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Health Insurance

Healthcare Choices

Before you retire: Be sure you understand the documents governing your healthcare plan.

Consult with your employer's human resources office, your union, the plan administrator, and check your summary plan description (SPD).

Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated.

With this information in hand, you can make other important choices, like deciding on future healthcare plans and providers. There are a number of different healthcare providers and plans that offer varying levels of healthcare coverage:

Group
Individual
Government programs, such as Medicare and Medigap

GROUP HEALTHCARE:

Employers or unions: This type of coverage is for current employees or retirees. Generally, employer plans have better rates than you can get if you buy a policy yourself, and employers pay the cost. Employees and retirees should know that private sector employers are not required to promise retiree health benefits. Furthermore, when employers do offer retiree health benefits, nothing in federal law prevents them from cutting or eliminating those benefits -- unless they have made a specific promise to maintain the benefits. The key to understanding your retiree health benefits lies in the documents governing your plan.

Organizations or associations: This type of group health coverage is for members of an organization or association. Just because you are buying through a group does not always mean that you are getting a lower rate. This type of coverage can cost as much as, or more than, the same coverage you get with a policy you buy for yourself. Be sure you understand the benefits included and how the premiums are decided, then compare prices.

INDIVIDUAL HEALTHCARE:

Healthcare insurance can be purchased as an individual. This method of purchasing insurance is very expensive due to the high premiums charged to individuals. There are a variety of private health insurance plans that are limited in scope for specific insurance needs. It's important to do plenty of research and comparison shop with a number of health plans and providers. The following links should help you learn about comparison shopping.

Comparison Shopping Tips and Services:

The U.S. Department of Health and Human Services provides a publication entitled, Your Guide to Choosing Quality Health Care. The publication is in a PDF file that describes quality measures including consumer ratings, clinical performance measures, and acceditation - what they are, where to find them, and how to use them.

The Life Insurance Foundation for Education (LIFE) is a nonprofit organization designed to address the public's growing need for information and education on life, health, and disability insurance.
The Health Insurance Association of America provides an online booklet entitled Guide to Health Insurance. This booklet discusses the basic forms of health coverage and includes a checklist to help you compare plans.
MetLife provides a number of tips about "How to Shop for Health Insurance". Their health insurance website includes additional topics about coverage choices, obtaining insurance, and how to save money.
InsWeb is a free service that lets you compare insurance quotes from leading insurance companies to find the best rates available. This site also provides a health plan analyzer that advises whether an HMO or PPO best meets your health insurance needs.
The GE Center for Financial Learning provides a website devoted to Healthcare Finance. The website contains resources that explain fundamental principles in the healthcare industry.

GOVERNMENT HEALTHCARE PROGRAMS:

There are a number of government programs aimed at assisting older Americans with healthcare expenses. The following links explain different government programs and their eligibility requirements.

Medicare - The Health Care Financing Administration (HCFA) administers Medicare, the nation's largest health insurance program, which covers 39 million Americans. Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant.)

HCFA provides an online Medicare Compare Database. Medicare Compare is an interactive database which includes detailed information on Medicare's health plan options in your area. Medicare Compare allows you to "comparison shop" and find the plans that will work best for you.

You may be eligible for health benefits from another government agency. The Railroad Retirement Board and the Department of Veterans Affairs are two government agencies that provide health benefits to qualified individuals. The Railroad Retirement Board provides Medicare information and publications tailored for individuals receiving railroad retirement or survivor benefits. The Veterans Health Administrations (VHA) provides a broad spectrum of medical, surgical, and rehabilitative care to its customers.

Need Help Reading Your Medicare Statement? - Ever wonder what all those codes on your Medicare Statement mean? The Center for Medicare and Medicaid Services has a web page that explains all.

Medigap Plans - A Medigap plan is a health insurance plan that fill the gaps in Original Medicare plan coverage. In all states, there are basic standardized Medigap plans. The Medicare Personal Plan Finder helps you narrow down your Medicare health plan choices, including Medigap Plans, and choose the plan that's best for you.

Medicaid - is a jointly-funded, Federal-State health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments. Medicaid is the largest insurer of long term care for all Americans, including the middle class. Click here for an explanation of the eligibility criteria for Medicaid. Click here for state and federal Medicaid contacts.

HIPAA (The Health Insurance Portability and Accountability Act of 1996) - provides protections for millions of American workers that improve the portability and continuity of health insurance coverage. HIPAA requires that most health plans provide coverage for pre-existing medical conditions after 12 months in the majority cases.

Tricare - National Defense Authorization Act - The FY2001 National Defense Authorization Act brings many new military health care benefits to the TRICARE program including two dramatic improvements -- the pharmacy benefit (effective April 1, 2001) and the TRICARE For Life (TFL) benefit (effective October 1, 2001) -- for the age 65 and over population. A popular feature of this service is the TRICARE Retiree Dental (TRDP) Program - the only dental benefits program authorized by the government for Uniformed Services retirees.

Federally Qualified Health Centers (FQHC) - is another possible way to lower your health care costs. At a FQHC, you can get routine care. When you use a FQHC, Medicare pays for some health services like preventive care that are not usually covered.

COBRA (The Consolidated Omnibus Budget Reconciliation Act of 1985) - is a law that requires employers with 20 or more employees to let employees and their dependents keep their group health coverage for a time (generally 18 months) after they leave their group health plan under certain conditions. You may have this right if you lose your job or have your working hours reduced, or if you are covered under your spouse's plan and your spouse dies or you get divorced.

The PACE Program - The Programs of All-Inclusive Care for the Elderly (PACE) is a program that combines both inpatient and outpatient medical and long-term care services. To be eligible, you must be at least 55 years old, live in the service area of the PACE program, and be certified as eligible for nursing home care by the appropriate state agency. The goal of PACE is to keep you independent and living in your community as long as possible and to offer quality care at low cost.

Programs to Help Pay Health Care Costs - Besides the standard Medicaid program, there are other programs that help certain low-income Medicare beneficiaries pay their health care costs. These programs are known as the Qualified Medicare Beneficiary (QMB), the Specified Low-Income Medicare Beneficiary (SLMB) and the Qualifying Individual (QI) programs. While these programs do not take the place of supplemental insurance, they could save you hundreds of dollars, if you qualify.