Q&A; : What to Do Now About Your Health Coverage
The nation’s most sweeping health reform plan is now on the table. However, if it passes at all, it’s sure to be changed. And it won’t take effect until 1995 at the earliest.
What should you do in the meantime? How should you handle today’s health care needs with so much uncertainty tomorrow? Here are a few answers:
Q. What’s my first step?
A. Get familiar with your current health plan. Find out what services are covered and the cost of your co-payments and deductibles. Compare that to what Clinton proposes. That will alert you to potential changes that might go into effect in 1995.
The more you know about what you want and how you use medical care, the better prepared you’ll be to choose.
For instance, is choice of doctor more important than what you can spend? Are you more likely to go in for baby well-checks than for care for a pressing ailment? Would you be unsettled if you had to wait more than a week or two for a doctor’s appointment?
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Q. Are there specific things I should be looking for?
A. Yes. First, there are a handful of elective treatments that are not covered under the Clinton plan that may be covered under your private insurance plan. Some of the more noteworthy Clinton plan exclusions: braces for kids’ teeth, eyeglasses and contact lenses for adults, dental check-ups for adults, in-vitro fertilization services, cosmetic surgery and other elective and experimental treatments.
If you need any of these services and they are covered under your current insurance program, consider having them done relatively soon. It’s possible that employers will offer only federally mandated benefits if the Clinton plan goes through. That’s because it could take a few years to determine the cost of providing benefits to all workers. Some predict that companies will be reluctant to offer more than what’s required until they have a firm grip on the tab.
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Q. What are the chances that my company will make changes in my health plan before the Clinton plan is enacted?
A. There is always a chance that your company will alter its medical plans, but it’s probably less likely that they will do it now--and spend money educating workers about a new plan--when they may be forced to do it again a year from now.
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Q. How will I know whether or not my employer will cut benefits to the federally mandated minimums? For example, what about dental care?
A. Ask. Few companies will be able to tell you for sure, but some may already have an idea. Your employee benefits representative should be able to say whether changes are already scheduled--or at least give you an idea of when the company will make a decision.
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Q. I have a medical condition that has precluded me from getting private health insurance. Instead of continuing to search for coverage, should I just wait to get insurance under the Clinton plan?
A. The Clinton plan would allow you to get coverage regardless of pre-existing conditions, but you should continue to look for coverage in case the plan does not pass.
Check with state regulators to see if your state has a health insurance program for high-risk individuals, just as they have for high-risk drivers and homes in fire-prone areas. Health insurance risk pools are comparatively more rare, but they do exist.
Additionally, if you were previously insured by an employee plan but lost coverage due to a job loss or the death of a spouse, check into so-called COBRA coverage that allows you to keep your former employers’ plan for 18 months or longer. Your former employer should be able to give you details of what’s offered, or call your local Department of Labor office.
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Q. I currently have a health spending account, where I contribute pretax dollars and use the money to pay deductibles and co-payments. Will these survive the Clinton plan? If not, what should I do about it now?
A. Other than using it to help pay for any elective treatments you may want, you shouldn’t mess with your health care account. It probably will be eliminated under the Clinton plan. But until the new law is enacted, it’s a great benefit.
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Q. What should I do if I’m currently covered by my spouse’s plan?
A. If you are also employed, talk to your company about its health benefits. That’s because the Clinton plan, as currently envisioned, requires all workers to get insurance through their own employers. If you work part time, your employer may also be able to limit the amount of premiums it must pay on your behalf. Check into both benefits, co-payments, deductibles and premium costs, since you may be paying a significant portion of the tab.
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Q. Are there other things I should be doing now?
A. Yes. By and large, there are a number of health care strategies that make sense in any environment, says Arthur A. Levin, executive director of the Center for Medical Consumers in New York.
For instance, get involved in your own care. If you have consistent medical problems, read up on them. Go to the library and seek out articles in newspapers and trade journals that discuss that ailment and its treatment. If you find your doctor is treating your ailment in a way that’s unusual or subject to criticism, ask why the treatment was chosen. Your doctor could have a great reason--or you could have a bad doctor.
Also consider preparing for each doctor’s visit by writing up a list of questions. In managed care environments, particularly, doctors are often pressed for time. If you’re prepared and can quickly run through your medical concerns, you may end up getting better treatment, or at least feeling more comfortable about your care.
Additionally, question your doctor about charges, particularly if you’re facing surgery or another major medical procedure. Once you get an estimate of the costs from the doctor, anesthesiologist (if any) and hospital, where applicable, call your insurer and make sure these charges meet your insurer’s criteria for “reasonable and customary†fees. If they don’t, you could end up paying a greater portion of the bill.
Finally, lead a healthy life. Exercise, eat a healthy diet and don’t smoke or drink to excess. Your lifestyle choices could have a bigger impact on your lifetime medical costs than any other single factor.
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Q. What about long-term care? If the Clinton plan is going to provide some long-term care automatically, should I put off buying a policy?
A. The Clinton proposal deals with long-term care in several ways. It provides some home care benefits to people who have lost their ability to complete a number of the so-called activities of daily living, such as bathing, dressing and feeding oneself. It also provides financial incentives for those who buy certain long-term care policies, and it promises to regulate the benefits provided.
If you’re afraid you wont shop effectively for a long-term care policy in today’s unregulated and complex environment, the regulations may make it simpler for you to get a policy that suits your needs.
On the other hand, if you wait, you may end up paying substantially more.
The cost issue is easiest to quantify. If you buy a policy when you’re 65, your annual premium will be roughly 20% less than if you wait and buy the same policy when you’re 67, says David E. Hughes, senior vice president of Unum Insurance Services in Portland, Maine.
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Q. I hear cigarettes are going to face another stiff tax. I smoke, have considered quitting, but smoking-cessation treatments are expensive and not covered by my health plan. Are they covered under the Clinton plan? Should I wait until it’s enacted to take them?
A. This is more of a lifestyle question than a financial one. The Clinton plan does propose to pay for preventive care and health education classes, which presumably will include stop-smoking classes and treatments. But his cigarette tax is expected to amount to $1 a pack. For those slow on the calculator, that’s $365 annually for a one-pack-a-day smoker and $730 for someone who smokes two packs a day.
If you wait, you could spend as much on the new cigarette tax as you would have paid to enroll in a stop-smoking clinic before the plan was enacted. If you want to stop smoking, do it now.
