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Medical Insurance

We all need medical attention from time to time. Even if you’re young and healthy, you never know when you’ll have an accident or develop a serious condition. The main reason to have health insurance is not to cover “normal” expenses like maintenance medications or office visits, but to protect your finances from the potentially disastrious consequences of a major illness or a serious injury.

It is important to remember that health insurance is regulated on a state-by-state basis, and that the gradual implementation of the 2009 Affordable Care Act changes the rules of the game on a seemingly daily basis.

Different Ways to Get Covered

Through Your Employer

Most large employers, and some smaller employers, offer group health coverage. Employers usually pay a significant part of the premium, which they view as part of an employee’s compensation. By law, group health policies do not have the same eligibility requirements as individual coverage. Enrollment occurs when you are hired (though there may be a waiting period before coverage begins), and coverage can continue (at your expense) after you leave the job for a period of up to 18 months.

Individual / Family Policies

Individual and family policies allow you to choose your own plan. There are many options for deductibles, coinsurance, copayments, and which services are covered or not covered. Unlike with employer-based insurance, however, insurers can decline to write policies for individuals and families, or place significant restrictions on the policy based on pre-existing conditions.

Some people — particularly those with higher incomes who are generally healthy — opt to purchase a high deductible plan at reduced cost, and open a health savings account (HSA.) The money contributed to this HSA grows tax-free as a retirement account would, enabling you to keep your money if it is not spent on medical services, while still having insurance protection for major medical expenses.

Medicare

Americans aged 65 or older, as well as people with certain disabilities, may qualify for Medicare, a federal health insurance program. The traditional plan is often referred to as Part A (hospitalization) and Part B (physician care) and Part D (prescription drugs outside of the hospital.) Private insurance plans called “medicare supplements” are written to cover services that Medicare does not cover. They are highly standardized and fairly affordable.

Medicaid

Medicaid is a federal program adminsistered by the states. It is designed to provide health coverage for certain eligible low-income individuals. Eligibility factors include age, pregnancy status, blindness or other disabilities, and income. Your child may be eligible for coverage even if you are not.

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