Urban academic medical centers such as top-ranked Johns Hopkins Hospital and the University of Maryland, with its world-class trauma center, are more expensive to run than community hospitals and rural teaching hospitals. The difference can mean patient bills that are higher by thousands of dollars.

Administrators at these urban medical centers fear the national focus on cost-cutting will hurt their ability to train doctors, research diseases and treat complex problems. Community hospitals don’t perform these expensive tasks, but medical centers say such work is essential to their mission.

And, the urban centers argue, they’re more pricey than rural teaching hospitals because they treat poorer and sicker patients in an area with higher costs.

“To do what we do takes a certain infrastructure, making teaching hospitals more expensive,” said Jeffrey A. Rivest, president and chief executive officer of the University of Maryland Medical Center, which trains half the doctors in the state. “If there are specific reductions through Medicare and Medicaid revenue cuts, this will hinder the nation’s ability to be a leader in innovation and creators of advancement in care and more cost-effective care.”

The U.S government has long paid urban teaching hospitals higher rates through Medicare. But now legislative proposals would slow the growth of Medicare payment rates overall and would study geographic disparities in spending – findings that could limit the amount of money going to pricier hospitals nationwide.

Maryland hospitals are not specific targets – in fact, the state has been hailed by some analysts for efforts to keep hospital costs down. But influential and hotly debated research from Dartmouth College on the cost of care at the end of chronically ill patients’ lives ranks the state sixth-highest in the nation. Lawmakers and the White House have seized on this research, which shows big differences in regional health care spending, as evidence of waste.

Hopkins and the University of Maryland are the state’s costliest hospitals, according to Dartmouth data from 2001 to 2005. Medicare reimbursed the University of Maryland, the highest spender, $95,000 per patient in the last two years of life. The national average was about $53,000.

“It’s just remarkable how much it differs from place to place,” said Dr. David Goodman, director of Dartmouth’s Center for Health Policy Research. He added, “Being an academic medical center is not really an important explanatory factor for why costs are higher. This is the immediate response from these hospitals when you talk to them.”

Differences show up even within the same region. The state of Maryland, which sets hospital rates, follows the lead of the federal government by allowing teaching hospitals to charge more for care. Thus, Hopkins can charge $155 for a chest X-ray, while St. Joseph Medical Center in Towson – not a teaching hospital – can charge $84.

Hopkins and the University of Maryland say they support the goals of health reform but don’t want it to mean fewer resources for training and innovation. “Medicine will not advance by doing the same thing over and over again,” said Dr. Edward D. Miller, dean and CEO of Johns Hopkins Medicine.

Cutting costs is part of the strategy to help pay for expanding coverage to most of the nation’s uninsured. Reform proposals would cap the annual increases in Medicare rates paid across the system, and they would also reduce the extra funds going to hospitals caring for a large share of uninsured patients. Fewer patients without insurance would be good for medical centers, but the centers are wary of reductions to Medicare – typically a hospital’s largest payer – before the benefits are clear.

“So, everyone’s trying to do the math – how do the cuts compare to the add backs,” said Carmela Coyle, president of the Maryland Hospital Association.

The economic implications go beyond the hospitals’ bottom lines. Big medical centers are a key economic engine in Baltimore and some of the largest employers in the state. Teaching hospitals and medical schools in Maryland employ 75,000 people, said the Association of American Medical Colleges.

But everyone, hospitals included, agrees that a health care overhaul won’t be successful if it doesn’t make the system more efficient and affordable. From 2000 to 2007 alone, annual health care spending per person in the U.S. jumped more than 50 percent to about $7,400, according to federal figures provided by the Henry J. Kaiser Family Foundation. The overall cost of living – and incomes – increased far less.

The House health care proposal, which passed earlier this month, would direct the Institute of Medicine of the National Academy of Sciences to study geographic differences in Medicare payments and recommend changes that would promote “high value care.” The bill says that only a joint resolution of Congress could prevent the recommendations from going into effect.

But figuring out what costs should be is not an easy job. Take just one issue: the mix of doctors. Robert Murray, executive director of the Maryland Health Services Cost Review Commission, says teaching hospitals argue that their costs are higher in part because doctors-in-training aren’t always as efficient as experienced medical staff. But community hospitals complain that academic medical centers reap benefits from the cheap labor medical residents supply.

“So this is a complicated issue and also a controversial one at times,” Murray said.

Goodman, of Dartmouth, said costs vary even among teaching hospitals. He said that remains true when controlling for differences in patient population, although the hospitals take issue with that. The Mayo Clinic, No. 2 behind Hopkins in U.S. News & World Report’s hospital ranking, does well in Dartmouth’s analyses. One of its hospitals, St. Marys in Rochester, Minn., gets just over $53,000 per chronically ill Medicare patient over the last two years of life. That’s about the same as the national average, and a lot less than Johns Hopkins’ $86,000.

And other research suggests higher spending doesn’t improve health.
“The places where we spend the most on health care are the places where Medicare beneficiaries, for example, are the least likely to get high-quality but low-intensity care. Like flu shots, mammograms, eye exams for diabetics, aspirin after heart attacks,” said Katherine Baicker, professor of health economics at Harvard School of Public Health.

Her research also found that high-cost areas have more specialists.

“We as physicians use whatever is available to us – we help by doing,” said Goodman. “If there’s more that allows us to do more – more physicians, more consultants, more availability of ICU beds – we use it.”

Medicare’s payment system rewards the do-more philosophy. But Ronald R. Peterson, president of the Johns Hopkins Health System, said many of the institution’s doctors are medical school faculty with no financial incentive to seek costly tests. “These are salaried people who are trying to do the best possible job for their patient base.”

Hopkins administrators say Dartmouth research only takes into account patients who died, rather than those saved by hospital care. The Mayo comparisons are unfair, they maintain, because Dartmouth’s research looks at Medicare payments, not total costs. Maryland is the only state in the country whose system sets rates that all insurers must pay, which puts private insurers and Medicare on basically equal footing. In other states, private insurers often pay much more than Medicare.

Miller, at Hopkins, has spent months working with a coalition of academic medical center administrators to lobby Congress. The group pushed back efforts to change reimbursement rates without study. In a September ad in Roll Call, they called the Dartmouth studies simplistic and urged Congress to probe why the regional differences exist before “arbitrarily ending them.”

Rivest, of the University of Maryland, said he fears cuts to hospital reimbursements would mean less money to train physicians at a time when more doctors will be needed to treat millions of newly insured Americans.

Both Hopkins and the University of Maryland say their hospitals serve a vital role by treating everyone from local residents to patients from across the country, and even the world, seeking their renowned specialists and top-notch trauma care. For instance, the University of Maryland received more than 8,000 very ill patients from hospitals around the Mid-Atlantic region last year alone.

Rivest said nearly half of the University of Maryland’s 700 patient beds are in its intensive-care units. And Maryland Shock Trauma Center costs a lot to run, regardless of whether it’s filled.

“Costs are the same, because you have to be ready for the worst, 24-7,” he said. “Most community hospitals can’t do this.”

The Mayo Clinic has also been active in the health care debate – pushing for changes in payments. Dr. Raymond J. Gibbons, a Mayo cardiologist and professor of medicine, said he doesn’t see it as big hospitals versus small ones, or urban versus rural. Instead, he said, he’d like Medicare to give everyone incentives to deliver excellent preventive care.

This sort of change is one Hopkins has tried and says can save money and improve patient care. Hopkins coordinates the care of Medicaid patients, and providers are paid per patient per month, rather than through the traditional fee-for-service model. The result has been a drop in total costs of caring for patients, including a 47 percent decrease in costs for patients with end-stage renal disease. But change – any change – makes many of the nation’s health care players nervous.

“The moment you propose things, then you potentially threaten interests who see that, ‘Oh, if this change takes place, we may be paid less,’ ” said Gibbons, of Mayo. “What they are really doing is defending the status quo. And the status quo is not sustainable.”

Functional Orthotics

The goal of the functional orthotic is to improve the mechanics of the foot, control the abnormal motion in the foot, decrease the pain in the foot, ankle, knee, hip or back and to add support. The orthotic should make standing, walking, jogging or running more comfortable. The orthotic must be rigid to help control the motion in the foot and add support. If the orthotic is soft, the weight of the body would collapse the device and it would no longer function.

Abnormal motion is typically in the form of pronation. Pronation is the rolling in of the foot and collapse of the arch. The motion starts at the rearfoot, or heel area. When the heel turns in, it allows the arch to collapse. This puts undue stress on the ligaments and tendons in the arch area and contributes to the development of tendonitis, plantar fasciitis, bunions and hammertoes. The functional orthotic helps to control the abnormal motion in the rearfoot. This is accomplished by taking a mold of the foot in its neutral position. The neutral position is the position the foot should be in when walking. When standing, the over-pronated foot is in the uncorrected position. The mold of the foot should be taken with the patient sitting so the foot can be placed in the neutral position.

The molds are sent to a lab and scanned into a computer. A reverse image is produced and the computer generates an image of the foot in neutral position. The computer adjusts the image based on the corrections recommended by your podiatrist. A model of the foot is then cut out, in some cases out of wood. The orthotic material is pressed over the foot model and the orthotic is created. The most common material is polypropylene, but other materials, such as graphite are used. In some cases, hand-made molds are created out of plaster. This was the classic way orthotics were made until newer technology made the process much less labor intensive.

Functional orthotics are a successful treatment for many problems affecting the lower extremity. In a recent article in the Journal of the American Podiatric Medical Association, 75% of patients surveyed had good to excellent results from functional orthotics. This includes 17% who felt the orthotics “cured” their pain. Less than 10% had no relief. The most commonly treated condition in the study was a painful heel. Over 20% of patients surveyed were treated for a painful heel and 20% were treated for a painful arch. Fourteen percent of the individuals were using orthotics for flatfeet. Other conditions treated with orthotics were knee, hip and back pain, foot arthritis, bunions and high arches. Tendonitis was not specifically evaluated.

Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to orthotics. The plantar fascia is a ligament type structure on the bottom of the foot which helps to hold up the arch. When the foot collapses, the weight of the body stresses the ligament and results in tearing and inflammation. This results in plantar fasciitis. These individuals typically respond well to orthotics in combination with other treatments. Certain types of tendonitis respond well to orthotics and other types require orthotics. Posterior tibial tendonitis is the tearing and inflammation of the tendon that helps to hold up the arch. When this tendon is overstressed by arch collapse it cannot heal. Orthotics are essential in the treatment of this condition.

Individuals with high arches may require orthotics as well, but they do not respond as well. Orthotics can help slow the progression of bunions and hammertoes, but they will not prevent this process. Orthotics may help with some pain at a bunion, but they will not “cure” the bunion. When the motion in the foot is contributing to the problem, orthotics are generally recommended. If the foot is stable and does not require support, the bunion, hammertoe, neuroma, tendonitis or even plantar fasciitis may not require custom made orthotics for treatment. These individuals may do well with a pre-fabricated orthotic.

Accommodative Orthotics

Diabetics can develop numbness and loss of circulation in the feet. This numbness and circulation loss puts them at risk for developing open sores on the feet called ulcerations. To help prevent excess rub and friction in certain areas on the feet, accommodative orthotics are recommended. Diabetics who do not have numbness or circulation loss (as diagnosed by their doctor) do not need to have accommodative orthotics. If the foot has a deformity, like a bunion or hammertoe, then accommodative orthotics are necessary.

Accommodative orthotics are made from many different types of material. Some are made of a foam type material, others made from cork and others have covers ranging from soft spongy material to leather. The type of material depends on the type of foot. Many accommodative orthotics, made for diabetics, have two or more layers that form around the foot once they are worn. Three pairs are dispensed every year and they are replaced every 4 months. Other materials are longer lasting. A mold of the foot is taken by stepping into a foam box. In this case, it is important to take the mold standing, so that the orthotic can be made to form around the foot.

The Cost

Many insurance companies cover orthotics for certain diagnoses. The most commonly covered diagnoses are plantar fasciitis (heel and arch pain), flatfeet and diabetes. Many insurance companies cover the orthotics at 80%. This means the patient is responsible for 20% of the cost unless they have a secondary insurance. If the deductible has not been met, then the amount is applied to the deductible and the patient must pay the full amount. Orthotics are not cheap. They range from $250 to $600.

Medicare covers orthotics for diabetics with neuropathy (numbness of the feet). Medicare does not cover orthotics for any other type of foot problem. Secondary insurance will not cover orthotics if Medicare does not cover them.

Podiatrists most commonly prescribe orthotics, but pedorthotists, orthotists, physical therapists and sometimes orthopedists will also provide orthotics.

Home Health Care is skilled nursing care and certain other health care services that you receive in your home for the treatment of an illness or injury. This could also include physical, occupational, and speech therapy. Medicare Part A will cover home health expenses at 100%. Private duty home care is not covered by Medicare and is paid for by the individual receiving the service. This type of service usually includes housekeeping and other routine personal care services (cooking, laundry, and shopping, and live in care givers.).
This could also include physical, occupational, and speech therapy. Medicare Part A will cover home health expenses at 100%. Private duty home care is not covered by Medicare and is paid for by the individual receiving the service. This type of service usually includes housekeeping and other routine personal care services (cooking, laundry, and shopping, and live in care givers.).

***FREE OF CHARGE***if Medicare approved

Call or email now to see if you are Medicare/Medicaid Qualified
If you or someone you know needs help with
1. Diabetes
2. High Blood Pressure
3. Wound Care
4. Arthritis/Joint Pain
5. Any Chronic Illness or Disease
We Also Provide:
1. Light House Keeping/Laundry Services
2. Senior Transportation
3. Meal Preparation
4. And Much More At No Charge to YOU!!

CLICK LINK BELOW TO WATCH VIDEO ABOUT HOME CARE  http://www.tahc.org/associations/1626/files/TAHC new VO.wmv

II. How to get Medicare Home Health Care:

• Your doctor must determine you need medical care in your home.

• You will need at least one of the following services: skilled nursing care, physical or speech therapy.

• You must be homebound. Homebound means that leaving your home is a considerable and taxing effort

III. What qualifies as Skilled Home Care Services?

• Wound Care for pressure ulcers or surgical wounds

• Physical Therapy (fall prevention, recent fractures, recent stroke, TIA’s, endurance issues, or transfer training)

• Occupational Therapy (recent strokes, ADL training-such as dressing, grooming, and bathing)

• Speech Therapy (swallowing issues, aspiration, recent stroke, pneumonia)

• Patient and Caregiver education

• IV Therapy

• Injections (diabetes, B-12)

• Medication Management

IV. Home Health vs. Hospitalization:

• In many cases home health care services may be appropriate to prevent an individual from being hospitalized.

• Most patients and their families prefer to stay at home rather than be placed in the hospital or skilled nursing facility when their condition allows them to remain at home.

• Home health care is usually less expensive and in some cases just as effective as care in a hospital or skilled nursing facility.

Home health care assists a person in their recovery from an illness, accident, surgery, or change in their medical condition. Professional health care and rehabilitation services are delivered in a person’s home environment under the direction of their personal physician.

Services offered include:

Skilled Nursing

24/7 Availability

Physical Therapy

Wound/Ostomy Care

Occupational Therapy

Infusion Therapy

Speech Therapy

PT/TNR results in home

Home Care Aides

Pain Management

Medical Social Workers

Rehabilitation

Who pays for home health care?

If you are Medicare eligible and qualified for care, there is no out of pocket cost to you. Home care can also be paid for by many private insurances or a variety of public programs.

To qualify for Medicare home health services, there are five basic requirements:

1. Your physician must determine that you need home health care services

2. Your own physician must write the orders for home health services, and oversee your care

3. You must need skilled services that are provided by a nurse or therapist

4. Your physician must determine that you are homebound, requiring considerable effort and help to leave home

Because benefits and requirements can vary, we can help you check with payors about your specific benefits, even before beginning services, so you can have this information at the start of care.

-Medicare pays 100% of the cost for home health care for individuals 65 years of age or over or permanently disabled.

-Private insurance will pay for home health care. Benefits vary per policy and verification of benefits is required.

-Medicaid pays 100%. Pre-authorization is required.

-Workers Compensation Insurance.-Private Pay.

We can HELP you in a number of ways.

·     Patient specific health data with observations by a professional nurse are reported to the physician.

Helping patients and their families to understand and follow physician’s orders regarding nutrition, special diets, medications, and general nursing care:

·       Assisting with home management of catheters and feeding tubes.

·     Giving injections ordered by the physician and teaching patients and family the proper techniques for doing so.

·       Helping patients restore strength and independence through physical therapy exercises,

Educating diabetic patients on how to manage diet, insulin, and other health related measures.  Enabling the patient with ostomy how to resume a full, active life.

·        Assisting patients with bathing and personal grooming (ADLS).

Once you have entered all of your information from prescription number to your name and address, as well as other identifying factors, the online pharmacy website will ask you for your insurance payment information as well as how you want to pay for the prescription. Some online pharmacies will allow you to either pay online or at the store for in store pickup. However, if you are ordering for delivery from the online pharmacy you will have to pay online.

An online pharmacy is generally the web presence of your general pharmacy. However, you should always check for verification of your online pharmacy before you place any orders. You will want to make sure your online pharmacy is a Verified Internet Pharmacy Practice Site as is defined by the National Association of Boards of Pharmacy. If you have any questions or concerns about an online pharmacy then find another online pharmacy that seems more legit or can at least answer your questions.

When you search for online pharmacy on the Internet you will get plenty of results from some of the bigger chains. If you are familiar with these pharmacy chains then you should trust their online chain as well. Remember, never enter any credit or bank information on an online pharmacy website unless the site is secure.

Their studies also indicates that about half (51.4%) of the $20.8 billion in retail drug spending in 2000 occurred among just eight categories of medicines-arthritis, treating cholesterol, chronic pain, depression, ulcers, high blood pressure, diabetes, predisposition to seizures and other stomach ailments.

The spending on prescription drug had a steady climb in recent years. It has played a big part on the health care cost and health insurance premiums. This trend continues up to this day and even if people, who already have a health plan as part of their health insurance, could still feel the impact of the raising cost on which is being passed onto them indirectly, through higher insurance premiums and co-pays.

There are a lot of factors that contributes to the soaring cost it could be the increase in the number of prescription drugs written, the used of more prohibitive drugs, price increase and the used of Advertising and Marketing campaigns.

You can still go to the traditional route of getting out patient prescription drug from drug stores, discount stores, pharmacies at food stores but come to think of it, it will save the you—the consumer a lot more you order your medicines online.

Why online? It saves you on prescription cost. It is more convenient as you can order it even if you are in a remote area as long it has internet connection. You can make price comparisons. You have the power to choose from generic drugs to brand named drugs, a choice of medications. You get the same assistance and you can also enjoy discounts.

It is best that you choose not just any online pharmacy, but a pharmacy with reputation such as Drugstoretm.com. Most pharmacies out there makes outrageous claims of instant fixed it or quick cure of all imaginable maladies. We have more butalbital tramadol, generic fioricet and cheap online soma medicines.

From brick-to-mortar setting, making the transition to online purchasing is safe. Like any E-commerce site Drugstoretm.com complies with drug safety and demand to give consumers access to drugs in a faster and simpler way. This also contributes to patient care, getting the right medicines where ever you are.

Online Pharmacy is the latest in electronic prescription adoption. We give no complex medical information. Everything is as straightforward. Our technology is enough to satisfy our customers changing needs quality top selling drugs like prescription tramadol.

You can save the money on car gas, time and energy from making a purchase at a drug store when all you have to do is order it online and the medicine can be delivered right at your doorstep. This is one convergence in online pharmacy that you can enjoy.

Have nutrient rich foods: It is a requirement that you almost need to consume 40 nutrients for good health, and it is not one product that supplies all these nutrients. Your daily eating pattern should contain whole wheat grain products, meat, poultry and other protein foods, fruits, vegetables, dairy products. However your calorie requirement pays a key requirement on the quantity you consume.

Make sure you consume plenty of whole, grains, vegetables: Statistics reveal that most of the Americans do not consume much of fruits, vegetables and grains. It is of utmost importance that you consume all of these. If you didn’t like these earlier then try a hand on them now .You can look into various recipes books to try and make these foods in different styles which you are not familiar with. It is required that you need to go in for 6-11 servings from bread, rice and pasta group. You should have 2-5 servings of fruits and 3-5 servings of vegetables.

Have the right weight: There are different factors that help you to determine the right weight like sex, hereditary, height, age etc. It is important that you need to maintain the right weight required. Excessive weight can increase the chances of high blood pressure, heart stroke, diabetes and some type of cancer and various disorders. However if you are too thin it can cause you menstrual irregularities, osteoporosis etc.

Make it a point that you eat your meals in short portions.
Have regular meals because skipping the meals can lead you to overeating.
These can be some of the points which can help you to maintain a balanced diet.

Short term disability pays a portion of your wages should you be out of work due to injury for up to one year. Some employers pay for this benefit for their employees, some offer it for employees to purchase.

If you have a pre-existing medical condition, the time to enroll is during the initial enrollment period when a medical exam is not required.

Replacement of wages is only partial; insurance underwriters, as well as your employer, want you back at work as soon as possible. Usually there is a waiting period of 14 days in which you will not receive payment.

Long term disability policies are purchased to replace what your potential earnings would be from the time you become disabled until age 65 when Medicare would be available.

For instance, if you are 55 and make $40,000 per year, you should purchase a policy for $400,000.

You cannot get a long term disability policy if

(1) you are or are soon to be pregnant,

(2) make less than $18,000 per year,

(3) are unemployed, or

(4) you are required to carry a weapon for your job.

Typically, the waiting period for long-term insurance to kick is at least 60 days and as much as a year.

Disability insurance is an important aspect of your overall insurance coverage plan, and if your employer offers it as a benefit you should definitely consider it as a wise investment.

When your vision is impaired or you are considered to have moderate low vision to profound low vision their can be light at the end of the tunnel for some. Visual acuity is not always a way of being able to determine how severe the problem may be. Different lifestyles can make the necessity of some sort of care plan for someone who is in need of low vision care. It is best to see an eye doctor first to help you determine which type of care is best for you.

An exam can consist of several tests including testing your visual acuity’s,  refraction, a visual field test, and even eye charts. An eye doctor is then better capable of prescribing the right device or devices and in some cases low vision rehabilitation. The cost for these services may vary and you should contact your doctor’s office to get a better understanding of what is involved. Medicare may have some coverage towards low vision rehabilitation services. You may want to check if it is available to you in your area.

The most common devices to help with low vision consist of:

Microscope or Spectacle magnifiers that contain a magnified lens that is mounted.

Stand Magnifiers equipped with lights, and hand held as well.

Hand held devices or bi-optic telescopes.

(CCTV) Closed Circuit Television, portable or can be used with computer.

Many of these high tech items can be quite costly so it is important again to see your eye doctor to better understand what is best for your vision needs. Just remember that there is hope and before giving up o being able to do things you enjoy talk with your doctor first or seek a second opinion. The technology and education we have today may help you see better tomorrow so see you eye doctor to be fit correctly by your eye care professional.

Solutions to Keep Life’s Quality

Las Vegas is home to the only center in Nevada that specializes in assisting people with partial sight, and the only husband and wife team of its kind in the country. Low Vision Services Inc. was founded by Nevada’s only board certified vision therapist, Sandy Yesnick. “We came up with the idea for the center by putting ourselves in the patient’s position. Visually disabled people need more than products; they need solutions that allow them to remain independent and to continue enjoying their favorite activities. That’s why we brought together in a single center the complete range of related professions and put together our multi-disciplinary approach. Our goal is to make sure that our patients achieve the absolute best results possible.”

Every effort has been made to facilitate access to the center, from the color of the walls to lighting and furniture design. The center assesses the patient’s needs and their remaining visual capabilities on-site before showing them how to make the best of their sight in order to help them remain independent as long as possible. Patients are not merely exposed to a world of innovative solutions; they are carefully matched with the product that best meets their needs and taught to make the best use of that product with ample follow-up care. As Dr. David Yesnick makes clear, “Our emphasis is placed on the rehabilitation service and the on-going care offered to each patient.”

The experts at Low Vision Services Inc. have built a reputation for solid professionalism by offering the kind of friendly, thorough, personalized attention their patients deserve.

In some cases, applicants will even have to undergo a medical exam. A preexisting condition as common as asthma could be enough for an insurer to hike your premiums, while a history of anxiety or depression might cause an underwriter to think twice.

And if you have a history of heart disease, cancer or diabetes, you could be out of luck entirely. A plan could either be too expensive or include a rider that excludes the very ailment for which you need coverage. If they look at your application and see something they don’t like, a $600 [a month] policy could go to $850, says Richard Reichmann, Florida Isnurance Broker.

You should also know that health insurance is regulated at the state level. In places like New York, New Jersey and Vermont, insurers must offer coverage to every applicant, regardless of age or health status. This egalitarian approach sounds great until you see the premiums.

Even young healthy men, who are the cheapest to insure, could be charged as much as $1,000 a month, says Reichmann. In other states, such as California and Florida, there are fewer restrictions on the insurers, and premiums tend to be more reasonable for young people and pricier for older folks. The problem in these regions is that insurers can outright refuse to provide coverage. In such cases, consumers can buy pricy policies from a state high-risk pool.

But it won’t come cheap, and it could exclude pre-existing conditions. For more information on the rules for your area, contact your state insurance commission’s Web site.

If you have the option to sign up for COBRA (a federal law that requires certain employers to provide former employees with the option to purchase health insurance), do it. In nearly all circumstances, it’s smarter to keep your former employer’s health plan for the full 18 months. Yes, paying the entire premium out of your pocket may be steep, but it’s usually cheaper than buying it on your own.

Before you exhaust your COBRA, start shopping around for your next plan. The quickest way to get a handle on your options is to look for policies on If you need a little more hand holding, you should contact a local insurance broker. (Contact the National Association of Health Underwriters for a listing of local brokers in your area.)

Just make sure you find someone who represents a lot of companies and understands the underwriting standards for each insurer. The last thing you want is to be rejected from a plan that doesn’t typically cover someone with your health profile. Not only is it a waste of time, but it could also raise a red flag when you apply to other insurers. An informed broker could steer you away from such insurers.

And since group coverage tends to be cheaper, don’t forget to check with your professional trade association for coverage. The Writers Guild and the Actors’ Equity Association are two examples of groups that offer their members health insurance. (In most states, however, people in their 20s and 30s may find cheaper coverage through an individual plan.) And for those starting a business: Most states allow as few as two employees to buy a small group policy.

One way to keep premiums manageable is to increase your deductible (don’t go beyond what you can afford to pay out each year) and skip the vision and dental coverage. Don’t even try to match your former employer’s lush plan. Blue Cross Blue Shield of Illinois, for example, charges a young family of four living in suburban Chicago $636 a month in premiums and a $250 deductible. If they accept a deductible of $1,750, they can lower the premium to $415 a month.

Insurance should be purchased to cover sudden accidental and unintended losses. With low-deductible plans and maintenance policies, you are trading dollar for dollar with the insurance company over the long run.

While there are some benefits you can live without, others are important. A maternity rider is one of them. I advise all of my female clients to get one. Unlike employer-sponsored plans, which usually cover birthing expenses, private plans don’t unless you pay for it upfront.

Even if you decide to start a family in a few years, it may be too late to add the coverage. Blue Cross Blue Shield of Tennessee, for example, won’t let a woman add the benefit after she initially purchases a policy unless she submits an official notification of change in status and gets married.

Before you make your final decision, read the fine print. Make sure you’re buying comprehensive coverage that will cover you should you suddenly fall ill and rack up thousands in hospitals bills. Insurers have been known to attract customers with low teaser rates that can change after only a few months. It may cost a little more, but you should look for one that will guarantee your premiums won’t rise for 12 months. And most important, go with a reputable firm. Check its claims-paying ability rating with an agency like Standard & Poor’s or Moody’s.

Buying health insurance may not top your list of fun things to do, but that doesn’t mean it’s unimportant. After all, there are few things in life more valuable than good health.