TYPES OF INSURANCE RELATED TO HEALTH - AND FOR WHOM THEY ARE APPROPRIATE

Health Insurance:

• If you are drawing a breath, you need to have health insurance. Health insurance is something everyone should have from the time they exit the womb, until they enter the grave. Health insurance is structured to pay medical expenses when you go to a doctor's office, or spend time in a hospital. It can be obtained either through your employer, or if that is not an option, purchased individually. If you have the option of having health insurance through your employer, it will most likely be better coverage, and less expensive than what you could purchase on your own. Furthermore, if you are eligible to be covered under a group plan, you are no longer eligible to purchase an individual plan. Regardless of how you have health insurance, and agent can act as the intermediary between you and the insurance company, and can assist you if problems arise. There is no additional cost to you and the insurance company pays the agents a commission. If your budget is tight, and you feel you can't afford health insurance, you need it all that much more. Health insurance is not inexpensive, but is certainly less expensive than attempting to cover the cost of a hospital stay out of your pocket.

Dental Insurance:

• As the name implies, this type of coverage covers limited dental experiences. Dental insurance, like health insurance, can either be obtained through your employer if they have a dental plan in place, or purchased on an individual basis if your employer does not offer this benefit. Premiums are relatively low, but often so too are the benefits. Many dental plans that I have seen will not cover major services for the first year or two years that the plan is in place. Often there are limits on what the plans will pay for routine care. If you are shopping for a dental plan make sure you understand how it works: will the plan reimburse you or the dentist? Will it pay a percentage of actual expenses, or does it pay a certain amount per service? Do you need to use dentists participating in the plan (DPO's) or can you use anyone? How long does the plan have to be in place before procedure such as root canals or crowns can be covered?

Long Term Care Insurance:

• The purpose of long term care ("LTC") insurance is to protect a portion of your assets and provide a benefit when you need nursing or custodial care at home, or are admitted to a nursing home. LTC is not inexpensive - premiums are often over a thousand dollars a year, and are affected by your age. However, the average cost of a nursing home stay in the Northern NJ area is presently over $200 a day - which equates to over $73,000 a year! Long Term Care insurance is certainly not for everyone. If you are over 45 years of age, you should analyze your situation and determine if it is right for you. A licensed agent can help you in determining just what combination of benefits and what company would best meet your individual needs.

Cancer / Heart Attack/ Stroke policies:

• There are still a number of these "limited" policies on the market, and frequently our clients ask us if they should purchase one of them. These policies typically have very low premiums but only pay benefits if you contract that specific disease. in your family you may feel that having a policy of this nature makes good sense for you. If you have good health insurance, it will cover you when serious illness strikes so there is no need to purchase a limited policy such as this.

In-Hospital Policies:

• These policies are often inexpensive and only pay a benefit if you are hospitalized. They are often marketed to individuals over the age of 50 and not a necessity in the insurance coverage arena, but do provide a nice benefit for those who elect to have one AND who end up spending time in a hospital. AARP for example offers such a plan which will pay $120 a day (or less depending on the policy you choose) for each day you are in the hospital. It provides you with extra income for the additional expenses related to a hospital stay, such as telephone, television or a private room.

Medicare:

• Medicare is a program funded by the Federal Government which acts as health insurance for individuals who fall into the following three categories: 1. age 65 or older, 2. Disabled for more than 2 1/2 years, or 3. On renal Dialysis. Medicare Supplements Anyone receiving Medicare benefits who has not been able to continue a group plan from their former employer should consider a Medicare supplement. There are several on the market today - and in order to make comparing the benefits of these plans easier, Congress standardized the supplement business in 1992. In New Jersey all ten supplements are available for sale, yet not all companies offer all ten plans. The premiums for Medicare supplements range anywhere from $37.00 - $140.00 a month depending on the policy and company. It is important to understand what benefits you need, and can comfortably afford. One thing you don't want to do is choose a supplement because it is the least (or most) expensive you could find. Be sure you understand the benefits offered under the various plans, and choose one that will meet your needs and budget.

Irene C. Card is the founder and president of Medical Insurance Claims, Inc. a health claims processing company serving individuals and physicians. If you have questions relative to this column or other related topics, we invite you to call (973) 492- 2828