Divorce does change everything, but what doesn’t change is a shared concern for everyone in your divorced family to stay healthy, and be covered by the best affordable health insurance plan. As a divorced parent when you consider health costs be sure to consider all the variables.
1) If both you and your EX no longer have insurance thru work what’s the plan for private insurance to cover your child? (50-50 split on everything? Policy, medicines, emergency room visits? etc.)
2) If your EX is covering your child on his/her work policy, what is the cost split for deductibles, and medicine? Is your EX paying for all medical expenses? Co-pays? etc.
3) If sharing medical costs for your child do yo have a set agreement on how each of you should be re-embursed? (My EX husband and I split medical costs for 2 daughters 50-50. But after 3 years, he presented 30 some odd receipts never submitted to me before to split, amounting to some 3-thousand dollars. (When I asked why he waiting so long, he said he lost track of some of these bills.) After that, I added to our divorce decree that all split bills needed to be submitted within 6 months, and paid off within 6 weeks if under $100.00).
4) If co-parenting regarding health concerns for your child be sure all doctors and school nurses know that you are divorced. Set up a primary parent as point of contact for appointments and billing. (We had some confusion with my address being on file with doctor’s office and my EX’s address being on file for health insurance.)
Health Insurance rules and regulations vary from state to state. So it’s best to stay informed and shop around.
Quick Tips:
Health insurance plans and costs do change. The health insurance rates typically increase with age, and health conditions. (i.e. Are you no longer a smoker? Have you lost weight? Are you no longer planning a family? If so make sure Maternity Benefits are off the list, because this is an added cost.)
What’s the deductible? When selecting private or employer-sponsored health insurance, focus on the annual deductible or the amount of coinsurance, or co-payments, that you’d have to make.
Cost vs. Coverage? What’s more important to you, the overall cost? The ability to get coverage whenever you choose to get care? Or, perhaps it’s a combination of both.
Know the terms: To make the right health insurance decisions, it’s good to know the basic terms. If you already know your way around these terms, scroll to the bottom of this page, for smart links and price comparisons on the best health insurance plans.
Health Insurance Terms:
HMO or a Health Maintenance Organization is a plan that provides patients coverage within a network of doctors. In an HMO, a client typically chooses a primary care physician (PCP) act as their regular doctor and issue referrals to specialists (also often members of the HMO). So it’s all done “in network.” Sometimes these have restrictions. For example if doctor or specialist isn’t in your HMO network, you’ll have to pay for it on your own, or choose another doctor “in network” so the costs are covered.
If you like the doctors in an HMO’s network, this could be a more affordable option. There’s no deductible and most routine procedures are covered at 100% once you submit a co pay.
PPO or a Preferred Provider Organization, is a network of physicians and specialists who have worked out a negotiated rate with your insurer. Usually, with these plans, you don’t need a primary care physician for referrals — so you can schedule appointments with any doctor at any time. Plus, you have the option to use a doctor who’s not in the network and still get some coverage (it’s customary for a PPO to cover 70% of out-of-network visits).
Although PPOs grant more flexibility to the patient, they often come with higher co-payments and other costs.
High Deductible/Catastrophic/Safety Net Plan: This option goes by various names from state to state, but the concept is simple. If you don’t need (or can’t afford) a doctor on a regular basis, but want protection should you get in a terrible accident, this is an option. The deductible for these plans are high, but they usually carry the lowest premiums.
Glossary:
Beneficiary – is the person (or persons if it’s a family plan) who is enrolled in the health insurance plan, and receives benefits.
Claim – is an application for benefits provided by your health insurance plan. Claims are filed before funds are reimbursed to the medical providers.
Coinsurance – refers to money that a person is required to pay for services, after a deductible has been paid. In some types of health plans (such as PPOs), your insurer doesn’t pay the whole medical bill. They pay part of it, and you pay the rest – your portion to pay is called “coinsurance.”
Cobra – A government program (Consolidated Omnibus Budget Reconciliation Act) that allows people who leave their job or who get laid off to continue using their previous employer’s health plan for up to 18 months after they stop working there. You have to pay the full price of your health plan by yourself; your employer no longer covers the set percentage of the premium.
Copay – Short for co-payment. Almost every type of insurance requires you to spend between $10 and $50 when you see a doctor. Copays can, in many cases, be applied toward your annual deductible.
Deductible — The deductible is the amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts.
Once you’ve “met” (paid) your deductible, you are eligible for all the coverage, discounts and benefits your health plan offers. Until the next calendar year, that is, when you have to start back at zero.
EOB Form or Explanation of Benefits Form is the insurance company’s written explanation regarding a claim. The EOB is supposed to show you how much the doctor charged the insurer, how much the insurer is paying the doctor and how much, if any, is left over that you have to cover yourself. The EOB is sent for your review, then you wait for the doctor to bill you separately.
Many EOBs are difficult to read and raise questions about what was and wasn’t covered. So, it’s not a bad idea to call your provider and verify the charges on any EOB before the actual is generated.
Lifetime Maximum Benefit – is the maximum amount a health plan will pay in benefits to an insured individual during that individual’s lifetime.
In-network — refers to providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts.
Maximum Dollar Limit – is the maximum amount of money that an insurance company (or self-insured company) will pay for claims within a specific time period.
Out-of-pocket maximum – is predetermined limited amount of money that an individual must pay, before an insurance company or (self-insured employer) will pay 100 percent for an individual’s health care expenses. Basically, this is how much you can spend before your plan starts paying for 100% of everything. Even after you’ve met your deductible, you’re still responsible for coinsurance and copays. For example, let’s say that you’ve met your plan’s $500 deductible, and then you get in an accident. The hospital bills add up to $90,000. If you didn’t have an out-of-pocket max, you’d still be on the hook for co-insuring, say, 20% of your hospital costs, or $18,000. But since your plan has an out-of-pocket maximum, you’re only on the hook for $2,500 (as you’d already spent the $500 in meeting your deductible).
Pay special attention to the out-of-pocket maximum. You want to make sure that, if something very bad—and very expensive to treat—happened to you (or a member of your family, if you’re all on the same plan) that you’d be able to cover the maximum amount before insurance would pick up the rest.
Prescription drug programs – Your health plan may run its own prescription-drug program, or it may contract it out to a third party. If that’s the case, the terms of your drug plan are still set by your health plan—the third party is just fulfilling the order. If your health plan says generic prescription drugs are $15, then they are $15 no matter where you buy them. If you are on a specific prescription drug, be sure this is covered under the plan.
Primary Care Physician – This is your main doctor, the person you go to for checkups and normal illnesses. HMOs and some others types of plans require you to have a PCP who directs your care and refers you to other doctors.
Additional Resources:
E HEALTH INSURANCE – provides easy comparison shopping for those buying health insurance nationwide.
HEALTHCARE.GOV – explains the new Health Insurance Law and helps you find out which private insurance plans, public programs and community services are available to you in each state.
HEALTH INSURANCE.ORG – offers statewide health insurance quotes, articles and health news.
THE U.S. DEPARTMENT OF LABOR – provides information about Cobra coverage for those who have recently left their jobs.