Expert Q&A: I can't afford health insurance

5 Comment(s) Posted by Christine Sebastian

Many of you have sent in questions about how the new health care law will affect you and your family. We’ve compiled answers for select questions to our experts in a short series to help you navigate changes to the health care system. Here's the latest:

Question: I cannot afford health insurance. What options are available under health reform and what will it take to qualify?

Health reform makes health care more accessible and affordable for everyone. Here are some of the options for affordable coverage under health reform, along with information about where you can find out if you’re eligible. (Note that many of these options do not take effect until 2014, but new information sources for existing options are available now).

 1. Medicaid: You may be eligible for Medicaid depending on your income and family size. Medicaid provides health coverage for low-income children and adults and people with disabilities, and it also provides assistance with health and long-term care expenses for low-income seniors. Currently, Medicaid eligibility varies from state to state. However, beginning in 2014, health reform will expand Medicaid eligibility levels to 133 percent of the federal poverty level, or $29,327 for a family of four (according to the current poverty guidelines). This means that many more people will be eligible for Medicaid.

2. Premium Subsidies: If you don’t qualify for Medicaid, but you still can’t afford coverage, you may be eligible for help with your premium. Starting in 2014, individuals and families earning up to 400 percent of the federal poverty level, or $88,200 for a family of four in 2010, will get help paying their health insurance premiums in the form of tax credit subsidies.

3. Cost-Sharing and Out-of-Pocket Help: In addition to providing help with premiums, health reform also includes ways to make out-of-pocket costs, like deductibles and copayments, more affordable. Beginning in 2014, plans for individuals and small employers will have new caps that limit how much enrollees have to spend each year out of their own pockets to get care. And, individuals and families with lower incomes will be protected with even lower out-of-pocket spending caps. Depending on your income, you or your family may also qualify for additional help paying copayments, co-insurance, and deductibles.

Next Step – Visit HealthCare.gov to find out about health coverage options available to you both now and in 2014, visit HealthCare.gov. This new web portal will provide you with information about health coverage options in your state, including private insurance, Medicaid, the Children’s Health Insurance Program (CHIP), Medicare, plans for individuals with pre-existing conditions, and coverage for small businesses.

 

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Comments

  1. Jimmy Gibney's avatar

    Jimmy Gibney

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    need health insurance baaad
  2. Marlon's avatar

    Marlon

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    Even if you don't think you can afford health insurance, it pays to do the proper research and perhaps talk to an expert. It really isn't enough to say "I can't afford it" because it is a complex issue, and there are many different types of insurance. Besides that, aid depend on your income and other factors. I would recommend at least looking through options on an online health comparison site. Individual plans can be structured around the needs, circumstances and budgets of the individual or family. In the interests of transparency, I work with http://www.HealthCompare.com an online health plan comparison site.
  3. Ethan Perkins's avatar

    Ethan Perkins

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    I would like to know what the minimum requirements are going to be for health insurance. As in deductible limits 10000? 5000?2000? 1000? 500? This makes a huge difference in the cost of a given plan. What about copays? 50%? 40%? 30%? 20? Help on this would be appreciated.
    thanks Ethan
  4. schrodinger's avatar

    schrodinger

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    Okay, so now I have a choice. I can pay a lower premium per month in times that I don't need to use the insurance to see a doctor, in order to pay a higher per-visit rate out of pocket when I do need to use the insurance so that I can satisfy a deductible (in other words, pay for the service I get at the doctor and also pay an insurance premium for insurance that I can't use until I pay even more)... OR I can just put that money away in a savings account until the time that I need to see the doctor,and then negotiate a lower self-pay rate that's less than what the doctor's office bills the insurance companies or people who do have insurance paperwork.

    Fortunately, there are a number of doctors who are transitioning to self/cash pay only, and don't accept insurance (or who will simply fill out the claim papers for the patient to submit on their own). Other doctors do offer a lower visit fee. My orthopedist, a respected sports-medicine doctor in this area, charges half as much for a self pay as he does for an insurance claim. Plus, he offers no-interest payment plans. Pretty accommodating for a busy specialist! This is another option for people who are generally healthy.

    There are also labs that can perform required blood tests on a self-pay basis, often much more cheaply than your doctor's lab. Since they're higher volume, the saving gets passed along. No claims handling means less cost to the lab and to you, as well. You just take the doctor's requisition to the lab, and they draw the blood. You pay at the time of the visit-- no surprise bills in the mail a few months later. The results are sent to your doctor, just like any other lab result, and the tests are all done to the same standards.

    I had several lab tests, some orthopedic imaging, and some physical therapy this year and paid all out of pocket. What I spent came out to less than I would have spent on premiums, plus 20% co-pay, and I would not have satisfied the $10,000 deductible on the plan that I could "afford" so all of my medical charges would have been self-pay anyway, and at the higher "insured" rate!
  5. Jim Alverson's avatar

    Jim Alverson

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    I am 64, and receive $1441/mo from early retirement. My wife is 55, and has been determined to be disabled by the Social Security Administration. We live in a small county in Northern Arizona and can not afford health insurance, and according to the DES, I make too much money to receive Medicaid, and under Arizona guidelines my wife receives nothing from Social Security. We can not afford our medications? What can we do?

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