Sorting Out The Basics: Insurance and Health Care Tips

Overwhelmed by health insurance options? For Americans, few things conjure the financial dread of an unexpected hospital or doctor’s visit because let’s be real – even with insurance it can be painfully expensive.

Getting your financial life in order does not mean that you should ignore your health, something that could be far more costly in the long run. That said, with the future of healthcare and insurance so up in the air right now, the fear regarding this facet of American life has probably never been more heightened, but don’t fret!

This list, while only a mere starting point, can help you identify some of your options when it comes to healthcare and ideally keep you from over/underpaying to keep yourself (and your family) protected.

Medicaid, CHIP, Medicare – What’s the difference?

Let’s get the obvious one out of the way first. If you don’t earn much money, you can qualify for one or more of these programs. They’re designed to assist the most vulnerable members of our society; Medicaid and CHIP for lower income families and families with children respectively, and Medicare for seniors.

Medicaid is a state-run program and the rules that govern the program can vary a bit state-to-state. The criteria for qualification is established by your state legislature, so you can check your state government website to find out more about income criteria. For most, it’s being under ~115% of the poverty level.

Here in Illinois that’s about $1,337 a month, but the Affordable Care Act expanded those mandates – people ages 19-64 who have income less than 138% of the federal poverty level are eligible. Again, that’s about $1,350 as an individual or $1,845 as a couple.

The coverage also differs, with various co-insurances, copays, deductibles, and premiums based on your income level, but it prevents you from going bankrupt from medical expenses. Many people won’t pay much of anything, so it’s a very good option when you’re getting back on your feet, financially.

CHIP is the same as Medicaid in terms of criteria being based on income, but it expands coverage significantly for people with children (Children’s Health Insurance Program).

Medicare is a program open to Americans aged 65 years or older, people with certain disabilities under the age of 65, and everyone who has end-stage renal failure or ALS. Like Medicaid, this program covers certain things more or less, depending on the level of coverage you want. Premiums and deductibles also change.

The enrollment for all of these programs has been simplified (to an extent) with the introduction of www.healthcare.gov, following the introduction of the ACA. You can go to that site and look up your specific state, determining if you qualify for any of the above programs. They’re not completely on-par with many private insurers, but can be better in some cases, depending on your income level.

Free Clinics & Teaching Hospitals

Many cities – particularly larger ones – have teaching hospitals with free clinics. These are a great place to get checked out without spending much or any money. Most don’t even check income levels – you simply sign in and wait to be seen.

The problems that arise from these clinics is that they are often understaffed or inundated with patients. If you yourself have the patience to wait, however, you can be seen essentially for free, but you may not be seen as thoroughly as you need to be. So be mindful that a free clinic may seem great, but it’s not necessarily a great choice unless it’s the only choice.

Thought not exactly medical, some cities also have teaching clinics for dentistry, where you can get very low cost cleanings, fillings, etc done. Again, it’s a waiting game, but it may be better than paying all your savings for a cavity, or worse, not getting the care you need.

Charity Care

Many hospitals – particularly religiously affiliated ones – offer a program called “Charity Care” or something similar. Essentially, you need to prove financial burden or sufficiently low income, and they will pay off some or all of your bills.

Quick story here – When my husband and I first started dating (like maybe four dates in), he sent me a text at 3am saying “You probably won’t want to date me anymore…”

Yeah, anyone else thinking he cheated? Because I did. And I lost it. Like what the hey, we JUST started dating and you’re already cheating??!

Oh. But no…

He had a blood pressure issue and passed out at a friend’s house, concussing himself on the way down. Unfortunately, his insurance had lapsed, because he’d just graduated college two days prior. The ER bill total was around $3,500 – a bill that was pretty insurmountable for a guy working at a sandwich shop with no insurance. He spoke to the financial services department and got the bill reduced substantially, and fortunately was able to pay the rest of it off with no problems.

Negotiation

Along the lines of #3, many hospitals are very willing to work with you on your bills, provided you contact them as soon as possible after the services. Solutions include bill reduction, payment plans (some will take anything over $10/month, no matter the size of the bill), or temporary forbearance of the bill for a period of time. Failing everything else, this is almost always going to work in some way to alleviate the burden of a huge bill all at once, so don’t hesitate out of fear. The longer you put off talking to them, the harder it’ll be to reach a deal that benefits you both.

Healthcare Exchanges

This goes back to #1, because the same website – www.healthcare.gov – that you use to qualify for Medicaid will also bring you to the exchanges if you make over the Medicaid limit. The exchanges are set up to offer a premium discount on the insurance you end up buying.

The amount is, once again, dependent on your income. The issue here, however, is the exchanges appear to have a rather sizeable blind spot; for a single person without children, income amounts between around $18,000/year and $29,000 a year don’t get any assistance. Under that amount, and you probably qualify for Medicaid. Over it, you get the premium assistance. It’s frustrating at times, but it’s another tool to ensure that you’re insured, and the premium assistance is actually pretty significant – typically at least half.

Student Insurance

Because of the ACA, most colleges – particularly state colleges – have started mandating that their students are covered by some level of insurance. Because of this, those same colleges usually offer student insurance at a significantly reduced rate.

For instance, a local University’s plan looks like this:

Blue Cross Blue Shield
$400 deductible
~ $110/month premium
They pay 80% after your deductible is met and they only require copay on prescriptions

This is incredible coverage, even if the price were doubled. The only caveat is you need to be taking at least 1 credit hour of on-campus classes, but one credit + the cost of insurance would still only be about $210/month.

Enrollment is automatic, and even with class fees and tuition, you’re still possibly looking at less total cost than healthcare on the exchanges, depending on your situation. In addition, if you’re already going to college, it’s totally worth it in most cases to be enrolled in the student insurance (unless you’re still under your parent’s plan).

Charities

Along the lines of charity cares specific to a hospital, local charities often help pay difficult medical bills for families in need. Check with local churches, and often food banks or crisis/domestic violence care centers will have contact information. Again, this is more of an “emergency” sort of situation, but it’s worth asking if you need the help.

Health shares

Health shares are newer programs that are typically structured around faith communities. In it, people share the cost of medical procedures across a very large group. This creates a scenario where someone will be covered for anything because everyone pays into the pool, and everyone benefits. These are typically tied to Christian communities, but if you’ve got the option, they may be great for you.

Living frugal means living healthy!

Medicine is about helping people, not bankrupting them. Without going into a broader, more convoluted conversation, let me just say that health insurance shouldn’t be as intimidating as it is. We all deserve the opportunity to make healthy choices and see a doctor when needed. And as I said, I know this list is just a small dip into the world of health insurance, but hopefully it’ll help you get started on making better choices today.

Do you find making health insurance choices overwhelming?

Sound off in the comments below and let me know what you think!

Healthcare and Insurance Options - Where Do I Start? Overwhelmed by health insurance options? This list, while only a starting point, can help you identify some of your options when it comes to healthcare. #insurance #healthcare #healthinsurance #medicaldebt

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