hospital bill is one broken bone away. Guess how a lot of Americans end up paying that HDHP $5,000 deductible? You guessed it, in the emergency room from a accidental bodily injury.
Accident health insurance supplements have been doing a good job filling this ER gap for years. Other names used for this plan include personal accident insurance, emergency room insurance supplement, accident medical coverage, personal injury insurance plan, 24 hour accident coverage, and accident supplemental benefit plan. These plans are under marketed in my opinion, and most licensed health insurance agents are doing a disservice to their clients if they don't bring it up. I say this because so many people are shelling out a lot of money each month to insurance companies, and if they actually use the insurance could be stuck with a huge deductible bill.
Opposite the PPO health insurance industry is Guarantee Issue insurance products. Emergency room insurance supplements fall into this category and are automatic approval. Online applications have zero health questions but do need social security numbers and birth dates. This type of guarantee issue accident medical expense coverage is an indemnity. Indemnity's compensate members with a predetermined benefit amount.
Personal injury insurance plans in this category are membership based associations. The membership organization helps individuals and families in the United States gain access to discount programs and in this case, the pound for pound most practical emergency room insurance supplement I've seen so far.
Each association member can choose a benefit level of accident coverage to fit their monthly budget or to match the HDHP deductible. Plans cover the HDHP deductible giving high deductible health plans a virtual zero deductible effect. Remember, a lot of HDHP's max out deductibles from ER visits due to injuries. ER plan pays injury related expenses to pay off the PPO deductible. Again, plans only cover ER related expenses due to injury and not sickness.
Members can choose a emergency room coverage level of $2,500, $5,000, $7,500, or $10,000. Accident compensation benefits pay out per injury and have no limits on use. Typically a person will have a $100 dollar deductible per covered accident. ER policy pays up to the $2,500, $5,000, $7,500, or $10,000 per accident excluding the $100 deductible. In simple terms, you'll owe $100 dollars for any covered injury assuming the bill doesn't exceed the policy benefit max of $2,500, $5,000, $7,500, or $10,000.
Here's some figures on what the leading personal accident insurance dues are. Indemnity plan rate increases are seldom because it's an association based health insurance product.
-$24 dollars a month: $5,000 benefit individual plan.
-$29 dollars a month: $7,500 benefit individual plan.
-$36 dollars a month: $10,000 benefit individual plan.
-$35 dollars a month: $5,000 benefit family plan.
-$41 dollars a month: $7,500 benefit family plan.
-$47 dollars a month: $10,000 benefit family plan.
(family policy prices include everyone, it's the same price for a 3 person family or 12 person family)
It doesn't matter what accident health insurance plan brochure you pick up, all plan brochures EOB (Explanation Of Benefits) page say the same important benefit: Members may choose any Doctor, Hospital, or Emergency Room. Since this is accident indemnity, benefits have no restriction on health care providers to choose from. Accidents are unpredictable and so is knowing what emergency room you'll be showing up at. I can't imagine accident plans would sell if they came with some lame network provider booklet of acceptable doctors. This brand of accident coverage is 100% portable and can be used up to two months outside the United States while traveling abroad.
Accident Plan benefits at a glance:
-Hospital Emergency Care
-Doctor's fee for surgery (in and outpatient)
-X-Rays and MRI's.
-Hospital room and board.
-Operating Room Costs.
-Physical Therapy (super important post operation)
-Doctors visits (inpatient and outpatient).
-Dental treatment for injury to sound natural teeth.
-Splints, Crutches, and Casts.