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Total Health

Supplementing Partial Health Benefits

By:
David Lack

Question :

My employer gives me partial health benefits. I have contacted a few insurance companies to see if they offer supplemental health insurance, but none of them did. Is there any way for me to supplement my insurance without buying a full insurance package?

Dee

Answer :

Supplemental insurance is very rare these days. Over a decade ago, when insurance plans became more and more comprehensive, the need for supplemental insurance diminished, along with the availability.
In addition, some states have passed laws with an adverse effect on coordination of benefits. When multiple coverage is a factor, insurance companies follow guidelines to determine which each company should pay. The two companies will coordinate their benefits so that the medical care is reimbursed appropriately. Some states do not allow coordination of benefits and require both insurance companies to pay full benefits. This, of course, results in the ridiculous situation in which a person can profit from an illness. Insurance carriers have adopted guidelines to avoid situations in which a person might be overinsured.

As the trend away from comprehensive insurance and "first dollar" coverage becomes apparent in the coming years, a new market for supplemental insurance might evolve. Until then, there may be other options.


"Partial insurance" may mean that the employer's plan covers hospitalization and outpatient surgery but has limited coverage for visits to a doctor's office for routine care. For some people, this leaves a gap in their coverage, especially if their main use of medical services is in the doctor' s office.

There are several ways to fill in this gap. First, if an employer's plan is not comprehensive, it is probably because the employer wants to save money. If the business has 50 or fewer employees, the employer could provide a low-cost medical savings account (MSA) plan. An MSA combines a savings element with a high-deductible health plan. High-deductible plans cost much less than comprehensive coverage, and the employer may find sufficient savings with such a plan as opposed to limited benefit insurance. This would allow employees to make tax-free deposits into the MSA to cover medical care under the deductible amount. Talk to your employer about establishing an MSA.


Second, employers can establish a "flexible spending account" (FSA), which allows employees to set aside part of their salary into a tax-free account to pay for medical expenses not covered by their health plan. Often referred to as a "section 125" account, this is a simple administrative function for employers, and a great benefit for employees.

Both FSAs and MSAs reduce your out-of-pocket medical expenses because the payments deposited into the accounts are considered reductions to your gross income, reducing your taxable income.


Third, you may be able to find individual insurance that is both cost-effective and fills the gaps in your current coverage. If your employer plan excludes office visits, you may look for a plan with a high deductible that uses a preferred provider organization (PPO) for office visits. Many plans charge a simple co-payment for office visits to PPO doctors. There is the chance, however, that this kind of plan would cost more than simply paying for office visits out of your own pocket. In other words, the benefit may be more expensive than living without it.

If the gap in your coverage is related to hospitalization, you may have many options for hospital-only coverage. You may find a policy that pays a daily benefit while you are in the hospital. If the coverage gap relates to prescription drugs, you may want to purchase a drug discount card membership. These are abundant and readily available.

No matter what you decide, make sure that the solution does not cost more than simply paying for your medical care out of pocket. Coverage is only valuable if it shields you from catastrophic financial loss.

 

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