A formulary is a list of which prescription medications are covered and what the coverage level is. The name formulary comes from the old pharmacist guide for how to mix compounds. Better names for insurance formularies would be simply the drug list or drug coverage list. Most insurance policies use a multi-level or tiered formulary. The…
Category: Health Insurance
What is Covered
Insurance Plans – What is Covered What is covered by insurance plans might seem like a simple question, but there isn’t an easy answer. Every plan is different, and the reasons might surprise you. For individual plans or plans that you buy yourself, what is covered is determined by the group or company you buy it from….
Health Savings Accounts
Health Savings Accounts – Health Spending Accounts Insurance companies have blended high deductible health plans with savings accounts to create a category known as Consumer Driven Healthcare. The idea is that, with the high deductible, you’ll be more careful as you are spending your own money and keep medical costs down. Then, once you have…
Policies
Types of Policies There are two major types of Health Insurance Policies, Fee for Service and Managed Care. Fee for Service Fee For Service is sometimes known as Traditional or Indemnity insurance and, as the name implies, pays a set amount (fee) for each type of claim (service). This amount is called the Reasonable and Customary…
Prescription Insurance
Prescription Insurance Prescription insurance often referred to as a prescription drug plan, is an insurance policy covering all or part of the cost of prescription medications. These are available separately or sometimes included as part of a health benefits package. Prescription coverage is also available for those who qualify through the Medicare Prescription Plan. Prescription…
Medicare Prescription
Medicare Prescription Part D Medicare Prescription, officially called Medicare Part D is a federal program to partially cover the costs of prescription drugs for Medicare beneficiaries. It is relatively new, just started in 2006, and very controversial. There are two aspects of Part D that are confusing to a lot of people. First, Medicare Prescription…
Medicare – Coverage for Older Americans
Medicare is a federal health insurance program that provides coverage for eligible individuals who are 65 years old or older, or younger than 65 with certain disabilities, or have End-Stage Renal Disease (ESRD). Medicare is funded by payroll taxes, premiums, and general revenue. History of Medicare The program was established in 1965 as part of…
Medicaid
Medicaid is a health insurance program for individuals and families with low incomes and resources. It is managed by the states, but the cost is shared between your state and the federal government. Medicaid provides health care services for low-income parents, children, seniors, and people with disabilities. It is the largest source of funding for medical…
Managed Care
What is Managed Care? The most common types of managed care plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Exclusive Provider Organizations (EPOs), and Consumer-Directed Health Plans (CDHPs). Each type of managed care plan has its own set of characteristics, benefits, and drawbacks. It’s important to consider your…
HIPAA
HIPAA, or the Health Insurance Portability and Accountability Act, is a law in the United States that was created to protect the privacy and security of individuals’ health information. It was signed into law in 1996 and has been amended several times since then to keep up with changes in technology and healthcare practices. HIPAA…