If you've explored health insurance options lately, you know that medical coverage costs "an arm and a leg" -- and that's presuming you've met the huge deductible and forked up the co-pay.

To further add insult to injury, once you've sacrificed your body parts, you'll need your insurance company's approval before the doc can prescribe the pain medication you'll need.

You can't deny the sickening feeling that all is not well with your medical benefits -- that is, if your employer still insures you. Employer-sponsored health insurance is becoming harder to find.

According to a recent survey by the Kaiser Family Foundation, the number of companies providing health benefits to employees dropped to 60 percent in 2005, down from 69 percent in 2000.

Even if you're lucky enough to be covered by your employer, you're probably paying more out of your pocket in return for reduced benefits. This is not a healthy trend.

But you can't place the blame solely on your employer. Healthcare costs are growing five times faster than wages, placing an enormous burden on businesses that provide coverage. Starbucks spends more on health insurance for its employees than on raw materials needed to brew its coffee. And Ford Motor Co. spends more on healthcare than for steel. It’s no wonder that more and more companies don't offer health insurance.

If you lose your job, or even quit voluntarily, you risk losing coverage, not only for yourself but also for your entire family. Only seven percent of the unemployed can afford to pay for COBRA health insurance, the continuation of group coverage offered by their former employers. Premiums for this coverage average almost $700 a month for a family and $250 for an individual: a very high price given the average $1,100 monthly unemployment check.

More than 45 million Americans currently lack health insurance. Meanwhile, a political standoff in Washington has blocked an honest evaluation of any major approach and has left everyone frustrated.

Conservatives propose encouraging individuals to buy private health insurance while liberals lean more toward publicly financed health coverage. Neither has persuaded the other. Meanwhile, the ranks of the uninsured swell, health costs soar, and states and businesses cut benefits.

So what does all this mean for you?

For starters, you can no longer assume that your employer or your elected officials are looking out for your health. Lily Tomlin was right -- "we're all in this alone.” So if you're considering changing jobs or accepting a new offer, you better take a hard, close look at your total compensation package. An increase in salary can easily be swallowed up by hidden health benefits costs.

Here are some questions to help you assess a prospective employer's medical coverage:

* What type of medical plan is offered? PPO, HMO, Blue Cross Blue Shield, Other?

* What expenses are covered? What is not covered?

* How much have the premiums increased over the past three years?

* How has the employer responded to these cost increases?

* What percentage of the cost does the employer pay?

* Are there deductibles and co-pays that must come out of your own pocket?

* Are there any exclusions for pre-existing conditions?

* Does the plan have open enrollment? Is there a waiting period?

* Does the plan require any medical exams or other evaluations prior to enrollment?

* Are there dental and vision care insurance options? Do they cover mainly exams or are surgical procedures covered?

Some companies also offer life insurance, which may cover the basic expenses in the event of unexpected tragedy, and accidental death insurance, which will pay more if your death is of a more spectacular nature, as if it somehow matters how you die. If they offer it for free, take it, but don't buy additional amounts. It is usually better to purchase additional insurance separately.

Despite the downsizing of benefits, smart employers are compensating with a range of additional perks, including such things as parking reimbursement, extra "floating" holidays, onsite childcare, extended leaves or sabbaticals, community volunteering on company time, telecommuting, gym memberships, recreation facilities, concierge services, take home meals, employee entertainment and product discounts, all designed to put more money in your pocket.

A thorough benefit-cost analysis, which includes an assessment of these non-monetary rewards, will help you adapt a healthy outlook. You may find that you can't always get what you want. But if you try sometimes, you just might get what you need.