Frequently Asked Questions

Adapted by the Network of Care Staff

At what age will my children no longer be covered by my health insurance plan?
Under some individual plans, eligibility automatically stops at age 18 while others will continue to cover full-time students to age 23, 24, or 25. Check the provisions of your plan regarding children who are students older than 18.

I recently left my employer and began a new job, and won't be eligible for health insurance for several months. What should I do in the meantime?
Most group insurance plans offer extended coverage after termination of employment - but you must apply. Don't delay. You can shop for alternatives later, but it is important to enroll for the Consolidated Omnibus Budget Reconciliation Act (COBRA) extension immediately after termination for your coverage to continue without interruption.

I'm young and in good health. Do I still need to get health insurance?
If you get seriously ill or in an accident (a car or ski accident, for example), the expenses could wipe you out financially. To safeguard both your health and your financial well-being, you should get health insurance.

Could you explain the difference between an HMO, a PPO, and a POS?

• Most HMOs (Health Maintenance Organizations) minimize the out-of-pocket expenses members pay, as long as members use the HMO's preferred providers and facilities. If members go outside of the network, they may be responsible for the whole bill.

  In addition, members must choose a primary care physician, and see that person first whenever they need medical attention. The primary care physician will make necessary referrals to specialists.

  With HMOs, the per-visit or annual deductibles are usually lower than with other plans.

• Most PPOs (Preferred Provider Organizations) charge members slightly more than HMOs to use providers and facilities outside of the PPO network, and do not require referrals to see specialists.

  PPOs are generally more flexible than HMOs but tend to cost members slightly more. The per-visit or annual deductibles are usually higher than with HMO plans.

• POS (Point of Service) plans are a combination of the features of HMOs and PPOs. With a POS, members choose whether they want to pay a flat fee for a network provider, or whether they want to pay a deductible and/or coinsurance charge to see an out-of-network provider.

I have Medicare, but should I consider a supplement?
Most people consider a supplemental health insurance plan to Medicare after age 65. Learn what is and is not covered by Medicare. If you are still employed, find out how your employer's group plan coordinates with Medicare - and what happens when you ultimately retire. Most people only need one high quality Medicare supplement policy.

I applied for health insurance, but was declined. What should I do?
Some people have health conditions that prevent them from buying an individual health insurance plan from an insurance company. If you are in this situation, contact your state's Department of Insurance. Many states have special programs to help people who cannot purchase health insurance.

I am self-employed. Will my health insurance cover work-related injuries?
If you are self-employed, it is important to learn how your health insurance does or does not apply to work-related injuries. You may wish to consult an insurance advisor about how health insurance and/or workers' compensation insurance applies in your situation. Some individual health insurance plans exclude all coverage for work-related injuries.