Whether you've just graduated from college or have been out of school for a couple years, you could be facing a health insurance dilemma.
| You could be facing a health insurance dilemma. |
Chances
are you were covered by your parents' health insurance policy while you
were a full-time student. Most health plans will stop covering the
children of policyholders once the children reach the ages of 22 to 25.
The benefits could end sooner, when a policyholder’s son or daughter is
not a full-time student. You might have been covered by a health plan
offered by your college, which ended when you graduated.
If
you don't have a job lined up right away, or if your new employer
doesn't offer health benefits, you must decide which you can least
afford: buying insurance or going without it. Even though you might not
want to spend the money on health insurance
premiums, don't be tempted to go without at least some kind of health
insurance to pay for hospital or doctor visits should you become sick
or injured. All it takes is one car accident, an ankle broken shooting
hoops or an allergic reaction to a bee sting to saddle you with massive
doctor and hospital bills that can hang around for years.
Even
if you are on a tight budget or if you'd rather spend your money on fun
stuff, you have a variety of options for health insurance. Individual
health plans range from bare-bones hospitalization coverage to
comprehensive HMOs that include prescription medications and wellness
care.
You
might think an inexpensive plan that covers only severe injuries is the
way to go, but a close look at such plans might change your mind.
"Catastrophic
health insurance" policies, as they are known, typically come with a
very high deductible (ranging anywhere from $500 to $15,000) and a high
maximum benefit payment, such as $2 million. They are intended only to
pay for major hospital and medical expenses, not routine visits to the
doctor's office or trips to the emergency room to get stitched up. A
catastrophic plan would cover such things as treatment in an
intensive-care unit for 10 days after an auto accident or complications
from a pregnancy.
Pressing questions when you're shopping for a health plan |
• Can you (or your family) afford to pay all your medical expenses if you become sick or injured and have no health insurance?
• How much is the premium per month, quarter and year?
• How much is the deductible?
• Is the deductible yearly or per illness or injury?
• How much of a deductible can you afford?
• Are there any discounts available?
• What is the co-insurance or co-pay per office visit?
• What is the co-insurance or co-pay for wellness care?
• How extensive do you want your coverage to be?
• Do you need prescription medications?
• Do you mind being confined to a provider network?
• Can you afford to pay for doctor's office visits on your own?
• Do you play sports where you could get injured?
• Do you have any pre-existing conditions?
• Do you get sick often? |
There
is a niche market for such plans: People who are healthy but want to
protect their assets or young people who aren't married and have no
dependents. A healthy person who unexpectedly suffers a serious illness
might not be able to afford a $5,000 deductible. You must decide what
you're comfortable with paying if the worst happens.
As
its name implies, short-term health insurance lasts from one month to
one year. That makes it a potentially good option if you're between
jobs or waiting for your employer-sponsored health plan to kick in.
Plans
are generally comparable to HMOs or similar plans and typically cover
various hospital charges, office visits, diagnostic tests prescription
drugs. Maternity costs are not covered, however. Unlike an HMO or PPO,
short-term coverage is an indemnity plan: That means you're not limited
to a network of doctors. Most recent graduates choose a $250 or $500 deductible.
You can generally pay for a short-term plan in
either monthly installments or one single up-front sum; paying up-front
will lower your total premium cost.
Short-term
policies are a good way to secure coverage when you're temporarily
lacking coverage. If you don't have another option in sight, however,
you're better off looking for a longer-term individual health plan. For
more on that, see Tips for buying individual health coverage.
There are a few things to keep in mind.
With
some insurance companies, the deductible you pay is per injury or
illness. That means you must meet the deductible all over again each
time you are treated for a sinus infection or other illness.
Short-term
policies also have certain strict eligibility requirements, although
they will vary from insurer to insurer. If you have ever been denied
health coverage, you might be ineligible for short-term insurance
because a denial suggests you might have significant health problems.
In addition, if you have a pre-existing condition (an illness or
chronic condition you've had within the previous three to five years),
it won't be covered under most short-term plans. The highest
deductibles are generally chosen only by older folks in an effort to
lower premiums. Pregnancies aren’t usually covered, although
complications arising from pregnancy generally are.
You
probably won't be eligible for short-term insurance if you are covered
by any other health plan, work in a hazardous industry (such as
construction) or play in professional or collegiate sports.
What
happens if you bought a three-month policy only to find the job you
hoped to land — with health benefits — hasn't materialized? Don't count
on automatic renewal of your short-term policy. You have to go through
the application process all over again and take out a new policy. If
you had any illnesses or injuries during your previous policy period,
those now become pre-existing conditions and might not be eligible for
coverage.
Shop around on your own or talk to an insurance agent to make sure you get a plan that's right for you. For more, see The basics of short-term health insurance.
COBRA allows you to continue to purchase your employer's group health plan for 18 months after you leave a job.
Known
formally as the Consolidated Omnibus Reconciliation Act, COBRA was
designed to protect people who change or lose jobs and are threatened
with the loss of their employee benefits plan. The monthly premiums are
expensive.
| COBRA can also benefit young people who have relied on their parents' health plans. |
While
most people only qualify for 18 months of continued coverage under
COBRA, those who get kicked off their parents' policies due to age or
lack of student status can get COBRA for up to 36 months. For more, see
Know your COBRA rights.
If you had health insurance through your college's health plan, you will not be eligible for continuation under COBRA.
Medical savings accounts (MSA) and high-deductible
health plans (HDHPs) open the door to health insurance for those who
might otherwise not be able to afford coverage. To qualify, you must be
an employee (or the spouse of an employee) of a small employer (who had
an average of 50 or fewer employers during one of the last two years)
or a self-employed person (or the spouse of a self-employed person).
A high-deductible health insurance plan has lower
monthly premiums than a standard individual health plan. You'll take
the money you save on premiums and put it in your MSA to spend on
non-covered medical expenses as needed.
Some HDHP provide preventive care benefits plus
hospitalization, while others cover only catastrophic care. Preventive
care includes periodic health evaluations, well-child care and
immunications, and routine prenatal care.
There has been an explosion of HDHP choices in
recent years. Because HDHPs are not "one size fits all," it's important
to shop around for a plan that best covers your needs.
You'll need to predict your health care use for the
coming year: The higher your deductible, the lower your premiums will
be. If you don't anticipate using the plan much, you might opt for a
very high deductible and take a gamble that you won't need to pay the
maximum out of pocket.
There are eligibility requirements to open an MSA. For more, see Medical savings accounts: Another way to pay for health care.
- Alumni associations: Most college alumni associations offer various types of health insurance to graduates. Contact your university for information.
- Individual policy:
Individual policies are generally much more expensive than group plans
you'd buy through work. If you have no other choice, it is better than
going without insurance. You might have to meet certain health
requirements to qualify and pre-exisiting conditions will likely not be
covered. Shop around to get the best deal.
- High-risk health plans:
If your health disqualifies you from buying a plan on your own, you may
be eligible for your state's "high-risk pool." Contact your state's
department of insurance for policy and eligibility information.
- Medicaid:
You must meet certain poverty-level income guidelines, or be disabled,
to qualify for Medicaid. For most young people, this is not an
attractive option.
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