How Do Insurance Companies Make Money?

Most of us have some sort of insurance protection. Whether it’s health insurance, car insurance, homeowners insurance, life insurance, or something else, we all are paying a premium (or someone is paying it for us) to reduce the potential financial burden in the case that something bad happens to us. When insurance companies are paying out for all those claims, how do insurance companies make money? Read on to find out.

What Is Insurance?

Before we can talk about how insurance companies make their money, it’s important to have an understanding of what insurance is. Insurance is when a policyholder pays another entity (the insurance company) a payment in exchange for the insurance company reimbursing the policyholder in the case of a financial loss.

For instance, if you own a home you pay homeowners insurance. If your home burns down, the insurance company will pay for the damages according to the details of the insurance contract.

With health insurance, you pay your premium, and in exchange you do not pay as much for an orthopedic surgeon as you would without insurance.

What if you never suffer a loss? Well, the insurance company keeps your premium. However, I will happily go the rest of my life paying out insurance premiums on my house, even if I never suffer a loss. Because that means my home was never burglarized, burned, etc. But if those things do happen, I can rest easy knowing that I will not be responsible for repairs or rebuilds.

How Do Insurance Companies Make Money?

An insurance company sets their premiums based on how much they expect to pay out in claims. Underwriters and actuaries do the math and predict an amount of financial loss that they will pay out to policyholders.

After they predict the amount of claims, they have to add in other things such as administrative costs, premium taxes, broker fees, and other costs of doing business.  Then, after that, they add in their margin, or profit.

They take all of those figures and divide by the number of policyholders to get a premium.

That actual formula for determining premiums is more complicated than that, but those are the basics. As you can see, if the claims come in higher than expected, the insurance company’s profit goes down. If the claims come in lower than expected, the insurance company’s profit goes up.  A lot rides on the accuracy of the underwriters and actuaries.

Shop Around When Buying The Best Insurance Rates

When insurance companies are battling for your business, it is usually the amount of profit they are willing to give or take that determines how competitive they will get with their pricing. Most of the other aspects of an insurance premium is fixed. Whether you are an individual or a group, insurance companies will many times come down on their premium if you press hard enough.

So when wondering how do insurance companies make money, it comes down to the profit they are taking on top of claims and fixed expenses.

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Iphones and Tables and ipads

Telemedicine Benefits and Disadvantages for Patient Primary Care

As the cost of health care premiums increase and out-of-pocket limits in health insurance plans continue to rise, people are left to wonder what can be done about the rising cost of health care. People with High Deductible Health Plans and HSAs are especially hard hit when it comes to the simplest parts of receiving health care. An HSA member can find that a routine visit to a primary care physician is at least $100. Many times, much more than that.

One of the ways to combat this charge is to enroll in telemedicine, such as Teladoc or DoctorNowPlease. With telemedicine you can have a doctor consultation over the phone. Sometimes this is done on a voice call, and sometimes this is done through a face-to-face interaction through a smartphone.

Telehealth is a terrific way to lower the cost of medical services while still receiving quality care. Here are some telemedicine benefits and disadvantages for patient primary care.


Telemedicine Benefits

Lower Cost for a Physician Consultation

The typical cost for a doctor visit varies based on the member’s plan design, but even the most generous copays today are $15 per visit. Usually the cost is much more, especially if you are on a bronze plan from the Marketplace.

As mentioned above, telemedicine is a great way to lower the cost of HSA out-of-pocket expenses, as an HSA plan could cost you $100-200 just to see a doctor about a sinus infection. That’s ridiculous.

If you buy a telemedicine program, the cost to see the doctor is much lower. When all you need is for someone to hear your symptoms and give you a simple antibiotic, do you really want to spend a small fortune? Of course not. The best telemedicine benefit is that the charge to have a doctor see you is lower than what you would pay to see him or her in person.

Less Time Spent Away From Other Things

In addition to too much cash out of your pocket when going to a doctor’s office, a trip to the doctor takes valuable time out of your day. How many of us have employers that will allow us to take half a day off to go see a doctor for something minor? That leaves us either taking vacation or going after-hours to an urgent care or emergency room, where the cost to be seen skyrockets.

With telemedicine, you can have a conversation by a doctor in a matter of minutes right from your home, office, car, wherever. And then you can go pick up your prescription at your convenience. Instead of 4 hours away from work, you can get by with just 15 minutes away from work.

Open on Weekends

What do you do if you get a sinus infection on a Saturday and your doctor is closed? Your choices are:

  • Go to an urgent care center (expensive and time consuming)
  • Go to the emergency room (more expensive and more time consuming)
  • Tough it out until Monday (suffer in pain and take off work on Monday)

An even better question is what do you do if your kids get sick on the weekend? Can kids use telemedicine? Of course they can. Another great telemedicine benefit is that you can call them on the weekend. A doctor will always be available. You can start taking a prescription on Saturday and be ready to go by Monday.

Telemedicine Docs Can Call in Prescriptions

Most doctors offices nowadays will call in a prescription for you during your visit. Telemedicine is no different. After your talk with the physician, he or she will send a message to your pharmacy to have your prescription ready. You can simply pick it up after school, after work, or any other time that is convenient for you.

Don’t think that just because you did not go to their offices that the doctors can’t get you taken care of as soon as possible.

Can Be Done Over the Phone or Face-to-Face

When telemedicine burst onto the scene, all of the consultations were phone conversations. Today, many of these companies offer both voice and video conferencing. The doctor can look you in the eye and tell if there is something wrong with you. Maybe not as good as a real doctor could see you, but any additional information that the teladoc can have, the better.

The Doctors Take More Time With You

My experience with telemedicine is that the doctors make a great effort to completely understand my situation. While primary care physicians are great at their jobs, they are overbooked. When you have a minor illness you are lucky to get 5 minutes of time with your doctor.

With telemedicine, you can have a good conversation with the doctor and feel comfortable that they are diagnosing you correctly. At least in my opinion and experience.

Telemedicine Disadvantages

Can’t Fix “Big Stuff”

Telemedicine is for issues that can be diagnosed and treated quickly and easily. If you suspect something larger, a telemedicine doctor is not for you. You need to see your primary care physician, specialist, or emergency room. Telemedicine is also not a replacement for a relationship with a primary care physician. While telemedicine is great for one-time issues, if there are recurring problems, a primary care physician should be consulted.

Can’t Dispense Narcotics

This goes with the above paragraph. Most states will not allow a telemedicine provider to write a prescription for a narcotic. So if you have something come up that needs the strong stuff, telemedicine will not be able to help you. But they may still charge you for the call. Go see your family doctor.

Won’t Count Toward Out-of-Pocket Expenses

With Obamacare, there are annual limits on the amount of out-of-pocket expenses that individuals can spend on any health insurance plan. If you have a medical service or get a prescription filled with your health plan, your out-of-pocket expenses count toward this limit.

Unless your telehealth program is through your health insurance plan, and some are, your telemedicine cost will not be counted toward the out-of-pocket maximum. Since a telemedicine consultation is not a huge expense it may not matter, but it is something to keep in mind.

Not Available in All States

Lastly, telemedicine is available in almost all states, but not every one of them. And some that do allow telemedicine only allow it through face-to-face smartphone calls. So if you are interested, check out the states that your potential plan operates in.

Telemedicine Benefits Outweigh the Disadvantages

The cost of telemedicine is low, and you save time by enrolling in a telemedicine plan. Why not take advantage? Usually all it takes is about 2 calls to make it financially worthwhile. If you have a family, you could go to the doctor twice by the time January is over each year. So take a look at telemedicine benefits and disadvantages and see if it is something that you want to participate in.

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Stack of Books

9 Great Health Insurance Books That You Need to Read Now

There are hundreds of books out there about the health insurance industry. Many of them have great ideas and action items about how to make an informed decision about your medical insurance purchase. While we haven’t read every book on the market, we thought it would be a good idea to break down 9 great health insurance books that will help you learn about the insurance world. Some of these books cover basic themes, such as what is a deductible, some are textbooks, and some cover more in-depth conversations like forward-thinking employer plans.

No matter your level of expertise, you can get some great knowledge from the books on insurance industry listed here. And you can also search for the best health insurance books with free downloads.  They have awesome information as well.

As a disclaimer, each link below will take you Amazon, and if you purchase one of the books, we will receive a small commission (seriously…small…but thank you!) If you choose to buy something through a link (at no cost to you) we appreciate your support!

Healthcare Made Easy:Answers to All of Your Healthcare Questions under the Affordable Care Act

Great Health Insurance Books - Healthcare Made Easy: Answers to All of Your Healthcare Questions under the Affordable Care Act by Michelle Katz

by Michelle Katz

This is a tremendous book that goes over the details of the Affordable Care Act. It is a great resource for employees, small business owners, and those that are self-employed. You will be able to save money when you read this book. It discusses things such as exemptions to the mandate that we all purchase health insurance, how can children be covered under the CHIP program, and how to receive lower costs on your prescription drugs.  It is written in a Q&A format, making it feel much more interactive and engaging.

Understanding the Insurance Industry: An overview for those working with and in one of the world’s most interesting and vital industries.

Great Health Insurance Books - Understanding the Insurance Industry: An overview for those working with and in one of the world's most interesting and vital industries.

by A.M. Best Company

If you want to know the basics of how insurance works, then this book is for you. It covers more than just health insurance and goes into property/casualty, life, and reinsurance and alternative risk transfer in addition to medical. This book is a great way to get an introduction to the key concepts and terms of the insurance industry. It is a short book and a quick and easy read. So if you are new to the insurance world either as a consumer or for your career, this book is a great place to start.

Easy Healthcare: Choose Your Health Insurance

Great Health Insurance Books - Easy Healthcare: Choose Your Health Insurance

by Lori-Ann Rickard

Under Obamacare, almost all Americans must be covered under a health insurance plan or else face a financial penalty at the end of the year. If you feel overwhelmed at Open Enrollment, don’t be alarmed. Choosing a health insurance plan is a daunting task for most people, and that decision is something that everyone wishes could be made easier. This book accomplishes that task. It is another short read that walks the reader through the steps to make the enrollment period much easier. You will be more confident that you are not overspending on your insurance plan while still making the best decision for you and your family. This is one of the great health insurance books for sale.

Affordable Care Act for Dummies

Great Health Insurance Books - Affordable Care Act for Dummies

by Lisa Yagoda and Nicole Duritz

Does the Affordable Care Act confuse you. Heard so much talk about Obamacare on the news that you have no idea what to think? This book does a great job of going over the details of the ACA. It discusses 10 essential benefits of the law, how to choose the best insurance policy for you and your family, and how the law affects employer coverage, whether it is a large or small employer. Written in the familiar “for dummies” style, the book is a quick read and set in brief sections. While not a deep dive at everything the law addresses, it is easy to understand and well organized. It’s a great book to read once and then keep around as a reference.

Health Insurance: Navigating Traps & Gaps

Great Health Insurance Books - Health Insurance: Navigating Traps & Gaps first Edition by Maura Loughlin Carley, MPH , CIC (Author)

by Maura Loughlin Carley

One of the comments on Amazon puts it best. Most of the talk surrounding health care and health insurance in America is so politicized, it is hard to make sense of what it true and what is not. This is one of the great health insurance books because it puts all of that aside and helps you understand how to handle your insurance needs. If you do not protect yourself the correct way with medical insurance, you leave yourself open to financial, physical, and emotional turmoil. Knowing how to play the game is vital, and this book helps you learn the rules.

Insurance: Concepts & Coverage: Property, Liability, Life, Health and Risk Management

Great Health Insurance Books - Insurance: Concepts & Coverage: Property, Liability, Life, Health and Risk Management

by Marshall Wilson Reavis III

The most important thing to know about the insurance world is risk. Risk is all around us, and everyone on the planet experiences risk at all times. How you and an insurance company handle risk is what forms an insurance policy. This book teaches you about the concepts of insurance and gives you ways to take action with your insurance. It will give you a way to see the big picture and what is at stake for everyone involved. Quick, and to the point, you will learn a lot in a short amount of time.

Health Insurance, Second Edition

Great Health Insurance Books - Health Insurance Second Edition

by Michael A. Morrisey

If you are looking for one of the great books about the Affordable Care Act, this is one for you. It gives a view of the role of private health insurance in the United States, and gives an understanding of Obamacare while predicting its effects. Health Insurance is a textbook, so you will learn a lot of great information including HSAs, moral hazards, Medicare, Medicaid, and more. Whether you are new to the world of insurance or a health policy expert, this book should be on your bookshelf.

Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care

Great Health Insurance Books - Cracking Health Costs: How to Cut Your Company's Health Costs and Provide Employees Better Care

by Tom Emerick and Al Lewis

This is a book written for CEOs, CFOs, and HR Directors and VPs, but don’t let that deter you from reading this book if you are not sitting in those chairs. This is a great book to help people understand what kind of thinking goes into the health insurance decisions that companies make. All companies have different attitudes and philosophies when it comes to covering their employees, and it is always good to know the decision-making process. The book looks at the myths, facts, and strategies about an employer-sponsored health insurance plans, and then goes into the authors’ solutions to fixing the problems facing employers. A definite must read, even if you do not agree with everything that is said in the book.

The Company That Solved Health Care: How Serigraph Dramatically Reduced Skyrocketing Costs While Providing Better Care, and How Every Company Can Do the Same

Great Health Insurance Books - The Company That Solved Health Care: How Serigraph Dramatically Reduced Skyrocketing Costs While Providing Better Care, and How Every Company Can Do the Same

by John Torinus Jr.

This is a book that has been valuable to some of our employer group clients. Despite the Affordable Care Act and other regulatory measures, healthcare expenses continue to climb. Coverage may be better under Obamacare, but that leaves someone footing the bill, which in many cases are private employers. This book details the steps that one company, Serigraph, took to curtail the rising cost of health care. What they did is not for everyone, but anyone that has a stake in employer-sponsored healthcare, which includes employees, should be willing to think outside of the box. Costs can’t continue to rise like this forever, and it will take some creative thinking to reign in spending.

What Other Great Health Insurance Books Do You Like?

These are 9 great health insurance books that we have enjoyed reading. What books have been helpful to you?

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