Options for the uninsured

Shopping for insurance coverage

If you are not already insured, here are some things to think about when looking for coverage:

• An independent broker may be able to help you find a reasonable benefit package. Group insurance is better for most people than individual insurance.
• You or your spouse getting a job with a large company is the surest way to get access to group insurance.
• Since 2010, your state has offered some type of Pre-Existing Condition Insurance Plan (PCIP) to cover people who have not had insurance for 6 months or more and have cancer or another pre-existing condition. Also, some states have health insurance options for low-income residents, in which the state pays for part of the coverage.
• Find out if there are health maintenance organizations (HMOs) or health care service plans in your community. You can sometimes get very good coverage through these plans. Many have an open enrollment period each year during which applicants are accepted regardless of past health problems.
• If you have been covered under your employer-sponsored plan for at least one day you should be able to keep your medical insurance through COBRA. Your employer is required to tell you, in writing, about your COBRA option. For more information, please see the section, “COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986)”
• Look into Medicare, which covers most people who are 65 or older, or children who are permanently disabled and have been getting Social Security benefits for 2 years.
• If you are in a low-income bracket or are unemployed, see if you are eligible for state or local benefits such as Medicaid.
• If you are employed, don’t leave your job until you have found out if you can convert your group insurance to an individual plan. Some group plans have a clause that allows people to convert to individual plans, but premiums may be much higher. You usually must apply for these individual plans within 30 days of leaving a job. (This is different from COBRA, which allows you to stay with the group insurance but only for a limited time.)

In looking at insurance options, find out about differences in coverage. Ask about these things:

• Choice of doctors
• Protection against cancellations
• Increases in premium costs
• What the plan really covers, especially in the event of a catastrophic illness (a serious illness, like cancer, that can add up bills quickly)
• How much will the deductibles and co-pays cost you? (Sometimes higher deductibles go along with better or more complete coverage.)

Be wary of ads or agents offering government-issued or low-cost health insurance. See “Fake health insurance” in the “Other things to know about health insurance” section for more on this.

If you think an insurance company has treated you unfairly, contact your state insurance commission. See the “To learn more” section to find your state insurance department.

Health insurance options for young adults

When you’re 18 to 25 years old, you may think you’re young and healthy and don’t have to worry about health insurance. Maybe you can’t afford it anyway. But even young adults have accidents and serious illnesses, and find themselves needing health care. There are health insurance options for this age group.

When choosing a plan, ask about coverage for common tests young people need, like blood tests or x-rays. Also, if you have any medical condition that you are concerned about, you might want to check with the insurance company about its policy on pre-existing conditions (medical conditions that you already have). (If you are younger than 19 you cannot be denied coverage for pre-existing conditions.) Here are some health insurance options for young adults.

Through your parent’s health coverage

The Affordable Care Act of 2010 provides coverage for young adults up to the age of 26 under their parent’s health insurance, if the plan has dependent or family coverage. This means that adult children can join or stay on a parent’s plan whether or not they are:

• Married
• Living with a parent
• In school
• Financially dependent on a parent (the young adult does not have to be listed as a dependent on the parent’s tax return)

The only exception is if the parent has an existing job-based plan and the young adult can get their own job-based coverage. If they can’t get their own job-based coverage, young adults who lose dependent coverage may qualify for COBRA even at age 26.

The insurance for young adults cannot cost any more than for dependent children under the age of 18.

Individual insurance

There are individual health insurance plans from private companies that are offered to young adults. Some of these insurers will turn you down, charge more, or not offer certain benefits if you have a pre-existing health condition. But in some states, insurers aren’t allowed to turn you down because of your health condition. This is called guaranteed issue insurance. Contact your State Department of Insurance to see if this protection applies to you. You can find your state’s insurance department in the blue pages of your local phone book, or see the “To learn more” section to contact the National Association of Insurance Commissioners. Be sure you understand the coverage offered, including yearly or lifetime limits, before you buy it.

Through your work or your spouse’s work

If your employer offers coverage, you generally can’t be turned away or charged more because of your health status. But employers can refuse or restrict coverage for other reasons (such as part-time employment), as long as these reasons are not related to your health and are applied to all employees.

Student health insurance programs

Some colleges or universities may offer reduced-cost student health insurance. Be sure you understand the coverage and payout limits. For example, coverage may be limited to $500,000 or even less per year. This may not be enough to treat a serious illness. Also make sure that you understand how long you are covered and whether you must be attending classes to be covered. Sometimes a serious illness can keep you from going to class, and that’s when you need insurance. One advantage of plans like this is that they are often integrated to cover any charges from Student Health Services, which may provide basic health care on campus. Keep in mind that many colleges and universities even offer counseling centers where students can get short-term therapy at no cost or for low cost co-pays at each visit.

Uninsurable risk programs

Some states provide special coverage for people who have a pre-existing condition (one you had before you applied for coverage) and do not qualify for individual health coverage. Your state’s department of health insurance can give you more information about your state.

Pre-Existing Condition Insurance Plans

A Pre-Existing Condition Insurance Plan (PCIP) is now offered in every state because of the Affordable Care Act. It can be administered by either the state or the federal government. You may qualify for PCIP coverage if you have been uninsured for at least 6 months, you have a pre-existing condition, and you have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. In some states you no longer have to wait for a private company to deny you coverage. Instead, you can get a letter from your health care provider stating that you have a pre-existing condition, disability, or illness.

PCIP cost isn’t based on your income. It covers major-medical and prescription drug expenses, but you must pay premiums, deductibles, and co-pays. PCIP won’t cost you more just because of your medical condition. You can learn more about PCIPs at https://pcip.gov/.

Medicaid, Indian Health Services, dependents of active duty US military, or other government aid programs

These types of programs are available for young adults, but some states exclude full-time students from these programs if the programs work mostly with low-income people.

While you are looking for health insurance

Check into Hill-Burton funds

A few hospitals and other non-profit medical facilities get Hill-Burton funds from the federal government so they can offer free or low-cost services to those who can’t pay. Each facility chooses which services it will provide at no or lowered cost. Medicare and Medicaid services aren’t eligible for Hill-Burton coverage. But Hill-Burton may cover services that other government programs don’t.

Eligibility for Hill-Burton is based on family size and income, and availability of a Hill-Burton facility. You will need to find out if there is a facility in your area that has any Hill-Burton obligation for which you may qualify. If you are cared for at such a facility, you may apply for Hill-Burton help at any time, either before or after you receive care. For more information, visit their Web site www.hrsa.gov/hillburton. There you can find a listing of Hill-Burton-obligated facilities, eligibility criteria, and frequently asked questions about the program. Or you can call 1-800-638-0742 for a packet of information.

Compare your drug list to low-cost prescription programs

Some drugstores, grocery store pharmacies, and discount stores now offer certain generic drugs at very low prices. Most of the time, these do not include cancer drugs — although some offer tamoxifen and other such drugs in their programs. Even people with insurance may be able to lower their co-pays and save money by getting some generic medicines at very low cost (often $4 to $10 for each refill).