| Where Do I Get These Health Plans?
Group Policies
You may be able to get group health coverage—either indemnity
or managed care—through your job or the job of a family member.
Many employers allow you to join or change health plans once a
year during open enrollment. But once you choose a plan, you must
keep it for a year. Discuss choices and limits with your employee
benefits office.
Individual Policies
If you are self-employed or if your company does not offer group
policies, you may need to buy individual health insurance. Individual
policies cost more than group policies.
Some organizations—such as unions, professional associations,
or social or civic groups—offer health plans for members.
You may want to talk to an insurance broker, who can tell you more
about the indemnity and managed care plans that are available for
individuals. Some States also provide insurance for very small groups
or the self-employed.
Medicare
Americans age 65 or older and people with certain disabilities
can be covered under Medicare, a Federal health insurance program.
In many parts of the country, people covered under Medicare now
have a choice between managed care and indemnity plans. They also
can switch their plans for any reason. However, they must officially
tell the plan or the local Social Security Office, and the change
may not take effect for up to 30 days. Call your local Social Security
office or the State office on aging to find out what is available
in your area.
Medicaid
Medicaid covers some low-income people (especially children and
pregnant women), and disabled people. Medicaid is a joint Federal-State
health insurance program that is run by the States.
In some cases, States require people covered under Medicaid to
join managed care plans. Insurance plans and State regulations differ,
so check with your State Medicaid office to learn more.
Pre-Existing Conditions
A pre-existing condition is a medical condition diagnosed or treated
before joining a new plan. In the past, health care given for a
pre-existing condition often has not been covered for someone who
joins a new plan until after a waiting period. However, a new law—called
the Health Insurance Portability and Accountability Act—changes
the rules.
Under the law, most of which goes into effect on July 1, 1997,
a pre-existing condition will be covered without a waiting period
when you join a new group plan if you have been insured the previous
12 months. This means that if you remain insured for 12 months or
more, you will be able to go from one job to another, and your pre-existing
condition will be covered—without additional waiting periods—even
if you have a chronic illness.
If you have a pre-existing condition and have not been insured
the previous 12 months before joining a new plan, the longest you
will have to wait before you are covered for that condition is 12
months.
To find out how this new law affects you, check with either your
employer benefits office or your health plan.
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