If you think there have to be better ways for an uninsured person to get health care than robbing a bank for $1 -- as a North Carolina man did recently to get access to medical care in prison -- you're right: There are.
While most people get their health insurance from their employers, that doesn't mean the jobless have to take desperate measures. If you're one of the nation's nearly 14 million unemployed, here's what you need to know.
Get the Facts
"The health insurance system is complex and can be confusing," says Ankeny Minoux, president of the Foundation for Health Coverage Education, a nonprofit organization and research resource, www.coverageforall.org. "Start by doing your homework and taking the time to fully understand all options before enrolling in a program or plan."
First off, decide what kind of coverage you want and need. "If you're healthy, single, only go to the doctor for annual checkups and maybe a sore throat once a year, you'll need something quite different than a young family with lots of kids, or someone who has an illness they are maintaining and need prescriptions and regular lab work," points out Ellen Laden, individual business spokeswoman for UnitedHealthcare's Golden Rule Insurance.
Next, make a realistic assessment of how much you can afford to spend for coverage. The goal is to look for a plan that fits your needs and budget, at least for the interim, says Laden.
"It can be tempting when you have a tight budget to do nothing, but when you're unemployed, this is the exact time you don't want to get hit with a $10,000 health care bill," she says.
Don't Let Costs Scare You Away From COBRA
People are often worried about the cost of COBRA, automatically assume they can't afford it, and choose to go without it, says Minoux. However, in many cases, COBRA may be the most comprehensive -- or the only -- coverage possibility available to save a person from the financial hardships of an unexpected medical emergency, she says.
COBRA, which allows laid-off employees to keeps their former employer's health insurance benefits for up to 18 months (up to 36 months in qualifying situations), should be at the top of your research list. There's a simple reason it seems so expensive: "You have to pay both the employee and employer portions of the monthly premiums," says Keith Mendonsa, consumer specialist at eHealthInsurance.com.
The average monthly cost of COBRA for an individual is around $400 and between $1,000 and $1,200 for family coverage. That's probably three to four times more than you were paying under your company plan when you were employed, says Laden.
Still, the coverage can be comprehensive, and in 20 states, the Health Insurance Premium Payment can help pay for COBRA if you're an individual with high medical cost, notes Minoux. Most states require Medicaid eligibility to qualify.
"The risk of having no insurance is too high and can ruin you financially for life," says Thomas Casey, a certified financial planner with Casey, Thomas & Associates.
Think Short Term
What do you do though, once COBRA runs out -- or if you don't qualify for COBRA, for example, because your company closed? Start by checking out your eligibility for programs like the government's Centers for Medicare & Medicaid or State Children's Health Insurance Program (S-CHIP), which is available in every state, but which may go by a different name in yours.
Explore short-term health plans: They can bridge the gap until you get another job. You choose coverage from a variety of plans for one to eleven months, and if you buy six months and need only three, you can get the unused portion of your money back, explains Laden. These plans are designed to protect you against catastrophic losses for a specific number of days, and coverage ends when the term does. The underwriting is less strict for these plans, and some allow you to re-up for one additional term of one to eleven months, without additional underwriting, says Casey. The plans are inexpensive because the coverage is more limited than under a comprehensive individual plan.
Go for High Deductible Plans
Generally, the higher your deductible, the lower your premium. Deductibles start at $500 and can go up to $10,000 per year. "If you choose a $5,000 deductible, you will pay much less premium, while being able to protect against larger medical expenses," says Laden. "Don't get scared off when you hear the term 'high deductible' -- find out what it means."
You can get individual insurance that's likely similar to what you had with your employer -- co-pays, prescription benefits and the like -- from plans that have a wide range of deductibles and premiums. Shop around. Know what's covered, and just as important, what's not. What are you responsible for paying for? Ask questions, says Laden.
But what if you don't qualify for an individual plan because of medical issues? Contact your state Insurance Department to determine what high-risk pool plans are available in your state. You can also see what's in the federal government's high risk, pre-existing condition pool, www.pcip.gov.
The U.S. Department of Health and Human Services recently released new guidelines making it easier for people with preexisting conditions to qualify for coverage in state and federal high-risk pools, reports Mendonsa. "You no longer have to be officially declined by an insurer or go uninsured for six months before qualifying."
Negotiate Like the Big Boys
You may be able to save up to 30% on your medical bills by negotiating with your care provider. Prices for the same health care service, test or treatment, can vary by thousands of dollars because prices are negotiated between different health care providers and different insurance companies. They bargain. You should too.
"If you're currently uninsured, you're not benefiting from those discounted rates, so the charges listed on your medical bill may be substantially more than others are expected to pay. Talk to your doctor or your hospital's billing department to see if you can negotiate a discount by paying up front or creating a payment plan," suggests Mendonsa. To learn more about negotiating medical bills, visit the Healthcare Blue Book website, which also provides suggested prices for many standard medical services.
The Smorgasbord Approach
You can mix and match your benefits. For example, if only one family member qualifies for COBRA, you can still find lower cost options for the rest of the family, saving considerable money, points out Minoux.
Don't Forget Your Teeth
If it's one thing people really put off when money is in short supply, it's the dentist. You don't want to go anyway, and being broke is a good excuse -- but not really. The health of your mouth matters. Investigate Quality Dental Plan, which is available for those who are unemployed or do not have insurance. The pre-pay dental plan has no monthly premiums, offers patients free initial exams, a whitening, X-rays and cleaning. QDP has 65 locations in the U.S.
Go for Quality
Whatever type of health insurance plan you go for, reputation counts. You want a company that is highly rated by firms like A.M. Best, and you want to spend time on websites comparing each of a company's plans, and comparing those to what the competition offers. Laden likes eHealthInsurance.com and insureone.com. She also favors independent brokers who can sit down one-on-one to answer your questions and steer you in the best direction for you. Most insurance companies have 800-numbers that allowed you to talk to a licensed broker in your state.
Lastly, says Laden, "Don't feel lost. You do have choices."