Sky-high premiums, unfair restrictions – it’s enough to make anyone sick.
Every now and then, in a moment of intense frustration, I ask my boyfriend to marry me. What drives me to this brink? The difficulty of obtaining affordable medical insurance. My boyfriend lives in the cloistered world of the large group policy. He works in a “low-risk” profession and has never seen the inside of a hospital. He has union representatives and their crafty lawyers protecting his interests, demanding (and getting) free insurance for all employees and their families. I, on the other hand, am self-employed and have been sick a time or two in my life, Like salon professionals, I am the only one looking out for my interests. We don’t have it so easy. We face rapidly rising premiums, limited options, and the rigors of a bureaucratic and often unfair screening process.
Your occupation is a major factor considered by insurance companies to determine their potential risk to insure you. For various reasons, insurers believe that members of certain professions are more likely to cost them money than others, and systematically deny coverage to anyone in these professions. Doctors, lawyers, and even cosmetologists are frequent victims of this practice. Explains one insurance industry veteran, “With AIDS reaching epidemic proportions, more and more industries are being blacklisted.” A recent article in the Los Angeles Times reported that beauty salons have been blacklisted because insurers presume that a high percentage of gay people work there and subsequently are at a higher risk for contracting AIDS.
Despite these difficulties, good basic coverage is available for almost everyone, although often for a hefty premium. “Health insurance is a game. People need to learn how to play it,” says one insurance agent.
The first step towards mastering the game is to familiarize yourself with the types of plans out there so you can make the best choice for your individual situation. A good agent can guide you through these occasionally treacherous waters, offering a variety of plans to choose from and advising you at every step.
The most complete coverage available is called major medical. A good major medical plan will cover all your basic health care needs, such as hospital stays, doctor visits, lab tests, and prescription drugs. You can get major medical coverage with health maintenance organizations (HMOs), preferred physician organizations (PPOs), and traditional indemnity plans. Blue Cross/Blue Shield is by far the largest provider of individual and small business health insurance. An insurance agent can put you in touch with a variety of other commercial insurers also offering plans for individuals or small businesses.
HEALTH MAINTENANCE ORGANIZATION (HMO)
As a member of an HMO or pre-paid Plan, you pay a monthly premium for which you receive complete care. You must use a medical facility or group of doctors that you select at the start of your coverage. The advantage of this type of policy is clear: There is no deductible and you can anticipate no out-of-pocket expenses beyond your premium, except for prescription drugs. If you have a family or you require more frequent doctor visits, HMOs are especially good. There are, however, a few disadvantages to consider. You have a limited choice of physicians, and you may have to leave behind a trusted family doctor. HMOs offer fewer treatment options, rarely providing non-essential or less traditional services such as chiropractic, acupuncture, or psychological counseling. You may also encounter more bureaucratic, less personalized service. For instance, an HMO may restrict how often a healthy pregnant woman may see her obstetrician
PREFERRED PHYSICIAN ORGANIZATION (PPO)
A PPO is a group of health care providers who have contracted with an insurer to provide their services at a predetermined discounted rate. PPOs have become very popular in the last few years because they allow an insurance company to control its costs while providing more options to the patient than an HMO.