“These uncertain times require us all to be vigilant about our insurance to make sure we are protected,” said NAIC President and New Hampshire Insurance Commissioner Roger Sevigny. “Consumers can safeguard themselves and their families regardless of their employment situation by making sure they understand their coverage and researching less expensive alternatives.”
The newly unemployed should examine their options early because some choices expire within weeks of job termination. The NAIC offers the following tips about health insurance for those who have recently lost their jobs or believe they might need to plan for the possibility:
- If married, consider joining your spouse’s plan: Transitioning to a spouse’s plan is typically the most affordable option, but you have to act quickly. There is a 30-day special enrollment period during which an employee can add a dependent who has lost coverage. If that 30-day window expires, then your spouse would need to wait to add you to his/her plan until the open enrollment period occurs.
Consider COBRA: The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) allows individuals who leave their jobs at companies with 20 or more employees to continue their health insurance coverage for 18 months. Many states extend similar access for those who worked for small companies through “mini-COBRA” laws. In most cases, you have 60 days to elect coverage. COBRA coverage can be expensive, because you are required to pay the full premium, plus an administrative fee. However, it is also retroactive once you elect it, so use those two months to evaluate other options. Those who lose their job because a company goes out of business might not be eligible for COBRA if the company stops its group insurance plan.
As part of the newly enacted economic stimulus package, the federal government will pay 65 percent of COBRA extended coverage premiums for workers laid off between Sept. 1, 2008, and Dec. 31, 2009. Employers had until April 18 to notify former staff eligible for this option. There are income limits for subsidy eligibility, however: $125,000 for single adults or $250,000 for couples who file taxes jointly.
- Research eligibility for government-sponsored plans: Check to see if you are eligible for insurance through a government program, such as Medicaid or Medicare. For more information, visit www.cms.hhs.gov/home/medicaid.asp or www.medicare.gov.
- Purchase a private plan: You can purchase coverage through private providers if you meet certain criteria. A high-deductible major medical policy will cover serious or catastrophic health costs if you cannot afford a comprehensive plan. Just remember, these plans will require you to pay more out-of-pocket costs should you need medical care.
- Join a state-sponsored risk pool: For those who have been denied affordable health coverage from a private insurer because of a pre-existing condition, high-risk pools provide the option of purchasing a state-sponsored insurance plan. These types of plans can be an alternative for individuals who are not yet eligible for Medicare or for those who are temporarily unemployed and need insurance in the interim. Thirty-four states offer high-risk pools, but the terms of coverage vary by state. Check with your state insurance department to see if your state has a high-risk pool and, if so, what your options are. Go to the NAIC’s Web site for a link to your state insurance department: www.naic.org/state_web_map.htm.
- Switch to generic prescriptions: If you are insured through your employer, your health plan likely provides a discount for generic medication. This discount can help you save on monthly out-of-pocket health costs. If generic options are not available for your medications, work with your doctor to help ensure your medications are listed among your health plan’s list of preferred prescriptions. If a drug is not on the formulary, then there is higher cost-sharing (co-insurance or co-pay).
- Schedule an annual check-up: Annual physicals can catch health problems before they become serious, saving you money in the long run. Many insurance plans cover 100 percent of wellness care for routine exams, immunizations and diagnostic tests.
- Stay in-network: Before booking an appointment, verify that your doctor is included in your plan at preferred rates. Sticking to network providers helps ensure lower co-payments and out-of-network costs. If you need to have a procedure done at an out-of-network provider, research the costs and be prepared to negotiate the price.
- Use preventive benefits: Some employers offer a subsidized gym membership or nutrition program. Staying healthy and active will reduce your chances of needing costly high-risk medical procedures throughout your lifetime.