getting and keeping health insurance in pennsylvania
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Getting and Keeping Health Insurance in Pennsylvania. The Center for Emerging Visual Artists February 28, 2013 Artists Health Insurance Resource Center A program of The Actors Fund Presenter: Jim Brown, Director of Health Services [email protected] 212-221-7300 x265. - PowerPoint PPT PresentationTRANSCRIPT
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Getting and Keeping Getting and Keeping Health Insurance inHealth Insurance in
PennsylvaniaPennsylvania
The Center for Emerging Visual Artists February 28, 2013
Artists Health Insurance Resource CenterA program of The Actors Fund
Presenter: Jim Brown, Director of Health Services [email protected] 212-221-7300 x265
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http://www.ahirc.org
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How can I get health insurance How can I get health insurance in Pennsylvania?in Pennsylvania?
Employment-related coverage
Private, direct-purchase plans
Government-subsidized programs
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What are my protections and What are my protections and limitations?limitations?
Elimination riders permitted
Group market: ◦6 month look back period/ 12 month
pre-existing condition exclusion◦Credit for coverage if less than 63 day
lapse in policies
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What are my protections and What are my protections and limitations?limitations?
No right to insurance
Right to receive care in a life-threatening emergency at any hospital regardless of insurance status
Individual market:◦5 year look back period/ 3 year pre-
existing condition exclusion◦No credit for prior coverage
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Current healthcare reform Current healthcare reform protections protections
PCIP (for the uninsured with pre-existing conditions)
Children under age 19 can’t be denied coverage
Adults up to age 26 can stay under parents’ plan
Insurers can’t rescind coverage if you get sick
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Current healthcare reform Current healthcare reform protections protections
Lifetime dollar limits on medical coverage are banned
Medicare and new private plans must cover certain preventive services for free
Medicare recipients in donut hole receive 50% off brand-name drugs
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Words to knowWords to knowCo-payCo-insuranceDeductibleHMOPPOHSAFederal Poverty LevelPremiumReasonable & customary charges
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Employment-related Employment-related optionsoptionsJob or spouse/domestic partner’s job
COBRA Guarantees right to continue coverage Must work for an employer with 20+
employees 18 months (sometimes more) 60 days to sign up (from date of letter) Full premium (at group rate)
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Employment-related Employment-related optionsoptionsMini-COBRA
Guarantees right to continue coverage
For employees of small businesses (fewer than 20 employees)
9 months coverage 30 days to sign up (from date of
letter) Full premium (at group rate)
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Employment-related Employment-related optionsoptionsSmall business insurance (2-50
workers)◦Guaranteed access to coverage◦Check with local Chamber of
Commerce◦http://www.ehealthinsurance.com
Self-employed: association plans◦e.g., Greater Philadelphia Cultural
Alliance (GPCA) www.philaculture.org
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Employment-related Employment-related optionsoptionsUnions
◦Actors Equity◦Screen Actors Guild◦AFTRA◦Writers Guild (East)◦Directors Guild◦Society of Motion Picture and TV
Engineers
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School-related options:School-related options:
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I can afford private insurance, I can afford private insurance, but I don’t know what type of but I don’t know what type of plan to get.plan to get.
Consider your medical & financial risk limits
Choose carrier & type of policy HMO HSA + high deductible plan
Min deductible: $1200; max OOP: $5950
PPO Short-term insurance
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Private insurance rates Private insurance rates https://www.ehealthinsurance.comhttps://www.ehealthinsurance.com
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I’ll be traveling/going on tour. I’ll be traveling/going on tour. Will I be covered while on the Will I be covered while on the road?road?
Check with insurer
International travel http://www.medhealthinsurance.c
om/traveler.htm
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I have a pre-existing condition. I have a pre-existing condition. What do I do?What do I do?
HIPAA◦18 mo prior coverage, last day of
which was through group plan◦Have exhausted COBRA
Not eligible for public programs or job-related insurance
◦Receive your HIPAA certificate!Medicaid, CHIP, Special
Pharmaceutical Benefits Program, COBRA
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I have a pre-existing condition. I have a pre-existing condition. What do I do?What do I do?
PA Fair Care◦Must have been uninsured for 6 months◦Must have pre-existing condition◦Comprehensive; pre-existing conditions
covered immediately◦Premiums vary according to age, type
of plan, and deductible◦$283/mo premium, $1000 deductible◦Out-of-pocket max: $5950/indiv◦http://www.pafaircare.com
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I can’t afford insurance. Are there I can’t afford insurance. Are there government programs I qualify for? government programs I qualify for?
Federal Poverty Levels 2012Federal Poverty Levels 2012
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Government programsGovernment programsMedicaid
◦Comprehensive ◦Very limited income (36%-185% of FPL) and fit one of these categories: pregnant, blind, disabled, over 65, under 19, or be a parent living with kid under 19
◦No premiums◦No pre-existing condition waiting periods◦2 month application process◦https://www.humanservices.state.pa.us/C
ompass.Web/CMHOM.aspx◦
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““Special Care” Special Care” Benefits: limited
◦ 4 office visits/year◦ Covered: maternity, surgery, ER,
chemo/radiation, hospital(21 days only), diagnostics ($1000 only)
◦ No coverage for: drugs, mental health, substance abuse treatment…
Prices vary: 1 person: $162/moEligibility:
◦ Cannot be enrolled in or eligible for private or government insurance
◦ Meet income guidelines: 1 person: $21,660◦1-866-282-2702
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Government programs for Government programs for childrenchildrenCHIP
◦Must be under age 19◦Must be uninsured◦Comprehensive◦Premiums and co-pays vary according
to household size and income◦Example: 4 person household, $60,000
income: $60/mo per child◦http://www.chipcoverspakids.com
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Non-insurance optionsNon-insurance optionsSliding-scale clinics
Health Center Program: http://findahealthcenter.hrsa.gov
◦ Be Well website: http://bewellpgh.org/category/freesliding-scale-clinics/
◦ PA Association of Community Health Centers: http://www.pachc.com/health_find.html
Retail clinics in pharmacies◦ Minute Clinic http://www.minuteclinic.com
Urgent care facilities ◦ Concentra Urgent Care
http://www.concentraurgentcare.com
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I have a special health condition. I have a special health condition. Are there any programs that Are there any programs that cover it?cover it?
SelectPlan for Women◦ Free reproductive-related services
◦ Eligibility: age 18-44, not pregnant, no or limited insurance, income under 185% FPL
Special Pharmaceutical Benefits Program◦Covers HIV/AIDS medications & lab work◦Must have income below 337% FPL◦http://www.dpw.state.pa.us/foradults/
healthcaremedicalassistance/aidswaiverprogram/specialpharmaceuticalbenefitsprogram/S_000352
◦
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I have a special health condition. I have a special health condition. Are there any programs that Are there any programs that cover it?cover it?
Healthy Woman Program◦Free mammos for women age 40+◦Free pap smears for women age 18+◦Must go to a participating provider◦Must be uninsured and have income
under 250% FPL◦http://www.pahealthywoman.com
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I’m 65. Are there any I’m 65. Are there any programs for people my age or programs for people my age or
older?older?Medicare
◦Part A: hospitalization; automatic at age 65
◦Part B: outpatient services; monthly premium
◦Part D: medications
◦Medigap◦Medicare Advantage Plans (HMOs/PPOs)
replace traditional Medicare◦http://www.medicare.gov
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I need mental health care but I I need mental health care but I don’t have insurance. Where can don’t have insurance. Where can I go?I go?SAMHSA mental health locator:
http://store.samhsa.gov/mhlocatorPMHCC: (215)-546-0300 www.pmhcc.org
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I have dental problems but no I have dental problems but no insurance. What do I do?insurance. What do I do?
Dental clinics◦http://www.padental.org
University of Pittsburgh School of Dentistry
http://www.dental.pitt.edu/patients/index.php
Negotiate with your dentist
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How can I get cheap or free How can I get cheap or free drugs?drugs?
The Partnership for Prescription Assistance◦http://www.pparx.org
$4 Generic Drug programs◦Walmart◦Target
PACE and PACENet◦ For low-income seniors
◦http://www.aging.state.pa.us
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Links & Resources Links & Resources
Pennsylvania Department of Health◦Info on facilities, providers, insurers,
health care programs, diseases, etc…◦http://www.health.state.pa.us/
Families USA◦http://www.familiesusa.org
Federal Health Care Reform website◦http://www.healthcare.gov