Health Insurance

Employer-Sponsored Insurance

If you are someone who uses a lot of factor or has other medical expenses, you’ll need a job that provides good health insurance. Today, employers are offering several types of health coverage plans.

The most common are:

• High-deductible health plans with health savings accounts.
• Preferred provider organizations (PPOs) that allow you to pick any doctor.
• Health maintenance organizations (HMOs) that provide low-cost care within a closed network.

When you have a choice, the best bet is to go with an HMO or PPO. High-deductible plans require you to pay out of pocket up to your deductible, and then a portion of your medical visits are covered. For those with chronic health conditions, such plans have resulted in people rationing their own care because they can’t afford treatment.

Here are some questions to ask before you choose a specific plan:

• What type of policy is it (HMO, PPO, high-deductible health plan with a health savings account, or something else)?
• What’s the copay?
• What are the premiums?
• Does the plan allow you to keep your current doctors?
• Does it cover factor?
• Does the plan have lifetime or annual spending caps that might require you to pay more?
• Does it have out-of-pocket limits?

You might want to bring your company’s benefits package to your Hemophilia Treatment Center (HTC) for review by a social worker or other staff member. They can help you understand what’s being offered and if there is any further information you need to make sure that your health insurance needs are sufficiently covered.

Individual Insurance

There are also other kinds of health insurance coverage available. Unfortunately, most people with bleeding disorders won’t be eligible for individual coverage due to bans on preexisting conditions. That will change under the Affordable Care Act in 2014, which will require all health insurers to offer coverage regardless of preexisting conditions. In the meantime, look for a preexisting conditions insurance plan through your state. If your state does not offer one, the US Department of Health and Human Services will provide a plan to meet your needs. This new coverage may be more expensive, so you’ll need to consider your financial status before deciding whether to enroll.

Government Health Coverage: What You Need to Know

Medicare is the federal health insurance program for people aged 65 years or older, certain young people with disabilities, and people with end-stage renal disease. It will be necessary to examine Medicare Part A and Part B coverage to see what services are covered for those with bleeding disorders. Medicaid is a joint federal and state partnership that provides coverage for people with lower incomes, older people, those with disabilities, and some families and children. The eligibility rules for Medicaid are different in each state, but most states offer coverage for adults and children at a specific income level. In 2014, most adults under age 65 with income under approximately $15,000 per year will qualify for Medicaid.

Another government-offered health coverage option for people with bleeding disorders is state high-risk pools. Not all states offer them; states that do often have long waiting lists and limitations, such as annual caps on spending. However, they could provide a bridge if you do not have insurance.

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The Ins and Outs of Disability Insurance

Coverage while you’re working is one thing. Coverage during times when bleeds and other bleeding disorder–related disabilities prevent you from working is essential for your long term economic health.

Disability Insurance

Disability insurance, like life insurance, is used to protect future earnings. Disability insurance will replace your income in the event that you become physically unable to work. Although it gets less attention than life insurance, experts agree that disability coverage is at least as important. While most people are prepared for the medical costs of severe injury or sickness (through health insurance), without disability insurance, they are not prepared for the loss of wages that accompanies such a health-related event.

In general, if you count on your job to pay the rent and buy food, you should seriously consider disability coverage. Many employers offer disability insurance for their employees; however, the plans vary greatly, and some may not offer adequate coverage. Furthermore, any disability payouts from an employer's policy are subject to taxes, while payouts from individual policies are not. Individual disability coverage is generally much more expensive than employer disability coverage; nevertheless, you should review any policies your employer has taken out, and consider purchasing individual coverage if the policy is insufficient.

Policy Types

Disability insurance comes in two types: short-term and long term.

Short-Term Disability

This coverage replaces a portion of lost salary in the event the policy owner misses six months or less of work. The coverage typically begins after all sick leave is exhausted, and replaces close to 100% of wages for the first payouts. If the policy owner remains unable to work, however, the payments will eventually drop, often to 60% of wages. The length of coverage and payment percentage vary from plan to plan, but these numbers are typical.

Some states have their own mandates for short-term disability and may have different requirements. Currently there is no federal law that requires employers to offer short-term disability benefits to their employees. For more information on short-term disability in your area, please contact your state department of insurance office.

Long-Term Disability

Some experts contend that long-term disability insurance is the most important insurance you can purchase. This can be partially attributed to advances in medical care; some diseases and injuries are now disabling rather than fatal, meaning that the incapacitation can be lengthy. Typically, long-term disability insurance can be purchased to replace 50 to 70% of salary. Some employers allow employees to purchase extra insurance from the same company, sometimes raising the total to 80%. Note, however, that some policies have monthly maximum payouts, which may reduce the actual percentage of salary the policy owner receives. The salary is set at the time the policy is purchased, and you will likely want to increase the value of the plan as your compensation increases. Some plans only allow increases with a physical examination, while some allow increases without a physical for the first few years of the plan, and some have other rules; check the plan for its particulars. Long-term disability policies vary in the length of payout: some policies will only pay out for 5 or 10 years, some will pay out until age 65. Experts recommend the latter. Policies also vary in definition of disability (some contentious categories include mental illness and back injuries) and exclusionary criteria (pre-existing medical conditions, injuries from dangerous activities, etc.).

Policy Features

Policies can be guaranteed renewable and non-cancelable.

• Guaranteed renewable means the insurance company cannot drop the policy, unless premium payments are skipped.
• Non-cancelable means the insurance company can never raise the premium on the policy.

Be aware that government agencies can take up to 24 months to approve a disability claim, and you may need to provide documentation such as a doctor’s note and a letter from your employer verifying your bleeding disorder–related disability.

Both are desirable, but non-cancelable is usually best. There are a few important policy options (or riders) that should be considered: residual benefits and cost-of-living adjustment (COLA).

• The residual benefits rider provides the difference between old and new salaries, in the event that the policy owner can get a new job, but not one with the same salary as the previous one.
• The cost of living rider allows the policy's value to increase with inflation.

Finally, a disability policy can be designated as an own-occupation policy. Most policies are any-occupation, which means the policy owner must work when he is capable, even if not in the same capacity as before. An own-occupation policy will allow the owner to collect benefits until he can resume the previous occupation. Typically, these policies are more beneficial to policy-owners with high-skill or high-paying jobs.

Social Security

Social Security is not a replacement or surrogate for disability insurance; at the most, it should be a last resort for those who can't get private coverage. Not everyone is eligible for Social Security benefits, even once disabled—the applicant must have significant work history, must have been unable to work for a year or more, and must not be able to work in any capacity.

Long-Term Care Insurance

Spending a long time in a nursing home, or under home care, is not something people like to think about; nevertheless, as medical science increases the average life expectancy, a growing number of seniors are finding themselves unable to live independently. At the same time, extended nursing home and home healthcare is becoming extremely expensive, primarily due to rising medical costs. Long-term care insurance covers these expenses, and is something people in their late 50s to early 60s should seriously consider purchasing. Long-term care policies generally cover extended healthcare at home, nursing homes, or assisted-living facilities. However, policies do not necessarily pay out in the same amounts for each of these choices; most notably, policies tend to pay less for home care.

Like long-term disability coverage, policies also vary in their eligibility criteria; in this case, the determination of when someone can no longer live independently. Experts say an ideal plan's eligibility criteria includes cognitive impairment and inability to perform one or more activities of daily living, and does not require previous hospitalization or home care. Policies vary in their length of payout, from 1 or 2 years to lifetime. Obviously a lifetime policy charges higher premiums, but not much higher—the typical nursing home stay lasts less than 3 years, meaning the risk of a lifetime policy to the insurer is not that much greater than a 2- or 3-year policy. Policies have a set amount of time between when care starts and when the benefits take effect (similar to a deductible in other types of insurance coverage). The longer the waiting period is, the lower the premiums. Finally, like long-term disability, long-term care policies can be guaranteed renewable, meaning the insurance company cannot drop the policy. Most experts recommend a policy that is guaranteed renewable.

Employer Sponsored Disability Coverage

Many employers offer short- or long-term disability coverage with an open enrollment period in which you do not have to disclose any health conditions. Ask your human resources department when that’s offered and sign up. If your employer offers long-term disability insurance, it’s a good idea to consider the benefits against the monthly expense.

Here are some considerations when looking at a long-term disability policy:

• Benefits until age 65. Policies have different time spans, usually five years, 10 years, or until age 65. Look for coverage until age 65.
• Non-cancelable/guaranteed renewable. You want to be sure that any long-term disability policy is non-cancelable and guaranteed renewable. This will allow you to renew the policy at the end of each premium term (usually annually), and during that time the premium rate cannot be changed, and the policy cannot be cancelled. Read the fine print on any policy you consider.
• Cost-of-living rider. Look to add this rider to your policy. It allows the policy’s value to rise with the cost of inflation.