I am 60 and am contemplating working part-time in two years. I don't want to be without health insurance. Are there insurance companies that offer a payment scale according to one's income or ability to pay, the way some health centers and hospitals accept the working poor? How would I go about signing up with such agencies, if they are out there? I enjoy excellent health, am not overweight, and don't smoke or abuse liquor. I've already had a hysterectomy. I plan to have complete exams done before I leave my company. Where do I go from there?

Sunshine

I know of no insurance companies that vary their premiums on the basis of a person's ability to pay. In fact, for most non-group insurance, the ability to pay for the coverage is a condition of the insurance coverage. In other words, if a person states on their application that they do not have sufficient income to pay the premium, it is unlikely that the person's application will be approved.

Insurance is a product more similar to a sofa or a refrigerator and less similar to hospital charges. When you go to buy a furniture or appliances, you pick a brand and model that fits into your income. You don't pick the item and then expect the merchant to charge you what you can afford.

The same is true of insurance. You shop around for a benefit package that suits your medical needs and financial resources. This may mean paring down the coverage level in the form of limited coverage provisions, a higher deductible and co-insurance, etc.

If you are in good health and expect to stay that way, you can save money on insurance my choosing a benefit package that is less comprehensive than the norm. Many insurance plans are flexible and can be tailored by excluding things like regular doctor visits. This can reduce premium costs. It is probably your most likely medical need, and it is the least expensive part of a medical regimen. By not insuring for this type of medical care, you may save more in premium than you end up paying for in medical care. Likewise, a higher deductible and co-insurance can produce further savings. This kind of insurance covers you for the potentially costly medical care, such as hospitalization.

You may need to shop around for a plan that fits in with your future financial condition, but you should be able to find something that meets your needs. Remember, too, that you will become eligible for Medicare on the first day of the month of your 65th birthday. So if you reduce your employment to part-time sometime after your 62nd birthday, you will have to cover less than three years with private insurance. Who knows, in the next couple of years, the federal government may even create a program for people between 60 and 65 to "buy into" the Medicare program.

Whatever you decide, it will be important for you to start shopping for insurance before your employment-based coverage terminates. You must maintain continuous coverage, or you risk losing coverage for pre-existing conditions.