Help! I Lost My Health Insurance!

It can literally be one of the scariest places to find yourself - without health insurance coverage. When a simple trip to the emergency room can lead to thousands of dollars in charges, the last thing you need is to not have health insurance. But what options do you have? Graduating from college can be a true rite of passage into adulthood, because this is the time when most health insurance plans drop you from your parents' plan. Even landing a job right after graduation can still mean that you will have to go through a grace period before the company's health insurance kicks in. And if you have left a job for greener pastures, well...don't get sick or injured!

But do I even have options?

Well you probably do have options for health insurance coverage, but they may not be ideal. If you have quit your job, then you will have the option of extending your health insurance benefits for up to 18 months - thanks to COBRA. The only catch is that you will have to pay for those benefits out of your own pocket. Not exactly an easy thing to do without that paycheck rolling in every week.

Is that it? Is that my only hope?

Before you panic, just relax. The solution is short-term health insurance. As the name implies, this solution offers you health insurance options for a limited period of time. Most short-term health insurance benefits are available for 30 to 180 days. Depending on where you live, you may be able to obtain these benefits for up to a year.

And short term health insurance is the same as what I had at work?

Well, if you mean that you have coverage in the event of a hospital visit or sudden illness, then yes. You also can pick your own doctors and hospitals, which is actually an advantage over some health insurance plans offered by employers. But there are definitely coverage limitations on short-term health insurance plans.

So what am I not covered for?

That really is the million dollar question, isn't it? Well, routine medical exams are not covered by a short term health insurance policy. Any kind of preventative care is also out the window with this type of coverage. Plus, you can forget about dental and optical coverage with short-term health insurance. For obvious reasons, this sort of health insurance also does not cover medical costs relating to a pregnancy nor, anything having to do with the childbirth itself.

No offense, by why should I bother with short term health insurance?

Because a simple trip to the emergency room can cost thousands of dollars, and any emergency procedure and hospital stay can cost tens of thousands of dollars. Hey, short- term health insurance is not supposed to be the long-term solution. It is just a way to make sure you are covered while you are not on any employer's health insurance plan. And it can help you avoid going into serious debt, should something happen to you when you are not otherwise covered on a health insurance plan. For that reason alone, it is definitely worth the expense.

Albert Medinas has developed and maintains the website Health Insurance Resources, which answers the most common questions people have about Health Insurance. Please visit us at http://www.healthinsuranceresources.ws today.

Health Insurance

When you are in your late teens and twenties, possibly up to the age of forty, it's hard for people to understand why they need health insurance. For some people, it may be less expensive to pay full price when going to the doctor then pay the monthly fee associated with health insurance. These people may ask whether or not health insurance is even worth it. For most people, however, health insurance is a huge money saver. But what are the different types of health insurance and how should you go about determining what is right for you.

There are mainly two types of insurance: Indemnity plans and managed care plans. Indemnity plans are insurance plans in which an insurer reimburses the insured for medical expenses no matter who provided the service. There are three plans within the indemnity category. These include reimbursement of actual charges, reimbursement of a percentage of the actual charges and indemnity. In the first plan, the insurer will reimburse for the entire cost of the service, the second plan covers a percentage, while indemnity pays a certain amount daily for a certain number of days.

Managed care plans have three main types: HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations) and finally POSs (Point of Service plans). In an HMO plan, members pay a flat monthly rate. In most circumstances, the HMO member must use medical professionals from the preferred network. Unlike HMOs, PPOs are paid on a service by service basis. PPOs are often sponsored by employers or insurance companies who reimburse the insured for the service, minus of course any co-payments. A POS is a plan in which the insured pays no deductible and a small co-payment as long as the service provider is a part of the network.

So, what should you do? Well, you should start by investigating your health insurance options. What does your employer provide? Most employers do not pay the deductible for their employees; however, the rate is reduced as it is often a group situation. The best way to determine the best plan for you is to educate yourself on what is available and what you need.

Sara Chambers is a marketing consultant and an internet content manager for http://www.healthinsuranceweblog.com

Health Insurance for the Self Employed

Health insurance, having enough and being able to afford it, is
one of the most nagging concerns for those who leave corporate
America to run their own business.

Many small businesses have dropped health coverage or reduced it
in the past three years because of rising rates. About 24
million of American small-business employees and their families
are uninsured, according to a study by the Kaiser Family
Foundation.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a
federal law that requires employers to allow departing workers
to buy health insurance through the employer's group plan. For
the first 18 months after you leave your employer you may elect
to continue to receive coverage in your employer's group plan at
your expense.

However, the cost of the monthly premiums for COBRA can come as
quite a surprise if you're accustomed to you employer picking up
most of your health insurance tab via pretax paycheck
deductions. COBRA coverage for a family can run $500 a month,
and upwards of $200 a month for an individual.

Depending on which State you live in COBRA may not necessarily
be the best deal for you. Shop around, you may find joining a
short term insurance plan to be less expensive than continuing
your current insurance under COBRA.

One piece of good news for the self-employed - Starting in 2003,
the self-employed health insurance deduction is increased to
100% from the 70% that was deductible in 2002. As a result, if
you work as a consultant, freelance worker, and other
self-employed individual you will be allowed to deduct all of
your health insurance premiums. The self-employed health
insurance deduction is especially valuable because it is an
above the line deduction for Adjusted Gross Income (AGI). This
means that you can take advantage of this deduction even if you
do not you itemize your deductions on your tax return.

Even with health insurance the portion of medical expenses that
has to come out of your pocket can be more than you imagine. If
you have to dip into your retirement savings for certain medical
expenses, distributions from your IRA used for that purpose may
be exempt from the IRS 10 percent early withdrawal penalty.
However, you still will have to pay taxes on the IRA
distribution. Another alternative is to transfer your IRA to a
Self-Employed 401(K) plan and take a loan from that plan. Loans
from a 401(k) plan are tax-free and penalty free as long as the
loans are paid back.

Daniel Lamaute is a retirement plans specialist with Lamaute
Capital. Its website www.investsafe.com covers retirement plans
and other benefits for the self-employed.

Health Insurance for the Self-Employed - Protecting Your Business's Greatest Asset

Health Insurance for the Self-Employed - Protecting Your Business's Greatest Asset

2002 Elena Fawkner

"I've been considering quitting my full-time job and getting a part-time job that would pay the bills [so I can start a home business] ... The one biggie my full-time job provides me now is health insurance. If I was to get a part-time job, I'd probably have to pay for my own health insurance and I know that can be expensive."

Like Jason, who sent me the above email this week, many a dissatisfied employee would chuck in their full-time J.O.B. (just over broke) for their part-time home-based business in a heartbeat if not for one thing. Employer-provided health benefits. It's a biggie, no doubt about it.

Undeniably, employer-paid or -subsidized health benefits are one of the few real perks of working for someone else. In fact, surveys have shown that, for employees (especially those with families), paid benefits are hands down the most important element of their compensation packages.

And there's no shortage of people already running their own home businesses with no health or disability coverage at all. Scary. After all, if you're dependent upon your home business as your sole source of income and you lose your health, you lose your livelihood as well.

Bottom line? If you run a home-based business you can't afford not to have health coverage of one form or another. Here's how to make it happen, whatever your circumstances.

BASIC OPTIONS FOR THE EMPLOYER OF ONE (YOU)

You have three basic options when it comes to health and disability insurance.

=> Spouse Coverage

If your spouse has health coverage from his or her employer, as a general rule, use that. It probably provides better and less expensive coverage than you could get on your own.

=> Group Health Insurance

The main advantage of group health insurance plans is that they can't turn you away because of health problems. The good news for the solo entrepreneur is that an increasing number of companies are offering group health plans for "groups" of one. This varies by state though so you'll need to do your homework to find one.

=> Individual Health Insurance

These plans are fine if you don't have any pre-existing medical conditions. (If you do, try your best to find a group plan that will cover a group of one.) They're subject to medical underwriting so your state of health will be a factor the insurance company takes into account in determining whether to accept your application.

Of course, the mere fact that you're able to get into a good plan is one thing. Doing so affordably is quite another.

REDUCING THE HIGH COST OF HEALTH INSURANCE

There are several ways of minimizing the cost of health insurance. Your tolerance for risk will determine which, if any, you are comfortable with.

=> Reduce the Level of Coverage

Do you really need to have every doctor's visit and prescription covered? If you only go to the doctor once a year for an annual examination, have no health conditions, don't need regular expensive prescription medications and are generally healthy, consider cutting out coverage for office visits and prescriptions.

=> Higher Deductible

Similarly, if you're reasonably healthy, don't visit the doctor very often and don't need to use expensive medications, consider switching to a higher deductible to save on premium costs. By increasing your deductible from $100 to $2,000, you can cut your premium payment in half.

=> Annual Premium Payments

If you can afford to do so, pay your premiums annually rather than monthly or quarterly to avoid service fees and to take advantage of prepayment discounts where available.

=> Join Associations

Just because you're going it alone in your business doesn't mean you can't take advantage of the group buying power that being a member of an association offers. Check out your local chamber of commerce, various trade and professional groups and small and home business associations for member benefits. Many offer access to discounted health insurance.

Here are a few small/home business association links to get you started (you'll need to cut and paste some of these links if they wrap to the next line):

National Association for the Self-Employed http://www.nase.org/nase_benefits/health_benefits.asp American Association of Home-Based Businesses http://www.aahbb.org/benefits.htm Home Office Association of America http://www.hoaa.com/allbenefitsnew.htm National Business Association http://www.nationalbusiness.org/NBAWEB/Directory/Internal_Pages/Member_Benefits/Health.htm

Don't forget to check out local associations in your area or associations relevant to your particular profession.

=> Shop Online

Being able to offer insurance products online means insurance companies save on broker and agent fees. Often, this translates into premium savings for policies purchased over the Internet. So, when your fingers do the walking, make sure they do so on a keyboard and not the Yellow Pages.

=> Medical Savings Accounts

Under the Health Insurance Portability and Accountability Act (HIPAA), if you're self-employed you may be eligible to use a medical savings account, or MSA.

MSAs work in conjunction with higher deductible health insurance policies to reduce premiums and allow you to use pre-tax dollars to pay for your medical expenses up to the limit of the deductible on your insurance policy.

Basically, you reduce your premium by replacing a low- deductible policy with high-deductible policy and use the premium saving to make fully tax-deductible contributions to your MSA. You can contribute up to 65% of the deductible each year into your MSA (75% for families). The money goes into a tax-deferred account or trust and you pay your medical expenses (until you reach the deductible) by drawing from the account. Once you hit the deductible, of course, the insurance policy kicks in.

If you spend less than you contributed, the surplus stays in the account and earns interest. Not only that, the funds can be invested in high-return vehicles such as mutual funds and stocks.

As the balance can be carried forward, an MSA can be used to accumulate a pretty healthy nest egg for retirement. In fact, a Journal of Financial Planning analysis calculated that if you contribute $1,500 per year into an MSA for 25 years, assuming a 12% rate of return, you'll end up with almost $1.5 million. That's assuming you don't draw from it to pay for medical costs, of course.

There are some limitations though. First, the range of deductibles is limited to $1,500 - $2,250 for individuals and $3,000 - $4,500 for a family. Second, as we saw above, you can contribute only 65% of the deductible as an individual or 75% for a family.

So, if you're an individual and you choose a policy with a $2,000 deductible, you'll be able to contribute 1,300 pre-tax dollars into an MSA each year. In other words, Uncle Sam pays for part of your health insurance/retirement fund. How fitting.

The money in the MSA can be used to pay any medical expenses incurred before the deductible is reached, as well as other eligible costs such as contact lenses and dental work. If you use the money for anything else, you must not only pay tax on the amount withdrawn, but a 15% penalty on the top. (If you're over 65 when you make the withdrawal the penalty is not applied but you'll still have to pay the tax.)

(By the way, MSAs are also available to you if you work for a business with fewer than 50 employees.)

In short then, MSAs offer a very tax-effective and potentially lucrative way to self-fund part of your health care costs while dramatically reducing your premiums. If luck is on your side and you remain healthy, by the time you reach retirement age, your MSA could well fund your retirement.

Pretty neat.

=> Self-Employed Health Insurance Deduction

Finally, the self-employed can write off 70% of their health insurance premiums in 2002. This increases to 100% in 2003. That's only so long as the total doesn't exceed the net profit from your Schedule C minus deductions for one half of the self- employment tax and Keogh, SEP and Simple contributions though.

Also, the deduction can only be claimed for months when you weren't eligible to participate in a subsidized health plan from another employer (including your spouse's employer).

Self-employed workers who qualify for both the self-employed health deduction and the itemized medical deduction can write off the other 30% this year on Schedule A. (Medical expenses are deductible on Schedule A only to the extent they exceed 7.5% of adjusted gross income.)

WHAT TO DO IF YOU'RE UNINSURABLE

The foregoing is all well and good if you're able to get health insurance in the first place. But what if you have a pre- existing condition that disqualifies you from an individual health plan and you can't get into a group plan? In other words, you can't get insurance at any price.

=> HIPAA

Although beyond the scope of this article, the Health Insurance Portability and Accountability Act (HIPAA) may offer you some protections. For more information about how HIPAA may help you obtain health insurance even if you have a pre-existing condition, visit http://www.hcfa.gov/medicaid/hipaa/content/hipsteps.asp .

=> Risk Pools

High-risk health insurance plans, also known as risk pools, are state-funded plans and are an important safety net for individuals who are denied health insurance because of a medical condition. They're available only in 29 states though.

To be eligible, you must be a resident of the state from which you seek coverage (unless there's reciprocity between that state and the state you reside in) and you must be able to prove at least one of the following:

1. that you've been rejected for similar health insurance coverage by at least one insurer; or

2. you're presently insured with a higher premium; or

3. you're presently insured with a rider or rated policy.

You will not be eligible for participation in a risk pool if:

1. you're not a resident of the state from which you seek coverage (again subject to reciprocity between states); or

2. you're eligible for Medicare or Medicaid; or

3. you've terminated previous coverage in the plan unless at least 132 months have since elapsed; or

4. you're an inmate of a public institution.

For more information on risk pools in your state, contact your state health insurance department, the national association "Communicating for Agriculture and the Self- Employed" (1-800-432-3276) or visit http://www.selfemployedcountry.org .

Coverage via the safety-net protections of the HIPAA may end up being "risk-pool" coverage.

=> Healthcare Savings Programs

Healthcare savings programs are patient advocacy programs that minimize out-of-pocket healthcare expenses.

They're not insurance policies but rather programs that allow you to access networks of healthcare providers for the same negotiated rates that large insurance companies enjoy. Savings range from 20% to 50%.

Not ideal but better than nothing. Also, since they're not insurance policies, all pre-existing conditions are accepted.

A modest monthly fee is usually required to participate. See, for example, Care Entree at http://www.careentree.com for $20 per month.

Although health insurance may seem like a luxury you just can't afford if your finances are already stretched to breaking point thanks to your home-based business, you never know what's around the corner. Quite simply, you and your business can't afford not to have health (and disability) insurance.

You are your business's greatest asset. Protect it.

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** Reprinting of this article is welcome! ** This article may be freely reproduced provided that: (1) you include the following resource box; and (2) you only mail to a 100% opt-in list.
Here's the resource box to use if reprinting this article:

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Elena Fawkner is editor of A Home-Based Business Online ... practical business ideas, opportunities and solutions for the work-from-home entrepreneur. http://www.ahbbo.com
Also, visit Elena's newest site, Web Work From Home http://www.web-work-from-home.com

Elena Fawkner is editor of A Home-Based Business Online ... practical business ideas, opportunities and solutions for the work-from-home entrepreneur. http://www.ahbbo.com
Also, visit Elena's newest site, Web Work From Home http://www.web-work-from-home.com

HIPAA and Email - How Does Your Practice Deal with Compliance in a Digital Age

The internet has created a new business model for the smaller medical practice, specialty clinic and medical service (e.g. dermatologist, plastic surgeon, physical therapist, psychologist, et. al). More and more, patients are looking to communicate with their healthcare providers as they do in their personal and business lives - via email.

Email as a communication solution for the smaller clinic can be a time-saving resource. It can replace the many phone calls and postal mailings, adding a financial benefit to the smaller clinic.

Does email eliminate the office visit? No nothing can replace the personal face-to-face office visit, but email can be an additional tool clinicians can implement to streamline their practice.

Some healthcare practitioners do however feel that emailing their patients equates to working for free, but some clinics have already adopted charging for email consultations.

At some practices, patients pay a flat rate from $100 to several hundred dollars per year for this type of service. Harvard professor of medicine Dr. Daniel Z Sands, a proponent to a digital clinic, stated "I think it's reasonable to assume that if lawyers and accountants charge for time, then physicians should too. (1)"

Sustainability of Health Information Technology is also on the government's radar. As part of the President's mandate to move the medical field towards a digital clinical setting within the next ten years (2). The National Coordinator for Health IT, Dr. David Brailer, noted the value-added benefit of investing in Healthcare IT:

Information technology supports treatment choices for consumers and enables better and more cost-effective care... Health IT not only adds value to the way people lead their lives, but it gets more out of our investment in healthcare overall. (3)

It is possible for clinics to shift towards a digital medical office while remaining financially solid. Rights management software tools have become a reality for the small and medium business office (4). Small Business Rights Management (SBRM) reflects a shift Rights Management software tools.

SBRM solutions provide clinics and practices of a smaller scale an equal level of user rights management and encryption previously available to larger medical organizations (e.g. state hospitals, large research facilities, university medical networks, etc.).

With any medical advance, the side affects of a solution or cure, must also be considered. While email is beneficial time-wise and financially, there are also cons to using this tool - many HIPAA related. According to the Health Privacy Project's 2005 study, 70% of Americans are concerned that personal health information (PHI) could be disclosed as a result of weak data security (5)

Currently, healthcare organizations are required to provide a disclosure statement when communication is sent to their patients. A sample of a healthcare professional's email disclosure statement may read like this:

Client information gathered by [Clinic or Organization's Name] is protected by Federal Law. If this communication contains any client information, including information which would identify a client, you are prohibited from redisclosing it to any person or organization in any manner, and you are required to maintain it as confidential. Failure to do so is punishable by civil and criminal penalties. If such information has reached you in error, please contact [Clinic or Organization's Name] contact@emailaddress.com

With the advent of phishing, malware, and spyware, the unintended recipient could possibly spread a patients PHI like a virus; using or selling data to any number of damaging sites.

Protecting a patient's PHI is an ingrained concept within the medical profession. Laws and government mandates are take this notion a step further, medical facilities not compliant to protecting their patient's PHI face stiff penalties under HIPAA. PHI includes and is not limited to:

* Patient's address, phone number
* Treating Hospital/Clinic number assigned the patient
* Patient's date of birth/ SSN
* Patients legal next of kin/guardian and their telephone number
* Patient's insurance information (pre-certification/ DSHS/ Medicare)
* Anticipated Admission date and time<

While there are some drawbacks to email, patients want the option of emailing their doctor, pharmacist, therapist or clinic. "People are often more comfortable talking to a computer than they are to a doctor," said Dr. Delbanco, a professor of medicine at the Harvard Medical School and the lead author of an article on doctors and e-mail in the New England Journal of Medicine (6).

Dealing with HIPAA compliance issues can often be frustrating to the small clinical practice. SBRM solutions bridge the gap between staying current with healthcare industry regulations and keeping a small physician practice open. Patient/client information, private communiqu? regarding diagnosis/treatment, and medical billing can stay discreet, only the intended recipient will see this information.

With SBRM solutions; clinics don't have to worry that their email content breaks the Hippocratic Oath's creed of confidentiality by revealing patient's PHI. Healthcare providers can remain both respectful and compliant under HIPAA regarding the patient privacy.

- - - - - - - - - -

End Notes:

1.) Dr. Daniel Z. Sands as quoted in Liz Kowalczyk's article "Is E-Mailing the Future of Doctor-Patient Relations?" The Boston Globe, D2, April 27, 2004, Lexis Nexus - http://www.lexisnexus.com

2.) United States Department of Health and Human Services, "Secretary Leavitt Takes New Steps to Advance Health IT," Press Release on HHS website, June 6, 2005, http://www.os.dhhs.gov/

3.) "Remarks by David Brailer, MD PhD National Coordinator for Health Information Technology HIMSS 2005" February 17, 2005, http://www.himss.org

4.) SBRM on Wikipedia - http://en.wikipedia.org/wiki/Small_Business_Rights_Management

5.) "Majority of Americans Have Privacy Concerns about Electronic Medical Record System," Health Privacy Project (www.heathprivacy.org): http://www.healthprivacy.org/info-url_nocat2303/info-url_nocat_show.htm?doc_id=263085

6.) Anahad O'Connor, "Take Two Aspirin, E-Mail Me Tomorrow," The New York Times, Section F; Column 5; Health & Fitness; 7., 30 September 2005, Lexis Nexis - http://www.lexisnexus.comMs. Veniegas is an alumni of the University of Washington Marilee joined the Marketing team at Essential Security Software, Inc. in 2005. She also serves as one of the ESS site editors for "I Want My ESS!

5 Facts About NPI For HIPAA Compliant Electronic Medical Billing Software And Service

The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and security standards for electronic health care transactions, including a national identifier for providers, health plans and employers. Accordingly, by May 23, 2007, healthcare providers and all health plans and clearinghouses must change both their processes and information systems to implement HIPAA’s National Provider Identifier (NPI) regulations.

Background on the NPI regulation

• HIPAA mandated regulation
• Effective nationwide on May 23, 2007
• The compliance date for health care payers with less than $5 million in annual revenue is May 23, 2008

 

What is the NPI?

• A unique 10-digit identification number
• Assigned for life to a provider and de-activated only upon death, retirement, or identity theft
• Replaces multiple legacy provider identification numbers, including Medicare UPINs, commercial payer IDs and state Medicaid IDs
• Contains no identifying information related to the provider - randomly generated
• Independent of key provider information changes, such as practice location or specialty
• Providers have 30 days to update their NPI record

 

Who is affected by the NPI mandate?

• Payers
  • Health plans
• Clearinghouses
• Providers
  • Organizational providers
  • Individual providers

 

Why is the NPI necessary?

• NPI delivers two-fold benefits for payers and providers:
  • Simplifies communication and administration
  • Facilitates efficient electronic transmission of certain health information
• Streamlines detection of billing fraud and abuse
• Improves debt collection efforts

 

What are the challenges of NPI implementation for payers and providers?

• Providers and payers must exchange information
• Technological implementation cost within organizations

 

What should payers and providers do now to prepare for the NPI?

• Organize project teams to ensure a smooth transition
• Identify and address processes and information system changes
• Evaluate outsourcing solutions offered by technology vendors

  Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

 

Health Insurance; COBRA; OBRA; HIPAA; Medicare. If asked, could you state that you knew that all 5 of these topics had the same thing in common: medical insurance coverage for you and, perhaps, your family? Would you know the qualifications for each? Well, in this article, we will discuss them. For a timeline that depicts, graphically, the time relationship between them, please see the timeline in www.disabilitykey.com.

HEALTH INSURANCE Coverage from Work

If we are lucky, we, and/or our spouse, work for a company that provides, as a benefit, health insurance coverage for us and our family. If so, we are very lucky. Even if that is true, there are some key things that you might want to look at to see if you have ENOUGH coverage.

1) From your Human Resources Department (or wherever else you would go to get information about your health insurance) get what is called a "Summary Plan Description" (SPD). This document should be kept where you can always find it, as it contains all the information you will need about what your insurance covers and what it doesn't.

2) Look up "Coverage" and "non-coverage" in your SPD.

These will tell you what your plan covers and doesn't cover. You need to see if, perhaps, you or one of the covered members of your family has a condition or circumstance that might not be covered, where you need additional coverage. For example, let's say that your family has a history of cancer; perhaps your plan restricts the number of hospitalization days for care; or, restricts the days per condition. In this case, (like my children) you might want to get additional "cancer insurance" (I think that AFLAC might provide this type of coverage).

It would be a good idea to contact a Health Insurance benefit Broker and ask him/her to read your SPD and see if you have any gaps in coverage. They then can help you supplement coverage BEFORE YOU NEED IT!

NO HEALTH INSURANCE COVERAGE

You might be one of the growing members of our society that, through one circumstance or another, does NOT have health insurance coverage for your family. In this case, I strongly encourage you to contact a Health Insurance Broker and get immediate coverage of what is called "catestrophic" (not sure if I spelled this correctly) coverage. In this type of coverage, you will generally have large deductibles, but will have coverage if, say, one of you has to go into the hospital.

CONTACTING A BENEFITS INSURANCE BROKER

Whenever you call or email a Health Insurance Broker, it is very important to prepare ahead of time. WHAT, specifically are you looking for; how much can you afford to pay every month; what circumstances do you want to make sure that your family is covered for. In this way, you can make sure to focus on your critical needs.

COBRA

COBRA is an acronym ( how can I spell acronym correctly, yet not be sure that I spelled catestrophic correctly?) that stands for: Consolidated Omnibus Budget Reconciliation Act. Basically, it is a federal law that allows you to pay for your Company-paid health insurance, as an active member, if you no longer work for that company for, generally 18 additional months.

1) COBRA is "triggered" (that is, you, or a covered member of your family, become eligible for COBRA) by events such as the following: resignation from the company; termination (FOR ANY REASON) from the company; divorce of a spouse; a covered chile's birthday makes them ineligible for coverage. These are the main "triggering" events for COBRA.

2) Now, when eligible for COBRA, you will be asked to pay for 100% to 105% of the company's employee/employee and family coverage amount. You should get a letter from your company explaining what that amount will be. BEFORE YOU DECIDE TO TAKE COBRA, there are some important things for you to consider.

What will be your cost, and what will be the coverage for that cost? Sometimes the cost is too much for the coverage. In these cases, you might want to select HIPAA coverage, instead (see HIPAA below).

Or, you might just want to get catestrophic coverage as was mentioned earlier, and wait for full coverage under your next job.

Part of this decision should be whether or not you or a member of your family has what is called a "pre-exisitng coverage" condition.

Here again, before automatically taking COBRA, it would be wise to contact a Benefits Insurance Broker and give him/her all of your options, and get their input. I have worked extensively with a Benefits Insurance Broker, and he is absolutely fantastic!

OBRA

What, you ask, is OBRA? I've never heard of it, you say, and no one I know has heard of it either! Well, that's because, 99% of Human Resource or Benefit folks that I know have never heard of it! OBRA is a federal law that was passed that extends COBRA for an additional 11 months FOR DISABILITY PURPOSES ONLY!! Why, you ask, is this important? Thanks for asking, let's see if I can explain.

If you are as nieve (did I spell this wrong too? sorry!) as I was when I first started looking to bridge my health insurance from working to Medicare, I assumed that when I got through all of the hoops to qualify for SSDI (Social Security Disabililty Insurance) I'd IMMEDIATELY be eligible for Medicare, RIGHT??? WRONG!!!!

When you FINALLY qualify for SSDI, you have to wait for 5 months before you get your first check. AND, the rules state that, you are eligible for Medicare 2 years (24 months) FROM THE DATE OF YOUR FIRST SSDI PAYMENT. Well, if you add 24 + 5 you get, 29 months between qualifying for SSDI, and Medicare coverage.

OK, I said earlier that COBRA is for 18 months of coverage. Well guess what 18 months of COBRA + 11 months of OBRA equal - 29 months!

BUT, there are two catches to OBRA; first of all, you have a small window of 30 - 60 days to apply ( this window opens the date of your SSDI approval); and, it can cost up to 150% of your plan coverage amount. BUT, if you have a "previously existing condition" this might be the best way for you to proceed.

Again, it is important to contact a Health Insurance Broker to help you with the risk/cost ratio of all of these situations.

It is also improtant to know all of these deadlines as you plan to ensure that you and your family have important health insurance coverage.

HIPAA

HIPAA is a federal law that is called, briefly, the "portability" law for health insurance. What that means is that when you leave a group (read company-paid plan), the carrier that provided that plan, must offer to you, another plan, different from COBRA, when you leave the group coverage. Generally this will be what is called a "bare bones" plan. Again, the best thing for you to do is to call/email a Health Insurance/Benefits Broker with all of your information: SPD, COBRA info, HIPAA info, needs, cost limits, and let him/her help you find the optimum plan coverage for you.

MEDICARE

OK, now, finally, we've reached Medicare! BUT (you really didn't think it would be that easy, did you?) if you have qualified for Medicare because of disability, there are RESTRICTIONS (of COURSE there are!).

First of all, if you are qualifying for Medicare because of disability, you are probably under the age of 65 - normal retirement age.

Medicare coverage does NOT cover prescription drugs, which, those of us with disabilities probably need, and which cost lots.

But, Congress prescribed that states (all but 11) offer what is called "Medicare supplement" plans, some of which do offer prescription coverages. BUT, these plans ARE NOT REQUIRED TO, and do not, offer these medicare supplement plans that offer prescription coverages to folks who qualify under age 65! So, if you are qualifying because of disability, your medical insurance plan doesn't cover one of your primary cost expenditures!

Here again is where you need to contact a health insurance/benefit broker. Again, he/she can work with you, and your specific circumstances, to get you the coverage you need.

Hope that this information was helpful to you. If you have any questions, please feel to ask them by commenting on this blog, and I'll be happy to get you an answer.

About Disabilitykey.com & Carolyn Magura:

Disabilitykey.com is a website designed to assist each person in his/her own unique quest to navigate through the difficult and often conflicting and misleading information about coping with disabilities.

Carolyn Magura, noted disability / ADA expert, has written an e-Book documenting the process that allowed her to:

a) continue to work and receive her “full salary” while on Long Term Disability; and

b) become the first person in her State to qualify for Social Security Disability the FIRST TIME, in UNDER 30 DAYS.

Click here to receive Carolyn 's easy-to-read, easy-to-follow direct guide through this difficult, trying process. If you are disabled, don't let this disabiling process

 disable you. Read Carolyns Disability Key Blog.