Posts Tagged ‘Pre-existing condition’
What is COBRA?
COBRA, the Consolidated Omnibus Budget Reconciliation Act of 1985, was initiated to provide emergency coverage for employees who receive health insurance through their employer, and for one reason or another, lose their job (for example, have been laid off) and find themselves without any health coverage. COBRA allows these employees to continue their group insurance coverage if they chose to even after they leave their position.
How Do You Apply For Cobra Coverage?
After you have been terminated, your employer should provide you with details as to how you can obtain COBRA coverage.
Any Specific COBRA Rules?
First, COBRA coverage also applies to the employee’s family. In addition, an employee can either choose to continue with COBRA or choose not to from the moment he has lost his job – he cannot use this coverage intermittently (i.e. start COBRA three months after he lost his job – in this case he will pay retroactively for those three months).
How Long Can I Carry COBRA coverage After My Job Loss?
COBRA coverage can last only a limited amount of time, typically about 18 months. This should give enough time to obtain a different source of health insurance. Hopefully by then the recession will be over as well, and the number of employed people would be on the rise.
What are the Advantages of Cobra?
The advantage of COBRA is that it is prevents an ex-employee from the need of obtaining a new health insurance - at least for a while. As stated in other articles, getting such insurance can prevent one from getting treatment for pre-existing conditions. For example, a pregnant woman who is laid off and loses her insurance will have a hard time obtaining a new insurance. Thanks to COBRA, however, this is no longer an issue, as she can simply continue her existing coverage.
And the Disadvantages?
Note that depending on the employer, although employees are eligible to continue their previous health, dental and vision coverage, the employer no longer needs to sponsor this. This effectively means that the ex-employee pays the full cost of his health coverage, which will be much greater than what it used to be.
Personally speaking, I was using the COBRA scheme for a while, and as far as I remember, I paid about four times as much as I paid before, and this is after limiting the coverage to myself only. This truly makes one realize how big of a benefit health insurance is, and how much companies pay for health coverage for their employees.
COBRA Health Insurance and the Stimulus Plan
Thanks to the economic stimulus package (which started in February 17, 2009), certain people who lost their jobs are eligible to receive partial payment for their COBRA premium. We will discuss the eligibility criteria in the next article in this series.
In a previous article, we introduced the reader to basic concepts in health insurance such as PPOs and HMOs. Here we try to answer how to use this knowledge to pick the most appropriate family health insurance plan.
Our first recommendation would be to follow the guidelines presented by our article, Tips on Cutting Your Health Insurance. By following these guidelines, it is almost certain one can reduce his and his family’s health care costs. Perhaps most importantly, as one of the tips suggests, it is shop around for various health plans and receive multiple family health care plan quotes. This gives a good starting point for considering plans, as getting the best plan for the lower amount of money provides one with the liberty to take other special considerations into mind. You can compare rates of 100 providers using this link.
One challenge that exists for getting family health insurance plans is that it depends on each member’s medical history. This is referred to as ‘pre-existing condition’. A pre-existing condition is an illness or injury that the family member has been treated for in the past, before applying to the current insurance plan. Although certain providers have different rules, normally there is a waiting period before becoming eligible to receiving treatment for this condition. However, this also depends on the previous type of coverage one held before.
Pre-existing conditions are a major factor in determining whether an insurance company will agree to cover one’s family, as well for the final cost, which depends on the risk the insurance company assigns to one’s family.
Useful tips:
- Most importantly, one must select the plan according to his family’s current and future expected needs. For example, if a family member may need to see specialists often, it might be advisable to go with a PPO plan that gives the liberty to go to a specialist without requiring a referral. Being covered in a plan which has a primary care physician (a ‘gatekeeper’), such as POS plans, can be a real problem at times, as the doctor might not agree that the issue requires seeing a specialist. Speaking from personal experience, this can be a very frustrating experience.
- An additional point is receiving second opinions: clearly when one requires approval to see a specialist, he may not get it twice unless he has a very good reason (just saying “I don’t trust that doctor’s opinion” is probably not good enough to convince the primary care physician). Going with a PPO gives the liberty to receive multiple opinions by specialists. However, if one does not expect to face this issue, then going with a different plan may be a better – and certainly cheaper – option.
- Preventative care: this can be an issue at times. For example, if a family is expecting to have children, and the plan offers maternity classes, then it is important to keep in mind. Normally HMOs are far better than PPOs in their preventative care offerings, so this is yet another issue to keep in mind.
- Dental plans: some providers offer dental plans in addition to the ‘standard’ health plan: this could be very useful in saving money, but it is important to take it only if one believes this may actually be used (though of course, certain things are out of control and cannot be predicted). Note that these plans normally offer very limited coverage, so if facing numerous dental issues, the plans won’t be of much help.
- Since insurance plans periodically change, it is important to make sure to follow up on these changes and the coverage that is being received in order to know that you are getting the most at the best rates; perhaps at times it might be a good idea to switch plans.
- Finally, it is important to remember that a cheap plan that does not protect you or a family member from major illnesses may not be worth it. Life is precious, and to face a horrible disease without the ability to pay for treatments is a terrible scenario to be in.
In conclusion, it can be said that it all comes down to the delicate balance between cost, flexibility and availability. If one predicts having to see multiple specialists, and can afford to take a PPO, that may be the best choice. However, if for a small, young, family that is generally healthy, a basic HMO plan may be the best one for you. An additional issue is preventative care: since HMOs are better at this aspect, this should also be taken into consideration.
Formerly branded as High Deductible Health Plans (HDHPs), Catastrophic Health Insurance plans were initiated with the sole aim of providing overall medical costs at a reduced monthly premium in lieu of a higher annual health insurance deductible in the United States.
These plans are the cheapest of all health insurance plans, and for a reason: a policy holder of a catastrophic health insurance plan would pay for all medical care until he reaches the annual deductible amount, which tends to be high or even very high. Only afterwards, his health insurance coverage begins and his insurance would begin paying for his medical expenses.
What does a Catastrophic Health Insurance Plan covers?
Historically, these plans didn’t cover routine medical care and that is why were called ‘catastrophic’; they were truly intended for extreme scenarios. Consequently, they normally required lower monthly premiums and high annual deductibles. That being said, many modern catastrophic health insurance plans offer routine care and even prescriptions (in other words, non-catastrophic care); as a general guideline, the more the plan covers, the higher the premium – however, paying more out of pocket, results in lower monthly premium.
Note that these plans tend to have a lifetime maximum benefit, also called a ‘cap’ which is somewhere between $1,000,000 and $3,000,000. After reaching this cap, the insurance company no longer pays any additional costs.
When do you need a Catastrophic Health Insurance Plan?
As the name suggests, these plans were historically a targeted towards people who were not too concerned with routine care, or at the very least, could afford to pay it, but wanted to protect themselves from a situation where they would need a very expensive treatment (a ‘catastrophic’ scenario), which then their insurance would pay for. So for example, a man could pay for all his doctors’ visits on his own, but still have the insurance pay for costs of the expensive surgery he needs after he reached his high deductible (which could be as a high as, say, $4,000 a year).
Consequently, if the goal is saving money, one really needs to carefully and responsibly consider the likelihood of needing routine care vs. the likelihood of needing a very expensive treatment. In a specific set of scenarios, it might prove to be cheaper, but in others, it would not. Either way, the policy holder takes on more risk since he essentially ‘gambles’ that the annual costs of his medical treatments would be significantly lower than his annual deductibles; otherwise, there would be no incentive for him to take this plan, since he’d end up both paying for his medical bills and paying monthly premiums (albeit cheap ones).
Is this plan for you?
This plan is probably suitable for people who don’t believe they will require a lot of medical treatments, but want to insure themselves against the situation where an extreme situation occurs, and they will be faced with enormous bills. For some people, this might be a wise course of action. Either way, as stated, one needs to carefully weigh the pros and cons before selecting this plan; the worst case financial scenario is that one just reaches his annual deductible, meaning, he pays his entire medical bills on his own, and yet still has to pay the monthly premiums to the insurance company.
According to health statistics, the people who pick this plan tend to be split into two groups: a group of young people who tend not to incur a lot of medical expenses because they are healthy, and thus, can afford to carry on this risk; and conversely, a group of people close to retirement age – and yet still not eligible for Medicare benefits - that can easily afford to pay most medical costs, but would not be able to afford treatments for serious conditions (such as extremely expensive cancer treatments).
Note that some individuals aren’t qualified to enroll on an individual catastrophic health insurance plan, for example, people with certain pre-existing conditions such as AIDS or diabetes. However, they can be covered under a group plan - though they may be subject to wait a certain period of time, depending on the policy.
Click on the image above to receive a quote for Maternity Health Insurance.
Although it is important for everyone to possess health insurance, it is particularly important in the context of pregnancy. The reason is obvious: there are many things that can go wrong during pregnancy or could be made better if the woman is aware of certain facts.
This not only affects the unborn child, but the pregnant women as well. For example, certain types of abnormalities or genetic diseases can be discovered in advance if screened for. Additionally, certain risk factors could be assessed and be taken of that could endanger the baby once born. Furthermore, since there is always some risk involved during a pregnancy for the women, it is wise to continuously monitor the state of the pregnancy to make sure all is well. Therefore, it is essential that pregnant women periodically receive check-ups in order to make sure the pregnancy is progressing properly and there are no detectable problems with the unborn child or the woman herself.
Unfortunately, many pregnant women do not have health insurance. It has been statistically shown that when they deliver, their babies are more likely to have low birth weight and higher incidents of death.
Obtaining health insurance coverage for uninsured pregnant women has become even more challenging today because of the towering costs of health insurance in the United States. According to the American Health Association, 41 million Americans are not insured, and around 13% pregnant women in the country do not possess any form of health insurance. This puts these women and their unborn children at unnecessary risk.
Prenatal checkups can be very expensive, not to mention hospital and delivery charges which could cost $10,000 or more. Furthermore, if there are complications, such as premature birth or the need for a cesarean section operation, the costs would be much greater. Therefore, it is strongly recommended for a pregnant women to obtain health insurance.
The problem is that most health insurance companies do not accept new insurance policies from pregnant women whose pregnancy has been assessed as a pre-existing condition. Ideally, if you are a woman and you know you wish to get pregnant, things would be much easier for you if you got health insurance before you got pregnant. But as is the case in life, often the unpredictable occurs, so if you are uninsured and found out you are pregnant, here are some useful tips that could help you obtain health insurance:
First, shop around – search the internet – for health insurance companies who can provide pregnancy health coverage and discounted health care coverage. It is easy to get free instant quotes from multiple providers. In fact, this site offers a way to shop around for maternity health plans: Click here to receive a quote.
Second, there are some federally funded programs which offer healthcare coverage for low income people. Medicaid, for example, allows you to enroll in a health insurance plan even when you are pregnant. An additional program is CHIP. Some states have specialized programs for this purpose: investigate whether your state offers one.
Third, look for additional benefits provided by other agencies. WIC is a federal agency that offers health services to low income women and children under 5, and also provides food supplements.
Finally, if you are in a position where you have several options, make sure you choose your plan carefully: choose the plan which covers all the benefits you may require. For example a hospital-only plan will not cover visits to a physician’s clinic.
Note that if you are a pregnant women that possesses insurance and wishes to travel abroad, you may want to check our article Travel Insurance and Pregnancy.