Your Options for Health Insurance

Coverage Protects Your Health and Money

If you don’t have health insurance, you’re more likely to go without medical care, face medical debt and even die sooner. The facts show health insurance can be a good investment, although it may cost you money upfront.

The good news: You have more options for getting health insurance, even if you have a pre-existing condition, thanks to the health reform law. If your employer does not offer insurance, you can purchase it on the individual market or check out federal and state resources.

Your Health Insurance Options
Consider the following choices for getting health insurance:

Work-based coverage: Most people under age 65 get health insurance through their own or a spouse’s job. But not all jobs offer health insurance. When workplace coverage is available, it is often the best deal going. Why? Many employers pay for some of the premiums on workers’ behalf, and you pay your portion of the premium cost with pre-tax dollars, which makes it cheaper for you. Employer-sponsored coverage often is more generous. Note: Even though many workers pay a fraction of the total premium, your costs still are hefty and are rising (about $4,000 on average in 2011 for family coverage). To see how different types of health plans work, read HK’s ”Understanding Your Health Plan Options.”

The individual market: About 14 million people buy health insurance on their own in the individual market, particularly if they are self-employed or work for a company that does not offer insurance. In most states, this kind of coverage is more expensive and less generous. Also, you can be denied coverage or pay much higher premiums for insurance in the individual market. If you are young and healthy, you can find cheaper coverage in this market. Many changes will occur in the coming years to make the individual market friendlier to buyers, with healthcare reform. [Read HK's "Healthcare Reform Hits 2011"].

High-risk pool or the Pre-existing Condition Insurance Plan (PCIP): Most states have so-called state high-risk pool programs that help people who’ve been rejected in the individual market get health insurance. High-risk pools tend to be pricey but they may be worth it. Check to see if your state has one of these programs, and what it covers. Meanwhile, if you have been uninsured for at least six months and have a pre-existing condition or have been denied health coverage, you can access a new, more affordable option, called PCIP, no matter where you live. There are new PCIP plan options offered in 2011.

Medicaid: This public health insurance program covers about 60 million low-income individuals and families and elderly with disabilities. Not all low-income people qualify, but it often covers children, pregnant women, seniors and disabled people. Find your state’s rules because states run Medicaid programs differently. Medicaid offers generous benefits and is free for some and costs very little for others.

Children’s Health Insurance Program: This state-run program provides low-cost health insurance coverage in every state to children up to age 19 in families who earn too much income to qualify for Medicaid but cannot afford to buy health insurance through their work or the individual market. See more about the CHIP program in your state.

Medicare: This is a federal health insurance program that covers people age 65 or older, those under age 65 with certain disabilities and people of all ages with permanent kidney failure requiring dialysis or a transplant. There are some costs associated with Medicare.

Other Options
Meanwhile, if you have coverage and are losing it or have recently lost it, you have several options to continue coverage or get other coverage. [Read HK's "Finding Insurance After a Job Loss"]. Many of these options can be expensive, such as continuing coverage under the COBRA law. [Read HK's "COBRA: Understanding Your Rights"]. If you are under age 26, you can now look into a more affordable option from healthcare reform: Becoming insured as a dependent on your parents’ health insurance. [Read HK's "Staying on Your Parents' Health Plan"].

Find out more about what’s available to you by contacting your elected officials or asking for information from your state insurance department or state health department. HealthCare.gov offers an insurance options tool, which now includes pricing information.