Americans have the most fragmented, and therefore the most expensive health care in the world. Fragmenting, or breaking health insurance consumers into many different groups, eliminates the efficiency of providing one service to a large number, as well as multiplying the kinds of forms and paperwork involved. There have been many volumes written on the American health care delivery system, (clicking on this should bring the reader to the book review page when I write one!) and I have no intention of exploring this problem in detail. What follows are several points relevant to getting and keeping health insurance. America is the only industrialized country in the world that considers access to health care a commodity to be bought and sold rather than a human right.
Option One: Research what options are open to you in your situation. If you are employed and your employer offers insurance, it is often the most cost effective for you for two reasons. First, your employer can negotiate a group rate and may be able to contract with several different insurance companies, which may bring you a choice of plans as well as lower rates. Secondly, employers traditionally pick up a percentage of the premiums. In general, the more individuals eligible for a single plan package, the less each person's premium will be.
Option Two: If your employer does not offer insurance, you have several different options. Insurance is regulated by states, so each state has a different way of offering different types of plans. Some states offer insurance deemed "high risks" in special high-risk pools subsidized by the insurance carriers licensed to sell health insurance in their state. Don't be fooled by that word "subsidized." Remember this is a high-risk pool whose members are difficult and expensive to insure, so the premiums are likely to be fairly high.
Option Three: If you have recently left a job, you may be able to remain covered under your employer's group plan, but you will have to pay the entire premium. This continued coverage is called COBRA and is only available under certain circumstances. Contact your employer or the U.S. Department of Labor to determine if you are eligible.
Option Four: You can shop for plans on the open market. The cost of this option is usually the highest, but it may be the only full service option left for you. Find a broker who can offer several plans and compare them in your specific circumstances.
Even if you have a pre-existing condition, you still have federal and state protections limiting the time your condition can be excluded from coverage. To be safe, do not allow a gap of greater that 63 days in a row or your pre-existing condition may not be covered during an initial waiting period.
Option Five: Medicare is a federal program providing health insurance for all persons over 65 years of age. There are two parts. Part A covers hospitalization, some nursing facilities, and hospice care, but not 100%. There are no premiums for Part A. Part B covers doctor's fees, lab tests, and many home health and outpatient costs, but you must pay a premium. These premiums can be directly deducted from your Social Security income, or through Medicaid if you qualify, but it is not automatic. Since Medicare coverage is incomplete, some insurance companies have developed Medigap policies that pay co-payments and deductibles, immunizations, testing, and some pharmaceuticals. Medigap Insurance is only offered through private insurance companies. The premium can vary quite a bit even though the services provided are controlled by government mandate, so it is best to shop around.
Option Six: If your income is very low, or if you are disabled, you may qualify for Medicaid. Eligibility for coverage is based on the income of the household, and favors infants, children and pregnant women. Even if you are not a citizen, you may still qualify for Medicaid in an emergency situation. Single adults and couples have the lowest income requirements and therefore the most difficulty qualifying for coverage. Every state also has a special managed care program for children under the age of 19. To determine if you or your children are eligible for either of these programs, contact your state Department of Health.
Option Seven: We do not recommend that you purchase discount health care. There are some companies that offer plans that claim you get discounted costs to participating physicians. These have been shown to be unreliable in terms of member physicians and in the amount of discount actually obtainable. If it sounds to good to be true, it probably is.
