Understanding Your Options
Grant seekers are often unaware of the free and low cost health insurance available to families and individuals with limited income. Because insurance plans are offered and managed at the state level, grant seekers will need to investigate what’s available in their state. Be assured you do not need a high income to secure insurance and subsidies. Help and assistance is available from the federal government to keep costs down.
Uninsured Americans can and must secure their own health insurance or face stiff financial penalties. One goal of the Affordable Care Act (ACA) was to provide a means for insurance companies to compete for business. It was hoped that this open competition would drive prices down. Additionally, the ACA wanted to give consumers some freedom to choose a plan based on their individual needs and preferences. Merging these and other goals into statewide systems resulted in anywhere from four to over one hundred options to choose from. Understanding the system can help you know what steps to take.
Navigating the Jargon
Medicaid – Medicaid is available nationwide. It is a free or low cost social program that provides health care for individuals and families with low income. The eligible income level varies from state to state. You will need to check the exact level for your state first. Many self-employed and full-time employed individuals and families have incomes that qualify them to receive benefits under Medicaid.
Expanded Medicaid – 31 states plus the District of Columbia have expanded Medicaid. 19 states do not have expanded Medicaid. Louisiana has not yet ruled. Under expanded Medicaid, families may earn up to 133% or higher of the poverty line for their state and still be eligible for Medicaid.
CHIP (Children’s Health Insurance Program) – CHIP is low-cost health coverage for children in families who earn too much to qualify for Medicaid. Each state has its own program, but in all states CHIP and Medicaid coordinate on coverage.
Affordable Care Act – This is the federal statute that establishes current standards. This act regulates who must have health insurance, what insurance plans must provide, and who is eligible for federal subsidies.
Obamacare – The everyday name for the Affordable Care Act. The Affordable Care Act and Obamacare are the same entity called by two different names.
Health Insurance Marketplace – Each state has its own marketplace where you can purchase a government-regulated health care plan. Government subsidies are available only through the marketplace; so if you are uninsured and eligible for a subsidy, you must purchase your insurance through the marketplace to receive the subsidy.
Health Exchange – Marketplaces are also referred to as health exchanges.
Open Enrollment – During open enrollment months, which typically come between late fall and late January, individuals and families may sign up for Obamacare and receive the best discounts. Outside of open enrollment months, you may qualify for short term insurance or may enroll with a Qualifying Life Event. Medicaid is always open and does not require a Qualifying Life Event for enrollment.
Special Enrollment – The months outside the open enrollment period are called the special enrollment period. During special enrollment, you can enroll in Obamacare without penalty if you have a Qualifying Life Event.
Qualifying Life Event – The provision to enroll anytime with a Qualifying Life Event allows you to sign up for Obamacare if you are in one of the designated situations. The most common events are loss of health coverage; marriage; new child in the home either through birth, adoption, or foster care; moving to a different state; or a change in household income.
Understanding the Process
Research eligibility in your state – Your eligibility for free or low cost health care programs and discounts is determined by where you fall within state guidelines based on your income and household size. On nearly all health care websites, the first information you are asked to provide is your zip code. From your zip code, you will be directed to plans available in your state.
Medicaid, CHIP, or Marketplace? – After giving basic personal information including your income and household size, you may be directed to Medicaid or you may be directed to the Marketplace. Regardless of where you are directed, look up the Medicaid standards for your state. If your annual income falls below the line set by your state either under Medicaid, Expanded Medicaid, or CHIP you may apply for Medicaid. It is not necessary for you to enter the Health Care Marketplace and choose your own coverage if you are eligible for Medicaid.
Federal subsidy? – If you make too much for Medicaid, you may still qualify for a federal subsidy toward your monthly payments. On the Health Care Marketplace, your subsidy will be automatically calculated. 8 of 10 uninsured individuals are eligible for some subsidy in the Marketplace.
Finding The Right Coverage For You
Is your doctor in the plan? – If you have a doctor that you are determined to stay with, you will need to choose a plan that your doctor participates in. Also consider the hospitals, labs, and other facilities included. You will want to choose a plan that has conveniently-located, quality facilities and providers.
What percentage of which prescriptions are covered? – Prescription costs can add up quickly. Choose a plan that covers medications you currently take or are likely to take in the coming year.
What is the real cost? – The total cost of your health care is much more than the monthly premium. Depending on the plan you choose, you will need to pay a deductible which could be several thousand dollars. Also, you may be responsible for copays on doctor visits or for a percentage of all services you receive.
Get help – Insurance company customer service representatives are professional, responsible, helpful sources of information. They can get you through the chaos and find the plan that fits your needs.
The bad news – Securing the best plan for you may require extensive research and may put you on more call lists than you imagined possible.
The good news – You can get health insurance for your family – and quite likely, you are eligible to get quality coverage either free or with substantial discounts.
Many individuals seeking low-income grants have a variety of immediate needs. Perhaps health insurance is not on the same level as food or clothes, but when you’re sick, have an unexpected accident or are diagnosed with a disease, it moves directly to the top of the list. While not a glamourous way to spend a Saturday afternoon, understanding and reviewing your options is time well spent. Give yourself and your family peace of mind while not adding another large expense to your budget.
