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With the state unemployment rate in the double digits and some 7 million Californians without health coverage even before the recession, you can only imagine how much worse the problem is now. The health insurance maze is daunting, to be sure. But there are plenty of options and resources if you know where to find them. Here are 10 tips to get you started.
One laid-off friend said she couldn’t afford COBRA “because it cost some horrid amount—about $400 a month.” And that’s just for an individual plan; a family premium could run three times that amount. But that was then, this is now: Rates have been slashed by up to 65 percent thanks to the American Recovery and Reinvestment Act, a federal stimulus bill enacted Feb. 17. The cut rate is available for up to nine months to those who lost (or lose) their jobs between Sept. 1, 2008, and Dec. 31, 2009, and are eligible for coverage under COBRA (the Consolidated Omnibus Budget Reconciliation Act), a federal program that allows terminated workers to continue on their former employer’s health care plan, typically for 18 months. The problem with the “old” COBRA was that unemployed workers had to pay the full cost of the premium, making it unaffordable to most. But with the dramatic new discount, COBRA actually serves the very audience it was originally intended to help. (How ’bout that?) There are restrictions, of course: You can’t take advantage of the bargain if you’re eligible for Medicare, for example, and if you make more than $125,000 (individual) or $250,000 (couple) in the year you receive the subsidy, you might have to pay some or all of the money back. But hey, those aren’t the folks we’re worried about, anyway: It’s the average Joe who’s out of a job and can’t afford to buy costly health insurance. If you turned down COBRA because it was too expensive at the time, you may want to take a second look.
Get on your partner’s plan
If your spouse or domestic partner’s employer offers a health insurance plan that is open to family members, see if you can hop on. If you lose your health benefits due to a major event (such as job loss), you may be able to join even if it is not open-enrollment season.
Consider “emergency” insurance
Ever since he became an independent contractor nearly four years ago, Jeff Ghiselin has been singing the health insurance blues. “I just can’t afford it,” says Ghiselin, a Sacramento resident and gun-for-hire operations manager for athletic events. “The least-expensive plan I found was $400 a month.” So he went for the bare-bones approach: emergency insurance to protect him in case of an accident. The cost? Only $25 a month for $25,000 in coverage. At 36 and more fit than most—he’s a mountain biker—Ghiselin isn’t especially worried about getting sick. But he also knows accidents can happen. “The main reason I keep [insurance] is in case of a car wreck,” he says. So far, he’s been lucky: Not only has he been auto-accident-free, but he’s been illness-free, never once requiring medical attention in the years he’s gone without comprehensive coverage. “I’ve cut my hand pretty bad in the kitchen,” he says, “but who hasn’t?” This is where his first-aid training comes in handy, says Ghiselin: It keeps him from running to the emergency room at the slightest sign of blood. (Probably good advice for everyone.)
Don’t assume you can’t afford it
As a single, self-employed freelance writer, I always have found “affordable health care” to be an oxymoron. But recently, after Kaiser tried to bump up my rates to nearly $500 a month for a comprehensive, low co-payment plan (including dental), I decided to tackle the monster head-on. To my great surprise, the HMO giant offered a number of plans at various price levels; I just had never taken the time to compare them. By choosing a plan with a $2,700 deductible—the amount I have to pay in a calendar year before Kaiser pays for certain services—I shaved about $200 off my monthly premium. Another plus: Preventive services, such as mammograms and annual physicals, are free. A peek at Blue Shield’s rates revealed potentially even better deals, but I didn’t feel like starting from scratch with a whole new batch of doctors (and a new system), so I stayed put. The bottom line: A little research can save you big bucks, even if it makes your head hurt.
Consult a broker
If you don’t want to go it alone, you may want to consult a health insurance broker who can help to steer you toward the right plan. “I don’t think most people even know that brokers exist,” says Lee Ann Trumbull, a local broker and board member of the Sacramento Association of Health Underwriters. But as increasing numbers of Sacramentans lose their jobs and confront the COBRA conundrum, she says, more clients are coming her way. In addition to offering guidance and information on insurance options, Trumbull says brokers also serve as advocates when their clients bump up against the system and don’t know where to turn. “When people buy insurance online or buy it directly from the insurer, they don’t have a representative—they just have an 800 number,” says Trumbull. But a broker will assist a client with any number of issues, she says, from denial of coverage to out-of-area claims. For all these services, a client pays no actual fees, says Trumbull, though a portion of the monthly premium pays the broker’s commission. And, contrary to popular belief, independent brokers are not employed by insurance companies, she notes. To find a licensed agent or broker, visit nahu.org, the website of the National Association of Health Underwriters.
Try an individual plan
Individual plans generally cost 30 per-cent to 50 percent less than group or family plans, says Trumbull, so it’s one of the first things she recommends to her clients. Like an a la carte menu, many plans allow you to pick and choose your points of coverage, she explains, resulting in a lower premium. A high deductible will help to drive down the cost, too. “You may not need or want maternity coverage or drug/prescription coverage, for example,” she says. “Why get a comprehensive plan if you’re having difficulty making the monthly payments?” If you’ve been laid off, Trumbull suggests assessing which, if any, family members may qualify for individual coverage and which may not. “It may be that you’re in great health, your wife has cancer and you’ve got a 19-year-old son or daughter in college,” she says. “So maybe you can qualify for an individual plan, your wife can remain on COBRA, and you can find a low-cost plan for your daughter at the college’s student health center.” While many unemployed people take their chances and forgo insurance entirely, hoping a new job with benefits comes along before the next medical problem hits, experts don’t advise it. In addition to the risk of facing a whopping bill if a medical emergency arises, the lapse in coverage may come back to bite you, especially if you have a pre-existing condition.
Look for discounts
If you’re a member of a professional or social organization, you may be in luck: Many offer discounted group rates on health insurance. And sometimes help is as close as your own backyard. Both Sacramento State and UC Davis offer medical coverage through their alumni associations, for example, including short-term plans that may be perfect for people between jobs. Self-employed folks may want to check for deals th-rough the National Association for the Self-Employed. Go to nase.org or call (800) 232-6273.
Ask what your government can do for you
“We’re seeing a lot more people who are needing help with government-sponsored programs like Medicare,” says Rosemary Younts, director of community benefit for Catholic Healthcare West/Mercy in Sacramento. Why? Simple: With the number of jobless on the rise, the number of insurance-less also rises. Younts says the staff at CHW/Mercy will help patients wade through the maze of Medicare and other public health programs, which is a good thing because many people may not even know they’re eligible for assistance. Children and teens may be able to get help through Medicaid or SCHIP, the State Children’s Health Insurance Program. For more information on these programs, visit the California Department of Health Services at dhs.ca.gov or the Healthy Families Program at healthyfamilies.ca.gov.
Ask for a payment plan
Daniel Funderburg had been squeaking by without health insurance until a kidney stone sent him to a local emergency room for diagnosis and treatment. The upshot? A bill for $5,300—money he does not have. But having seen another uninsured friend struggle with a mountainous medical bill of $75,000, he knew a payment plan was an option. “I knew from my buddy’s experience that as long as you’re making payments, you won’t be charged interest or turned over to collections,” says Funderburg, a restaurant worker whose current employer does not offer medical benefits. Just as federal law dictates that hospitals must treat all patients requiring emergency services regardless of their ability to pay, California law mandates that hospitals must work with patients by providing options for payment, including sliding scale plans and/or free care for those who meet the criteria, says Jan Emerson of the California Hospital Association. “Hospitals serve as the medical office of last resort,” says Emerson. “But it’s the mission of hospitals to be there to help people.”
Visit a community clinic
If you’re low-income and/or uninsured and need medical care for a nonemergency, community clinics are a rich-resource, adds Emerson. “ERs (emergency rooms) are the most expensive place to go for medical care,” she says. “Ideally, people should be thinking about other resources—like clinics.” CHW’s Younts seconds that notion. “For the most part, for people who come in and aren’t insured, it’s free primary health care,” she says of CHW’s clinics. In other cases, fees are determined on a sliding scale based on income. For a list of licensed local not-for-profit community clinics, check the website of the California Primary Care Association, cpca.org, or phone (916) 440-8170.
Uncovered—One out of three Americans younger than 65 went without health insurance at some point during 2007 and 2008. Source: Families USA
COBRA and Cal-COBRA UncoiledCOBRA—the federal program that allows laid-off workers to continue on their employer’s health plan for a defined period of time (usually 18 months)—applies to companies with 20 or more employees. In California, there’s also protection for people who worked for smaller companies (two to 19 employees) through Cal-COBRA, which offers the same kinds of benefits as COBRA. In addition, if your COBRA coverage expires after 18 months, you may switch to Cal-COBRA for another 18 months of insurance. If that ends, you may have the option of enrolling in an individual plan through HIPAA (the Health Insurance Portability and Accountability Act).
For more information about COBRA, Cal-COBRA, HIPAA and related issues, visit the California Department of Managed Health Care’s website at dmhc.ca.gov. The department’s toll-free help-center line is (888) 466-2219.
• California Department of Insurance (800) 927-4357; insurance.ca.gov
“Consumers overview” section offers a health plan comparison checklist, guidelines on filing a complaint with your provider and more
• Californians for Patient Care (916) 444-5255; calpatientcare.org
Nonprofit provides resources for low-income/uninsured consumers throughout California
• The Foundation for Health Coverage Education (800) 234-1317; coverageforall.org
Comprehensive resource for consumers seeking low-cost insurance, with links to applications for public health care programs, an eligibility quiz and other user-friendly tools
• Health Rights Hotline (916) 551-2100; hrh.org
Free information about health care rights for residents of El Dorado, Placer, Sacramento and Yolo counties
• U.S. Department of Labor (866) 444-3272 (toll-free); dol.gov/COBRA
Comprehensive information about COBRA for both employers and employees