Dealing Without Health Insurance

The reality of losing a job and the health insurance that went with it is daunting for people accustomed to employer-sponsored plans. It's a challenge self-employed people struggle with all the time, but going it alone on the open market is becoming more common as employers bow out of the health care business.

Karen Pennington, Ph.D., an associate professor in the nursing program at Regis University, says, "75% of the health care in this country traditionally comes from your place of employment. That number is falling. It is now down to 73% because employers are saying, 'I can't do it anymore. It's either pay an employee or pay into a health care system and fire an employee.'"

While the current administration places health care among its top priorities, it will take time to implement a plan. In the meantime, if you find yourself outside the relative safety of group health insurance plans, you have important decisions to make. Here's how you can make the best of a tough situation.

3 ways to avoid gaps in insurance coverage
Any lapses in health insurance coverage void federal and state protections and make getting insurance harder or even impossible. Avoid them whenever possible.

COBRA. The Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows employees, in most cases, to continue an employer's group plan at their own expense for up to 18 months. Often this is the best option if serious medical conditions make you ineligible for private health insurance, but it can be expensive. "COBRA was more than our mortgage," says Christina McMenemy of Columbus, Ohio, whose husband lost his state job in June 2008. "We're talking over $1,200 a month for a family of four, and we were like, 'Wow! That's just too much.'"

Unfortunately, the McMenemy family falls outside criteria for COBRA subsidies embedded in the American Recovery and Reinvestment Act of 2009, signed into law in mid-February. The act offers premium assistance of 65% toward COBRA insurance for up to nine months, not the full 18 months, under the following conditions:

The unemployed person has an individual income of less than $125,000 per year or a family income of less than $250,000.
The person must be laid off between Sept. 1, 2008, and Dec. 31, 2009.
The person was participating in group coverage at the time of layoff.
Another caveat is that the former employer must continue to exist, so if a company files for Chapter 7 bankruptcy, these subsidies would not apply.

However, says Sam Gibbs at eHealthInsurance.com, "If a person was laid off in September 2008 and did not choose COBRA within the required 62-day window, the new stimulus package allows them to become eligible for COBRA again, as long as the former employer continues to exist and offer group coverage."

For those currently employed but worried about needing COBRA, Gibbs recommends downgrading your insurance to a less expensive option during the annual open-enrollment period.

HIPAA. The Health Insurance Portability and Accountability Act, or HIPAA, offers some protection against insurance gaps. These "plans of last resort" guarantee coverage for those rejected on the private market. "As long as you have continuous coverage, you are always eligible for some type of program," says Gibbs. "As soon as you're left without coverage, then you are not eligible for a HIPAA plan."

For example, William Fogler of Atlanta made a COBRA payment mistake in November 2007 and lost his insurance before he could move to an individual plan. Because of this gap and a major pre-existing condition, Fogler is now uninsurable.

Individual or family plans. The same insurance providers who offer group plans also sell individual and family plans to those who qualify. Known as "major medical" plans, these insurance offerings use a catastrophic model, where you take responsibility via large annual deductibles (medical expenses paid out of pocket) in exchange for coverage beyond that. Common deductible options can be $1,000, $2,500, $5,000 or even $10,000 per year. Higher deductibles correlate with lower monthly premiums.

Gibbs uses a car insurance analogy to explain the difference. People expect car insurance to cover accidents and maybe a rental car, but they would never expect it to pay for regular maintenance such as wiper blades, oil changes, brakes and tires.

Inexpensive -- and Lousy -- Health Insurance

An estimated 49 million Americans don't have any health insurance. Frightening. But even more startling are the discoveries of a Consumer Reports investigation, which found that many people who've purchased their own insurance are not as protected as they think.

It's not until people get sick that they discover the problem. That's what happened to Gina Eaton. Her policy has such a high deductible that she says she opted not to get medical treatment after a miscarriage. "I just kind of went to bed for about three or four days and tried not to walk around or do anything. I just stood real still and hoped that it would heal itself."

Consumer Reports says that the policies are like Swiss cheese. And the way they're written, it's really hard to spot the gaps. Even the insurance expert Consumer Reports hired to help check out the policies had a hard time deciphering some of them.

Consumer Reports' Nancy Metcalf says that many big-name insurance companies are offering those so-called junk policies. They look like a good deal because the premiums are low—but they're low for a reason. They are so riddled with loopholes, limits, and exclusions that they will not come close to covering your expenses if you ever fall seriously ill.

Consumer Reports says here's how to avoid junk health-insurance policies:

--Never buy a policy labeled "limited benefit" or "not major medical insurance."

--Don't leave out a category of care because you say to yourself that you never use it. You might not use it now, but you could desperately need it in six months.

--Don't take a salesperson's word for anything. Always read the fine print, which will help you avoid low-cost coverage that comes with a high price tag.

Consumer Reports' complete article on Hazardous Health Plans.

Healthcare on life support

As we go to sleep tonight there are at least 48 million Americans without healthcare. I have only one question to ask to the 250 million Americans who are fortunate enough to have healthcare. Is that okay with you? Our current healthcare system was basically set up under the Nixon administration with the promise of providing quality healthcare to all Americans. Yet how can it be that more that twenty five years after the Nixon administration opened the gates for HMO's to decide the level of medical care we should receive, that there are more Americans without healthcare than ever.

There is a simple answer to that question. Medical coverage is now a matter of dollar and cents. The medical insurance companies are in the business of making money. Their bottom line is that they only make money if they take in more than they pay out. That means that they would like your insurance premiums to be more than the medical care that you are provided with for that year. Judging by immense profits that the medical insurance companies have been amassing over the last two decades, they have been doing a very good job at making sure the ledger balances in their favor.

When the former Fed chairman, Alan Greenspan was in front of a Congressional committee trying to explain what went wrong with Wall St., he said "I thought they would do the right thing". What he meant was that he thought that the people whose only job was to make as much money as they possibly could, would also take it upon themselves to police their own greed. That was akin to letting wolves loose in a hen house and expecting them to make sure that they left enough chickens alive so that everyone would have omelets the next morning. The health of Americans is now a "for-profit" enterprise. The insurance companies "do the right thing" by making sure that their profits are as big as possible. After all, they have stock holders to answer to. The health and well being of their policy holders is not their primary concern. They have thousands of people hard at work right now, trying to find a way to deny needed medical procedures for their policy holders. The system is now set up so that less medical help you get, the more money they get.

The "for-profit" system is what those fortunate enough to have coverage have to endure. The almost 50 million without health insurance have a different set of problems. While having insurance is not a guarantee that you won't end up tens of thousands of dollars in debt because of uncovered "experimental" treatments, or denied claims, or non pre-approved emergencies, but at least you usually get treated at the hospital. Try to show up at a hospital without medical coverage and see how you get treated. Hospitals have been known to try and ship people to other hospitals for emergency care because they don't have medical coverage. They have been known to put sick people in cabs and drop them off in the middle of the city because they don't have medical coverage. There is no such thing as preventative medicine for those without health insurance. A simple infection can turn deadly without proper treatment, but under the current system, those without coverage are almost destined for the more serious situation.

At the end of the day, the question has to be, what kind of country do we want to be? Do we want to be a country where we let children and the elderly die because of the lack of affordable medical care? Do we want to be a country where possible life saving treatments are denied because they hurt the bottom line? Our healthcare system is broken. The insurance companies, along with the American Medical Association and the Pharmaceutical companies seem hell bent and milking every penny possible from the pockets of the American workers. The lobbyists for the "Triangle of Terror" (that's my trademark, by the way), spend tens of millions of dollars every year to make sure that our representatives in Washington keep the gravy train rolling. I have always believed that we as a people are better than our current healthcare system would reflect. We are generous when people are in need. We spring to the aid of neighbors during time of crisis. We help strangers half way around the world that we will never meet. I simply cannot believe that the majority of Americans are happy with a system that holds human life as cheaply as our healthcare system does.

Is Universal healthcare possible in America? The answer is obviously yes. The American people cannot be afraid to do what's right. The opponents of healthcare reform will say that the government will now be deciding whether you get to have surgery. They will say that you will have to wait much longer for life saving treatments such as transplants. They will say that we are not socialist and that providing healthcare to everyone is a socialist idea. They will try and convince the majority of Americans that they currently get treated like they wealthy do and that reform will lead to them being treated like the poor are. If Americans were to closely examine the current system they would realize that they are already being treated like the poor. Healthcare reform is absolutely necessary for us to move forward as a world leader in this new century. The health of our citizens should not be one of those things that gets worse as time goes on, but somehow it is. We rank behind every developed nation in western hemisphere in life expectancy. We rate no better than in the thirties in overall infant mortality rates. We can do better and we must do better. There is a better way, we just have to demand it.

Health Care Seen As The Top Priority By Many Americans

Washington (dbTechno) - It appears that many Americans feel that the top priority of our government should be health care reform.

As of right now, there are still over 40 million Americans who are living without health insurance, leaving many to wonder why health care reform took so long to get put under the spotlight.

There are clearly many issues in the United States, with unemployment, the housing market, stock market, etc.

The belief of many though is that by fixing health care in the U.S., it may actually trickle down to help those other areas.

This not only includes just providing health care to all of those uninsured, but also to make health care more affordable to normal Americans so it does not take such a big dent in their wallets.

In the year 2008, health care costs skyrocketed yet again, causing major issues for those trying to afford health insurance.

This puts a strain on individuals, as well as businesses who try and give health insurance programs to employees.

It is going to take time, but health care reform needs to get done, and started this year.

That appears to be the case according to President Barack Obama and others, now we are waiting to see it happen.