Current Issue » Cover Story

Why are more than 47 million Americans under the age of 65 skipping out on having routine physicals, letting their asthma run amuck or not getting antibiotics for urinary tract infections? They don't have health insurance. One reason so many are without healthcare: Lack of employer coverage. And, too many families are gambling with their health while trying to save a buck or two by cutting out paying for healthcare coverage. Lloyd Michener, M.D., chairman of Duke University Medical Center's Department of Community and Family Medicine says regardless of your income level, healthcare is one thing you shouldn't cut from your budget. "You can effectively manage healthcare costs and stay healthy at the same time."

We've got you covered if you lose your job - and corresponding healthcare benefits - tomorrow. Or aren't covered by an employer sponsored plan. And, although these solutions are good no matter the reason you're without coverage, we've found the best solutions for the four most common scenarios you may encounter.

You're unexpectedly unemployed
If you just lost your job and corresponding health insurance coverage, you're probably eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage for yourself, and your family if you carried insurance for them, through your former employer's group plan.

"In most cases, employers pay a portion, sometimes up to 75 or 80 percent, of an employee's health insurance premium," says Ellen Laden, director, public relations, UnitedHealthcare's Golden Rule Insurance Company, "but when you elect COBRA coverage, you're responsible for paying the entire monthly premium." Laden says act quickly, you've only got 60 days from the last day of employment to elect coverage which may continue for up to 18 to 36 months. Rates are based on your employer's premium and can vary anywhere from $400 to $1000 per month (depending on if you're opting for individual or family coverage).

COBRA, Laden says, is especially good for people with pre-existing conditions or health issues requiring daily prescriptions and routine visits to the doctor like diabetes, hypertension or even asthma. "These conditions can be costly, too costly, for someone to go without healthcare coverage," says Laden.

If an over-stretched budget can't handle a COBRA premium payment or you're no longer eligible for COBRA, and you need medical care, ask your physician if he will discount his services. "Uninsured people don't realize they can negotiate a discounted rate," says Laden. To get a reduced rate, speak directly to your doctor since the receptionist or nurse my not be authorized to reduce rates. If you go to the ER, ask to speak to a representative in the patient billing department to discuss payment options and discounts for self-pay patients.

And, when you do go to the doctor, make sure to cover everything in one trip. "Make the most of the visit," suggests Laden, "If you're there for a urinary tract infection, ask if you can also have your blood pressure checked or have a physical." This can cut out the need for another trip to the doctor and additional charges.

Waiting doesn't have to be the hardest part
If you just started a new job, or your employer switches carriers, chances are you're facing a 30 to 180 day waiting period before healthcare coverage kicks in.

A short-term policy can give you peace of mind without biting too deep into your budget. These policies are typically very flexible, offering deductibles ranging from $250 to $5000 as well as co-pay and prescription coverage options. "The higher the deductible, the lower your premium will be," says Laden. Plan lengths vary by state, but are usually available from one to six months, and pre-existing conditions or treatment for a condition that occurred within six months of the application date are generally not covered.

As you start searching for affordable coverage, take note of any professional or fraternal organizations, institutions, clubs, groups, associations or unions you're affiliated with. Give the membership coordinator a call or dig out your member information packet to see if group health insurance is one of your member benefits.

Ask your physician or pharmacist for the name and phone number of the manufacturer of the drugs you need. Most pharmaceutical companies have either a discount or free medication plan for individuals without insurance.

For the rest of the story, pick up a FREE COPY of Pittsburgh Parent Magazine today!