In Pursuit of Health Benefits
For many, finding affordable health benefits has become a very daunting task. As a result an estimated one out of every six Americans is without coverage – a number that continues to rise.
Those fortunate enough to have health benefits through their employer are also in a vulnerable situation as companies scale back coverage options and raise premiums and deductibles. And of course there are the ranks of the underinsured that face certain financial instability if they ever encounter a catastrophic health condition.
I have personally had a number of experiences that speak to the value of having good health benefits. In 1991, my daughter Amber was born prematurely and diagnosed a short time later with cerebral palsy. The medical bill for her early entry into the world and neonatal intensive care unit stay was around $150,000.00. Fortunately I had health insurance through my employer, which covered nearly 100% of it. In 2002, my other daughter Gwen was born healthy. While this bill represented a paltry sum of $12,000.00, our lack of health insurance forced us to pay all of it out of pocket.
It’s situations like the ones that I have just described with my two daughters that leave families open to disaster from unexpected medical expenses. Unfortunately there are many self-employed business owners, seniors, and those with pre-existing conditions that are finding the road to obtaining affordable health benefits bleak. Compounding the situation is a health insurance marketplace that many consumers find confusing; with its array of complex health plan options and technical jargon. Some would in fact argue that sorting through all of this could be as stressful as any health condition that one might face
While the prospects may appear bleak in your pursuit of affordable healthcare, there a number of options available to you to protect yourself from crippling medical bills:
1. Employer Health Plans: Taking a job for the sake of having access to quality, affordable health insurance is an option that many are pursuing these days. If you are self-employed, it may be in your best interest for you or your spouse to pursue a part-time job that provides health coverage. What’s great about employer policies is that your company will often make a significant contribution towards your premium so that your costs are lower than if you were to have purchased a private policy. In addition, qualification requirements are frequently much lower – a factor that is particularly important if you have a pre-existing condition that might otherwise disqualify you from finding affordable rates.
One of the things that many overlook when they secure employer coverage are the other benefit options that may be available to them. Section 125 flexible spending plans are one such option. This is where you can set aside pre-tax dollars for out-of-pocket medical and dental expenses. If you have significant deductibles, co-payments, over the counter medication needs, and many other qualifying out-of-pocket expenses, then this option could save you a significant amount of money while reducing your taxable income. Another option that many fail to consider is supplemental insurance coverage. AFLAC is the most widely known supplemental provider that provides an extra layer of protection for what your plan doesn’t cover at very modest rates.
2. Associations: In 1993 when I began my self-employment journey, I secured inexpensive yet quality health coverage through my university alumni association. Today there are many plans on the market via the likes of AAA, AARP as well as other professional and trade associations that may be valuable to consider. One word of caution though. Make sure to check out these plans through your state insurance commissioners office and the Better Business Bureau before signing on. Some of these plans promise more than they can deliver and in some cases amount to no more than an outright scam. If fact, there are several health insurance companies currently being sued on behalf of policy holders who failed to read the fine print and racked up medical bills in the tens of thousands of dollars!
3. Catastrophic Coverage: Because your greatest risk in having no insurance is falling prey to an expensive health condition, catastrophic insurance is one relatively inexpensive option that can allay some of those fears. These policies typically come with a high deductible level for major medical services and may even offer preventative care at a very low co-payment rate. While the thought of having a $5,000.00 plan may seem overwhelming, it is important to weigh that against the possibility of ending up in the poor house as a result of a $25,000, $50,000, or even a $100,000.00 claim.
4. Government Programs: A true but sad reality is that there are a lot of great public options that many eligible American’s don’t take full advantage of. These include Medicare for older adults and Medicaid for low-income individuals and families. Veterans can turn to services through VA Centers and affiliated outpatient clinics for free and low cost medical care. And if you have kids, don’t forget that many states have healthy children programs that fund the need of children younger than 18 at a very low cost.
5. Global Coverage: A recent documentary on the CBS television show 60 Minutes reported that a growing number of uninsured or underinsured Americans are going oversees for the healthcare needs. In many cases they are finding reasonable healthcare rates that they can pay for out-of-pocket (in America, self pay patients typically pay a higher rate than those insured), as well as higher quality outcomes.
6. Public and Specialty Hospitals: Despite the fact that they are dwindling in numbers, public hospitals guarantee care to those with little or no ability to pay as a part of their mission. There are also specialty hospitals like Shriner’s that provide subsidized care to eligible children faced with difficult health issues.
One other important thing to consider if you are either without insurance or have a bare bones policy is in the event of a hospital visit or stay, keep in mind that you are likely to receive billing statements requesting that you pay all or part of the services. It is important to know that hospitals often mark up the cost of these services and frequently make major errors that can significantly increase the cost of your bill. For example, when I received the itemized bill for the birth of my second daughter, it included a $1,500 charge for what I personally witnessed as a 10 minute visit by the staff respiratory therapist. When I brought this to the attention of a hospital representative, they admitted that an error had been made and reduced it to $320.00.
A further audit yielded additional findings which included a nearly 100% mark up on the over the counter pain medicine that was given to my wife. At the end of the review our entire bill was reduced by approximately 30% and the hospital set us up with a convenient payment arrangement for the remaining amount. The moral of this story is, if you happen to be among the uninsured, check your bills closely and immediately report any discrepancies to a hospital representative for an audit review. If you are uncomfortable in doing this on your own then you may want to consider seeking the help of a medical bill review company such as Medical Billing Advocates of America www.billadvocates.com. They will verify and review every charge and insure that you are only paying for those things that you owe.
Navigating through the process of securing affordable health coverage can be tricky, particularly if you have insufficient income to pay for it or have a pre-existing condition to contend with. Nevertheless, by considering the options above, you will be well on your way to addressing this critical and necessary need.
