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Wed Without Benefits

What to Do When You Don’t Have Employer Coverage

Not having health care coverage can put stress on any marriage. But options are out there — whether you or your spouse are self-employed or lost your benefits.

To help you find answers, here are some alternatives. Just remember as you work through them that you are in this together. That’s the healthiest support anyone could have.

Individual insurance for two

This could be a great choice for both of you. It’s coverage that you get on your own — no groups, no employers.

Plan types

These plans range in price and come in all sizes. Plus, they have tons of options. You can enroll as a family or separately. Choose a plan that only has preventive or emergency care benefits. Or you could go for total coverage. It all depends on the care you need and what you can afford.

Cost and eligibility

To apply for coverage you usually have to answer questions about your health, age and location. Depending on where you live, the insurer bases your acceptance and rate on your response. This is called medical underwriting.

A 2007 survey found that 89 percent of applicants who go through underwriting are eligible. So the chances are high you’ll make it in. But there’s always a possibility you might not be eligible. It could also be too expensive.

Is it right for you?

Here are a few questions to help you decide:

• What is the monthly payment?
• What medical services are covered?
• Is preventive care like checkups and shots covered? How about emergency care?
• Are there benefits for eye-care, prescriptions or dentist visits?
• How much of your bills will the plan pay?
• Are the doctors and hospitals you like in the network?
• Are there deductibles or limits to what you pay each year?
• Are costs that might drain most of your savings covered?
• Is there a yearly or lifetime limit the plan will pay?

The bottom line

Individual coverage may be exactly what you are looking for. Just be sure to do your research and ask the right questions.

Almost all insurers have websites. You can read up on plans, get quotes and even apply online. Try eHealthInsurance.com. The site lets you compare plans where you live.

Out of work and out of coverage

Introducing COBRA

If you recently lost your benefits, COBRA can help. Depending on your situation, it lets you continue your health coverage for up to 36 months.

Eligibility

Really, it’s for more than just job loss. It can help workers and their families who are forced to move. It also applies to people who lose benefits because their hours were cut.

To be eligible, you had to be enrolled in your employer's health plan when you worked. The health plan must also still be available for active employees.

Eligible employees will receive a COBRA notice from their employer. Read this carefully. You must sign up within a specific period. It’s usually 60 days from your eligibility date.

Cost

Sometimes COBRA is the best choice. But that doesn’t make the sticker price any less shocking. The cost can be double or more what was deducted from your pay. However, as part of the national economic stimulus package, people who were laid off (or may lose their jobs in the near future) and who select COBRA coverage will receive help paying for it. With the rising unemployment rate, these changes are a positive temporary solution and will make COBRA coverage more affordable for eligible consumers. Learn more here.

If you still find COBRA too costly, you may do better with individual coverage. For help weighing your options, visit the U.S. Department of Labor's website for more information.

Still no luck? Try these tips

Be prepared. Start putting money away for future health care expenses. One idea is to set aside what you would have paid in premiums. While it’s not the same as insurance, it’s still protection against the unexpected.

Get help cutting through red-tape. These days, you shouldn’t have any trouble finding a health care advocate near you. An advocacy group can help you find insurance, tackle bills and learn more about the resources available in your state

Apply for state or federal assistance. If you’ve exhausted all possibilities, check with your local family and social service offices. They can help you apply for public health assistance.

Find low-cost care. Many states and cities have health centers and clinics where you can get care for less. Go to the Health Resource and Service Administration’s website to find one near you.

Walk-in and urgent care clinics are more popular now than ever. They also help you get affordable care for everything from the flu to broken bones.

If you have to visit the doctor, dentist or hospital, try and find one that bills based on your income. Or, if you are already struggling with bills, try and negotiate. Many providers will work with you to set up a billing plan.

Get a health care or prescription drug discount card. For a low monthly fee, many companies sell cards that offer savings on medical, dental and pharmacy products and services. After all, every little bit helps.

Go part time. What do Target, Starbucks, Lowe’s, Barnes & Noble and JCPenney have in common? They all offer benefits to part-time workers.

No couple wants to be without benefits. But with smart thinking and a little research you can make it through together.

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