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CHAPTER 9Health and Disability Income Insurance

Pssst. Here are a few words to the wise: Don’t Get Sick.

More Americans Wanted the Health Care Bill to Do More

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Health Care Costs The United States has the highest per capita

medical expenditures of any industrialized country in the world Predicted over $9,000 per person in 2011 This amount is over twice as much as the average

for the 24 industrialized countries in Europe and North America

6% of the GDP in 1965, but expenditures rose to over 17.6% of our GDP in 2010 – $2.5 trillion! And it is growing fast − 21½% by 2018?

Health expenditures jumped 5.7% in 2009 National Coalition on Health Care

“Americans want too much of a very good thing.”Health insurance rose dramatically in 2011

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Why Does Health Care Cost So Much? High administrative costs – Insurance companies!

26% of health care dollar vs. 1% in Canada Use of sophisticated, expensive technologies Duplication of tests and technologies Increases in the variety and frequency of

treatments Increasing number and longevity of elderly people

From ages 60 to 70, the average person uses more health-care resources than they did from ages 0 to 59

These are the most significant reasons, especially the first and the last reasons. Malpractice insurance is often used as a

scapegoat for spiraling costs but it is a very small amount.

4 What is Being Done About the High Costs of Health Care? Careful review of fees and charges Establish incentives for...

Preventive care Services provided out of the hospital where medically

acceptable Community health education programs to get

people to take better care of themselves Preventive care is almost always cheaper than allopathic

care Medical “vacations”

750,000 in 2007; 6 million by 2010?

The real answer to this question is, “Not much.” Are you willing to forego medical care?

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Which Would You Choose?You are 50 years old. Recently, you have been experiencing severe abdominal pain and a nagging cough. You go to your family doctor who sends you immediately to the hospital. After a few tests, the specialist asks you to sit down with her and tells you that you have stage 4 liver cancer that has spread to your lungs and spine. She tells you that you probably have three to six months to live. She gives you two choices:

Choice 1: You decide to forego radical treatment. Instead, you are given pain medication and placed in hospice care

after two months. Your chances of living 5 years are 1 in 1,000.

You die in four months.

Choice 2: You decide to undergo radical treatment. You have

surgery, radiation treatment, and several rounds of chemotherapy.

Your chances of living 5 years are 1 in 85. You die in nine months.

Total cost: $45,000 Total cost: $1,250,000

6 How Can You Reduce Your Personal Health Care Costs?

Stay well – focus on prevention Eat a balanced diet and keep your weight

under control Learn to deal effectively with Don’t smoke – Don’t drink to excess Get enough rest, relaxation, and exercise

“Yeah, sure, Mom. Right.”

Do financial health and medical health have any correlation?

7 Disability Income Insuranceand Financial Planning

Disability income insurance protects your most valuable asset – your ability to earn an income One of the most neglected forms of insurance No matter what your age during your working years,

you are more likely to become disabled than to die Young, healthy people don’t think about the risks

related to all their future earning potential Provides regular cash income lost by employees as

the result of an accident, illness or pregnancy If you become disabled your income drops but your

expenses usually go up

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Carefully read a policy’s definition of disability May (will!) only pay if you can not work at any job Look for a policy that pays if you are unable to work

at your regular job (You will not be able to find any!)

Aim for a benefit that when added to your other income will equal 60-70% of your gross pay I have never seen more than this

How long do benefits last? To age 65? For life? How long is the waiting period? 90, 180 days? Look for a policy that is...

Non-cancelable Guaranteed renewable

Disability Income Insuranceand Financial Planning (continued)

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Four Sources of Disability Income

Employer-sponsored disability insurance Group disability policy may be short or long term

but usually not enough by itself Individual disability insurance

Good Luck! It is very hard to find and, if found, is expensive and restrictive What a deal, huh?

Social Security Covers total disability that lasts more than one year

Workman’s Compensation If you are injured at work

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Health insurance alleviates the financial burdens people suffer due to illness or injury Part of your overall risk management plan to

safeguard your family’s economic security A week in the hospital can literally kill you (financially,

that is) 47 million Americans have no health insurance

Two-thirds are full-time workers and their families Older college students can now be covered by their

parent’s policy until age 26 under the new law

This number was climbing as more and more smaller businesses claimed they can no longer afford the cost of health

insurance for their employees. The new health care law is supposed to reduce this number to just below 20 million.

Health Insurance and Financial Planning

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Medical Savings Accounts (MSAs) (HSAs) Allows small businesses and self-employed

workers to place pre-tax money into an account set aside solely for medical expenses

Health Savings Accounts (HSAs) Are replacing the MSAs (less restrictions) Anyone is now eligible if they have low-cost (?),

high-deductible comprehensive major medical insurance The major problem is “low-cost” insurance ain’t so

low-cost anymore! We used to have an MSA/HSA but we switched to

Southwestern’s HMO

(continued)

Health Insurance and Financial Planning

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Comprehensive major medical insurance Low or high deductible offered without a

separate, basic plan Hospital indemnity

Pays a fixed amount for each day you are in a hospital Cheap and not very useful

Dread disease and cancer insurance policies Focus on unrealistic fears, and only pay out for

very specific conditions Often sold by people working on commission

Expensive and not very useful

Types of Health Care Coverages

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Dental expense insurance Group coverage for exams, cleaning,

x-rays, fillings, oral surgery Vision care

Some group plans include exams and glasses Long-term care insurance

Virtually unknown 20 years ago, but now is growing faster than any other form of insurance

Oversold, especially to younger adults who could easily start an investment plan to self-insure their long-term care

(continued)

Types of Health Care Coverages

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A Good Health Insurance Plan Should…

Offer basic coverage for hospital and doctor bills Cover at least 120 days hospital room and board Provide at least $1,000,000 lifetime maximum per

person (still plenty of coverage)

Impose no unreasonable exclusions Pay at least 80% of out-of-hospital expenses after

the yearly deductible is met Limit your out-of-pocket expenses to no more

than $4,000 to $5,000 in a year, excluding dental, optical and prescription costs – a.k.a. “stop-loss”

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Health Insurance Policy Provisions

Eligibility Varies with age, marital status and dependency

Internal limits Fixed amount/day for hospital room

Co-payment Cost sharing in the form of a flat dollar amount

you pay, such as $15.00 per office visit or Rx Exclusions and limitations

Pre-existing conditions for the first year Coordination of benefits

If more than one insurance company is covering you, they will not together pay more than the total cost of medical bills

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Health Insurance Policy Provisions

Guaranteed renewable / Cancellation & Termination Can only be cancelled if you don’t pay

premium Premiums can only go up for the entire group Can convert to an individual policy if you leave

group

(continued)

17 Sources of Health Insurance and Health Care Group plans comprise close to 90% of all health

insurance issued Most group plans are employer sponsored, and the

employer pays part or most of the cost The Health Insurance Portability and Accountability Act

(HIPAA) provides some protection If you changes jobs you need not lose your health

insurance

Individual health insurance policy Typically (but not always) cost more than group policies

Mangled care, uh… Managed care Two of the prime examples are HMOs & PPOs …

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Health Maintenance Organizations (HMOs) Contract with care providers Fixed monthly premium Focus on prevention and wellness

Preferred Provider Organizations (PPOs) Several providers to choose from Costs more than a HMO, but you have more

choice and fewer restrictions If you go to another provider it costs more

(continued)

Sources of Health Insurance and Health Care

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“Catastrophic” Health Insurance

Low-cost / High-deductible insurance It is really a comprehensive major medical plan Choose your own health care providers Pay out of pocket Can usually negotiate lower fees

Just mention this magic little four-letter word, “Cash” Protected against large losses Great for small businesses, the self-employed

and employees with cafeteria plans that allow employees to opt-out Example: Southwestern Community College

But our Administration wants out of it! (It is expensive)

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Medical Information Bureau (MIB)

The MIB operates much in the same manner as the credit reporting agencies Used by the life insurance in much the same manner

as the credit reports and the C.L.U.E. reports Protected by the same laws as the credit agencies

Fair Credit Reporting Act MIB must correct any inaccurate information or

allow you to report your side of the story Allowed one free report each year (like credit reports) 866-692-6901 www.mib.com

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Government Health Care Programs

Medicare – Federal program for those age 65 and older, and certain disabled persons Part A – compulsory

Covers hospital costs including doctor Part B – voluntary

Doctor’s office visits & prescriptions Now being “means tested”

More about this later when we get to retirement…

Medigap – Will pay what Medicare does not Medicaid (MediCal in California)

Low income people of all ages State administered with Federal guidelines

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Bottom Line on Health Insurance

BOHICA That’s right – it is pretty much the bottom line

on all insurance…

Oh, Yeah. Don’t Forget. Don’t Get Sick.