Medical Professionals

How HSA's Work

Health Insurance

The continuing escalation in health care costs makes a well designed health insurance program essential to your financial security.  With semi-private room rates averaging over $500 per day, a "few days" in the hospital could equal thousands of dollars in expenses.  You can tailor an individual plan to provide essential protection by eliminating unnecessary features and costs.  For this reason, an individual plan is often more cost effective than a group plan.

When reviewing your health insurance coverage, consider the following:

Deductibles - Calculate the long-term premium savings achieved with a higher deductible versus the maximum exposure to additional out of pocket medical expenses. When also considering the potential for professional courtesies, a high deductible plan may reduce your cost dramatically.

Co-insurance - Beyond the deductible, what percentage of the expenses must you pay...0%, 10%, 20%? More importantly, how long do you pay this co-insurance percentage before the plan begins to pay 100%?  Is there a "Stop-loss" provision?

Family benefit maximums - This should be $3,000,000 or more, due to potential costs of a major surgery, hospitalization, a series of family illnesses, etc.

Inside limits - Limits such as "$200 for X-rays," etc., should be avoided in favor of "comprehensive coverage," i.e., a flat percentage of the cost incurred.

Outpatient benefits - These should be examined carefully since many procedures are now done on an outpatient basis; e.g., pre-admission testing, diagnosis, etc., due to the high costs of hospitalization.

Preferred Providers - Premiums are often lower when a PPO network is selected. With a PPO option you are encouraged to seek treatment at network hospitals and physicians to receive the maximum benefits. If non-emergency care is received from non-network providers, benefits are usually reduced.

Health Maintenance Organizations (HMOs) -  These offer a different approach than traditional health insurance in which you pick the doctor, pay as you go, and receive reimbursement from an insurance company.  With an HMO you or your employer pays an annual fee for which the plan's own doctors handle almost all of your health needs.

Routine Maternity Benefits -This is normally an optional rider. Complications of pregnancy are normally covered under the base plan. Consider the long-term premium savings of omitting this rider versus the maximum exposure to routine maternity expenses.

Prescription Drug Coverage - Outpatient drugs are usually not covered until after the deductible is met. A prescription drug card may be available as an optional benefit. Prescriptions can then be filled at participating pharmacies for a small co-payment, and are not subject to the major medical deductible.

Risk Pools - For the uninsurable without prior group coverage, many states offer a guaranteed issue major medical plan.

COBRA - Companies with more than 20 full time employees are required to allow their former employees to continue their group health insurance for up to 18 months. The employee is responsible for the full premium.  For those in good health, an individual health insurance plan may be more cost effective.

HIPAA - The Health Insurance Portability Accountability Act of 1996 made it easier for individuals with existing health insurance to change jobs and still maintain health insurance coverage. It guarantees the availability of health insurance to individuals losing group health insurance. The exact benefits and requirements vary by state.

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Disability Income Insurance

Many physicians perceive that disability income insurance contractual provisions are fairly uniform. Unfortunately, this is not the case. One subtle difference in a definition or a benefit can potentially become significant in the event of a claim.
 
From a medical professional's point of view, the following are features to consider when reviewing your options.  You need to know if your policy has the following features either as part of the contract or by an additional rider...

Non-cancelable and Guaranteed Renewable Coverage - The policy can't be changed (as long as premiums are paid on time) and your rates will not increase, until age 65. In fact, you should be able to keep your coverage for as long as you continue to work full time.

Coverage for HIV - If your employment is terminated due to being diagnosed HIV positive, benefits will be paid to you even though you are physically able to work at your occupation.

Liberal Definition of Total Disability - You are considered totally disabled when, due to injury or sickness, you are unable to perform the primary duties of your specialty. You can receive full benefits if you are unable to perform the primary activities of your current medical specialty.

Residual Disability Benefits - This provision ensures that you will continue to receive benefits even if you can perform some work and earn some income while partially disabled.

Indexing Pre-Disability Earnings - This benefit allows your residual benefits to keep pace with inflation.

Recurrent Disabilities - You are not subject to another waiting period for continuing illness or injury should a related disability reoccur within 12 to 18 months of the time you returned to work.

Presumptive Disability - This provision provides 100% of policy benefit for some conditions even if you are able to work in your occupation. These conditions are normally: loss of sight, speech, hearing, use of both hands, both feet, or one hand and one foot.

Waiver of Premium on Both Total and Residual Benefits - This provision waives premiums as they come due when you are receiving either total or partial benefits from your policy.

Guaranteed Increase Option - This feature allows you to increase your coverage, without proof of insurability.

Claims Paying Ability - When protecting your most valuable asset, you should prefer a top rated company.

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 Life Insurance

Advisors with Fogarty Financial Services assist Medical Professionals in determining the amount of coverage that is required to help assure survivors are left in the same “Financial World” to which they are accustomed while the client is actively producing income.  Current liabilities (e.g., mortgages, outstanding loans, etc.) and future liabilities (e.g. education for children) are considered.  The professional will also provide you with rates from the most competitive insurance policies the industry offers and recommend the appropriate type of coverage for your current situation.

Click here for a quick life insurance calculator to help determine the right amount of coverage.  While our analysis involves a more in-depth understanding of your financial situation, this calculator provides a quick reference estimate.

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 Long-term Care Insurance

Your Fogarty Financial Services Professional will assist you in analyzing the numerous types of Long Term Care Insurance Policies and help you identify the most appropriate coverage from the nation’s leading insurance companies.  Planning for long-term care is essential so families may retain independence and choice when care is needed.  A properly designed plan is critical in dealing with the increasing need and cost of assisted living.

What is Long-Term Care?

One day, you or a loved one may have a physical or a cognitive impairment which requires long-term care.  Many different services help those with chronic conditions overcome limitations that keep them from becoming or remaining independent.  Unlike traditional health insurance that helps to improve or correct medical problems, long-term care insurance aids in providing the financial means to make more desirable choices with respect to long-term health and nursing care options. Long-term care services may include assistance with activities of daily living, home health care, respite care, adult day care, and care in a nursing home or an assisted living facility.

Who needs Long-Term Care Insurance?

Whether a long-term care policy is right for you depends on several factors, including: your age, health status, overall retirement goals, income, and assets.  Many individuals secure long-term care coverage because of their desire to remain independent of government aid, to protect savings and assets, and/or they do not want to burden others with caring for them.

Who Pays for Long-Term Care?

Long-term care can be very expensive and is escalating.  The cost depends on the amount and type of care you need.  Medicare and Medicaid pay for some benefits, but both are limited in what and who are covered.  There are strict guidelines on what type of services are paid for and when you are eligible to receive those benefits.  Some people use personal or family savings.  Unfortunately, due to the “unpredictability” of the length and type of care needed, personal assets can be quickly eroded.  Long-term care insurance is a relatively new type of insurance.  Originally introduced in the 1980’s as Nursing Home Insurance, this type of coverage has changed dramatically to cover much more than just nursing home care.  Long-term care policies can provide benefits for home health care, assisted living facilities, adult day care, and services in other community facilities.

You should consider securing long-term care insurance if you:

• Want to help protect significant assets and income
• Want to have control of where you receive long-term care services
• Want to be able to pay for your own care
• Want to stay independent of the support of others
   

Long-Term Care Insurance Important Provisions

When considering a long-term care insurance policy, you should know if it has the following features available in the base contract, or by additional riders at additional costs...

Home and Community Based Services Available - Since most individuals view a nursing home as a last resort, your policy should cover community care, assisted living, adult day care, and home health care.  This benefit could be what postpones or even eliminates the need for a nursing home.

Inflation Protection - Inflation riders are critical in keeping policies effective since costs are projected to increase significantly.  This provision increases your benefit amount each year to keep it in line with rising costs.

Restoration of Benefits - This feature restores the maximum benefit of your policy after claims are made.  Usually an individual must go through a ‘recovery’ period (e.g. 6 months) after your policy has paid you benefits.

Indemnity Benefit Payments - Once eligible for benefits, the insurance company will make payments (based on policy limits) directly to you regardless of the specific services and costs

Joint Policy Discounts and Waiver of Premium - Couples can secure a joint policy with a significant premium discount.   A joint policy that waives the premium if one of you need long term care is an important feature.

10 Year and 20 Year Payment Options - These options can be attractive as policies can be completely paid up during your working years.

Single Payment Policies - These policies are structured to first pay out long-term care benefits.  If long-term care is not needed the policy pays a stated death benefit to your survivors.

Financial Strength and Claims Paying Ability - Establishing coverage from a credible and highly rated company is important.  LTC policies help protect your assets, standard of living, and help provide quality health care.  You should consider a financially sound, highly rated company with significant assets.  Check the ratings from services such as A.M. Best, Standard & Poor’s, and Moody’s.

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Long-Term Care Insurance addresses three important issues:

1. Access to options for location of care,
2. Choice of long-term health care providers, and
3. Asset preservation.