Getting covered: health insurance in trying times

It's not poor diet, lack of exercise or even a bad smoking habit.
The single, biggest risk to American's health? A lack of health insurance – and the situation is becoming worse as unemployment levels rise.
The vast majority of Americans get their health insurance through their employers. For LGBT people, the threat of losing health care insurance is complicated by the fact that too often, employers and insurers do not recognize their relationships and families, and therefore do not extend the same health benefits to their partners and children as they do for their heterosexual employees.
Some are finding unexpected solutions to getting affordable health care coverage. For some, individual health care plans are a workable solution, not only for people who are unemployed or under-employed, but even for some working people, too.
"Insurers offer a lot of options today. You can tailor an individual plan to meet your needs and your budget," said Jim Spencer, a health insurance specialist with C.B.I. Insurance Specialists in Waterford. "There are lots of variables, like selecting what is covered, what deductibles or co-pays. I also have found that HSAs (Health Savings Accounts) can be a good option. It all depends on a person's health and financial situation."
Spencer said that the most important step is to find a professional who understands the changing complexities of health insurance policies. He also recommended that people work with an independent agent who represents many insurers, rather than an agent who offers only one company's plans.
"Especially now, with so many changes in health coverages and their availability, COBRA rule changes, companies offering different plans all the time – it can be very confusing," said Steve Carroll of The Insurance Exchange in Northville. "Each insurance company looks at their market, figures their risk appetite, and then they structure the plans they'll offer. It is definitely not a 'cookie cutter' market for health insurance."
Most working people just rely on whatever plan is offered by their employer. But Spencer said that for some, an individual plan can provide coverage better suited to them at a lower cost.
"For healthy, young people who don't need or expect to regularly use their health insurance, but need catastrophic coverage, they can get covered at a cost that is far lower than what most group insurance plans cost," said Spencer. "The coverage will not be as comprehensive. But it will be cheaper, and sometimes employers will even cover some or all of the premium."
Spencer said that some small companies are even abandoning the whole concept of the "group plan." Instead, each employee is getting their own policy, tailored to their unique situation, and the employer can pay some or all of their premiums.
"I have one customer, a company with about a dozen employees. The employer gives each employee $200 a month towards health insurance, through payroll deduction. Then I sit down with each employee and design the plan that is best for them," said Spencer. "The variables are endless. I even have a plan that allows you to have MRI (Medical Resonance Imaging) coverage or not. It's amazing how specific we can make the coverages."
Cost is only one factor in figuring out the best policy. One's health situation, and whether any pre-existing conditions exist, must be understood and factored in to any decision about health care coverage.
"Private insurers can deny or limit coverage. Blue Cross has to accept everyone and anyone, because they are a non-profit company. That's the deal they have with the government – they don't pay taxes, but they have to cover everybody who applies," said Spencer. "So if someone has a pre-existing condition, it's important that I understand that so I can structure the right plan for that individual's medical situation."
"The most important thing is to have health care coverage," said Carroll, emphasizing that medical expenses are the leading cause of personal bankruptcies. "It is just too big a financial risk to have no coverage."

Contacts for health insurance:

Jim Spencer
C.B.I. Agency
1370 N. Oakland Ave., Ste. 120
Waterford, MI 48237
[email protected]

Steve Carroll
The Insurance Exchange
670 Griswold
Northville, MI 48167
[email protected]

Marty O'Neill
State Farm Insurance
22637 Woodward Ave.
Ferndale, MI 48220
[email protected]


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