How to Maximize Health Care Coverage

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By Tom Murphy, AP Business Writer

Job loss or the fear of it has pushed more people to use their employer-sponsored health insurance before they lose it.

Major health insurers have seen their medical costs rise in recent quarters, in part because people covered by employer-sponsored plans have rushed to use services before their benefits are cut off.

People trying to make the most of their coverage while they still have it need to keep certain priorities in mind. Here are some things to consider.

GET A PHYSICAL

Visit your doctor to get an assessment of your overall health. Know your blood pressure and cholesterol numbers. Have the doctor perform a skin cancer screening.

"Not that you're looking to find something wrong, but if there is something, and if any treatment is required, you want to be able to do that under your coverage," said Tracey Baker, a financial planner and co-author of the book "Navigating Your Health Benefits for Dummies."

Don't forget dental and eye exams. Cavities caught at an early stage are generally easier to treat. Have your prescription eye glasses adjusted while you still have coverage.

INVEST IN PREVENTIVE MEDICINE

Get a flu shot this fall. Even if it's not covered by insurance, it will be much cheaper than a hospital stay if you wind up really sick.

Colon cancer screenings and mammograms also should be done before coverage ends. Dr. Jane Sadler, a family physician, recommends screenings for people older than 50 or sooner for patients with a family history of colon cancer.

The Garland, Texas, doctor said women older than 40 also should think about annual mammograms.

Keep your weight under control to ward off future medical bills. A person who loses about 11 pounds can see a substantial drop in blood pressure and an improvement in cholesterol and blood sugar, Sadler said.


ASK YOUR DOCTOR FOR HELP

Tell your physician about your situation. Doctors know about programs that offer prescription discounts for patients. Some may offer payment plans or discounts of their own. They also may know social workers who can tell you about additional programs.

Doctors also may be able to provide some extra supplies. Indianapolis resident Les Bullard, 49, said his wife got about four months of diabetic test strips from her physician.

"That's just people being nice," he said. "They understood the situation."

PLAN FOR YOUR PRESCRIPTIONS

Bullard lost his factory job in May 2008, and the health insurance covering his family ran out this past June. Before that happened, he asked his doctor to write a year's worth of prescription refills and to prescribe generic versions whenever possible.

Those are generally less expensive than brand-name medicines.

Bullard takes cholesterol and blood pressure medicine. He said his prescriptions now cost $8 a month, when he would have had to pay between $65 and $70 a month for just one of the brand-name drugs, Lipitor.

Generics can be big money savers, but patients who switch to them may need to make a follow-up doctor visit to make sure the new drug works as well as the old one.

LOOK FOR MORE INSURANCE

Start thinking about your next step for insurance before your current coverage runs out. Some people can just switch to coverage through a spouse's job.

Another option is continuing the coverage you received through work. Under the federal law known as COBRA, a former employee can generally continue coverage for 18 months if the person keeps up with premium payments.

COBRA normally requires people to pay their entire premium plus an administrative fee. But a temporary federal subsidy will pay 65% of that premium for nine months for people who lose jobs between Sept. 1, 2008, and the end of this year.

The COBRA law only applies to people who worked at companies with 20 or more workers, but many states have their own laws to give small-businesses employees a chance to continue coverage.

Professional associations also may provide some group benefits. Individual policies offer a range of coverages, but they can be expensive.

Some of these options can cost several hundred dollars a month. But Baker, the financial planner, strongly encourages people to find some form of insurance, even if it just covers major medical care.

She noted that the cost of care is too expensive to risk gambling without coverage.

"You can be the healthiest person in the world and get in a car accident or fall and twist an ankle or break it," she said. "That $10,000 expense can be devastating, especially if you're not working."

Copyright 2009 The Associated Press.  All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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