Have Questions? He Has Answers
Are you confused about co-payments and deductibles? Do you get a headache when you try to pick an HMO? Are you wondering what happens to your coverage if you are pregnant and switch jobs?
Relax, you have come to the right place. This monthly column by Times staff writer Bob Rosenblatt will help you deal with the riddles of health insurance--public and private--so you don’t have to tear your hair out. And if you do, we’ll tell you when hair replacement is covered.
We will select the most common concerns and perplexing puzzles. Sorry, we cannot answer questions personally.
Question: I was insured through my wife’s company and we just got a divorce. My job doesn’t have any health insurance. What can I do?
Answer: Good news for you. The federal law that allows people to keep their insurance coverage when they get laid off also applies in case of divorce. You are entitled to keep the health insurance from your ex-wife’s company for a maximum of 36 months. But you must pay the full premium for the cost of the coverage, plus an allowance of 2%.
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Q: My 87-year-old father has severe arthritis and has trouble handling pots and pans when he wants to cook. He also needs periodic inhalation therapy for his emphysema. I want to keep him out of a nursing home because he is mentally sharp and alert.
A: Nursing homes, at $40,000 a year on average, are dreadfully expensive. Patients have to pauperize themselves to qualify for Medicaid, the health program for the poor. There may be a good alternative for your dad. Medicare, which covers those older than 65, has a home-care program. It is available for homebound people who can’t go outside without help--and a doctor has certified that they are in need of care. This might include anything from intravenous feeding, to physical therapy, to the hiring of an aide to help a person get dressed. Aides also help with cooking and shopping when needed. Have your father examined by a doctor to find out if he is eligible.
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Q: I am six months pregnant and have just started a new job. My old employer had health insurance coverage, but there is a waiting period on my new job. I am facing big hospital and delivery bills I cannot afford.
A: COBRA comes to your rescue. No, it’s not a snake, but shorthand for the Consolidated Omnibus Budget Reconciliation Act, a federal law with some vital health guarantees. COBRA allows you to keep the health insurance umbrella that would normally be taken away when you lose a job or change jobs. If you pay the premium charged under your old job, the coverage continues. But you must pay the full premium--both your share and the amount paid by your former employer.
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Q: I have good coverage at work for myself and my wife. But I am retiring at 65 this year and will go on Medicare. She is just 62, and I am worried about coverage. Buying her an individual policy would cost an arm and a leg.
A: You can continue the dependent coverage from your job for your wife until she turns 65 and can go on the Medicare rolls. You must pay the full premium.
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Q: My son graduated from college and hasn’t found a job yet. He turned 23 and is no longer eligible for my policy at work. What should we do?
A: You can buy short-term policies, probably at no more than $300 or $400 for six months. Your son is young and presumably in good health. Get a policy with a relatively high deductible, $500 or more, to keep down the price. It should have major medical coverage to pay all the bills for doctor care and hospitalization should your son suffer a major illness. When he gets a job with health insurance, he can drop this short-term coverage. Meanwhile, both of you have peace of mind.
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Q: I run a small business in El Monte, and find it hard to get reasonably priced insurance coverage for my workers. Where do I go?
A: Try the Health Insurance Purchasing Cooperative (HIPC) created by the California Legislature to help small businesses with two to 50 workers. The HIPC offers a choice among 24 benefit packages from 20 health plans and negotiates with the insurers for low premiums for its participants. State law says an insurance company cannot reject a business because of the health status of the workers or the nature of the business enterprise. It doesn’t matter if your vice president has high blood pressure and smokes four packs a day or your business is a school for skydivers, stunt pilots or circus acrobats. The HIPC won’t turn you down and renewal is guaranteed--even if a few acrobats are injured. But the HIPC goes one step further in helping small companies; it acts as a purchasing pool, offering a wide selection of plans on a regional basis at the most competitive rates. Call (800) 447-2937 for information.
* Tip of the Month: Call (800) 998-7542 for a free federal government booklet explaining your COBRA rights.
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This column appears every second Monday in Health. Send your questions, worries, tips, successes or failures in navigating the health care revolution to Benefits Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053.
