Health insurance

What if I leave my job?

The Consolidated Omnibus Budget Reconciliation Act
(COBRA), a law created in 1986, gives workers (and
members of their family) who lose their health
insurance benefits the right continue their group
health insurance for a limited period of time under
circumstances such as voluntary or involuntary job
loss, reduction in hours, transition between jobs,
divorce, adoption and death.

Generally, the employee pays up to 102% of the premium
cost for the same policy; this is still usually less
expensive than buying an individual insurance policy.

There are three basic aspects for qualifying for
COBRA: the qualifying event, the insurance plan
coverage and the qualified person.

Each aspect is taken into consideration when applying
for COBRA and you must elect to either apply for COBRA
or waive your rights to COBRA within 14 days after a
qualifying event.

You must also have been in the group insurance plan
during your employment to be eligible. Although there
are exceptions, generally you may continue to pay your
own premiums to keep COBRA coverage intact for up to
18 months.

Companies who have fewer than 20 employees, State or
Federal employers or employee organizations may not
offer COBRA coverage.

Check with your health insurance administrator to see
if you may qualify. You may also have this information
readily available in your group health insurance
policy or in your company handbook.

Although it may be expensive, the cost of being able
to keep your group insurance coverage rate may be well
worth it.

What Happens When I Retire?

Health insurance considerations weigh heavily on the
minds of people wanting to retire before Medicare
coverage kicks in at age 65. Many people put off
retirement simply because the cost of an individual
health insurance policy is too great on a limited
income.

What options for health insurance do you have if you
choose to retire before age 65? Although they are not
required to, you may be able to get COBRA-like
coverage from your employer.

As an added retirement benefit, your employer may
allow you to pick up the premium on your policy;
although paying 100% of your premium may initially
appear to be an expensive option, purchasing an
individual policy apart from a group may be even more
costly and not provide you with the level of coverage
you previously had.

Some companies are offering basic high-deductible
insurance reasonably in the hopes that they will be
able to enroll you in Medicare Part C (supplemental
insurance) when you retire.

Another option is to budget and save money to cover
your anticipated medical costs for the time period
between retirement and age 65. If you are in very good
health, this may be a viable alternative for you.

Pre-planning for retirement is an important issue; the
earlier you start planning, the better. Realizing the
Medicare does not pay all of your medical expenses,
you should budget money for medical expenses even
after retirement.

The Importance of Keeping Good Files

As in everything that involves money, it is important
to keep good records of your medical expenses for many
reasons.

Keeping track of deductibles, especially for a family,
can be time consuming, but is an important task. Every
policy has different deductibles for lab work,
hospital emergency room visits, hospital stays, doctor
visits and x-rays, and it is often difficult to track.

Keeping track of your out-of-pocket expenses becomes
very important when it comes time to complete your
taxes. It also comes in handy to know what your
expenses are for medical care when choosing to change
companies or policies.

A file folder that includes a copy of the policy,
copies of your medical bills and copies of what your
insurance company has paid on those bills is usually
all you will need.

When a bill comes for a provider, you will usually
receive a statement from your insurance company
showing what portion of the bill they paid, and many
times providers write off the remainder, if it is not
a large sum.

If you visit several doctors, you may want to have a
file folder for each doctor or provider.

Insurance companies do occasionally make mistakes, but
they are usually on top of their game. Having a copy
of the policy handy makes it easy to check deductible
levels and whether a particular service is covered or
not.

It also serves as a ready resource for telephone
numbers, website information and your contact at the
insurance company.

The Basics

Health insurance, in this modern world of cancer,
heart disease, AIDS, diabetes, asthma, ageing and
other diseases and afflictions, it is essential to
have some sort of health insurance.

There are many levels of health insurance coverage
available; unfortunately, like most things in life,
you get what you pay for, and good coverage can be
very expensive.

The two most common terms in referring to health
insurance are premium, which is the amount paid for
the insurance, and deductible, which is your
out-of-pocket expense before the insurance pays your
provider.

For instance, you might pay $300 premium per month for
family coverage, and your deductible might be $250 per
person, which means if you fell and broke your ankle
and went to the hospital emergency room, you would be
required to pay the first $250 of the bill.

You can purchase very basic catastrophic coverage,
which would carry a very high deductible and the
premium would be less than comprehensive coverage
which would have a higher premium and lower
deductible.

It pays to invest the time to investigate various
insurance options, taking into consideration your age,
your general health and the health of your family
members.

Your employer may offer group health insurance, which
is most likely the least expensive option for you, and
usually the premium is deducted from your paycheck.

Health insurance is a calculated risk; can you afford
the premiums or are you willing to risk that you would
pay less out of pocket for medical expenses in a year
than the premiums would cost? Consider carefully.

Prescription Insurance Policies

Some health insurance policies do not provide for
prescription coverage and a separate policy must be
purchased for prescription medications.

This is an area where it pays to do some homework and
research and find the best policy for you.

Prescription coverage insurance is not a necessity;
like health insurance coverage, it is a calculated
risk, although the risk is not as high.

Usually you can buy prescription insurance at any
time, so if the doctor determines that you need an
expensive maintenance drug, you may opt in at that
time.

It is important to know that if you presently have
prescription insurance you can usually only change it
at a specific time of the year, although you can add
new prescriptions, you can’t change plans.

The person who seldom takes prescription medications
probably does not need prescription insurance;
however, a person who takes maintenance drugs for high
blood pressure, diabetes, depression, heart disease or
immune disorders most likely needs insurance against
the high costs of drugs.

Prescription insurance policies usually have « tiers »,
which usually means that a generic drug is at a low or
no co-pay, a tier 2 level may be the brand name
genuine, and a tier 3 may be a brand new expensive
drug that the co-pay could be a set high-percentage of
the cost.

In choosing prescription insurance, you should first
list the prescriptions that you take and the retail
amount of them. If you chose not to purchase
insurance, this would be your monthly cost.

Find out from the provider what the monthly premium
for you would be, then what the prescription co-pay
amount would be and add these two figures together.
Which is the less expensive alternative?

Medicare

Medicare is a governmental program which provides
medical insurance coverage for retired persons over
age 65 or for others who meet certain medical
conditions, such as having a disability.

Medicare was signed into legislation in 1965 as an
amendment to the Social Security program and is
administered by the Center for Medicare and Medicaid
Services (CMS) under the Department of Human Services.

Medicare provides medical insurance coverage for over
43 million Americans, many of whom would have no
medical insurance. While not perfect, the Medicare
program offers these millions of people relatively low
cost basic insurance, but not much in the way of
preventative care. For instance, Medicare does not pay
for an annual physical, vision care or dental care.

Medicare is paid for through payroll tax deductions
(FICA) equal to 2.9% of wages; the employee pays half
and the employer pays half.

There are four « parts » to Medicare: Part A is hospital
coverage, Part B is medical insurance, Part C is
supplemental coverage and Part D is prescription
insurance. Parts C and D are at an added cost and are
not required. Neither Part A nor B pays 100% of
medical costs; there is usually a premium, co-pay and
a deductible. Some low-income people quality for
Medicaid, which assists in paying part of or all of
the out-of-pocket costs.

Because more people are retiring and become eligible
for Medicare at a faster rate than people are paying
into the system, it has been predicted that the system
will run out of money by 2018. Health care costs have
risen dramatically, which adds to the financial woes
of Medicare and the system has bee plagued by fraud
over the years.

No one seems to have a viable solution to save this
system that saves many people throughout the country.

Health Savings Accounts

If you are considering changing your health insurance
policy, you should be aware of the alternative of a
Health Savings Account (HCA).

Health Savings Accounts started to become available
(and legal) in 2004, allowing people with
high-deductible insurance policies to set aside
tax-free money to fund medical expenses up to the
maximum deductible amount.

If you don’t have to use the funds, it rolls over
every year. Once you reach age 65, you no longer are
required to use it for medical expenses, although you
certainly can; you can withdraw funds under the same
conditions as a regular IRA.

Although you will be penalized if you use the funds
for non-medical expenses prior to age 65, you can use
the money for vision care, alternative medicine or
treatment and dental care.

For 2008, an individual may fund up to $2,900 tax
free. The maximum deductible would be $1100 and the
maximum out-of-pocket cost would be $5,600.

For a family, the maximum tax-free contribution is
$5,800 with the maximum deductible of $2,200 and the
maximum out-of-pocket cost would be $11,200.

Health Savings Accounts are certainly a viable way to
shelter income while providing catastrophic insurance
coverage in light of the high cost of low-deductible
health insurance plans.

For healthy people, it deserves some research. Consult
with your insurance agent for all of the details
involving this approach to managing your insurance
needs.

Getting the Most Benefit From Your Policy

The key to getting the most benefit from your health
insurance policy is knowing your policy coverage.

Many people don’t actually read the policy for the
policy plan book; they may not be aware that the
policy may pay 100% of certain procedures, like annual
physicals, mammograms, flu shots or certain labs
tests.

The policy plan book will outline for you what
procedures are not subject to the deductible or co-pay
(your out-of-pocket expense).

Some insurance companies have shifted their emphasis
from health insurance to health improvement and
maintenance and will pay for the cost of gym
membership, nutritional counseling or plans to stop
smoking.

If you were trying to lose weight and knew that you
could get these services at no cost, wouldn’t you take
advantage of them?

If you wanted to quit smoking, wouldn’t it be
beneficial to know that you could get the patch for
free?

It is very wise to know what services are available to
you through your insurance company, and you will only
know if you take the time to read through your policy.

Health insurance is an expensive item; take advantage
of every aspect of it that you can, not only for
yourself but for the members of your family.

By taking full advantage of the free benefits of your
health insurance policy, you will be healthier and
possibly require fewer visits to your doctor.

For College Students

The tuition arrangements are set up; the dorm room is
assigned and your son or daughter is headed off to
college in the fall. In all of the confusion of the
paperwork, deadlines and financial arrangements did
you remember to check on their health insurance?

Many, but not all, insurance companies provide for
health insurance for college students under a family
policy; do you know for sure that yours does?

With some insurance companies, coverage depends on
whether or not the student is a full time student.
Review your policy or ask your insurance
administrator; if you have an HMO plan, will your
student be covered if they go to the student
healthcare facility away from home?

Check the age limit as well; you may find that once
your son or daughter reaches a certain age they are
dropped from the policy no matter what.

Ask your insurance company to provide an extra
insurance card for your son or daughter to carry with
them; if there is an additional card for prescription
medications; make sure they have that too.

This preventative step will help eliminate confusion
when they suddenly have to see a doctor.

There are student health care plans that are available
through most colleges that are a reasonably priced
alternative if your policy excludes your child.

Isn’t college confusing enough without having to worry
about whether your child is covered should he or she
need to seek medical attention? Take the time to look
into health insurance before they head off to college
in the fall.

Disability Coverage

Disability insurance policies are designed to pay part
of your wages should you be injured in an accident or
are unable to work because of illness. Here are two
types of policies available: long-term disability and
short-term disability.

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.