Answer: More than half the states have banned the use of Social Security numbers on health insurance cards, but those laws don’t apply to the federal Medicare program. Unless Congress acts to change the federal law, you’re stuck with having your Social Security number as your Medicare identifier.

The Privacy Rights Clearinghouse recommends you protect yourself from identity theft by making a copy of your Medicare card and using a black marker to cross out the last four digits of your Social Security number, or cutting out the last digits with scissors. Then you could carry that version of your card, so that if your wallet is stolen the thief doesn’t have access to your full number. You would still need to bring your original card the first time you visit any new healthcare provider, but you wouldn’t have to carry it with you all the time.

Answer: Eating healthful food, exercising, maintaining an appropriate body weight and investing in preventive healthcare can lower healthcare costs on average. But no individual, no matter how vigilant, is immune from an accident or illness that can result in catastrophic medical bills.

So you’re right that people who voluntarily go without health insurance are deluding themselves. They’re pretending they have the sole power to determine their future health, when that’s clearly not the case.

And the extra costs can be signficant, according to a recent article in the Washington Post. A 90-pill bottle of anti-cholestrol med Zocor costs $459.98, while 90 pills of simvastatin, the generic version of Zocor, are only $83.97. At pharmacies that have $4-a-month generic drug programs, such as Target and WalMart, you could shrink the cost to $12.

With a few exceptions, generics are essentially the same as their brand name counterparts, but many doctors still (not entirely rationally) distrust them, the Post noted. There are other reasons for insisting on brand names, the article goes on to say.

It is also habit. Brand names are the names doctors most easily remember. Drug samples left in physicians’ offices — seemingly a free gift for doctors to dispense and patients to receive — make them more memorable. Often, sales representatives will treat a physician and his staff to lunch, and leave behind an array of pens, coffee mugs and USB memory sticks branded with the name of their drugs.

Advertising also has an effect, both on doctors and on patients, who ask for specific drugs they’ve heard mentioned on TV.

Want to save money? Ask your pharmacist about generic versions of any drugs you’re prescribed, and question your doctor if DAW is on your prescription.

Answer: You were better off not using the credit cards. If you hadn’t charged your medical bills, you probably could have negotiated a lower settlement amount with the hospital and medical evacuation company.

In many cases, people without insurance are initially charged more than those whose insurance companies have negotiated lower rates. We’re not talking minor discounts, either: The “sticker price” for hospital care for an uninsured person can be two or three times the price paid by insurers, according to the National Consumer Law Center.

Medical providers in these situations are often willing to settle for the lower, negotiated rate, but you have to ask.

Also, most hospitals have charity programs that could have paid some of the cost if your income isn’t high. A typical charity program would erase bills for people whose incomes equal 200% or less of federal poverty limits, and would offer discounts for those with incomes up to 400% of those limits.

Even if you didn’t qualify for the charitable program, a close review of your bill might have turned up errors that, if corrected, could have lowered your cost.

Furthermore, most medical providers have payment plans that would have allowed you to reduce your debt over time at a much lower interest rate than what you’re probably paying on your cards.

Now that you’ve charged these bills, you have to make a realistic assessment of whether you can pay them off within five years. If not, bankruptcy may be a better option. A Chapter 7 liquidation would allow you to erase unsecured debts such as medical and credit card bills, but may not be available if your income is too high. In that case, a Chapter 13 repayment plan would require you to repay some of your debt over the next five years and erase any remaining bills after you completed the plan.

Alternatively, you might negotiate a settlement with your credit card companies.

Any option other than paying your bill in full will trash those excellent credit scores. The damage won’t be permanent, but it initially will be severe, and it may take several years for your credit to fully recover.

Answer: The good news is that many countries (although obviously not all) offer high-qualify healthcare that’s less expensive than in the U.S. Still, it’s smart to have insurance coverage.

Kathleen Peddicord, author of “How to Retire Overseas,” says you typically have two options: in-country and international policies. In-country policies tend to be less expensive (some cost as little as $100 a month) but may be tough to qualify for if you’re in your 60s or older. International policies are more expensive but you can qualify as a new client if you’re younger than 75. Furthermore, international policies will cover you if you move from country to country; an in-country policy won’t.

As you research your retirement destination, contact expatriates who live there to ask about their health insurance coverage, as well as about other details of their lives. You can start with Peddicord’s site, LiveandInvestOverseas.com, but also check out International Living (internationalliving.com and find country-specific sites by typing the name of the country and the word “expat” into an Internet search engine.

Answer: Going bare really isn’t smart, since a single accident or illness can bankrupt you. And you typically have to exhaust your COBRA coverage before you (or your wife) can be eligible for continuing coverage under HIPAA, the Health Insurance Portability and Accountability Act, which requires insurers to cover people even if they have pre-existing conditions. Canceling your COBRA coverage prematurely could make it tough or impossible to find replacement coverage.

Your best option (other than finding a job with health insurance benefits) may be to choose a high-deductible policy. You’ll have to pay for most healthcare out of pocket, but you’re protected from catastrophically high expenses should you or your wife become injured or sick. You might want to seek out an experienced insurance agent who is familiar with plans in your state for more advice.

This is for a policy that has a $5,000-per-person deductible ($10,000 family). Eight years ago, when we first secured coverage, the premium was less than $250 a month.

We’re not alone. Our insurer, Anthem, is jacking rates on thousands of its policyholders, as this Los Angeles Times article attests. California’s insurance commissioner says he’s “very concerned.” I’ll bet.

Anthem is blaming this on rising health care costs. Insurance agents are saying Anthem’s trying to rid itself of less profitable policies.

Anthem does offer policies with even less coverage that might save us some money on monthly premiums, but we’d have to go through underwriting again—and our insurance agent doubts we’d pass.

Why is that, you might ask? Do we have cancer, diabetes, heart disease?

No. Neither of us is overweight. We don’t drink or smoke, we exercise regularly and we’re in excellent health.

But I’m over 40, and my husband is over 50, and we each take a prescription medication. Mine’s for an underactive thyroid. My husband’s cholesterol is a little high.

That’s it. But that’s enough to prevent us from getting new insurance.

There is nothing about this situation that isn’t insane.

I don’t believe insurance should cover every sniffle and check-up. I was fine with paying most of our family’s health care costs out of pocket, as long as we had protection against catastrophic expenses. But I also expect insurance companies to hold up their end. When they cherry-pick their customers, drop those who are sick and jam through eye-popping rate increases, they aren’t providing insurance in any real sense of the word. They’re not pooling risk; they’re evading it.

The good news is that we can afford this increase, and probably a few more to come. Others can’t. One of my friends got a notice that her premium is going up to $500, and she can’t pay it. She, like many of Anthem’s other customers, will be going bare.

Kathy Kristof writes in this thoughtful column that the reason health care reform is dead is that Congress doesn’t understand what insurance should really do.

So instead of getting what we needed—coverage that’s available, affordable and there when you need it—we got squat.

UPDATE: The Los Angeles Times is reporting that the Obama Administration has called on Anthem to justify these huge price increases. Health and Human Services Secretary Kathleen Sebelius, who used to head the National Association of Insurance Commissions, wrote that Sebelius said that Anthem’s “strong financial position” made the increases “even more difficult to understand”:

These extraordinary increases are up to 15 times faster than inflation and threaten to make healthcare unaffordable for hundreds of thousands of Californians, many of whom are already struggling to make ends meet in a difficult economy.

And that was before the recession kicked into high gear.

The results are from the Commonwealth’s 2007 survey of 2,616 adults. The survey has an overall margin of sampling error of plus or minus two percentage points. (That basically means the survey is scientifically accurate, for those of you who fell asleep during statistics class.)

Women are far more likely to be affected by rising health care costs than men because women have lower average incomes and higher out-of-pocket costs and are more likely to seek care, the fund reported.

Here are the lowlights:

• 52 percent of women had any one of four problems getting needed health care because of cost compared to 39 percent of men: did not fill a prescription; did not see a specialist when needed; skipped a recommended medical test, treatment, or follow-up; or had a medial problem but did not visit a doctor or clinic.
• 45 percent of women accrued medical debt or reported problems with medical bills in 2007, compared to 36 percent of men.
• Women were also more likely to skip tests and screenings: almost half of women (45%) delayed or did not receive a cancer screening or dental care because of costs, compared to 36 percent of men.
• The proportion of women earning $40,000 – $60,000 who spent more than 10 percent of their income on out-of-pocket health costs increased from 21 to 41 percent between 2001 and 2007; 17 percent of women with income over $60,000 had high out-of-pocket costs in 2007.
• About  one-third (34%) of women with incomes of $60,000 or more reported problems getting needed care because of cost, as did  23 percent of men with similar incomes.
• Six in ten women with moderate incomes (between $20,000 and $40,000) report being unable to pay medical bills, being contacted by a collection agency for unpaid medical bills, changing their way of life to pay medical bills or paying off medical debt over time, as did almost half (46%) of middle-income women. About 50 percent of men with moderate incomes and 32 percent with middle-incomes reported medical bill problems.

For more on health insurance, read:

• “Survival guide for the uninsured“
• “Know your COBRA rights“
• “Laid off? Your work’s just starting“

If you elected to take COBRA — which lets laid-off workers continue with their former employer’s coverage for up to 18 months — the government will now subsidize 65% of COBRA premiums for up to nine months. The subsidy is limited to workers laid off from Sept. 1, 2008, to Dec. 31, 2009.

COBRA is not cheap. The average monthly COBRA premium for individual coverage is $388, or about 30% of monthly unemployment benefits, says the Families USA Foundation. The monthly COBRA premium for family coverage is $1,069, or about 84% of benefits. So getting those premiums reduced by 65% is a big savings.

Employers and health plans will be sending notices to former employees about the aid plan, and the U.S. Department of Labor will post updates on their Web site HERE.

The California Society of CPAs – the nation’s largest professional, non-profit state association of about 33,000 CPAs – suggests going through this checklist of questions when deciding what to do about COBRA:

1. Can you get coverage through your spouse or domestic partner’s employer?
2. Can you continue your coverage through COBRA?
3. Find out if your state has any laws or programs that can help you
4. Find out if you are eligible for Trade Adjustment Assistance and the Health Coverage Tax Credit that comes with it
5. Ask if you or any family members are eligible for Medicaid, the Children’s Health Insurance Program or VA coverage
6. If you can’t afford COBRA and can’t get help through any public programs, shop carefully for insurance on the individual market
7. And finally – realize that you may not be eligible for COBRA. (If your employer had fewer than 20 workers or went of out business completely and no longer has a plan – you don’t qualify.

Check out some of my previous columns on this topic:

• A survival guide for the uninsured

• Job at risk? Save your insurance

• How early retirees insure their health