• October 25, 2014

Finding affordable coverage can be a challenge

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Posted: Monday, August 10, 2009 12:00 pm | Updated: 8:16 am, Thu Aug 16, 2012.

By Rebecca Hertz

Killeen Daily Herald

In this uncertain economy with rising unemployment, maintaining health insurance coverage is a challenge. Often individuals don't know where to begin when attempting to navigate the uncertain and confusing terrain of the health coverage world.

According to the United Health Foundation rankings of healthiest states, 24.9 percent of the population in Texas is uninsured, compared with 18 percent nationwide. The state fell nine spots from 37th in 2007 to 46th in 2008. Only 50.1 percent of Texas employers offer health insurance to employees.

While the most economical choice for access to health insurance is through an employers plan, there are alternatives if that is not possible. Some employers offer health benefits to employees but dependent coverage is either too costly or not offered at all. An individual policy may be the most affordable alternative for covering dependents. For children's coverage, review program requirements for Medicaid and the Children's Heath Insurance Program (CHIP) as low cost options. Information on these programs is available at www.chipmedicaid.org.

When shopping for health coverage, consider your previous health insurance usage. You want a plan that fits your health needs as well as your budget. The amount of the deductible makes a big difference in the monthly premium.

Most major carriers offer individual plans. These plans can be costly and rely on your past medical history going back as many as five years, in determining insurability. Typically, employer plans review the previous six months. The waiting period for any exclusion to be covered can be up to two years for individual insurance plans in Texas. Carriers may deny coverage because of health status or offer a plan at an increased rate. Individual plan options include health maintenance organization (HMO), major medical, hospital surgical policies, hospital indemnity, specified disease and short-term plans.

Health savings accounts are portable savings accounts where money is set aside for health care, tax-free. To qualify for an HSA, you must have a high deductible health insurance plan. You cannot have any other health insurance, be enrolled in Medicare or be claimed as a dependent on someone else's tax return. The account balance rolls over year to year, unlike the "use it or lose it" flexible spending accounts. Contributions to the plan are pretax.

Interest and investment gains on an HSA are tax-free as are withdrawals for qualified medical expenses. Portability means that you own the account and it stays in place regardless of where you work or what insurance company insures you. For more detailed information about HSAs, go to the U.S. Treasury Web site at http://www.ustreas.gov/offices/public-affairs/hsa/.

Job loss

If you lose your job, you may qualify for continuation of benefits through COBRA (Consolidated Omnibus Budget Reconciliation Act) for up to 18 months for primary plan members, provided the employer has 20 or more employees and does not go out of business. But that coverage is expensive, requiring that individuals pay 102 percent of the total premium, according to the Texas Department of Insurance Web site. Many people think that they will pay the same premium as when they were employed, but usually employers pay a portion of the cost, up to 75 percent, while the employee pays 25 percent. However, you will be paying a group rate, which may still be less than a comparable individual plan. Employees have 60 days to decide if they wish to continue coverage through COBRA.

The American Recovery and Reinvestment Act (ARRA) offers some relief to people who were laid off between Sept. 1, 2008, and Dec. 31, 2009, by giving a 65 percent subsidy toward the cost of COBRA for up to nine months.

There are many options to choose from when shopping for health insurance. In Texas, both the insurance carrier and the agent must be licensed in the state.

U.S. News & World Report published a ranking of health plans in Texas based on a consumer survey. The top five health care companies were listed as CIGNA HealthCare of Texas, Scott & White Health Plan, Humana Health Plan of Texas, Aetna Health – Texas and UnitedHealthcare of Texas.

UnitedHealthcare's Golden Rule has redesigned its short-term, temporary health insurance plans. They offer a range of seven deductibles ranging from $250-$10,000. Individuals can choose the length of coverage from one month to 12 months and reapply for the coverage an many times as necessary. The plan offers the flexibility to discontinue coverage at any time without penalty and premiums paid up-front will be refunded.

"No one should go uninsured. There are solutions available," said Ellen Laden, public relations director of United Healthcare Golden Rule Insurance Company. "You just have to know how to find the right coverage that meets your budget and health care needs."

Health insurance brokers

For those with complex needs, Laden suggests consulting an independent health insurance broker about available options. Brokers receive commissions from the insurance company so there is no cost to the individual for their services. Be sure you are dealing with a reputable company. If a plan looks too good to be true, it probably is. The Texas Department of Insurance has a searchable Web site where consumers can research agents and companies operating in the state at www.tdi.state.tx.us.

Scott & White offers both group and individual plans "for benefits available at Scott & White Health Plan designated facilities, when medically necessary and provided authorization, ordered or arranged by a SWHP network provider," according to the SWHP Web site. SWHP is underwritten by New York Life Insurance Company.

For individuals, according to the Web site, SWHP offers three plans: Health Plus, Portfolio and Saver, with deductibles ranging from $0 to $5,000. Premiums depend on age and level of coverage. SWHP also has three levels of the Young Texan plans for child-only coverage.

To be eligible for the Scott & White health plans, you must live or work within their service area. A full list of eligible counties and detailed policy information is available on their Web site at www.swhp.org.

A good resource to help in understanding the difficult world of health insurance is www.planforyourhealth.com. The Aetna-sponsored Web site covers all stages of life and includes a glossary of health insurance terms and is available in both English and Spanish. A free publication "Navigating Your Health Benefits for Dummies" is available on the site.

Aetna offers a variety of individual PPO plans with deductibles up to $7,500. All individual plans are comprehensive medical plans that can be canceled at any time without penalty.

PPOs

Most carriers offer high deductible and HSA plans, but PPOs are most popular. Aetna does not provide individual HMO plans because the mandated benefits make the price higher than most customers want to pay, said Anne Rote, general manager, consumer segment of Aetna Inc.

It is important to look at your current health situation. Do you visit the doctor often or just a couple of times a year? If you don't go often, you may be able to reduce your monthly premium by selecting a higher co-pay amount. Don't automatically assume that a health condition will cause denial of coverage. You may have to pay a little more because of it, but you may still be able to get coverage.

"It is so important to get coverage. If you have it, find a way to keep it," Rote said. "I worry about people who don't realize the importance of health coverage – there really are a lot of options available."

The amount of your monthly premium is determined by age and health status. Plans with higher co-pays and deductibles are usually less expensive. Consider your needs and health insurance usage when shopping for coverage. Talk to a licensed broker who can discuss the options and compare plan benefits and rates. Don't feel pressured to purchase a plan.

Ask friends and family about their coverage and don't hesitate to take someone with you when gathering information from a broker or agent.

The Internet is a great resource for comparing the options available. Most insurance companies take applications online, over the phone or face to face with a licensed broker.

Contact Rebecca Hertz at rhertz@kdhnews.com or call (254) 501-7475.

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