Health insurance helps you pay for medical services and sometimes prescription drugs. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses. These amounts are usually a certain dollar amount or percentage of the expense.
You can have health care coverage through:
a group coverage plan at your job or your spouse/partner's job
When purchasing health insurance, your choices typically 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 co-payments and cover the costs of more preventive care, but your choice of health care providers is limited.
Read the fine print when choosing among different health care plans. Also ask a lot of questions, such as:
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 co-payments? Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from co-payments, 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?
The Affordable Care Act (ACA), also known as Obamacare, is intended to lower health care costs, provide more health care choices, and improve the quality of health care. Major provisions include:
The Open Enrollment period begins on November 1, 2015 and ends on January 31, 2016. You can enroll year round if you have certain life changes — like getting married, having a baby, losing other coverage, or moving — or if you qualify for Medicaid or CHIP.
Apply for health insurance coverage through the ACA Marketplace:
The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides continuation of group health coverage that otherwise might be terminated. COBRA contains provisions giving certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.
Most health insurance plans and Medicare severely limit or exclude long-term care. Read the Guide to Long-term Care Insurance. You should consider these costs as you plan for retirement.
Here are some questions to ask when considering a separate long-term care insurance policy.
What qualifies you for benefits? Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet and remaining continent.
What type of care is covered? Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
What will the benefits amount be? Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing-home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
What is the benefits period? It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
Is the benefit adjusted for inflation? If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
Is there a waiting period before benefits begin? A 20 to 100 day period is not unusual.
Complaints about Long-Term Care
To report an emergency where there is immediate danger, call 911 or contact your local authorities.
If you have a complaint about a long-term-care facility, read about the long-term care ombudsman program, which investigates complaints.
If you have an elder abuse complaint, contact your long-term ombudsman or local elder abuse resources.
Contact your local city or county government to determine what assistance is available in your area to help people with disabilities with their medical and health needs.
Contact your state social service agency for help finding programs that are available to assist people with disabilities with their medical and health needs.
