“Americans are playing by the rules, they’re working, they’re waking up every morning to go to their jobs and they have no health security. . . .”
That statement was Kathleen Stoll’s, director of health policy for the consumer health group Families USA*, in response to $10B in cuts to Medicaid in 2005. And it makes a point that many of the stories written about healthcare in the U.S. do not. That is, all this discourse about money- the billions cut in Medicaid health benefits to address a 7% increase in costs, the percent of costs covered by state and local government for the uninsured (which is about 85%, by the way), the $41B in costs that hospitals absorb for the uninsured – has an impact on real people. People like you and me, who play by the rules, pay their taxes, get up every morning to go to work, and come home everyday to their families.
Let’s consider an average family without health benefits today. John and Kate, for example. They have two children, Kate is a part-time teacher at a private pre-school where she can bring her two young children with her while she earns her teaching credential at night. She makes about ~$16K per year. John is a construction worker, which pays well (almost $5K per month), but it is seasonal work. He does well from spring to late fall. But from October to February, there isn’t much work. So John picks up work as a handyman when he can. And he grosses about $40K per year.
Neither of them get health benefits through their employer.
So John and Kate, like more and more Americans these days have to make a choice. No not between food on the table and clothing, but between paying for adequate healthcare for their family today and investing IN THEIR future. In other words, they cannot afford health benefits insurance AND tuition for Kate to get her teaching credential.
What would you do?
Well, John and Kate decide to roll the dice. They pay out-of-pocket to take their children to the pediatrician on a regular basis. But they decide that for them, since they are both young and strong and pretty healthy, they will skip insurance and regular medical check ups. They will only go to the doctor when it is absolutely necessary.
As chance would have it, John starts feeling pain in his side. He doesn’t think much about it at first. But as the days pass, it doesn’t get any better. In fact, it gets worse. But he says nothing to Kate because he doesn’t want to worry her (about the money it will cost for a doctor or about his health). Finally, the pain gets so bad that just touching the area causes excruciating pain. Until one day, he can’t bend down to put his pants on. He can’t go to work. Nothing.
Kate calls an ambulance, and they rush John to emergency. Kate follows in the car with both children in tow. When she gets there she finds out that John’s appendix has burst, and they are performing an emergency appendectomy.
Flash forward to the next day. Things are okay-relatively speaking. John is recovering. Kate is sitting by his bedside. The kids are with grandma. And John will go home soon enough. But they have incurred thousands of dollars in hospital costs. Some of those costs may be deferred by the hospital. But John and Kate WILL PAY a sizable amount deducted from their wages each month for a long while.
Kate’s degree? That will have to wait.
This is a sad story and not really true. But it is believable. Because that is the situation we’ve all been placed in, by employers who opt not to provide health plans and by our government that restricts access to subsidized health benefits.
Kate and John and others (like you and me) need to look for viable alternatives to employer-backed and government-subsidized health plans. One alternative is called Consumer Driven Health Benefits. It includes vision, dental, prescription, physician care AND hospital advocacy. Which means, had Kate and John had a Consumer Driven Health Benefits package, John would have been able to visit a doctor regularly. And whether John still had to have a scheduled appendectomy or an emergency appendectomy, he would have been covered.
*45.8 Million in U.S. Now Lack Health Insurance; Web Med Medical News; Todd Zwelich, Aug. 30, 2005
Most individuals get group health insurance through their employer. The employer pays part of the monthly premium and the employee pays the rest. Individuals not covered in an employer group plan or choose to opt out of such a plan usually purchase an individual health plan for themselves and their families.
Ohio Individual Health Insurance
Individual health insurance in Ohio includes indemnity or managed health care plans. Indemnity plans offer a greater choice of health care providers. In managed-care plans, health care providers in the health insurance company’s network provide services at fixed rates. Managed care means less paperwork and lower out-of-pocket costs for the consumer compared to the indemnity plan. The best individual insurance option is a low premium, high deductible health plan.
Ohio Group Health Insurance
In Ohio, group health insurance is very different from individual health insurance. In the case of group insurance, a group of employees are insured together under a plan that the employer chooses. It is the health of the group as a whole that determines the premium that each employee will pay. Group insurance plans are guaranteed issue.
Individual or Group Health Insurance?
A group policy that your employer offers is a better option if you have a medical condition like diabetes or arthritis. However, if your spouse and children are young and healthy, the premium for an individual insurance plan could be much lower compared to the group insurance plan that your employer offers you. This is because group rates usually depend on the average age and health on the entire group which could mean to a higher premium for each member of the group. Moreover, with the economic downturn, employers have begun to cut down on their share of the premium, making group policies quite expensive.
If you have to choose between an individual health insurance plan and a group plan, the best solution is to seek the advice of a professional insurance agent who is well-informed in all matters relating to individual and group health insurance for Ohio residents.
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Group health insurance is much less costly than an individual policy because it spreads the risk over many people with different needs. The more healthy people in the pool, the less the insurer will spend in health care costs and the less the premiums will cost. While most people access group health insurance through their employers, many people don’t have it. Either they are not employed or their employers don’t offer health care.
If you are not employed or if you work for a company that doesn’t offer health insurance you can still get group health care coverage through a membership organization.
How a Membership Organization Works
Membership organizations are groups of people that have an interest or a cause in common. The Screen Actors Guild and the American Association of Retired Persons (AARP) are two examples of membership organizations. These groups offer benefits and resources to their members such as discounts on travel, health insurance and auto insurance, and represent them in their profession or try to influence lawmakers in their behalf.
These membership organizations all have requirements for becoming a member and some are very narrow. For instance, AARP doesn’t accept application from anyone under the age of fifty. You can undoubtedly find one, though, that you qualify for and that will allow you to take advantage of group health insurance.
The Best Insurance Choice for You
The ideal way to get group health insurance is through your employer because they usually pay a part of the premium. Some employers pay the full amount but most contribute just a portion. However, there are many people that have lost their jobs recently and don’t have access to employer-provided health insurance. Others have started their own businesses and are self employed now. Still more people are underemployed in jobs that are part time or for companies that don’t offer insurance.
If you don’t have employer provided health insurance you could get an individual policy. You would contact several insurance companies and compare their rates and coverage then purchase a policy from the one that best meets your needs. These policies can be quite costly and may require a medical exam. They often don’t cover pre-existing conditions.
Obtaining group health insurance through a membership organization can save you a lot of money and you’ll often get better coverage than with an individual policy.
Finding a Membership Organization to Join
You may already be part of a membership organization without realizing it. If you union you’ll be able to join their group health insurance. If you earned a college degree you can join that institution’s alumni association; they often offer health insurance and other advantages to their members. Perhaps you belong to a professional association such as your chamber of commerce.
If you are not part of a professional group or society you can still find several that you may qualify for by using an internet search engine. Look for “membership organizations” or “health insurance through membership benefits”. The search phrase is up to you; you may find references in your first set of results that will help you pinpoint better keywords.
You’ll see a lot of groups that you might qualify for. Don’t just confine your search to your profession, however, as there are many membership organizations that could involve your hobby or something else of interest to you. When you do begin finding some that you qualify to join, look at the benefits they offer. If health insurance is one of them, try to find out what kind of coverage it is. Some coverage isn’t worth the price of membership while other organizations offer excellent health insurance with reasonable premiums.
Don’t forget to factor in the membership fee, if there is one. You may be required to pay an annual fee or it could be a monthly addition to your insurance premium, a method used by the National Association for the Self-Employed.
If you are self employed you might want to look into the Small Business Service Bureau or other organizations that target small businesses.
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