While our three (ring circus) branches of government try to figure what to do with health care, life for us down here in the trenches continues to march on. This means accidents happen, people get sick, and at some point every one of us ends up (at one time or another) in a doctor’s examination room wrapped in a paper gown. For this reason, you need to consider all your health insurance options whether you’re employed or not. Unfortunately, when your job status changes, so does your coverage. Here are the three most important times you need to re-examine your health care benefits.
When You Start a New Job
The sad truth is most employers can’t afford to cover their employees with 100% health care. In most cases, an employer pays for part or most of an employee’s plan, but then the employee has to also kick in to make up the difference. When you hire on with a new company, be sure to read the company’s health insurance policy from cover to cover. If you don’t understand something, ask your employer to spell it out for you. Typically, an employer health care plan DOES cover general doctor visits and catastrophic care, but usually DOESN’T include extras like dental, vision, chiropractic care, etc. If these things are important to you then often you can include them as extras on your policy, but you’ll have to pay for them.
Also if you or someone in your family has a pre-existing condition, you need to make sure that condition will be covered under your new plan. In fact, check on this BEFORE you quit your old job. And if you like the doctors you’ve been seeing make sure those doctors are covered under your new plan. If not, you may be paying for your doctor visits 100% out of your own pocket.
If You Quit or Are Fired From Your Existing Job
Regardless of the reason you leave a job the COBRA Act of 1985 ensures that you can take your company’s health insurance benefits with you for up to 18 months. Unfortunately, you’ll have to pay 100% of those monthly premiums yourself, but at least you’re covered. This is especially important if you’re going through specific treatment at the time you leave a job, or you want to retain your same health insurance while you look for a new job.
Whatever you do, DO NOT roll the dice and go without health insurance. That’s never a gamble worth taking.
If You’re In Between Jobs
If your employer’s health plan is too expensive for you to continue with on your own, then you need to get some sort of health insurance while you look for work. If you’re married, check to see if your spouse’s plan will cover you, at least for catastrophic care. You may have to pay a little extra, but it probably won’t add up to what you’d pay for your own policy.
If you have to purchase your own health insurance you basically have two options; A PPO (expensive, but covers a lot) or catastrophic care (cheaper, but with less coverage). The one you choose depends upon A) How much money you have to spend on health care, and B) How long you anticipate being unemployed.
A PPO is the closest thing your employer provided you with in terms of health care. Typically, a PPO has a family deductible of anywhere from $1,000 to $5,000 annually and also offers co-pays for doctor office visits and prescription drugs. This means you pay your doctor office co-pay of, for example, $25 per visit, every time you go to your doctor. But after you’ve paid enough medical bills (in a calendar year) to meet your deductible, then the insurance company pays anywhere from 80% to 100% of your remaining medical bills, but only for the rest of the calendar year. After January 1 the slate is wiped clean and you start paying toward your deductible all over again.
A PPO plan is pretty expensive because it covers everything from a cold to cancer. If you know you’re going to be out of work only for a short time, then a PPO may be overkill. Instead, you can go with a catastrophic care plan, which has a very high deductible (usually $5,000 to $10,000), and only covers you for major medical expenses, such as accidents or long term severe illness (like cancer). If you’re healthy, and left without health benefits for a month or less, then a catastrophic care plan may make more sense. It’s way cheaper than a PPO, but still guarantees you won’t lose everything if you happen to have an accident that requires expensive treatment while you’re without employer benefits.
Regardless of your employment status you should NEVER go without health insurance. It only takes something as simple as a hernia surgery or a broken leg to wipe out everything you’ve ever worked for. True, you don’t know if you’ll ever need to go to the doctor while in between jobs, but that’s why they call it insurance – because then you won’t have to worry if you do.
Any questions, please drop me a line.
Nursing Entrepreneurs, Nurses In Business
Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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