With the economy weighing heavily on the wallets of Kansas consumers, and health reform still confusing to many, Kansans have more to think about than ever as they make health insurance decisions this fall.
With rising medical costs and new coverage laws, now is a good time to review your options, whether you receive coverage through your employer or are self-employed.
In our state, according to a 2010 report, more than half (53.4 percent, 1.468 million) of Kansans have employment-based coverage, which means that all or some of their health insurance is paid by their employers. A little more than 150,000 Kansans (5.5 percent) have individual (non-group) health insurance.
(Just to fill in the percentages, those on Medicare in Kansas account for 13.7 percent of the population; Medicaid/Children’s Health Insurance Program, 10.2 percent; Medicare and Medicaid combined, 1.6 percent; other public insurance, such as military, 2.6 percent; and uninsured Kansans, 13 percent.)
Whatever your situation, health insurance choices can seem complicated. Consumers should consider the following tips when evaluating their options for coverage.
Employer-based group health insurance
Many Kansans will soon be entering open enrollment periods for the 2012 calendar year. If you have plan options, do not automatically renew what you had without a side-by-side comparison. Here are some practical considerations:
- Make sure you know which current physicians and area hospitals are in your plan’s network.
- Review any pre-existing condition exclusions, prior authorization requirements and annual limits.
- Check any prescriptions you take against the list of each plan’s approved drugs for co-pay variations.
- Make a list of premiums, out-of-pocket expenses, co-pays, co-insurance, deductibles and benefits for each plan.
- See if the cost for dependent coverage has increased. Some employers are raising costs now that coverage is available for dependents through age 26.
- Ask if your employer offers a wellness program or incentives for healthy behaviors such as exercising regularly or not smoking. Many employers offer incentives to employees committed to living a healthier life.
- In addition to health insurance, you may be able to contribute pre-tax dollars to a flexible spending account (FSA) or health savings account (HSA). Check closely to see if the list of covered expenses for reimbursement has changed since last year.
Individual Health Insurance Coverage
If you are self-employed or your employer doesn’t offer coverage, here are some tips to help when shopping for coverage:
- First, investigate the cost of being added to your spouse’s employer plan, if that option is available to you.
- If that is not an option, consider shopping for private insurance. Be aware that you may be charged more than a standard rate based on your age, gender or health, and some pre-existing conditions may not be covered. But, note that recent tax law changes make it possible to deduct the cost of premiums from your taxable income.
- For a list of companies writing individual health insurance in Kansas, contact the Kansas Insurance Department (KID) at (800) 432-2484 or go online at ksinsurance.org/consumers/majmed.htm.
- If you have a pre-existing condition and have been uninsured for at least the last six months, you may qualify for the new Kansas Pre-existing Condition Insurance Plan (PCIP). Go online to khiastatepool.com to find out if you are eligible for the temporary federal PCIP or the Kansas high-risk pool.
As always, if you need assistance in reviewing the various health insurance options you have, call our Consumer Assistance Representatives at KID at the number above. Your health, as well as your wallet, take center stage when you are concerned about your coverage, and we can help get you answers.
—Sandy Praeger, a Republican, is the Kansas commissioner of insurance. The opinions in the columns solely reflect those of the author. They aren’t endorsed by the Kansas Health Institute, which seeks a broad range of opinion to stimulate discussion.