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 chambers of commerce, unions, professional associations, or social or civic groups—offer health plans for individuals who are members of the organization. You may want to talk to an insurance broker, who can tell you more about the various health insurance plans that are available for individuals. Some states also provide insurance for very small groups or for self-employed persons.  (See “State Programs”.)

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 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.

Preexisting Conditions

A preexisting condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a preexisting 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 went into effect on July 1, 1997, a preexisting condition will be covered without a waiting period when you join a new group plan if you have been insured during 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 preexisting condition will be covered—without additional waiting periods—even if you have a chronic illness.

If you have a preexisting 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 employee benefits office or your health plan.