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Health insurance information resources

October 19, 2009|By ARNOLD S. PLATOU

Need health insurance?

There are a lot of options out there.

Lots of big words and long sentences, too, but at the same time, there are some handy guides online to help consumers wade through the information.

Many questions

You have a job, but your company doesn't offer health insurance.

You've just graduated from college and have to go off your parents' insurance policy.

You're old enough for Medicare, but you'd like supplemental coverage, too.

What's out there, if you have to buy your own?

Where do you even begin looking for coverage? What coverage should you have? What should it cost? And how can you tell whether XYZ's insurance is better for you than ABC's or PQR's?

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The following is a look at some of the guides that can help you navigate the complexities of our health care system.

Maryland Insurance Administration

To begin, go to the Web site for the Maryland Insurance Administration (MIA) at www.mdinsurance.state.md.us/sa/jsp/Mia.jsp

Or just search the Web for "Maryland Insurance Administration."

On the main page, click on "Available Public Information" on the left side of the page.

That takes you to a page where there's a list. Click on "Consumer Information." That takes you to another page, another list. Click on "Insure U -- Get Smart About Insurance."

Look at that list: Young Singles (Out on your own for the first time); Young Families (Recently married with young children); Established Families (Now the kids are becoming teenagers); and Empty Nesters and Seniors (Time to re-evaluate your needs without children and plan for retirement).

Each is a consumer guide written for "you."

Click on what fits.

Some nifty stuff, written in a friendly style, should appear.

The Maryland Insurance Administration, the regulator of insurance, and the National Association of Insurance Commissioners, the national organization for insurance regulators, jointly developed these booklets.

Consumer Guide to Health Insurance

Another useful download is the Maryland Insurance Administration's A Consumer Guide to Health Insurance.

It's produced by MIA, but finding it from the home page can be difficult.

So search for: A Consumer Guide to Health Insurance. Or go directly to www.mdinsurance.state.md.us/sa/documents/CGHealth-04-09-web.pdf

This 40-pager can get you started with some basic info.

Topics include "How to select the health coverage that is right for you"; "What options are available to Maryland consumers to pay for medical care"; and such frequently asked questions as "How long may I keep my child on my health plan?" and "I just got divorced. May I stay on my ex-spouse's insurance policy?"

There are descriptions of several types of medical plans, and you also will find 28 questions MIA says you should ask when shopping for health care coverage and 13 tips to follow as you shop.

Other company Web sites

Brenda Wilson, associate commissioner of MIA's Life and Health section, said consumers should visit various insurance companies' Web sites, too.

There, they can find descriptions of what health insurance policies are available, she said.

In addition, Wilson said, you should call your doctor's office when you are narrowing the choice of an insurer.

"The thing that gets surprising to people, they haven't really done the legwork to make sure their doctors will accept" whatever insurance they are considering, Wilson said.

"You really do suffer penalties if you go out of network," she said.

"Suppose you have a visit to the doctor and he'd normally charge $150 and he's negotiated with the insurer to accept $100. If you stay in-network and your policy pays 80 percent, you know it'll be a $20 co-pay."

But, she said, if you go to what is called "out of network," meaning the doctor isn't on your insurer's main plan, you'll be footing more of the bill.

"Many policies pay 60 percent (for out-of-network care), so you'll be paying 40 percent," she said.

Here's the catch.

"You might think, it'll be 40 percent of $100, but it'll be 40 percent of $150," she said.

The information above applies if you have a Preferred Provider Organization (PPO) kind of insurance and you go out of network.

It works differently if you have the Health Maintenance Organization (HMO) kind.

Questions and Answers

Another online guide is Questions and Answers About Health Insurance.

This 32-page guide was developed jointly by the Agency for Healthcare Research and Quality -- a federal agency for research on health care quality, costs, outcomes and patient safety -- and America's Health Insurance Plans, a national association representing nearly 1,300 health insurance companies.

This guide discusses such questions as "Why do you need health insurance?"; "Which type of health insurance is right for you?"; and "How does Medicare coverage work?"

Health Policy Institute

The Health Policy Institute at Georgetown University in Washington, D.C., does some things that are helpful to consumers.

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