Up a Creek Without Insurance

Several adjuncts have written me in recent weeks asking for advice on how to obtain health insurance for themselves or their dependents. Because the vast majority of adjuncts earn only modest salaries and do not receive any kind of health-insurance coverage from our hiring institutions, this remains a big problem for us.

It’s easy to feel like a special victim in such circumstances, but adjuncts are only a small fraction of the nearly 40 million Americans without health insurance. This is an American problem, not merely an adjunct problem. And like millions of other people, we must figure out how we can manage this problem on our own.

When You’re Uninsured

If you see no way of affording insurance in the near future, you must take advantage of whatever low-cost or free health-care programs are available in your area. Area drugstores, clinics, or other health-care facilities may offer screenings, tests, and other routine medical procedures free or for a small fee. Things like flu shots, cholesterol tests, pelvic exams, and certain blood tests fall into this category. Take advantage of them because if you go to a doctor’s office, it will usually cost you a lot more. Additionally, some clinics have programs for those who fall below a certain income level and/or are uninsured. They may offer discount services on certain days, or in conjunction with certain providers. Check the Yellow Pages or the Internet to find out what programs exist in your area. They may not be too user friendly or they may insult your pride, but if you’re sick, you’re sick, and you need to take help where you can get it.

Another alternative for the uninsured is to keep a stash of cash available in an account somewhere for health-care emergencies, or for routine visits. Try to build up several hundred dollars, set it aside, and forget about it until you need it. Of course, some will say that if you can afford to set aside cash, you can probably afford to buy insurance, but that will depend on your insurability and what you generally require annually in terms of health care. You’ll have to decide that for yourself.

Short of having cash set aside, you might consider another option that I am not officially recommending here. I’m simply mentioning it for your consideration: Keep a credit card with a decent credit limit available for emergency health-care needs. Use it only in case of a major medical emergency, something that you cannot pay for out of your checking account right away. This is obviously a last resort. But I’ve seen many people without health insurance suffer indefinitely with an illness because they didn’t have the money to pay for it upfront. If they had used either a credit card or the hospital’s payment options (almost all hospitals have them) they could have returned to health sooner, gotten back to work, and paid off those bills more quickly.

In my view, two things are worth going into debt for: education and your health. Without them, you are going nowhere fast, and the money you supposedly saved by not going into debt won’t matter anyway.

Getting Insurance

Your ultimate goal should be to get some sort of health insurance. In this pursuit, as in just about any other one, knowledge is power. Learn all you can about the different kinds of policies available to individuals without employer-sponsored insurance. Educate yourself about HMO’s, PPO’s, POS’s, indemnity policies, co-payments, deductibles, comprehensive vs. major medical plans, and much, much more.

Fortunately, the Internet is a wonderful source for this, and there are scads of Web sites that will give you the lowdown. Just do a search on “health insurance” and you’ll find more than you ever wanted to know. Follow some of the links to Web sites that will give you online quotes, glossaries, and comparison charts. Just spend a few hours surfing around. You’ll come away overwhelmed, but smarter. For those who don’t have the time, though, here are a few of my favorite Web sites: healthinsurance.org is a non-profit site that offers great information without the sell pressure; quotesmith.com is in business with the insurance companies but offers glossaries, comparison charts and really good FAQ sections for all kinds of insurance needs; and insurekidsnow.gov is a great site for people with childen who worry about not having coverage for their kids. It lets you plug in your state and tells you what low-cost programs are available there.

And maybe more hopeful, too. Why? Because although health-care costs are astronomical for individuals outside of group coverage, there are some options. You can join a group and have access to lower rates. Check with the professional organizations in your field and see if they offer group health insurance. You might also look around for other organizations that offer group rates, such as the National Adjunct Faculty Guild and the American Association of University Professors.

Your home state might also offer special insurance programs. Texas, for example, provides low-cost coverage for children at a network of hospitals across the state. So, even if the parents don’t have health insurance, they can buy it for their kids through low-cost programs. Texas has such a program that works through a certain network of hospitals across the state. So, even if you don’t have health coverage, you may not have to leave your kids uninsured.

Here’s another tip that I rarely hear adjuncts mention: If any of your income is reported to the IRS on a 1099 form rather than a W-2, then you are considered “self-employed.” That means you can go right now to the National Association for the Self-Employed, join online, and have access to group insurance rates.

It also means that you are eligible to participate in a relatively new federal program for those who are self-employed or who work for companies that have fewer than 50 employees and that do not provide health insurance. Such employees can put a certain percentage of their income into a Medical Savings Account, or MSA, in conjunction with a major medical insurance policy. The money in the accounts can be used only for qualified medical expenses, but it rolls over year after year if not used and earns interest as well. It’s tax-friendly, too, which is always good for the self-employed.

Let me now turn to the major medical insurance plans, which are the ones used in conjunction with MSA’s. As an adjunct, a major medical policy is the kind you will be able to afford, especially early in your career. What is it? It’s a policy designed to cover you in case of a major medical need. It does not cover routine visits to the doctor for exams or minor illnesses. But in the event of a major illness that required lots of medical attention and cost thousands of dollars, you would be covered. The higher the deductible (the amount you pay out of pocket toward that major illness before the insurance kicks in) the lower your monthly premium. So, if you are in generally good health, a major medical policy may be just right for you.

I had one of these policies for a while. I got it through a broker, which is something else you might try since they can do the comparison shopping for you and are usually free to you, the consumer (the insurance companies pay them a commission). I was healthy, in my 30s, rarely ever went to the doctor even when I was sick, and could get a major medical policy with a $5,000 deductible and a prescription drug plan for about $120 a month or so. That was about five years ago, and rates have increased, but such a policy is still much more affordable than the comprehensive plans. And at least you have some sort of basic coverage in case of a major illness.

The truth is, it’s hell to be uninsured in this country, and there are no easy solutions that anyone, certainly not me, can pull out of a hat. Health care is a consumer product and you, as the consumer, should try to get the best deal for your money. You just have to learn as much as you can about the policies available to you and then shop around.