Health Insurance
Group Policies
Many consumers have health care coverage from their employers. Others have medical care paid through a government program such as Medicare, Medicaid or the Veterans Health Administration (https://www.va.gov/health/). You may also purchase health insurance through the Health Insurance Marketplace, at https://www.healthcare.gov/.
If you have lost your group coverage from an employer as the result of unemployment, death, divorce or loss of "dependent child" status, you may be able to continue your coverage temporarily under the Consolidated Omnibus Budget Reconciliation Act (COBRA). You, not the employer, pay for this coverage. When one of these events occurs, you must be given at least 60 days to decide whether you wish to purchase the coverage.
Medicare and Medicaid
There are also health insurance programs for people who are seniors, are disabled or have low incomes:
- Medicare provides health insurance for people who are 65 years or older, some younger people with disabilities and those with kidney failure.
- Medicaid provides health insurance for people with low incomes, children and pregnant women. Eligibility is determined by your state.
More information on these benefits is available. Contact the Centers for Medicare & Medicaid Services (https://www.cms.gov/).
Programs for Children
Most states also offer free or low-cost coverage for children who do not have health insurance. Visit https://www.insurekidsnow.gov/ or call 1-877-KIDS-NOW (543-7669) for more information.
Health Care Plans
When purchasing health insurance, your choices typically will fall into one of three categories:
- Traditional fee-for-service health insurance plans are usually the most expensive choice, but they offer you the most flexibility in choosing health care providers.
- Health maintenance organizations (HMOs) offer lower copayments and cover the costs of more preventive care, but your choice of health care providers is limited. The National Committee for Quality Assurance evaluates and accredits HMOs. You can find out whether one is accredited in your state by calling 1-888-275-7585. You can also get report cards on HMOs by visiting http://www.ncqa.org/.
- Preferred provider organizations (PPOs) offer lower copayments like HMOs but give you more flexibility in selecting a health care provider. A PPO gives you a list of providers you can choose from.
If you go outside the HMO or PPO network of providers, you may have to pay a portion or all of the cost.
When choosing among different health care plans, you will need to read the fine print and ask lots of questions, such as these:
- Do I have the right to go to any doctor, hospital, clinic or pharmacy I choose?
- Are specialists such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? Are there any copayments? Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from copayments, which are the amount of money you pay when you receive medical services or a prescription.
- What is the most I will have to pay out of my own pocket to cover expenses?
- If there is a dispute about a bill or service, how is it handled? In some plans, you may be required to have a third party decide how to settle the problem.
U.S. General Services Administration (GSA). (2016, January). Health insurance. In Consumer action handbook (p. 31). Retrieved December 7, 2016, from https://www.usa.gov/