1. Why do you need health insurance?

As medical care advances and treatments increase, health care costs also increase. The purpose of health insurance is to help you pay for care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. In addition, you are more likely to get routine and preventive care if you have health insurance.

You need health insurance because you cannot predict what your medical bills will be. In some years, your costs may be low. In other years, you may have very high medical expenses.

If you have health insurance, you will have peace of mind in knowing that you are protected from most of these costs. You should not wait until you or a family member becomes seriously ill to try to purchase health insurance.

We also know that there is a link between having health insurance and getting better health care. Research shows that people with health insurance are more likely to have a regular doctor and to get care when they need it.

2. How do you get health insurance?

Most people get health insurance through their employers or organizations to which they belong. This is called group insurance. Some people do not have access to group insurance.

They may choose to purchase their own individual health insurance directly from an insurance company.

Many Americans get health insurance through government programs that operate at the national, State, and local levels. Examples include Medicare, Medicaid, and programs run by the Department of Veterans Affairs and Department of  Defense.

3. Which type of health insurance is right for you?

Whether you are eligible for group insurance or choosing an individual plan, you should carefully compare costs and coverage.

Be sure to compare:

1. Premiums.
2. Coverage/benefits.
3. Access to doctors, hospitals, and other providers.
4. Access to after hours and emergency care.
5. Out-of-pocket costs (coinsurance, copays, and deductibles).
6. Exclusions and limitations.

Even if you do not get to choose your health plan—for example, if your employer offers only one plan—you still need to understand your coverage.

4. What is consumer-directed coverage?

Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive, and how much they spend on health care services. The major types of consumerdirected coverage are:

• Health savings accounts, usually coupled with highdeductible health plans.
• Health reimbursement arrangements.
• Flexible spending arrangements.
• Archer Medical Savings Accounts.

5. How does Medicare coverage work?

Medicare is the Federal health insurance program for Americans age 65 and older, some disabled Americans, and individuals who have end-stage renal disease (ESRD). The Original Medicare Plan, which is available nationwide, is a fee-for-service plan that is managed by the Federal Government.

It pays for many health care services and supplies, but it won't pay all of your health care costs.

Generally, you should enroll in Medicare when you first become eligible. If you choose to enroll at a later time, you will pay a lateenrollment penalty.

If you already have health insurance from an employer or another source, talk to your benefits administrator about whether you should join Medicare or not while still covered.

6. What other government programs are available?

Other government-sponsored programs for specific groups—such as Medicaid and the State Children's Health Insurance Program (SCHIP) for low-income individuals and families—and plans that meet a specific need, such as long-term care, supplemental coverage, and disability insurance, are also available.

7. Are there other types of health-related coverage?

Other types of health-related coverage include long-term care insurance, disability insurance, and supplemental insurance.

8. What happens if you have a pre-existing condition?

Before passage of the Health Insurance Portability and Accountability Act (HIPAA) in 1997, people had to worry about health insurance coverage for preexisting conditions like diabetes,

heart disease, or cancer. If you changed jobs and had to change insurers, you might not have been able to get some of your care covered because of the preexisting condition exclusion.

9. What happens if you have health insurance through your employer and you leave your job?

If you leave a job where you have had employer-sponsored health insurance, you will want to ensure that you have continued protection against the high costs of health care.

Whether you leave the job on your own or you are forced to leave, there is a Federal law that may help you to maintain coverage.


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