An Overview of Health Insurance Plans

Chances are, you have health insurance—only about 11 percent of Americans are uninsured. But unless you've had experience using your health insurance plan for significant medical treatment, you might not have paid much attention to the details of your coverage. And if you've had to shop for your own coverage or select from among several options offered by your employer, you might have found the choices overwhelming or confusing.

Regardless of where you obtain your health insurance, it's important to understand the terminology used to describe policies and coverage and to be able to compare plans. Knowing how your plan works—before you need to use it—is essential; you don't want to be sorting out the details of your coverage while you're sitting in a hospital room.

Where Can You Turn for Help?

Roughly half of Americans get their health insurance from an employer.

Help with plan selection, enrollment, and using your coverage is always available, regardless of where you get your coverage. If your employer offers health insurance coverage, don't be shy about asking questions. If there's a human resources department at your company, helping you understand your benefits is part of their job.

If you work for a smaller employer that doesn't have a dedicated human resources team, they can direct you to resources that can help you, including the health insurance carrier, the broker who helped the employer choose the coverage, the small business health insurance exchange, or a third-party payroll/benefits company that the employer uses.

Anytime you're verifying benefits or claims data, ask for details in writing so that you know for sure that the information is accurate.

In the case of buying your own health insurance, brokers are available to provide assistance online, over the phone, or in-person—and there's no charge for their services. Brokers can help you compare plans both on and off the exchange. If you know you want to use the health insurance exchange, there are navigators and certified enrollment counselors available to help you enroll. To find the exchange in your state, you can start at Healthcare.gov and select your state. If you're in a state that has its own exchange, you'll be directed to that site.

For Medicaid or Children's Health Insurance Program ( CHIP), your state agency can help you understand the benefits available to you, if eligible, and assist you with the enrollment process. You can also enroll in Medicaid or CHIP through the health insurance exchange in every state.

If you're eligible for Medicare, you can use your State Health Insurance Assistance Program as a resource.

  •  
    With Multiple Coverage Options, Which One Should You Choose?
  •  
    Open Enrollment Is Your Time to Pick the Best Medicare Plan for You

There are also brokers nationwide who help beneficiaries enroll in Medicare Advantage plans or supplemental coverage for Original Medicare.

Decisions, Decisions, Decisions

In some cases, your plan options may be limited, like if your employer offers only a single plan.  But most people have a few choices when it comes to selecting their health insurance. Your employer may offer a range of plans with varying coverage levels and monthly premiums. If you buy your own health insurance, you can select from any plan available in the individual market in your area (on or off-exchange, although premium subsidies are only available in the exchange).

 

 There's no one-size-fits-all when it comes to health insurance. The plan that will be best for you depends on a variety of factors:

  1. Do you have any pre-existing conditions? This is no longer an issue in terms of coverage availability as the Affordable Care Act banned medical underwriting as of 2014. But it will definitely be a factor in terms of picking a plan, because benefits, out-of-pocket exposure, covered drug list (formulary), and provider network vary considerably from one plan to another.

    If one member of your family has pre-existing conditions or is anticipating significant medical expenses in the coming year, you may want to consider enrolling the family in separate plans, with more robust coverage for the family member who's expected to need more health care during the year.

  2. Do you take any prescription drugs? Be sure to check the formularies of the health plans you're considering. You may find that one plan covers your drugs in a lower-cost tier than another or that some plans don't cover your medication at all. Health plans divide covered drugs into categories, generally labeled Tier 1, Tier 2, Tier 3, and Tier 4.

    Drugs in Tier 1 are the least expensive, while those in Tier 4 are mostly specialty drugs. Drugs in Tier 4 are generally covered with coinsurance (you pay a percentage of the cost) as opposed to a flat-rate copay. Given the high sticker price on specialty drugs, some people end up meeting their plan's out-of-pocket maximum very early in the year if they need expensive Tier 4 drugs. Some states, however, have implemented limits on patient costs for specialty drugs.

    If you're enrolling in Medicare, you can use Medicare's plan finder tool when you first enroll and each year during open enrollment. It will let you enter your prescriptions and help you determine which prescription plan will work best.

  •  

    Is Pregnancy a 'Qualifying Event' for Health Coverage?

  •  

    Does Health Insurance Cover Transgender Healthcare? It's Complicated

  1. Are you currently receiving medical care from a particular physician or hospital? Provider networks vary from one carrier to another, so compare the provider lists for the various plans you're considering. If your provider isn't in-network, you may still be able to use that provider but with a higher out-of-pocket cost or you may not have coverage outside the network at all.

    In some cases, you'll need to decide whether keeping your current provider is worth paying higher health insurance premiums. If you don't have a particularly well-established relationship with a specific doctor, you may find that selecting a plan with a narrow network could result in lower premiums.

  2. Are you anticipating any expensive medical care in the coming year? If you know you have an upcoming surgery, for example, or you're planning to have a baby, it will likely make sense to pay higher premiums in trade for a plan with a lower out-of-pocket limit.  Keep in mind that you may get a better value from a plan with a lower total out-of-pocket limit, regardless of how much the plan requires you to pay for individual services prior to meeting that out-of-pocket limit.

    For example, if you know you're going to need a knee replacement, a plan with a total out-of-pocket limit of $3,000 might be a better value than a plan with a $5,000 out-of-pocket limit. Even if the latter plan offers copays for doctor visits, the former plan counts your doctor visits towards the deductible.

    It would ultimately be a better deal to pay the full cost of your doctor visits if you know that all of your healthcare spending on covered services will cease once you hit $3,000 for the year. Getting to pay a copay—instead of the full cost—for a doctor's visit is advantageous in the short-term. But for people who are going to need extensive medical care, the total cap on out-of-pocket spending may be a more important factor.

  3. Do you travel a lot?  You may want to consider a PPO with a broad network and solid out-of-network coverage. This will be more expensive than a narrow-network HMO, but the flexibility it offers in terms of allowing you to use providers in multiple areas might be worth it. If you're enrolling in Medicare, your travel plans will probably make Original Medicare—plus supplemental coverage—a better choice than Medicare Advantage, since Medicare Advantage has limited provider networks.

  4. What's your tolerance for risk? Do you prefer to spend more on premiums every month in trade for lower out-of-pocket expenses? Is having a copay at the doctor's office—as opposed to paying for all of your care until you meet your deductible—worth higher premiums? Do you have money in savings that could be used to pay for your health care costs if you opt for a plan with a higher deductible?

    These are questions that don't have a right or wrong answer, but understanding how you feel about them is a key part of picking the health plan that will provide you with the best value. The monthly premiums will have to be paid regardless of whether you use a million dollars worth of healthcare or none at all. But beyond the premiums, the amount you'll pay throughout the year depends on the type of coverage you have and how much medical care you need.

    All non-grandfathered plans cover some types of preventive care with no cost-sharing—meaning there's no copay and you don't have to pay your deductible for those services. But beyond that, coverage for other types of care can vary substantially from one plan to another. If you select the plan with the lowest premiums, be aware that your costs are likely to be higher if and when you need medical care. 

  5. Do you want to be able to contribute to a Health Savings Account (HSA)? If so, you'll need to make sure that you enroll in a High Deductible Health Plan (HDHP) that is HSA-qualified. These plans cover preventive care before the deductible, but nothing else. HSA-qualified plans have minimum deductible requirements along with limits on maximum out-of-pocket costs.

    You or your employer can fund your HSA and there's no "use it or lose it" provision. You can use the money to pay for medical expenses with pre-tax dollars, but you can also leave the money in the HSA and let it grow. It will roll over from one year to the next and can always be used—tax-free—to pay for qualified medical expenses even if you no longer have an HSA-qualified health plan.

A Word From Very well

Health insurance is essential but it can also be frustrating and complicated. Regardless of whether you have a government-run plan, coverage offered by your employer, or a policy that you bought for yourself, a solid understanding of how health insurance works will serve you well.  The more you know, the easier it will be for you to compare plan options and know that you're getting the best value from your health insurance coverage. And rest assured that help is always available if you have questions.

Share or Bookmark this post…

How Important Is Exterior Painting Surface Preparation ?



You could spend $80/gallon on the best lifetime-warranty paint on the market and apply six coats, but if you're not spending the time to do your surface preparation correctly it would all be for naught.  Without a doubt, the amount of prep you do will determine the longevity of your exterior painting job.  

When I used to work for one of the largest coatings manufacturers, part of my job description was resolving paint failure complaints.  And I can tell you from experience, the overwhelming majority of paint failures are the direct result of inadequate surface prep.  Period.

Some people skimp on prep work because it's hard, time-consuming work; some because they don't understand just how important it really is; and some because they don't know how to go about it.  While we can't do much about the difficulty of the job, this week's article will go through each step in the process so at least you'll have the know-how to get it done right.

 

1.)  Clean

Houses get dirty from dust and other environmental contaminants.  If you leave these contaminants on the surface when you paint, your paint will be sticking to the dirt and not to the surface that you want it to stick to.

When I was investigating paint failures it was easy to tell when lack of pre-paint cleaning was the cause of a paint failure.  I could just look at the back of a paint chip that was peeling off of the house and if I could see dirt then I knew that it hadn't been cleaned properly.

I can also tell you that if you begin the warranty claim process with the store where you purchased the paint, they will likely send a representative out to your home and go through the same steps to determine the cause of the failure.  If they find contaminated paint chips they will most-likely refuse to honor the terms of the 20-year, 30-year, or lifetime warranty on the label of the can that you paid so much extra money for.

So do yourself a huge favor and do a thorough pre-paint cleaning of all of the areas to be painted.  You will get far more life out of a mid-grade paint that's been applied over a clean, well-prepared surface than you will out of a top shelf product that's been put on a dirty house.

The only question really is how to do your pre-paint cleaning.  There are a couple of choices when it comes to cleaning -- high pressure washing or hand scrubbing.  There are benefits and drawbacks to both methods, so check out our blog article 'Pre-Paint Cleaning Methods:  Pressure Washing Vs. Hand Scrubbing' for specifics on how to go about doing both of them.

 

2.)  Let It Dry

This may sound a bit ridiculous but it should be said that paint, primer, and caulking do not stick well to damp surfaces.  Pre-paint cleaning will make your siding wet, and if you've used a pressure washer it can stay wet for days.

Always be on the safe side and allow several days for the surface to completely dry-out before you proceed to the next step.  For those of you in a rush to get the project completed, down-time can be frustrating, but at least this step doesn't require any physical labor on your part.

 

3.)  Scrape

By the time most folks get around to painting their home it's because they're starting to see peeling paint.  If that's also true in your case, you'll need to scrape all of the loose coatings until all that's left are sections of well-adhered paint and bare surfaces.  Leaving any peeling or curled edges will definitely result in paint failure.

There are lots of different types of scrapers on the market.  I personally prefer a long-handled pull scraper.  They make quicker work of removing peeling paint, and have replaceable blades for when it becomes dull.  Just be careful with them because they can gouge into the siding if you get aggressive with your work.

It's also helpful to have a painter's multi-tool so you can get into tight areas and corners easier.

 

4.)  Repair Damage & Set Nail Heads

If you have any rotted or damaged sections of siding or trim then you'll want to repair them at this stage of the game.  Check out this recent blog post on Exterior Rotted Wood Repair Tips for more information on how to do it.

Be sure to set any protruding nail heads just slightly below the surface as well, using a hammer or the butt end of your painter's multi-tool.

 

5.) Sand

The next step is to sand all of the surfaces smooth.  This includes sanding down any rough exposed wood as well as feather-sanding the edge of the remaining paint that's still on the siding.  This will reduce the appearance of the transition from the bare surface to the existing coating when you paint over top of it all.

Do yourself a favor and either purchase or rent an electric sander for this job.  A belt sander will work, but can be a bit aggressive at times.  The best choice would probably be a random orbit sander.  Pick up some medium and fine grit sandpaper.  If the surface is rough you'll need to start with the medium grit and finish with the fine grit, if it's not then you can skip straight to the fine.

After you've sanded everything down you need to remove the dust from the surface so the primer and paint will stick.  You can wipe it all down with a rags, blow it off with an air compressor, or give it a rinse with a garden hose or the pressure washer.  If you do use water, make sure you wait until it's completely dry before proceeding.

 

6.) Prime

If you didn't have any peeling paint you should be able to skip this step and go on to the next.  If you did then you'll at least need to do some spot-priming of the bare areas, because paint doesn't always stick well to bare substrates.  Make sure to use a good quality primer that's suitable to being used on the surface you're applying it to.  

There are several multiple-use primers on the market that will work for most applications.  One of my personal favorites is Bullseye 1-2-3 made by Zinsser.

Rarely is there a need for complete stripping of the old coating prior to painting.  However, there are some situations when the old paint will not stop peeling.  Fortunately there is a line of primers that are on the market now that can even solve this problem and save you from a paint stripping nightmare.

Also check out our blog article entitle Primer Before Paint:  When Is It Necessary & When Is It A Waste? for more information on the topic of priming.

 

7.) Caulk

Caulking doesn't just make your paint job look pretty it also keeps water from getting into the structure and causing damage.  Make sure all siding butt joints, as well as gaps where siding meets trim are sealed to prevent water infiltration.  But don't get overzealous and caulk the horizontal laps on clapboard siding as this would prevent it from breathing.

Before applying new caulking be sure to dig out any existing caulking from the joints that has either cracked or pulled away from the joint.  With a little instruction and practice you can apply caulking like a professional painter and your project will turn out looking great.

FYI, there is a huge selection of caulking to choose from along with a wide range of prices.  There is absolutely a big difference in performance in caulking so buy the best that you can afford to use.

 

Once you've completed these steps, you're ready for paint.  There are some important things to consider when choosing an exterior paint so do your research before going shopping.  If you're going to put that much time and effort into prep work you want to make sure that you're picking a coating that will hold-up well for you for several years.

 

Share or Bookmark this post…

Maintain Your Car With An Auto Warranty

A car is a huge investment. The cost of a car doesn’t end when you pay the sticker price listed on the window. There are a multitude of other costs including, gas, maintenance, insurance, depreciation, and an auto warranty.

Luckily for consumers, cars designed today run for about 15 years and for more than 100,000 miles.

Even though costs like insurance, fuel, used car warranties, and new car warranties are out of a consumer’s control, the owner of the car can maintain the car in order to keep the value of the car as high as possible when it comes time to trade it in.

A car that is taken care of properly can increase the value of the car dramatically. Money you get from selling the car can always be put towards the purchase of a new car.

Studies have shown that approximately fifty percent of motorists keep their cars for a range of one to four years. As a result, motorists should know the their car’s true value when it comes time for them to sell it.

Therefore, it is always smart to maintain your vehicle. In addition, purchasing an auto warranty can help save you money on the costs of necessary repairs and maintenance that need to be performed on your car. When it is time to sell your car, you will not regret properly maintaining it.

 

Share or Bookmark this post…