1 Illustration by Jen Oaks
Dollars & Sense
Issue #35
Navigate the U.S. healthcare system without going broke
By Amy Westervelt
Published: March 1st, 2008 | 1:41pm
Health insurance is scary stuff for U.S. residents, particularly for the self-employed, freelancers, unemployed, or one of the thousands of “permalancers” — a full-time employee classed as an independent contractor and thus not eligible for staff benefits.
In late 2007, several MTV workers protested their parent company Viacom’s intention to freeze 401K accounts and reduce health-insurance benefits for its several thousand permalancers. The walkout drew significant media spotlight to this growing class of employees, but even for those lucky enough to have insurance subsidized by their employer, there are loopholes and backdoor policies to watch out for. With the presidential election on the horizon and health-insurance woes continuing to make headlines, the polls have consistently ranked healthcare as the number-one concern of voters in the next election, and all of the candidates have a defined health platform. While we wait for things to get better, following are a few tips and tricks to make the current system work for you.
GET YOUR OWN
If you don’t have employer-subsidized healthcare, you’ll need to find your own. According to the last census in 2000, 47 million people (15% of the population) live in the U.S. without insurance. According to a year-long study conducted by Consumer Reports in 2007, 76% of uninsured Americans cannot afford to buy it, particularly those who might actually have to use it. Following are a few of the more affordable options, but keep in mind that coverage under these plans is generally limited:
• Tonik (tonikhealth.com): From $77 per month to $106 per month in California, Colorado, Nevada, Connecticut, New Hampshire, and Georgia.
• Kaiser (kaiserpermanente.org): From $126 per month to $283 per month in California, Colorado, Georgia, Hawaii, Virginia, Maryland, D.C., Ohio, Oregon, and Washington.
• GoldenRule (goldenrulehealth.com): From $70 per month to $168 per month in all 50 states.
HMOS, PPOS, AND THE NETWORK Even if your employer does pay for healthcare, you may have to chip in for it (usually from $50 to $100 per month). You might also have to choose between a health maintenance organization (HMO) and a preferred provider organization (PPO). HMOs require that you choose a primary care physician, who must refer you to a specialist if needed. HMOs typically provide no coverage for care received from doctors or labs not in their network. This is an important distinction as one Venus Zine editor discovered. “My doctor sent me to a lab to get blood drawn, and I ended up getting a bill for $3,000 because the lab was out of the network,” she says. PPOs also have a network but will cover out-of-network services … just not as much. They might pay 90% of the cost of your in-network doctor’s visit, for example, but only 70% of the out-of-network lab work. PPOs also have deductibles that members must meet before the insurance pays for anything at all, while HMOs generally charge a nominal copay for all services and medications.
HEALTH SAVINGS ACCOUNTS (HSA) These are the sorts of things the government cooks up to pretend they’re actually improving the healthcare system. You can set up an HSA through your insurance company, and the IRS will let you put pre–income-tax money into it until you reach your deductible. Usually only high-deductible insurance qualifies for an HSA account. You can accumulate money in the account throughout the year to pay for routine medical care or save it up for a big emergency. Wee! Thanks government!
MEDICARE AND MEDICAID
Medicare is insurance provided by the government for citizens older than 65 and the permanently disabled. Medicaid is insurance provided by the government for low-income Americans. Unlike Medicare, which is federally run, each state runs its own Medicaid program. Coverage rules vary by state, but typically if you make $20,420 (200% of the national poverty level) or less a year you qualify. See cms.hhs.gov for details.
ERS AND RETAIL CLINICS
President Bush famously said that all Americans have access to health insurance ‘cause you can just go to the emergency room. While that’s technically true — ERs must treat all patients regardless of insurance or ability to pay — hospitals do send out bills that they expect to be paid, and their mandate is to stabilize the critically ill or injured, not provide ongoing health maintenance. In the last few years a new crop of retail clinics has cropped up in stores such as WalMart and CVS to provide low-cost treatment for basic illnesses, including the flu, bladder infections, and strep throat. Visit venuszine.com’s archives (issue #34) for details on retail clinics.
DEALING WITH REJECTION
Some state rules make it easy for insurance companies to reject applicants, while others mandate that all individuals have access to healthcare. Of course, a company can still set premiums sky-high for accepted applicants with preexisting conditions. Check your state’s insurance department Web site for a breakdown of its policies. If you are rejected by private insurers because of a pre-existing condition, you could be eligible for your state’s risk pool, which essentially provides healthcare coverage for the uninsurable. Currently 34 states offer these pools; check the Georgetown University Health Policy Institute Web site (see sidebar) for information on your state’s policy.
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Take care of yourself
Georgetown University’s Health Policy Institute
(healthinsuranceinfo.net) provides a ton of useful, free information, both online and through various free documents that you can request.
Freelancers Union (freelancersunion.org) provides information, forums, tips, advice,
WebMD (webmd.com) has posted an exhaustive and well-researched breakdown of all of the candidates’ positions on healthcare and proposed healthcare plans.
Gawker (gawker.com) put its snarkiness on hold for a minute and did an amazing job covering the Viacom/MTV permalancer situation. Most people think that the outcome of this will dictate how permalancers are treated throughout the country.
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