Everyone needs quality health insurance coverage. When do you
need it? Before you have an accident, become ill or get pregnant.
Insurance only covers health issues that happen after the policy
begins. For example, if you are pregnant before the policy is
issued, the plan benefits will not apply to your pregnancy costs.
Finding the right coverage for your family is a daunting task. By
knowing the basics of health insurance, you can make the right
Health insurance is not a right
Your employer does not have to provide you with health insurance.
It isn't required by law, and many employers are unable to afford it
with rising premium costs. Don't simply assume that when you find a
job, you will find insurance. Many employers offer it, but many do
If you are lucky enough to have benefits through your employer,
when you quit or lose your job, the coverage will end. Don't expect
to find new coverage for the same price. And don't expect your
former employer to insure you for a single day over your last day on
the job. They aren't going to give you any free insurance.
If you leave a job that has health insurance, you can apply for
COBRA. COBRA stands for Consolidated Omnibus Reconciliation Act. It
is a federal plan that can provide you with a short-term health
insurance. You may qualify for HIPAA, which stands for Health
Insurance Portability and Accountability Act. Make sure you talk
with your human relations department about your insurance options
after leaving work.
Health insurance is expensive
Individual health insurance is quite expensive. With a group
plan, the costs and risks are spread evenly among many people. With
an individual plan, you health policies are dependent on your
personal health history. Pre-existing conditions can boost your
premiums. Expensive medical claims can raise your premiums, as well.
You may find that it is often difficult to find health insurance
if you have several pre-existing medical conditions. However, some
states require that individual health insurers offer everyone a
plan, known as "guaranteed issue."
Health insurance is always going up
Your premiums are not fixed for the life of your policy. Health
insurance companies are always raising premiums to cover the rising
cost of health care. Some heath insurers only have to notify you of
the increase and then begin charging you more money. State insurance
regulators do watch to see that rates are not excessive.
Even if you have group health insurance, your rates could climb.
Even if you haven't personally had any claims, the group in whole
could have experienced an increase in claims - causing everyone's
rates to increase.
If you can't afford insurance
If you are a college student and unable to afford individual
coverage, you should check with your school. Many universities offer
reasonable health insurance.
No matter how old you are, there are several federally sponsored
insurance programs that help you with individual health insurance
Medicare is a health insurance program for those 65 and older,
young disabled persons and people with end-stage renal disease.
Medicaid is a program for low income individuals. The Children's
Health Insurance Program (CHIP) provides health care to children
whose parents do not qualify for Medicaid, yet still cannot afford
individual health insurance.
Many states offer health care plans for children whose parents
cannot afford health insurance. Some states have plans that cover
expectant mothers and parents as well.
Low-income families are encouraged to sign up for low income
health insurance programs. They provide thousands of families with
high-quality health care at no impact to the financial situations of
Understanding health insurance lingo
There are so many key words and phrases in insurance. It can be
difficult to understand what is and isn't being said. There are many
different health insurance plans, including fee-for-service plans
(FFS), health maintenance organizations (HMOs), point of service
plans (POS) and preferred provider organizations (PPOs). Each plan
has its own advantages and disadvantages that must be considered
when shopping for health insurance.
Fee-for-service plans (FFS) are often referred to as traditional
indemnity health insurance. They offer flexibility, but come with
high out-of-pocket costs, more paperwork and higher premiums.
With an FFS plan, you can choose your own doctors and hospitals.
You may also visit specialists without having a referral from a
primary care physician.
The deductible on a FFS may run between $500 and $1,500, or
higher. You usually have to meet the deductible before the insurance
company pays any claims. After your deductible is met, doctors are
reimbursed for 80% of the bill, while you pay the remaining 20%.
You may be required to pay for the medical services up front,
submitting your paperwork for reimbursement later. Most FFS plans
will only pay for "reasonable and customary" medical expenses. If
your doctor is more expensive than others in your area, you will
make up the cost personally.
Finding the right individual health insurance plan
When looking for a health care plan, the key is to shop around.
Start with your local insurance agents or companies. An agent should
be able to provide you with information about insurance companies
that provide individual coverage in your state.
Captive agents work for one insurance company. Independent agents
can sell policies for a variety of different insurance companies. A
list of agents is available through your yellow pages or through the
state department of insurance.
Discuss with the agent your health insurance needs. Do you need
insurance for your entire family, or just yourself? Do you want to
choose your doctor? If you are over 65, do you need Medicare
supplemental insurance? Do you need long-term disability and
long-term care coverage? What can you afford?
When you have chosen the proper coverage for your needs, you will
fill out an application through the agent. Be honest in disclosing
your medical history. Report all of your health problems to your
agent. If you think something is insignificant, let the agent make
that call. If any of your health information is false or incomplete,
the company could refuse to pay future claims and cancel your