Since the start of the pandemic, many Americans have changed jobs, which usually also means changing health insurance companies. Employer-sponsored insurance, also called a job-based plan or group health plan, is health insurance provided by an employer for its employees, and in many cases their families. (Coverage for dependents under most group health plans ends when a person turns 26 years old.)
If you or someone in your family has a blood disorder, it’s important that your new health insurance plan covers what you or they need. Here’s what to keep in mind:
Get Lots of Details During the Interview Process
Inquire about health insurance benefits before you accept a new position. You’re not required to disclose that you have a bleeding disorder when talking with a potential employer; however, it’s often beneficial to ask specific questions related to coverage for bleeding disorders, especially if the company you’re interviewing with offers a choice of health insurance plans.
Questions to ask may include:
- Is clotting factor covered? If so, is it a major medical or a pharmacy benefit?
- Do I have a choice of more than one specialty pharmacy provider?
- Is my hemophilia treatment center (HTC) in the network?
- Do manufacturer copay cards count toward my deductible or out-of-pocket expenses?
- Does the plan accept third-party premium assistance?
- Is durable medical equipment covered?
- Do I need a referral to see a specialist?
- Are physical therapy services covered?
- What medical services require prior authorization?
Talk to Your HTC Social Worker
Health insurance can be confusing and overwhelming. Social workers at HTCs are well versed in the nuances of all types of health insurance and can help guide you on where to find specific coverage information within a policy, what to look for, and how to compare plans. While they can’t make the health insurance decision for you, they can help make the process easier.
Find Insurance Guidance from NHF
The National Hemophilia Foundation’s Personal Health Insurance Toolkit is an invaluable resource for anyone who needs information about health insurance, whether it’s employer-sponsored insurance, a plan through the health insurance marketplace, or a state Medicaid program.
The toolkit includes a glossary of health care terms, worksheets, fact sheets, and links to guides on a variety of health insurance topics. There’s also a step-by-step guide to getting started and a Health Plan Cost Comparison Worksheet to size up different plans side by side.
Consider Other Options
You may decline your employer’s health coverage and purchase other insurance on your own, but keep in mind that most employers subsidize the cost of your monthly premium. If you buy your own insurance, you won’t receive this subsidy.
It’s also possible to keep the health insurance plan of your current employer through COBRA (Consolidated Omnibus Budget Reconciliation Act) for up to 18 months after you leave your job. You have 60 days to sign up, and you must pay the full premium, which can be several times more than your payroll deductions.
Further Reading: What Are Health Insurance Options for People with Hemophilia?