Introduction to The Delaware Individual Health Coverage Program Buyer's Guide

What should young adults look for in health insurance?

As health insurance in the U.S. is typically employer-provided, getting a job is often the first time a young person begins to think about this matter.

While you are young and healthy, you might actually feel that you don't need health insurance. In fact, you might be tempted to do without coverage because you are strapped for cash and want to avoid paying the premiums. The National Association of Insurance Commissioners recently surveyed U.S. consumers and nearly a fifth of young singles indicated they would decline employer health insurance to save money.

However, forgoing health insurance is a dangerous decision. Accidents and unforeseen illnesses can be financially devastating for you and your family. Weigh carefully the repercussions of not being covered, and seriously consider buying health insurance suited to your needs.

Know your family's health history. If you are at high risk for developing a medical condition - such as diabetes - later in life, think carefully before saying no to your employers' health policy, even if it means paying higher premiums while you are young and healthy.

Understand that if you have been covered under your parents' health insurance policy while you were in college or by a plan offered through your college, often this coverage ceases when you graduate. Additionally, many companies have employee probation periods before health coverage goes into effect. For these periods of no coverage, you should check to see whether you can extend your parents' coverage short-term under COBRA. Some colleges also offer graduates interim coverage. As an alternative, talk to an insurance agent about purchasing catastrophic health coverage as a short-term measure.

As you sort through job prospects, don't make the salary your sole priority. Health coverage is perhaps the most important job-related benefit you can receive; so study the health plans that prospective employers provide. Many companies have coverage through an HMO or a managed-care plan, which means that many decisions - including which physicians are included in the network - are made by the healthcare provider. Others have more flexible plans that allow their participants to choose their physicians. In either case, the employee is responsible for co-payments which help keep costs under control.

Here are some ways that you can control your health insurance costs or cover an interim period before or between jobs when you are not under an employer's plan:

If you feel you can't afford regular health insurance, a more affordable option you may want to consider is purchasing a high-deductible major medical policy that only covers very serious or catastrophic health costs. It will offer lower premiums than regular health insurance policies and help you cover bills for "major" medical events, like surgery, hospitalization or emergency room care. But it will typically not cover routine doctor visits or check-ups.

If you are convinced that you are generally healthy and have a healthy lifestyle and definitely do not want to pay (or can't afford to pay) high insurance premiums, consider a Health Savings Account. HSAs can be set up individually or, increasingly, as an option through employers. They allow you to accumulate and spend pre-tax money for health expenses via an account that you own and can take with you should you change jobs.

If you are in a physically demanding job, you might want to consider purchasing disability insurance, as research shows that young people are four times more likely to be disabled than die at an early age. As an option, many employers offer disability coverage, which provides lost income in the event that you are injured and unable to work. If the injury is work-related, then workers compensation coverage applies.

If you decide to purchase disability insurance, try to get a non-cancelable, guaranteed renewable policy. That means it can never be canceled and it's good until age 65. Make sure you review your disability policy on an annual basis to ensure any disability payments continue to keep pace with your increase in earnings.

What should young families look for in health insurance?

Here are some special considerations for young families:

If both parents are working in full-time jobs, it is recommended that you compare these health insurance policies to see which best fits the needs of your family: Employee; Employee and Spouse; Employee and Family; Employee + one, where the spouse has separate coverage

Make sure to review the co-pay amounts and different options carefully to see exactly what is covered - and what isn't - for both parents and children.

Check to see if your employer offers a flexible spending account. These plans, which allow you to set aside pretax dollars for medical expenses and childcare, are a good way to reduce your out-of-pocket medical costs.

When expecting a child, review the coverage options available to you, and find out exactly how your healthcare plan handles the costs. Remember to consider the costs of prenatal vitamins, prenatal and neo-natal screenings and tests, emergency procedures, delivery - C-section and traditional - and pediatric care.

Also, make sure you are aware of the deadline to register your newborn with your health insurance company. Consult with your employer and health insurance provider regarding the requirements before your child is born. If you decide to adopt a child, consult with your employer and health insurance provider regarding the requirements for obtaining health insurance coverage in advance, and also check with your state health department.

What should midlife families look for in health insurance?

As your family matures, its health needs change. Thus when your annual enrollment date approaches for employer-provided health insurance, recognize that you may want to alter elections or eliminate certain types of coverage, if you have the choice.

For example, if you and your spouse have decided not to have more children, you may not be interested in a policy that covers pregnancy-related services. But note that if you decline pregnancy-related coverage and your teenage daughter becomes pregnant, she will not be covered. If you still have young children, consider a program with a preventative care option that provides shots and "well visits".

Keep in mind that health insurance policies will most likely not cover some common childhood procedures and problems, such as allergy tests, braces, and replacements for lost eyeglasses, contacts or retainers. Consider contributing money to a flexible spending plan, if your employer offers one, to help you put aside pretax money to cover these types of expenses.

Know your rights and entitlements under COBRA - the Consolidated Omnibus Budget Reconciliation Act. If you lose or change your job or decide to start your own business, be sure to familiarize yourself with COBRA so that you're clear how your family will be covered when your situation changes.

If you're over 50, you may want to consider whether long-term care insurance make sense for you. Before purchasing long-term care insurance, do a thorough analysis of your financial situation to be sure you can continue to afford the premiums for an extended period of years - through your old age until death - and figure out whether you have significant savings or other financial assets you want to protect. Many people find they cannot afford the premiums as they get older and get closer to the point when they are most likely to need the coverage. In addition, make sure you know what triggers will result in benefit payments, as well as the likelihood and potential size of premium increases.

What should seniors look for in health insurance?

As you age, health insurance considerations become paramount. Here are several issues you need to address:

Are your children still in college full-time? You may be able to cover them under your existing health plan if you are still employed. If your children are in college out-of-state, you may need to explore a health plan through the school or from a private insurance company in the geographic area where they are living for most of the year.

If you decide to retire or have been laid off from your job before you turn 65 - and you are not yet eligible for Medicare, what do you do?

Check to see if you are eligible to continue to get health insurance at the group rates from your former employer under COBRA (Consolidated Omnibus Budget Reconciliation Act). COBRA is a federal law enacted in 1985 that typically entitles you to continue your employer's coverage for up to 18 months. Note that you will be responsible for paying the premiums for this insurance and that you must let your former employer know within 60 days of leaving your job if want to continue your health benefits.

If you are no longer employed and your COBRA benefits have run out - but you are still not yet eligible for Medicare - you might want to consider a catastrophic or high-deductible medical plan which typically carries lower premiums than other individual policies. The caveat here is that people with serious pre-existing health problems like heart disease, diabetes or Multiple Sclerosis typically can't get catastrophic health insurance.

Be wary of health discount cards. If you are considering the purchase of a health discount card of any sort - for example to cover pharmaceuticals, dental care or doctor visits - be sure to investigate whether the insurer is legitimate by calling your state insurance department. Also research how many complaints have been filed against that insurer and find out exactly what is covered and whether your physician/dentist accepts the card.

Consider whether you still need disability insurance. Important considerations include whether you are still employed, your age, how many years you have until eligibility for Social Security, your individual financial needs and your ability to pay the premiums, which typically escalate significantly as you age.

Carefully evaluate whether long-term care insurance make sense for you. Before purchasing long-term care insurance, do a thorough analysis of your financial situation to be sure you can continue to afford the premiums for an extended period of years - through your old age until death - and figure out whether you have significant savings or other financial assets you want to protect. Many people find they cannot afford the premiums as they get older and get closer to the point when they are most likely to need the coverage. In addition, make sure you know what triggers will result in benefit payments, as well as the likelihood and potential size of premium increases.

Where can I find the definition of common health insurance terms?

Click here for a list of health insurance terms.

What are the major health insurance companies offering coverage in Delaware?

The following are the top 5 companies that provide health insurance in Delaware, based on 2006 figures. Together, they account for the vast majority of the health insurance coverage in the state. They are listed by name and the premium volume (in dollars).

Blue Cross Blue Shield of Delaware Inc.	$422.9 million
United Healthcare	$170.9 million
Coventry Health Care of Delaware	$129.6 million
Aetna	$30.8 million
Amerihealth HMO	$18 million

Are there proposed laws in Delaware that would make health insurance more affordable?

The Insurance Commissioner's Office has proposed and supported a number of measures in the General Assembly to address the high cost of health care. You can find descriptions of these proposals and their status in the state legislature here.