Take Time To Re-examine Health Insurance Coverage


December 7, 2007 7 min read


Take time to re-examine health insurance coverage

By Keith Darce

Copley News Service

Most people don't like change, especially when it comes to their health insurance. Your health plan might not be ideal - maybe you don't like your doctor or the monthly premiums are a little too high - but sticking with what is familiar can seem easier than learning a whole new system.

That could be a mistake, says Gary Claxton, vice president of Kaiser Family Foundation, which does health-related research and philanthropy.

"People become comfortable with a plan, and the unknown is sometimes worse than the known," he said.

Annual open enrollment periods, which typically occur in the fall, give workers and retirees the chance to evaluate how well their health plans are working for them.

Claxton says workers should take advantage of the opportunity. "They should certainly look at what is available."

But evaluating and comparing coverage can be difficult and confusing.

Here are some things to keep in mind that might help make the process less taxing.

How much will it cost?

While there is no way to know when you might get sick or injured, you can predict some of your health-care needs, such as routine checkups, care for chronic diseases and immunizations for children.

It's important to have some idea of how much you might spend out of pocket if you're thinking about changing health insurance plans.

Start with the services you used last year by reviewing medical and insurance records, then add any other services that you know you likely will need in the coming year, such as a mammogram, immunizations for children or an eye test.

To get an idea of which plan best meets your financial needs, calculate for each plan you are considering how much you will spend on premiums, deductibles, co-payments and services that aren't covered.

Will I still be able to see my regular doctors?

Changing health plans could force you to change physicians, particularly if you sign up with a health maintenance organization or preferred provider organization. HMOs require members to use doctors who are part of the group's network of health-care providers, while PPOs allow members to see out-of-network doctors for a higher fee. The same conditions apply to specialists, such as cardiologists and surgeons.

For a healthy person, changing doctors might not be that big of a deal. But for someone with an ongoing illness or a chronic disease, maintaining a relationship with a trusted physician could be more important than switching to a new plan for nominal financial savings.

Is preventive care covered?

Check if the plan you are considering provides things like childhood immunizations, cancer screenings and periodic physical examinations. You might have to pay more for those services than you do under your current plan.

Most managed care plans cover annual health screenings, but other types of insurers don't.

Location, location, location.

When it comes to receiving health care, convenience can be an important factor. If you or a family member is sick, you don't want to have to

travel a long distance to receive care.

When considering an insurance plan change, check on the locations of doctors, clinics, hospitals and emergency rooms that are part of the new plan's network.

Will I be covered for a pre-existing condition if I change plans?

Don't assume that a pre-existing condition will be covered under a new plan, particularly if you are signing up for coverage through a new employer for the first time.

Under the federal Health Insurance Portability and Accountability Act of 1996, an employer-sponsored group health plan may deny coverage of a pre-existing condition for up to 12 months after enrollment. However, that period could be shortened if the employee's health insurance coverage didn't lapse for longer than 63 days between jobs.


Reconsider supplemental insurance policies

By Keith Darce

Copley News Service

With health-care costs rising and employer-sponsored health insurance coverage shrinking, more people are paying more out of their own pockets for medical expenses.

Supplemental health insurance policies can cover some of those costs, but the extra policies aren't always worth their price.

A growing number of employers are offering supplemental policies for covering specific illnesses such as cancer, accidental injury, disability and hospital stays. Typically, employees pay the entire premium through a tax-exempt payroll deduction.

Policies can cover the cost of co-payments and deductibles, lost wages, medical equipment and rehabilitation services, extended hospital stays and travel between home and treatment centers.

"There are just more and more gaps," said Tom Gilligan, senior vice president of marketing and branding for Colonial Supplemental Insurance. The Columbia, S.C., company offers employer-sponsored policies in California and 48 other states.

Colonial's typical policy holder earns between $20,000 and $80,000 a year and pays between $20 and $40 a month for the policy, Gilligan said.

Critics say supplemental health insurance is often unnecessary or not worth the cost.

In California, where health maintenance organizations dominate the insurance landscape, HMOs are required by state law to provide among the most comprehensive benefits available anywhere, said Cindy Ehnes, director of the California Department of Managed Health Care.

"I would advise people to consider very carefully what is the real value they are going to realize from paying two or more premiums," she said.

A supplemental policy holder can pay premiums for years without ever collecting on the coverage, said Gary Claxton, vice president of the Kaiser Family Foundation, the research and philanthropy group.

"I'm not sure that you can recommend it for anyone," he said.

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