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JANUARY 14, 2009 -- What To Do When Your Health Care Is Cut

Follow these tips to get the best insurance coverage for your dollar.

In 2008, the financial services sector alone shed 148,000 jobs, according to the latest figures released Friday by the Bureau of Labor Statistics. For these laid-off workers, losing their salaries had to hurt; losing their employer-sponsored health care benefits could hurt more. Whether it's paying the full cost of the premium or buying insurance independently, trying to find the right health coverage after being thrust into unemployment can be an overwhelming challenge.

There's jargon to decipher, deadlines to consider and the sticker shock of purchasing health care without an employer contribution. The costs vary greatly, with a study by eHealth Insurance finding that, when purchasing a policy directly from a provider, premiums average $158 for individuals and $366 per month for families, but with sky-high deductibles--$1,972 and $2,610, respectively. Never mind the costs, the complexity of insuring one's self can lead to poor decision making.

"If you find yourself suddenly without work," says Ellen Laden, a spokeswoman for United Healthcare's individual business, "often it's most tempting to go without health insurance. But it's the time you can least afford to have an accident or injury." Laden and other insurance experts stress that the newly uninsured have several options, but the hard part is figuring out which solution is best for you.

Extending Coverage

Frank McCauley, head of Aetna's (nyse: AET - news - people ) consumer business segment, says that extending coverage for the right length of time and at the right price requires asking yourself three basic questions.

First, how long do you expect to go without insurance? A six-month coverage gap should be handled much differently than a 36-month gap. Second, what extent of coverage do you require? A 45 year old in perfect health, for example, will have different needs than a 60-year-old diabetic. Lastly, how much do you want to spend on a premium? A low-cost premium might be attractive in the short term, but this is often paired with expensive deductibles. If you plan to use your insurance, it's wise to pay a premium relative to the expected out-of-pocket expenses.

The Consolidated Omnibus Budget Reconciliation Act (COBRA), say both Laden and McCauley, can be an ideal solution for a worker who wants to keep his or her coverage for up to 36 months. Under COBRA, the former employee still participates in the company plan if he or she pays the full premium.

There are a few hitches, though. This alternative is only available to former employees of firms with more than 20 workers. And if the employer stops offering health insurance or if the company is dissolved in a Chapter 7 bankruptcy, COBRA may be no longer applicable. Finally, it can cost up to 102% of the plan's cost--the extra 2% is for administrative expenses.

"Employees are not used to seeing the total cost," says Laden. "You can pay three or four times more than what you're currently paying," because an employer often subsidizes 75% to 80% of the plan's cost. Coverage for an average family in 2008 was $12,680 and $4,704 for an individual, according to the Kaiser Family Foundation, a nonprofit health policy organization.

Getting the Best Deal

When investing that much, it's important to shop around. The Department of Labor maintains a comprehensive Web site on COBRA, which includes information on deadlines and life-long eligibility for coverage when COBRA expires.

McCauley also suggests that the uninsured explore obtaining coverage through a spouse. Depending on the carrier and company policy, the newly uninsured may qualify for spousal coverage. If unemployment does not count as a so-called "qualifying event," you may need short-term insurance until the once-a-year open enrollment phase.

Another option, says McCauley, is purchasing insurance through professional or membership organizations. AARP, for example, has partnered with both Aetna and United Healthcare to offer insurance to members. While AARP members buy directly from the individual market, in some cases professional organizations allow consumers to take advantage of discounted group rates.

Finally, carriers offer many short- and long-term options. United Healthcare's one- to six-month plan can be extended an additional six months if necessary. It does not cover preventive care, like an annual physical, but it is insurance against unexpected ailments and injuries.

The deductibles run between $250 and $500, but the carrier refunds unused premiums. Providers that don't offer short-term coverage--like Aetna--sometimes allow plans to be canceled without penalty and often offer a wide range of long-term options, including high-deductible and PPO policies. To compare various policies, McCauley recommends ehealthinsurance.com, a Web site where consumers can evaluate different quotes based on their age, location and health status.

"There are options available," says Laden, "that will cover the needs of most everyone."

Doom And Gloom Ahead? If you still have health insurance but are worried about potential layoffs, it is crucial to become proactive about your health.

The good news, according to analysts at the consulting firms Mercer and Watson Wyatt, is that most large companies are not planning to eliminate benefits in 2009. However, many have asked employees to contribute more toward their rising premiums. A Watson Wyatt survey of 117 U.S.-based companies in December showed that 20% of them had raised employee contributions for 2009.

Ted Nussbaum, director of health care consulting in North America for Watson Wyatt, says employees should take advantage of free health-improvement programs. These include health risk evaluations, routine screenings and weight management programs, and they often come with financial incentives used to encourage employees to maintain good health.

For example, the building materials company LaFarge, which is a Mercer client, has invested $6.5 million in preventive initiatives. Employees who get an annual wellness exam and routine cancer screenings, for example, receive a $75 gift card. The incentives have boosted the number of employees who participate in such programs from 700 in 2007 to 4,500 in 2008.

Philia Swam, director of health and group benefits at LaFarge, says the program has been so successful that it even led to early detection of colon cancer in a 50-year-old male employee. It's an encouraging story, particularly for those who still have benefits. The lesson? Get healthy while the resources are still affordably at your disposal.

Private Health Insurance

One tenet of free-market conservatism is that private companies with a profit motive will always be more efficient than the government. It is certainly a compelling argument if you look at countries like Cuba or North Korea, or even at the U.S. government when it has ventured into businesses like running rail and mail systems. All of which makes opposition to a key part of President-elect Barack Obama's health reform plan curious. Obama — and former senator Tom Daschle, his point man on health care — want to provide a government-run option, modeled after Medicare, as a choice for people who don't get insurance through their employers. This public plan — presumably to be offered at cost — would compete with commercial insurers to provide better service and benefits.

Such a plan is a compelling idea for the simple reason that it tests the notion that private health insurance plans operate more efficiently than government. To its critics, however, the public plan would put private insurers at a disadvantage because, unlike the government, they have to earn a profit. What's more, critics argue, it could lead to an unraveling of employer-provided plans. That, too, is an interesting argument because many conservatives are trying to do just that, by ending the tax deduction enjoyed by employer-based plans.

Ultimately, the advantages of the government plan would be so strong, the opponents argue, that it would lead to a single-payer health care system like those in Canada and Europe. In other words, they seem to think private health insurance plans are so inept that they can't compete with Uncle Sam. Actually, they already do to some extent in the seniors market, where about 10 million people have opted out of traditional Medicare to take private coverage through a government-subsidized program known as Medicare Advantage. And if private plans can't compete in other markets, they will have essentially have validated the argument of those who want a single-payer system.

We've never favored single-payer, but there's no denying that private programs have higher administrative costs than public plans. According to the Urban Institute, public plans spend about 5% on administration, while large private group insurers spend about 12% and some niche insurers spend as much as 23%. What's worse, private insurers have shown little ability to restrain costs. Each year, they pass along increases to employers, which pass them on to employees or drop insurance altogether. This has not only resulted in medical costs rising much faster than inflation, it has also meant that governments at all levels have picked up more of the nation's health care tab. Government already accounts for about 46% of all U.S. health spending, according to a recent study in Health Affairs magazine. So for all the howling about "socialized medicine," the nation is already halfway there, and those who have it — Medicare recipients most notably — seem to like it.

As a matter of reality, the potential relationship between a government-run plan and private insurers is immensely complex and hard to gauge. On one hand, private insurers would see government as a potent competitor (too potent in our view if the government subsidizes its premiums). On the other, they could benefit from government's entry into the market by piggybacking on the cost savings that the government wrings out of providers.

Something must be done to get health care costs under control before they bankrupt the nation. So why not let people pick the plan they like? If commercial coverage becomes unaffordable to all but the few, the future of private insurance will be the least of everybody's concerns.

Also: Congress appears to be moving ahead quickly on a reauthorization of the State Children's Health Insurance Plan, which covers 6.7 million poor and low-income children nationwide and will expire in March.

President Bush twice vetoed expansions of the program that passed Congress with broad bipartisan support in 2007, saying they cost too much and expanded the program beyond its mission to serve as a last-resort option for the poorest kids.

A quick vote could provide momentum for President-elect Barack Obama, who supports the program and campaigned on a proposal to require all children to have some form of health insurance. Congress is not moving nearly so quickly to embrace the economic stimulus proposals Obama wants passed.

Senate Finance Committee Chairman Max Baucus today released an outline of his $31.5 billion, 4.5-year proposal, which he said his committee would take up tomorrow. The House is considering its own version.

Baucus's proposal would provide health insurance to 3.9 million additional uninsured, low-income children. The expansion would be paid for by increasing the cigarette tax by 61 cents to $1 a pack. The money would help expand the program at a time when states, which pick up a portion of the costs, are under serious budget constraints and the unemployment rate is at its highest level in 16 years. "The Children's Health Insurance Program is needed now more than ever," Baucus said in a statement. "In these tough economic times, more and more parents can't afford health coverage for their kids. But CHIP can get uninsured, low-income kids the doctors' visits and medicines they need to stay healthy."

Baucus's bill does not lift a ban on Medicaid and SCHIP for children and pregnant women who are legal immigrants during their first five years in the country, but he said he looks forward to discussing how to do that as the bill moves toward final approval.

¿Qué hacer cuando su salud está cortado

Siga estos consejos para obtener la mejor cobertura de seguro para su dólar.

En 2008, el sector de servicios financieros por sí sola nave 148.000 puestos de trabajo, según las últimas cifras publicadas el viernes por el Bureau of Labor Statistics. Para estos los trabajadores despedidos, la pérdida de sus salarios habían herir; perder su patrocinado por el empleador, la atención de la salud podría perjudicar más beneficios. Tanto si se trata de pagar el costo total de la prima o la compra de seguros independiente, tratando de encontrar la cobertura de salud después de haber sido clavado en el desempleo puede ser un reto abrumador.

No hay jerga de descifrar, los plazos a considerar y la etiqueta de choque de la compra de servicios de salud sin la contribución de un empleador. Los costos varían mucho, con un estudio realizado por el seguro de salud en línea conclusión de que, en la compra de una política directamente de un proveedor, las primas un promedio de $ 158 para individuos y $ 366 al mes para las familias, pero con los altísimos deducibles - $ 1972 y $ 2610, respectivamente. No importa el costo, la complejidad de un seguro de auto puede llevar a la mala toma de decisiones.

"Si usted se encuentra de pronto sin trabajo," dice Ellen Laden, un portavoz de United Healthcare individuales de las empresas, "a menudo es más tentador para ir sin seguro de salud. Pero es el momento en que menos pueden permitirse el lujo de tener un accidente o lesión". Laden seguros y otros expertos subrayan que la nueva no asegurados tiene varias opciones, pero la parte difícil es determinar qué solución es mejor para usted.

Ampliación de Cobertura

Frank McCauley, jefe de Aetna (NYSE: AET - news - people), segmento de negocio de consumo, dice que la ampliación de la cobertura de la longitud de tiempo y al precio justo requiere preguntando tres preguntas básicas.

En primer lugar, ¿cuánto tiempo van a esperar sin seguro? A seis meses de cobertura brecha debe manejarse muy diferente a una diferencia de 36 meses. En segundo lugar, qué grado de cobertura que necesita hacer? A 45 años de edad en perfecto estado de salud, por ejemplo, tienen diferentes necesidades que una de 60 años de edad diabético. Por último, ¿cuánto quieres gastar en una prima? Una prima de bajo costo podría ser atractiva en el corto plazo, pero esto es a menudo vinculados con costosos deducibles. Si va a utilizar su seguro, es conveniente pagar una prima en relación a la espera de gastos de bolsillo.

La Consolidated Omnibus Budget Reconciliation Act (COBRA), por ejemplo, tanto Laden y McCauley, puede ser una solución ideal para un trabajador que quiere mantener su cobertura hasta 36 meses. En virtud de COBRA, el ex-empleado todavía participa en el plan de empresa si él o ella paga la prima completa.

Hay unos pocos problemas, sin embargo. Esta alternativa sólo está disponible para los antiguos empleados de las empresas con más de 20 trabajadores. Y si el empleador deja de ofrecer seguro de salud o si la empresa se disuelve en una bancarrota del capítulo 7, COBRA puede ser dejado de ser aplicable. Por último, puede costar hasta 102% del coste del plan - el recargo adicional del 2% es para gastos administrativos.

"Los empleados no están acostumbrados a ver el coste total", dice Laden. "Usted puede pagar tres o cuatro veces más de lo que estás pagando", porque a menudo un empleador subvenciona el 75% al 80% del costo del plan. Cobertura para una familia promedio en 2008 fue de $ 12,680 y $ 4,704 para un individuo, de acuerdo con la Kaiser Family Foundation, una organización sin fines de lucro, la política de salud.

Cómo obtener la mejor oferta

Mucho más que la hora de invertir, es importante comparar precios. El Departamento de Trabajo mantiene un sitio Web sobre COBRA, que incluye información sobre plazos y largo de la vida de elegibilidad para la cobertura de COBRA, cuando expira.

McCauley también sugiere que los no asegurados explorar la obtención de la cobertura a través de un cónyuge. Dependiendo de la compañía aérea y la política de la empresa, el nuevo sin seguro pueden calificar para la cobertura de los cónyuges. Si el desempleo no cuenta como el llamado "caso de calificación", es posible que a corto plazo hasta que el seguro una vez al año la fase de inscripción abierta.

Otra opción, dice McCauley, es la compra de seguros a través de profesionales o asociaciones. AARP, por ejemplo, se ha asociado con Aetna y United Healthcare para ofrecer seguros a sus miembros. Si bien los miembros de AARP comprar directamente de los distintos operadores del mercado, en algunos casos, las organizaciones profesionales permiten a los consumidores tomar ventaja de las tasas de descuento de grupo.

Por último, ofrecen muchas compañías aéreas de corto y largo plazo de las opciones. United Healthcare de uno a seis meses de plan puede ser ampliado otros seis meses en caso de necesidad. No cubre la atención preventiva, como un físico anual, pero es un seguro contra enfermedades y lesiones inesperadas.

El plazo deducibles entre $ 250 y $ 500, pero el transportista no utilizados restituciones primas. Proveedores que no ofrecen cobertura a corto plazo - como Aetna - a veces los planes de permitir que ser cancelada sin penalización y, a menudo, ofrecen una amplia gama de opciones a largo plazo, incluidos los de alto deducible y PPO políticas. Para comparar las diversas políticas, McCauley recomienda ehealthinsurance.com, un sitio web donde los consumidores pueden evaluar diferentes presupuestos sobre la base de su edad, ubicación y estado de salud.

"Hay opciones disponibles", dice Laden ", que cubrirá las necesidades de la mayoría de todos".

Adelante negativo? Si tiene seguro de salud, pero están preocupados por los posibles despidos, es fundamental para ser proactiva sobre su salud.

La buena noticia, según los analistas en la empresas de consultoría Mercer y Watson Wyatt, es que la mayoría de las grandes empresas no son de planificación para eliminar beneficios en 2009. Sin embargo, muchos han pedido a los empleados a contribuir más hacia el aumento de sus primas. Una encuesta de Watson Wyatt de 117 empresas con sede en EE.UU., en diciembre mostró que el 20% de ellos han planteado las contribuciones de los empleados para 2009.

Ted Nussbaum, director de consultoría de atención de salud en América del Norte de Watson Wyatt, afirma que los empleados se aprovechan de la libertad de programas de mejoramiento de la salud. Estos incluyen evaluaciones de riesgo para la salud, exámenes de rutina y programas de manejo de peso, y que a menudo vienen con incentivos financieros para alentar a los empleados utilizan para mantener una buena salud.

Por ejemplo, la empresa de materiales de construcción Lafarge, que es un cliente de Mercer, ha invertido 6,5 millones de dólares en iniciativas de prevención. Los empleados que reciben un examen anual de bienestar y exámenes de rutina del cáncer, por ejemplo, recibir una tarjeta de regalo de $ 75. Los incentivos han impulsado el número de empleados que participan en este tipo de programas desde 700 en 2007 a 4.500 en 2008.

Philia nadaron, director de salud y prestaciones en LaFarge grupo, dice que el programa ha tenido tanto éxito que incluso dio lugar a la detección precoz de cáncer de colon en un 50 años de edad, sexo masculino. Es un panorama alentador, especialmente para aquellos que todavía tienen beneficios. La lección? Obtener sanos mientras que los recursos siguen siendo asequible a su disposición.

 

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