Life Stages Health Insurance:
STUDENT
In most cases, a full-time student will be covered in the family’s health plan until he or she graduates from college, or remains a full-time student up to 23 years of age. However, if the parents belong to a closed-network HMO that doesn’t provide non-emergency coverage in the school’s area, a separate policy for the student should be considered. Most colleges have a clinic on campus and may offer supplemental insurance as well. If a child gets sick and has to temporarily drop out, parents might want to consider having tuition insurance. Otherwise, even though the child has left school, the family may be on the hook for the tuition.
SINGLE
Once you are out of school or older than 23, your parents’ health plan won’t cover you. As you sort through job prospects, it’s tempting to go for the opportunity that puts the most dollars in your pocket. Health coverage is perhaps the most important job-related benefit you can get. Many companies have coverage through a managed-care plan, which means that many decisions, including which physicians are included in the network, are made by the healthcare provider. Others have more flexible plans that allow their employees to choose their physicians. In both cases, the employee is responsible for some co-payments which help keep costs under control.
MARRIED
Most people who work full-time get health insurance through their employer. Along with bringing two lives together, if both spouses work, the marriage also brings two health insurance plans. These health plans frequently include dependents. Medical inflation is rising dramatically today and employers are increasing the amount they expect workers to pay as they cope with health care costs. In certain cases, they may not cover a family member who has another health care plan. If you have a choice, families with two working spouses should compare coverage, co-pays and costs and choose the best mix that offers the best coverage for the least amount of money.
MARRIED WITH CHILDREN
Most people get their health insurance through an employer. These plans include family members. Medical inflation is rising dramatically today and employers are increasing the amount they expect workers to pay as they cope with health care costs. Families with two working spouses should compare coverage, co-pays and costs and choose the best mix that offers the best coverage for the least amount of money.
DOMESTIC PARTNERS
Increasingly, many employers offer health benefits for domestic partners. If you have this option, you may want to consider adding your partner to your health insurance. Keep in mind that this may involve an additional payroll deduction. If you are both working, and have separate health insurance policies, you should take the time to calculate whether dropping one partner’s health coverage and adding that partner to the other’s coverage makes financial sense. You should look at:
• Payroll deductions for each plan
• Deductibles for each plan
• Whether your personal doctors are covered under each plan.
DIVORCED
Unless both spouses each have their own health insurance and there are no children, health insurance should be clearly agreed upon in the divorce decree. Federal law states that spouses and their dependent children who are currently insured by a health plan are eligible for Consolidated Omnibus Budget Reconciliation or COBRA coverage for 18 months. The divorce decree should state how this is going to be paid for and a plan should be legally agreed upon to make health insurance available after that time.
EMPLOYMENT CHANGE
If you’re changing jobs, one of your first concerns might be maintaining your health care coverage. Under the Consolidated Omnibus Budget Reconciliation or COBRA Act, the federal government requires employers with 20 or more employees to provide healthcare coverage for up to 18 months after a person leaves the job. Dependents are also included in the coverage. To continue receiving this group health insurance, you must inform your employer within 60 days. You continue to pay the full premium and administrative fees. If you do not qualify for COBRA, you may be able to convert your group policy to an individual policy. There are also interim or short-term options that provide medical insurance on a temporary basis, usually a few months. You can only renew this coverage once. The short term policy provides coverage for hospitalization, services such as X-rays and laboratory test, intensive care and surgical needs.
SENIORS
Most people under 65 get group health insurance through their or their spouse’s job. Group health insurance costs less than individual health insurance. Most people who are 65 and older get Medicare from the federal government. Medicare has two parts:
• Hospital Insurance (Medicare Part A) helps pay hospital bills; and
• Medical Insurance (Medicare Part B) helps pay for doctor bills. Anyone enrolled in Social Security is automatically signed up for Medicare when turning 65. Anyone not on Social Security can sign up for Medicare at the local Social Security office. Initially, most people get Medicare Part A coverage when signing up. There is no fee involved. Medicare Part B is optional and has a fee. Generally, individuals who are still working and covered by a employer-provided group health plan not need Medicare. It’s best to keep group coverage for as long as possible. Some employers may continue health care coverage for long-time employees when they retire. But Medicare becomes the primary insurer and the group coverage will pay only when Medicare does not provide coverage. Those on Medicare without such group coverage to fill in health care gaps can buy a Medicare Supplemental or Medigap policy, regardless of health. Anyone who misses this “open enrollment” period may not be able to subsequently buy the Medigap coverage desired.
Used with permission of Insurance Information Institute, Inc. http://www.iii.org/
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