Your health insurance is one of the most important benefits you receive as part of your employee package. Having health insurance helps you avoid budget-breaking bills for routine care or for those occasional times when you need more. If you or a member of your family has special health needs such as diabetes or heart conditions, health care coverage can mean the difference between receiving the care you need and being denied these important treatments.
The Cost of Family Health Insurance Coverage
However, health insurance is not cheap. A recent study by the Kaiser Foundation shows that the average premium costs were $5,615 for single coverage and $15,745 for family coverage, or $468 per month and $1,312 per month, respectively. These 2012 prices reflect a three to four percent increase over 2011 prices, and some claim they may rise even further next year.
Family coverage is more expensive because more people are covered by the plan. However, families may save a bit if the employer sponsors a plan that includes “family” coverage rather than simply increasing the premium per person. For a family of four, if the average price for single coverage is $468 per month, the price for the entire family could be $1,872 if every person was charged the same amount. Family coverage is usually a set price no matter what the size of the family. Therefore, the average price for family coverage is more than $500 per month less than the individual cost times four, and would be the same for a family of four, five or six.
Who Can Be Covered Under My Family Coverage?
For the same price, almost anyone who is your dependent and lives in your household can be covered. There are some exceptions to this rule and every company treats these situations slightly different.
For example, if your widowed mother lives with you and has no source of income, you can probably declare her on your taxes as a dependent. Your insurance company may allow you to include her in your “family” group health care plan. On the other hand, if your mother is part of the Medicare health system, you may not be able to include her and will have to purchase a supplemental policy to pick up her costs of care not paid for by Medicare.
Similarly, the “blood” relationship does not necessarily matter for family coverage. Step-children as well as adopted children or nieces and nephews who live with you are usually covered if they meet the dependency test.
What Does Family Coverage Actually Cover?
Every plan is different, so family coverage is highly dependent on the type of insurance you have. Some plans, for example, pay 100 percent of costs for wellness care while others pay nothing. You must review your own plan’s guidelines to determine what is covered, or talk to your doctor or the insurance company about your concerns.
Recent changes to healthcare law may make it easier for some members of your family to receive treatment and medications. The Affordable Care Act or ACA was a landmark piece of legislation that was passed in 2008. Despite debate about some of the provisions of the Act, there are definitely benefits for families who have health care coverage contained in its language, such as:
- Insurance companies cannot deny coverage to any individual based on a pre-existing condition as of 2014
- Patients can use any doctor in their particular health care network without referral
- Preventative care must be supplied at no cost to the patient
- Children away at college or even working can continue on their parent’s plan until age 26
- Health insurance cannot be cancelled simply because a covered person develops a serious illness.
However, even with the help the ACA provides, many families simply cannot afford health insurance premiums. In fact, the ACA may have actually worsened the problem to a certain extent as insurance companies raise premiums on families to try to recoup losses mandated by some areas of the Act.
Affordable Alternatives to Health Care Insurance
If you need to insure your family but cannot afford to do so under your employer’s health insurance plan, here are a few programs that may provide low- or no-cost coverage for you and your family:
- Medicaid. Medicaid benefits are available only to those with the very lowest incomes, but if you are out of work you and your family may qualify
- State-sponsored health plans. Many states sponsor low-cost health insurance for children. Income requirements are more generous than those of Medicaid
- Local health departments. You can save tremendously on many routine healthcare treatments by visiting the local health department. There your children can receive immunizations and well-baby checkups and other family members can receive basic services at a very low price
- Hospitalization coverage. Some families elect to take out only “major medical,” the type of coverage that pays for hospitalization if someone is seriously injured or sick. This coverage is much less expensive than regular health insurance but does not provide coverage for anything but the most dire of situations.
After reviewing your healthcare insurance costs and exploring your options, you will be able to find a balance between your needs and what you can afford to take out in the form of health insurance.