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Today's Health Insurance Topic:: A Health Insurance Consultation

JANUARY 15, 2009 -- What To Do When Your Health Care Is Cut

If you lose your job, 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, 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.



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