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» Why do you need health insurance?
» Disability Insurance
» Annuities
» Permanent Life Insurance
» Long-term Care Insurance |
Where Do People Get Health Insurance Coverage?Group Insurance:Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a health maintenance organization (HMO), or a preferred provider organization (PPO), for example. Employers with 25 or more workers are required by Federal law to offer employees the chance to enroll in an HMO. What happens if you or your family member leaves the job? You will lose your employer- supported group coverage. It may be possible to keep the same policy, but you will have to pay for it yourself. A Federal law makes it possible for many people to continue their group health coverage for a period of time. You also will be able to get insurance under COBRA if your spouse was covered but now you are widowed or divorced. If you were covered under your parents' group plan while you were in school, you also can continue in the plan for up to 18 months under COBRA until you find a job that offers you your own health insurance. Not all employers offer health insurance. You might find this to be the case with your job, especially if you work for a small business or work part-time. Individual Insurance:If your employer does not offer group insurance, or if the insurance offered is very limited, you can buy an individual policy. You can get fee-for-service, HMO, or PPO protection. But you should compare your options and shop carefully because coverage and costs vary from company to company. Individual plans may not offer benefits as broad as those in group plans. In the state of Washington, individual health insurance applicants are required to complete a 21-page health questionnaire when applying for coverage. All carriers use a standardized rating system of points for each medical condition indicated. If an applicant receives 300 or more points, then they are declined. They are then eligible to receive their coverage through the state. Premium are generally 25-50% higher than private plans, but coverage is guaranteed.
Before you buy any health insurance policy, make sure you know what it will pay for...and what it won't. To find out about individual health insurance plans, you can call insurance companies, HMOs, and PPOs in your community, or speak to your insurance agent. Tips when shopping for individual insurance:
Medicare:
Medicare has two parts: hospital insurance, known as Part A, and supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor. If you are eligible for Medicare, Part A is free, but you must pay a small premium for Part B. Medicare will pay for many of your health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs. There are also special rules on when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse. [Part D] Medicare usually operates on a fee-for-service basis. HMOs and similar forms of prepaid health care plans are now available to Medicare enrollees in some locations in Washington. The best source of information on the Medicare program is the Medicare Handbook. This booklet explains how the Medicare program works and what your benefits are. To order a free copy, write to: Many people who are covered by Medicare buy private insurance, called "Medigap" You need to shop carefully before deciding on the best policy to fit your needs. You may get another booklet, Guide to Health Insurance for People with Medicare, to help you in making the right choice. To order a free copy, write to: Another good source of information on the same topic is The Consumer's Guide to Medicare Supplement Insurance. To order a free copy, write to: Medicaid:
General information on the Medicaid program is given in the Medicaid Fact Sheet. For a free copy, write to: Related topics:
» Why do you need health insurance? Want to learn more? Additional resources may be found at America's Health Insurance Plans - Consumer Information web site. Note: Link will open in a new window as you leave the Carney Cargill web site. |
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Please Note: This web site may contain concepts that have legal, accounting and tax implications. It is not intended to provide legal, accounting or tax advice. You may wish to consult a competent attorney, tax advisor, or accountant. To inquire about Insurance for Washington State groups and individuals or schedule an appointment, please contact Carney-Cargill, Inc. at (206) 842-8987 or (888) 842-8987 during normal business hours 9 am to 5 pm Monday through Friday. Content © 2006 Carney Cargill Inc. |
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This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost. 
Called COBRA (for the Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if you work for a business of 20 or more employees and leave your job or are laid off, you can continue to get health coverage for at least 18 months. You will be charged a higher premium than when you were working.
If your employer does not offer health insurance, you might be able to get group insurance through membership in a labor union, professional association, club, or other organization.
If you get a non-cancelable policy (also called a guaranteed renewable policy), then you will receive individual insurance under that policy as long as you keep paying the monthly premium. The insurance company can raise the cost, but cannot cancel your coverage. Many companies now offer a conditionally renewable policy. This means that the insurance company can cancel all policies like yours, not just yours. This protects you from being singled out. But it doesn't protect you from losing coverage.
Medicare is the Federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare.
or Medicare Supplement policies, to pay the medical bills that Medicare doesn't cover. Some Medigap policies cover Medicare's deductibles; most pay the coinsurance amount. Some also pay for health services not covered by Medicare. There are 10 standard plans from which you can choose in Washington. If you buy a Medigap policy, make sure you do not purchase more than one. 
Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are aged, blind, or disabled or certain people in families with dependent children. Medicaid is a Federal program that is operated by the States, and each State decides who is eligible and the scope of health services offered.