Health Insurance: All prescription drug coverage is not alike

Not only are health insurance plans likely to vary on their approach to costs, but they also use different procedures to determine whether they’ll cover your prescription drugs, a new study shows.

Some health plans employ internal teams to make these decisions, while others assign the task to outside consultants, according to the study, sponsored by the National Pharmaceutical Council and conducted by research firm RTI International. Health plans also differ in what type of information they use to make these decisions. For example, one plan might place more weight on peer-reviewed studies about a prescription drugto determine whether it'll be covered, while another might rely more heavily on the plan’s internal data, such as the treatment outcomes of other plan members. 

Consumers should also take comfort in the fact that health plans look to an array of expert sources when it comes to evaluating drugs for specific conditions, says Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade association for the health insurance industry. For example, a plan might tap the National Comprehensive Cancer Network Drugs & Biologics Compendium for guidance about a cancer drug, Pisano says. 

A variety of approaches

The study examined 26 health plans. Most of them use medical directors and pharmacy directors as key members of the decision-making team, as well as specialists for certain conditions. “If a health plan were evaluating a new drug for rheumatoid arthritis, they would often bring in a rheumatologist to give expert input into how that drug compares to other drugs,” Halpern says.

All of the plans that participated in the study noted that a drug’s effectiveness was the most important factor in figuring out whether it would be covered.

However, that’s where the similarities end. Large health insurance companies typically spend more time and resources in the assessment process. They also are more likely to run the entire process internally, while smaller health plans are more likely to outsource the work to pharmacy benefits companies.

Cost also plays a role in the decision-making. Many plan providers place more expensive drugs on a higher tier, which means consumers will pay higher out-of-pocket expenses for them. However, some plans measure a drug’s effectiveness over time so that a drug that’s on a high tier may be re-evaluated and found to be more effective than alternatives. As a result, it may be put on a lower tier, making it less expensive for consumers.

A case for empowerment

While the health plans that participated in the study were not named, consumers can take steps to become aware of a plan's rules regarding drug coverage.
Consumers should look for transparency, says Jennifer Graff, the National Pharmaceutical Council's director of comparative effectiveness research. If a plan doesn’t post information about its decision-making process on its website, consumers can ask such questions as:

• What type of evidence is used to determine the effectiveness of a particular drug?
• Who makes the decisions about whether a particular drug is covered?
• How long after a drug is approved by the U.S. Food and Drug Administration is it reviewed by the health plan?

A good time to ask these questions is during open enrollment, when members can make changes to their health plans, particularly if an employer offers more than one health plan, Graff says.

Even if a drug isn't covered by an insurance plan or is considered too costly, consumers have options. They can look for assistance from co-pay assistance programs. For example, the Patient Advocate Foundation offers co-pay help to patients with chronic, life-threatening or crippling diseases.

Also, health plans typically offer generic drugs as an alternative to costlier brand-name drugs, Pisano says. In those cases, the generic drugs have undergone the same scrutiny as their more expensive counterparts, she says.

The bottom line: Consumers should take an active role in all facets of how their health care is managed.

By Tamara E. Holmes, InsWeb.com

Medical marijuana: Insurance and other questions

What was once considered an illicit street drug is quickly becoming a popular medicine across the U.S., raising questions about access and health insurance coverage.

Marijuana is now legal for medicinal use in 23 states and the District of Columbia, less than 20 years after California became the first state with such a law. But despite the rapid acceptance of medical marijuana, strict federal penalties remain for those caught possessing, selling or using pot.

"Although we've seen widespread adoption of medical marijuana and a real shift in how people think about this issue, we don't have one clear set of nationwide laws that medical marijuana patients and their doctors can easily follow," says Kris Hermes, a spokesman for Americans for Safe Access, a medical marijuana advocacy group.

People closely involved with the medical marijuana issue say the legal disparities have left bewildered consumers asking many questions, including the ones that follow.

Top 25 Insurance Companies

Below you'll find a list of the largest U.S. property and casualty insurers as measured by net premiums written and reported by A.M. Best.

Ranking	Insurance Company	Net Premiums Written
1	State Farm Group	$50,808,635
2	Allstate Insurance Group	$24,796,256
3	Liberty Mutual Insurance Cos.	$21,483,996
4	Berkshire Hathaway Insurance (includes Geico)	$21,358316
5	Travelers Group	$20,594,458
6	American International Group	$19,687,720
7	Nationwide Group	$14,489,531
8	Progressive Insurance Group	$14,476,676
9	Farmers Insurance Group	$14,129,512
10	USAA Group	$10,679,414
11	Hartford Insurance Group	$9,688,760
12	Chubb Group of Insurance Cos.	$8,927,736
13	CNA Insurance Cos.	$6,188,618
14	American Familiy Insurance Group	$5,324, 290
15	Aliianz of America	$4,666,301
16	Auto-Owners Insurance Group	$4,485,442
17	Munich-American Holding Corp.	$4,413,834
18	Zurich Finanical Services NA Group	$4,400,123
19	Erie Insurance Group	$4,019,273
20	Ace INA Group	$3,705,475
21	Transatlantic Holdings Inc. Group	$3,408,020
22	W.R. Berkley Group	$3,392,330
23	The Hanover Insurance Group Property & Casualty Cos.	$3,053,508
24	MetLife Auto and Home Group	$2,983,236
25	Cincinnati Insurance Cos.	$2,965,462

Health Insurance -- Everything You Need to Know

Health Insurance refers to a policy that is designed in such a way that it shall help you to protect yourself from the high cost of health insurance, in a way providing you with special insurance coverage for both the specific health and medical care services. In such circumstances usually a monthly premium is paid, that is considered to be a co payment for the services that you are bound to receive. The health insurance premium can be said to be the premium that is paid to the insurer in order to purchase health coverage from an insurer. These premiums are paid on monthly, quarterly and annual basis. Deductibles refer to those amounts that are paid for the covered services, within a certain frame of time, as per the terms and conditions with your insurance agent. There are many members that have a high deductible, and these people are required to pay their first installment in thousands of dollars, before the insurance company begins to make its payments. A co-payment refers to an amount that is paid by the member along with the doctors’ visit that is made, and also along with the surgical and doctors care.

Health Insurance can be categorized in two ways, such as the indemnity plan and also the managed care plans. Managed care plans include different plans such as health maintenance organizations, the preferred provider organizations and the point of service plans, are some of the types of health insurance facilities that are available. In the case of indemnity plans, you are provided the freedom to choose your own doctor as well as pay for your medical expenses. Various payment options are provided for such expenses, and payment can be made in totality in part or in specified amounts for a day. There are several managed care plans that shall provide you with broader coverage that is related to an arrangement that is made between the insurer and the selected network that helps you to coordinate all your care and also helps you to get referred to the different specialists in the network. The health insurance policy that is subsidized by the employer is considered to be the most inexpensive and in cases where the employer is not providing the facility of health insurance, there should be an individual health insurance policy.

In cases of good health insurance, there are several types of coverages.There is a coverage for hospital expenses insurance, that helps you to make payments for your room, board and other incidental costs, in case you are hospitalized. There are many surgical expenses insurance that helps you to make coverage for the surgeon’s fees and other costs that are related with it. There is also a physician’s expense insurance that shall help you to pay for the visits in the different doctor’s chambers and hospitals visits also. There is also a major kind of medical insurance that provides a very wide coverage, and that which has a maximum benefit policy, that is specially designed to provide you with high range of benefits and is designed to protect against several kinds of catastrophic losses. Before making any choice about any kind of health insurance facility, you are required to consider the amount of affordability of the doctor’s visit and hospital care.

Coverage Guide

There are so many types of health insurance to choose from, it’s no wonder people often feel helpless about it. At InusranceUSA.com we provide you with thorough and up-to-date information on all types of health insurance.

Indemnity Health Insurance – With indemnity, you choose your own doctors, hospitals, and other healthcare providers. You can go see any specialist you want or have any procedure you need without the insurance company’s say-so.
Flexible Spending Account Health Insurance – Health insurance flexible savings accounts or cafeteria plans are established by your employer and are intended to help reimburse employers for specific medical costs.
Basic and Essential Health Insurance – Includes COBRA, worker’s compensation, Medicaid, Medicare, and other types of basic and essential health insurances.
Health Savings Account (HSA) Insurance – The coverage provided by Health Savings Account (HSA) insurance consists of two parts: a high-deductible individual health insurance plan and an HSA.
High Deductible Health Insurance – These health care insurance policies carry a higher deductible than other basic plans. It is ideal for people who simply want coverage from the most expensive worst-case scenarios.

Managed Care Health Insurance:
HMO Health Insurance – A Health Maintenance Organization (HMO) is one of the more affordable individual health insurance alternatives. HMOs usually have an extensive network of doctors, specialists, hospitals, and clinics, plus much more.
POS Health Insurance – Point of Service (POS) plans are essentially a mixture of the HMO and PPO. Like an HMO you pick a primary care physician but as in a PPO, if you can seek help from any medical professional in or out-of-network and you will still be covered.
PPO Health Insurance – Preferred Provider Organization (PPO) plans are an affordable and popular option for family health insurance because they are comprehensive and flexible.

Government Sponsored Health Insurance:
Medicaid Health Insurance – Medicaid does not pay you money but instead sends money directly to healthcare providers. There may also be a small co-payment for certain medical services. Medicaid is state-administered so each state has its own eligibility and services guidelines.
Medicare Health Insurance – Medicare health insurance is a government funded program for people who are 65 years and older, people under the age of 65 with certain disabilities, and anyone who has End-Stage Renal Disease.
State Children’s (SCHIP) Health Insurance – For the nation’s low-income citizens, Medicaid and State Children’s Health Insurance Program (SCHIP) is children’s health insurance available to low income parents who don’t qualify for Medicaid.
Military Health Insurance – Military Health Insurance also known as TRICARE is the healthcare program for the United State military system.
Low-Income Health Insurance – If you’re a low income individual or family and you can’t afford medical care, you may be eligible for low-income health insurance.
Indian Health Insurance – The Indian Health Service (HIS) is the principle health care provider and advocate for Native Americans.

Specialty Health Insurance Policies:
COBRA Health Insurance – COBRA or Consolidated Omnibus Budget Reconciliation Act is for anyone, who involuntarily or voluntarily loses their job or has their hours drastically reduced.
Critical Illness Health Insurance – Critical illness health insurance provides payments if you suddenly fall ill to a disease or illness that is covered under your policy’s contract.
College Student Health Insurance – College student health insurance is designed to protect students from the unexpected and at a mere fraction of the cost than if they were unprotected.
Medigap Health Insurance – Medigap health insurance is sold by private insurers to help fill any gaps found in Medicare policies.

Premium Factors

There are so many types of health insurance to choose from, it’s no wonder people often feel helpless about it. At InusranceUSA.com we provide you with thorough and up-to-date information on all types of health insurance.

There are several factors that you should be aware of so you know how health insurance premiums are calculated.

We explain how raising your deductible can lower your premiums and how your credit score affects your health insurance costs.

Then we explain how community ratings may or may not be a good for you as well as the various pros and cons of co-payments vs. co-insurance.

Finally, we give you the complete rundown on whether you should purchase a family plan or individual health insurance policy.

When you use InsuranceUSA.com, you get fast, easy quotes with side-by-side comparisons of health insurance policies. All you have to do is fill out a short online questionnaire that only takes a few minutes to complete.

Once you submit your details, we’ll search over 100 health insurance providers and you can take as much time as you need to find the best policy at a price you can afford.

So what are you waiting for? By using InsuranceUSA.com you could save up to 20% on health insurance so just enter your zip code and gain peace-of-mind for you and your family!

Saving Money on Health Insurance

There are so many types of health insurance to choose from, it’s no wonder people often feel helpless about it. At InusranceUSA.com we provide you with thorough and up-to-date information on all types of health insurance.

There are several ways you can save money on health insurance and control rising healthcare costs including purchasing low cost health insurance or taking advantage of the many affordable health insurance options already available. Finally, you can mitigate a lot of healthcare costs by knowing how to save on medical bills.

When you use InsuranceUSA.com, you get fast, easy quotes with side-by-side comparisons of health insurance policies. All you have to do is fill out a short online questionnaire that only takes a few minutes to complete.

Once you submit your details, we’ll search over 100 health insurance providers and you can take as much time as you need to find the best policy at a price you can afford.

So what are you waiting for? By using InsuranceUSA.com you could save up to 20% on health insurance so just enter your zip code and gain peace-of-mind for you and your family!

Health Insurance

As health insurance costs continue to soar it is becoming harder to find an affordable policy. InsuranceUSA.com can help you compare rates and find one best suited to your particular health needs and financial situation.

Health insurance can cost a lot, especially if you have a family but it can be even more devastating if you don’t have insurance. Almost half of all bankruptcies result from catastrophic medical expenses.

One possible solution is to obtain coverage through your employer’s group plan if they offer one. If that is not an option, there are a few things you should know when you’re shopping for your own policy.

First, even if you have coverage with your employer, it may not be enough so you may want to consider a supplemental plan to cover you in every situation. If you don’t have a group plan option, you can sometimes find coverage through an alumni association or even with your credit card company.

Be sure to find as much coverage as you can afford. It is especially beneficial if you can find a plan that covers preventative care and prescription drugs.

Finally, and perhaps most importantly, if and when you do find an affordable health insurance policy, make sure you know which healthcare providers you can use. Health insurance providers should have a provider directory that you can browse to see if the doctor you want to use is in their network.

When you use InsuranceUSA.com, you get fast, easy quotes with side-by-side comparisons of the most important policy features. All you have to do is fill out a short online questionnaire that only takes a few minutes to complete. Once you submit your details, we’ll search over 100 health insurance providers and you can take as much time as you need to find the best policy at a price you can afford.

So what are you waiting for? By using InsuranceUSA.com you could save up to 20% on health insurance so just enter your zip code and gain peace-of-mind for you and your family!