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- Health Benefits Advisor

Other Coverage

You may be able to buy health coverage for yourself and your family other than through your job or your spouse's job, Medicaid, Medicare or SCHIP (State Children's Health Insurance Program). Coverage may be available from an insurance company or an HMO (health maintenance organization) or through your membership in a student, professional, or other type of association (such as AARP). In addition, some states also make health coverage available through high risk pools. Generally, your state insurance department regulates the kinds of coverage offered, the cost of the coverage and the terms and conditions of the coverage.

In addition to any other health coverage that might be available, each state must "guarantee access" to health coverage with certain features for eligible individuals.

For information about eligible individuals, contact the Centers for Medicare and Medicaid Services or your state insurance department .

How to Choose Among Health Coverage Options

Depending on your circumstances, you and your family members may have health coverage options available besides guaranteed access coverage for eligible individuals. Before making any decisions, you should carefully consider information about other coverage for which you and your family members may qualify.

In choosing among the options available to you, you should review the SPD (Summary Plan Description) for each available group health plan to determine which plan best meets your needs. You should also review and compare the information on the other coverages for which you are eligible. In making your decision, you may want to consider such things as:

  1. Any waiting period (or affiliation period) imposed under the plans;
  2. Types of benefits offered (Is dependent coverage available? Do the benefits cover your family's medical needs?);
  3. Cost of coverage (premiums, co-payments and deductibles for prescription drugs and doctor visits);
  4. Limitations on coverage (annual or lifetime dollar limits, visit limits, pre-existing condition exclusion period, prescription drug coverage limits, or limits on the availability of doctors and hospitals); and
  5. Any exclusions from coverage (treatments, procedures, conditions or prescription drugs).

NOTE: Whatever coverage you choose, you should try to avoid incurring a significant break in coverage, especially if you or a family member has a medical condition that requires regular medical attention. A significant break in coverage is a period of 63 consecutive days (or longer in some states) without health coverage. Depending on the circumstances, avoiding a significant break in coverage may enable you and your family to shorten or eliminate any pre-existing condition exclusion period or to qualify for the individual coverage with special protections described above.

To find out about other kinds of health coverage that may be available, return to the Legal Separation/Divorce Page and select another option.