Health Insurance: Putting Adjunct Faculty in the Picture

by Jo Gibson

Right now,” Diane said, sitting at her desk in the adjunct faculty offices, “I’d probably faint dead away if I were offered health insurance through my job. This is no joke. As an adjunct, I feel like I’m
in the only profession that allows me to be a professional, while
continuing to live like an undergraduate. So I’m going after an
M.A. in Counseling. I want to diversify my skills, but I’m also looking for job security and benefits, too. Of course,” she deadpanned, “right now I feel like I’m taking a second ‘vow of poverty,’ not going after a second advanced degree.”

Michelle, on the other hand, doesn’t want to think about doing anything else.

“I love teaching, and I don’t like one day to pass when I don’t feel I’ve made a difference in some student’s life! And I know, worrying about health insurance doesn’t seem right balanced against that. I’m going to sound pitiful here, but I’ll give you the facts: I’m epileptic and I need $250 worth of medication a month to control it. Not having insurance to cover this is bad enough, but struggling to make rent and food, coupled with not having enough for medication, is an unimaginable pressure.”

Whenever adjunct faculty talk about health insurance, they are troubled — “I’m struggling … “ “It’s my biggest concern …” “If only the university offered minimal coverage ….”

Research findings show reason for concern:

Commenting on what he has observed, Richard Moser, Ph.D., Associate Director at the American Association of University Professors (AAUP) terms it “far from ideal, for both tenured and adjunct faculty.” While the former find themselves with fewer benefits, an increase in health insurance co-pay, and costs rising well above the inflation rate, it’s the latter who are severely disadvantaged.

“The majority of universities and colleges,” Moser reports, “do not offer health insurance benefits to their adjunct faculty. While health insurance ought to be, in this, the richest country in the history of the world, a basic right and a non-issue, it continues to hinder the economy and is a serious problem for millions of Americans. Clearly, the federal government has priorities other than our health. The bottom line is, it’s a crisis, a crisis everywhere.”

Not to put too fine a point on it, but the picture painted does seem bleak.

But take heart. There are things that adjunct faculty can do to expand their health insurance options.

Start reading

If you want to start with a book, you could use the “Navigating the Health Insurance Maze” chapter in Healthcare Online for Dummies (Howard and Judi Wolinsky, Hungry Minds, Inc., New York, 2001). But be wary.

“Health insurance is dynamic,” according to Kala Ladenheim, Ph.D., Program Manager with the National Conference of State Legislatures, “and any book only tells you how it is at that moment in that one place. Laws vary from state to state, and if you live in Montana you’d need one book and if you live in Massachusetts you’d need another one.”

Note: Because the health insurance industry is constantly responding to changing conditions, and because rules are so state-specific, reliance on Web-based information as a first-line research tool is wise.

Learn the lingo

As you begin by surfing on the Internet, using your favorite search engine and some key terms, you’ll encounter “health-insurance-speak.” You’ll want to know a few terms going in, to understand the basic categories of health insurance:

Fee-for-Service: With the “fee-for-service” arrangement, the insured choose their physician and/or hospital, and the insurance companies reimburse the physician and/or hospital for services rendered. This indemnity-type insurance, an expensive option, is sometimes called “major medical.”

Managed Care: As noted, the health insurance situation changes frequently, as companies attempt to control costs by consolidating and coordinating medical services. The term “managed care” is a general term used to refer to the hundreds of permutations of health insurance packages, which typically fall into one of two categories:
PPO: A Preferred Provider Organization is a network of medical professionals who provide discounted services to those who are insured. You may elect to go outside of this network for some health services, but there is a financial penalty.

HMO: Health Maintenance Organizations, like the PPOs, are health plans that contract with particular medical groups to provide medical service for a fixed rate. A traditional HMO, with no choice outside the network, is the most economical option.

For all the many other terms that you are certain to encounter, e.g., pre-existing condition, premium, co-pay, cap, deductible, as well as the acronyms (COBRA and HIPAA will be of interest if you’re leaving full-time employment), you’re in luck. Most Web sites feature a “Frequently Asked Questions” (FAQ) link that leads to a glossary or definitions of terms.

Be realistic

The chances are that you’re not going to find cheap insurance (premiums under $2,000/yr., for instance) with no deductible, no co-pay, and a fee-for-service plan, even if (best-case scenario) you’re under 25, don’t smoke, are not overweight, have no incipient medical condition, are not pregnant, and have never had to use healthcare services before in your life. Remember, if it sounds to good to be true, it probably is.

But it’s not necessarily as bad as it sounds. Paul Fronstin, Ph. D., Director of Health Research and Education Programs for EBRI (Employee Benefit Research Institute), offers this helpful advice: “Adjunct faculty who are young and healthy will probably be able to find some marginally comprehensive private health insurance that meets their needs and is not a budget buster. As employees get older, and especially if they have complicating health factors, the insurance will get more expensive. In some cases, it may not be available. In short, for some segments of the population, there will be fewer options.”

Obtain quotes

The following sites are good starting points, and you’ll be surprised to see how easy it is to compile a list of at least 40 insurance plans. The sites are user-friendly, and you’ll be led efficiently through the process:

http://www.ehealthinsurance.com

http://www.insure.com

Do the research

Once you have completed the groundwork, you will have generated some specific options and will have some insurance companies on your list. (You’ll see a variety from state to state: in Colorado, for instance, you may find Golden Rule and Celtic on your list; in Ohio, Anthem Blue Cross and Kaiser; in Washington, Group Health Cooperative and Life Wise Health Plan; in California, Pacific Care). Now, you can begin your detective work.

First, you need to recognize that the information you have at this point is preliminary. As Karen Pollitz, Project Director of the Health Policy Institute at Georgetown University, points out, “The quotes that you obtain on-line give you simply a general idea of what’s available, not the universe of possibilities. Insurance companies such as the ‘Blues’ [Blue Cross / Blue Shield], which continue to have the majority of the market share, are not always part of the on-line quotes. Also, you need to know that the on-line quotes represent premiums for people with no health problems. Underwriting may change the quote.” (You might contact http://www.bcbs.com for information on Blue Cross/Blue Shield, to add to your mix.)

Look for other ways to expand your list. John Curtis, Ph.D., Director of Research with AAUP, frankly states that “part-time faculty really should have access to group insurance through their employers, but absent that, the best strategy is to compare rates and coverage from as many different sources as possible.” You can look, as Colette did, for a medical insurance plan through a professional/academic organization or alumni group. An enterprising adjunct, she took a second part-time job as a Financial Representative, knowing that as a “self-employed” worker she could join a professional association which offered group health insurance.

Yet, as you enlarge your search and obtain additional quotes, you must examine each company on your list. Wise consumers want to know how the law works in their State, understanding that there are marked differences from State to State in terms of the legal protections offered vis-à-vis health insurance. For openers, Pollitz suggests visiting http://www.healthinsuranceinfo.net to obtain a copy of the “Consumer’s Guide to Getting and Keeping Health Insurance” for your state. Authored by Georgetown University researchers, there’s a guide custom-tailored for each state and the District of Columbia. The Guides explain your state’s legal protections offered you against age and/or health status discrimination and highlight the possibilities for reduced-fee medical aid. This Web site also features “Consumer Alerts,” bringing to the fore those instances when an unlicensed and illegal company has sold health insurance (many times–alas–via professional organizations) to small businesses and/or the self-employed.

To grade the various health insurance companies and their plans, so that you can pick the best one for you, you’ll gather specifics about their performance. The premiere consumer link to help you with this task is http://www.naic.org. At this National Association of Insurance Commissioners site (NAIC) you’ll find vital consumer information. The Consumer Services link leads to answers to important questions:

As you close in on your short list, remember that the cheapest is not necessarily the best.

“Think carefully,” Pollitz notes, “before buying less. Evaluate your risk exposure. Being underinsured is in many ways as bad as being uninsured.” She recommends that, at a minimum, the insurance coverage you’re offered (1) define the deductible and the co-pay, (2) offer 365 day hospitalization, (3) guarantee your monthly rate up front.

Become an activist

The chances are that researching the subject of health insurance made you more aware, and you’ll want to: