Everyone knows about the professional criminals who are now working up and down the country to bilk insurers out of their money. They stage accidents, fake injuries and receive several billion dollars a year for their trouble. Why, you ask, do they get away with this. The answer comes in two parts. The first is at state level. As you might have noticed, almost all states are running deficits and are under pressure to find savings – for some reason, no state wants to be seen raising taxes. This means even essential services are being cut. So when it comes to law enforcement, where does a Police Chief spend his reduced budget? What are the priorities? Well, we all want to feel safe so a focus on violent crimes like robbery and burglary wins votes in the election. So-called white collar crime takes a back seat. That means local police forces only investigate fraud when it’s really serious, i.e. there’s a lot of media coverage. The FBI are interested in anything crossing state lines and there is a task force set up to deal with insurance fraud. But this is a drop in the ocean when you consider how many billion dollars are involved every year.

The second reason is that you are not exactly overjoyed by the prospect of better fraud detection. Just imagine the sequence of events. Insurance companies have to recruit and train investigators to work alongside claims adjusters. This immediately boosts the insurer’s costs which get passed on to you in higher premium rates. Now all these eager-beaver investigators finish their training and they are released on to the current files. Suddenly everything slows down as these investigators decide whether there’s anything fishy about your claim. How long are you going to put up with someone poking around your claim to decide whether you really did suffer whiplash in that accident? At what point do you start complaining? It’s possible, of course, that these investigators may detect real fraud. If so, the savings they make could start paying their salaries and the premium rates would come down. Well that’s the theory, anyway, and we can all dream.

This leaves all those little frauds. Now we have pay-as-you-drive black boxes, this does away with the most common which was people lying about their mileage. Honest drivers with low mileage can now enjoy their justified discounts. Everyone else can go back to paying the proper rate. But this still leaves about $15 billion in other problems. You would be amazed (well, that’s probably an exaggeration) at the extent to which people lie. They forget to tell the insurers exactly who will be driving the family car, or they edit the driver’s experience, age or marital status. Relatives suddenly develop membership of clubs and affinity groups which produce discounts, and all this is before we get to those who forget to mention they are using their vehicle in a business. Yes, these are only small frauds, only barely dishonest really. But the industry estimates it loses $15 billion a year because of these little lies. That’s $15 billion we all have to cover with higher car insurance rates. So, be honest, what would you prefer: everyone telling the truth and most paying lower rates, or higher car insurance quotes to cover this continuing dishonesty?

According to the Book of Common Prayer we often leave undone the things we ought to have done. It’s a fact of life. In many ways, we are our own worst enemies. Yet, for most everyday purposes, there are no penalties. We do the things we left undone when we have the time. We might never actually catch up with the backlog, but we keep moving forward. Except there are times when the failure produces instant consequences and, no matter how hard we try, it’s impossible to go back and put it right. Let’s be clear about this. The majority of traffic accidents could be avoided if everyone followed the rules of the road and kept a proper lookout. But we are easily distracted, multitasking when we should focus on the driving. This leaves the insurance companies with a bill and a problem.

In a no-fault state, it does not matter whether the insured driver or the others involved were negligent. The insurance company pays out regardless. But this only applies in twelve states. The remainder rely on the law of tort which order the party at fault to pay compensation to the other. So, if you were not at fault, your insurance company collects the compensation from the other driver and, in theory, suffers no loss. But if the other driver was not insured or underinsured, or you were at fault, your insurer now faces a loss. If this was just down to the math, the insurer would calculate a “fair” premium rate increase and slowly recover the loss. But if the insurer put up the rate every time one of its drivers was at fault, many of those drivers would move to a competing company. So the math has to bend to match social considerations. Sometimes, the insurers have to accept the loss.

In this, we need to distinguish really serious errors of judgement from more everyday inattention. A driver who has an accident because of excess alcohol or drugs will be classified as high risk and the rates will automatically rise. Few people will argue against this. But suppose you open your car door and another vehicle crashes into it. We start with the general rule you should always look before opening your door. Even if you are not on the road, there’s still a risk you might hit someone walking past. So if a vehicle hits the door as you are opening it, that looks like your fault. But if the door has been open for a reasonable period of time, other drivers should see the problem and take evasive action. This is always a 50/50 decision for the insurer, but if you hit the other family car as you are leaving your driveway, this is always going to cause more problems. The first factor is that you cannot claim on the liability policy. This only cover liabilities to third parties. Your only hope lies in having collision cover on both vehicles. This form of car insurance pays out for the repair of your own vehicle if damaged in a collision. If it’s the same insurer, try negotiating for only one deductible payment, but don’t hold out much hope on the premium rate. The next car insurance quote is likely to be higher.

When it comes to insuring ones health there’s no denying the fact that this form of insurance is a must for everyone even though it’s not legally required and is purely optional. It’s hard to imagine the current healthcare system without insurance because otherwise people couldn’t afford most medical services and doctors wouldn’t get their high salaries, which are among the highest all over the world. Thanks to insurance both customers and service providers are pleased, and everyone’s getting the thing they want. Among many types of insurance available managed care plans are the most widespread, so let’s take a closer look at some of the most common forms of insurance offered by insurers:

Health Maintenance Organizations (HMO)

This is the most common form of managed care plans as it provides the lowest price and a wide range of services included. It’s main drawback is the lack of flexibility in what concerns the places you get care from. Under HMOs you are limited to a network of facilities and specialists you may get care from and covered to the full extent. If you choose to get your services from someone outside the network your costs won’t be covered at all. Moreover, you are required to choose a primary care physician who will refer you to all the required specialists, so there’s more paperwork involved with this type of plans. Yet, you usually pay lower premiums for that so it’s really worth the effort.

Preferred Provider Organizations (PPO)

Preferred Provider Organizations offer more flexibility but for a higher price if compared to HMO plans. You are still limited to a network of providers to get care from, however if you choose to go out of network there will still be some part of your bill covered only to a lesser extent compared to in-network services. And you aren’t obliged to choose a primary care physician so there’s not so many office visits to do under this type of managed care plans. If you have the additional money and want more flexibility with your health insurance this plan type will definitely appeal to you.

Point Of Service (POS)

Point Of Service plans are often referred to as a mix of HMO and PPO plans as they provide the benefits of both these forms of health insurance. You gain the flexibility of PPO in what concerns the places you get services at, yet you still have to choose a primary care physician and have a network of providers to work with. One of the greatest benefits is that you may choose your family doctor as a primary care physician even if he or she doesn’t make part of the insurer specified network, which is definitely appealing to those who have long term relations with their family doctors. PPO plans may vary in price so it’s really recommended to shop around if you want to get the best rate possible.

As you see, managed care plans come in different forms with the sole purpose of giving you exactly what you need. So it’s really important to assess your individual health insurance needs before choosing the plan type to address them adequately.

There are many sides of having your health insured and it’s certainly a good thing because it allows to tailor a plan to your exact needs and make it as adequate as possible. But as with all things there are also negative aspects of this diversity that can lead you to misunderstanding and unnecessary spending if you aren’t aware of them. And these days additional spending could seriously harm an average family budget. If you’re trying to optimize your costs knowing about some common insurance traps is necessary in order to keep your costs as low as possible. So if you don’t want to become a victim of misunderstandings that will cost you money keep in mind the following health coverage traps when getting medical care:

Avoid going out of network

The vast majority of insurance plans you’ll find on the market are managed care plans. Whether group or individual these plans offer good premiums in exchange for certain limitations. One of such limitations is the place you can get medical care from. Each insurance provider has a network of medical facilities and specialists you can get your services from and have your bills covered. But once you choose to visit a doctor who doesn’t make a part of the network you will end up paying the entire bill out of own pocket, which is certainly not very convenient assuming the current medical prices. So the first advice would be sticking only to in-network specialists and facilities if you want all your services to be covered properly. Otherwise it really doesn’t make any sense having health insurance since you will end up paying for the larger portion of your medical bills.

Keep an eye for co-payments and deductibles

Co-payments, co-insurance and deductibles refer to virtually the same aspect of any health insurance plan. These are the payments that the customer has to make out of own pocket for getting the service he needs before the coverage starts to apply. These can be doctor visit fees or any other additional costs that you will typically find in a medical facility. Now, you have to be very careful with these payments since they can make up a good sum of money by the end of the year comparable to your premium. Usually they are higher in plans with lower premiums, however it’s not a necessary condition. So it’s highly recommended to check the co-payments and deductibles when assessing a health plan besides the usual premium comparison, since it adds up to the final cost of the policy in the long run.

Don’t get the first plan offered

One of the most common mistakes an inexperienced customer makes is that he or she buys the very first health insurance plan offered. The probability that this plan will be both affordable and adequate to your needs is very low, so don’t risk this way since it’s your money you are going to spend. Instead, take your time to consider all your options, shop around online, determine which plan type best appeals to your needs, compare quotes from different providers and only after doing some research buy the plan that appeals to you the most. You can save really good this way so don’t rush with your decisions if you have some time to compare different offers.

The trouble is that one state’s progress is often considered a treasonous betrayal by others – think Rick Perry and Ben Bernanke. Here we have this pesky law called the Affordable Care Act that no one in the Republican camp likes. As proof of this, twenty-six US states have challenged the law as unconstitutional. The Supreme Court has accepted the case and it will be heard sometime during the next nine months. The reason why this makes the Act pesky is because it’s actually a part of the law unless and until the Supreme Court rules it unconstitutional. Contained with the statute is a timetable and it’s ticking away. This creates a dilemma for the Republican states. This timetable is not going to be rewritten so, if the Act is upheld, the states that have failed to take the steps towards implementation could suddenly find themselves losing control of the process.

Each state must have a working exchange in place come 2014. Note this is not a requirement simply for a proposal or a detailed specification. The actual exchange must be up and working. That means commissioning the design now, allowing plenty of time for the coders to work their magic and then debug until the exchange actually works. Most experts take the view this is getting close to the deadline for beginning the work if a properly tested exchange is to be ready in time. This is reinforced by the federal government which is providing funding support on a use-it-or-lose-it basis. If states have a viable plan and greenlight the project, they get the money. The latecomers either pay for the work out of their reserves (not a good thing given most states are running a deficit) or they accept the electronic exchange provided by the federal government.

As an example of how some states are approaching the problem, let’s look at Illinois. Lawmakers are now considering a bill to approve work on the exchange and, equally important, to create the management structure to oversee the operation of the exchange once it’s up and running. The bill calls for the initial work to be complete by June 2012 which is the deadline for access to federal funding – estimated to be about $150 million for the hardware and software. Because of pressure on the state budget, the unanswered question for now is who will be responsible for paying the administrative costs of the exchange after 2014. Independent experts estimate this will be about $75 million per year. As the Affordable Care Act is written, it appears this must be paid by the state but it’s possible new regulations could change this.

While we wait for all this to become more clear, the latest estimates for the cost of insurance through the exchange are encouraging. Taking current reality, some 1.7 million are uninsured and a floating population of 1.4 million is expected to use the exchange. Assuming about 1 million become steady users within the first two years, the health insurance plan would cost about $12 per month. If the poor were to be charged extra to cover the administrative costs, this could make the insurance significantly less attractive. This will genuinely be cheap health insurance for the poor of Illinois and a good model for all to follow.