Frequently Asked Questions
The clearest route to gaining insurance is through your own job or your spouse's job, although this isn't always possible. Under group insurance rules, you cannot legally be denied insurance due to a pre-existing condition. You may also consider joining a professional or trade association, as these organizations often offer members the option to purchase health insurance. Finally, if you recently left or are about to leave a job that offers insurance, you can remain enrolled in your insurance plan under a federal law known as COBRA. Through COBRA, you can purchase your old health insurance plan for up to 18 months although you will be responsible for paying the total monthly premium, which will probably be higher than your previous monthly premium since most employers partially subsidize health insurance costs. Some states have COBRA extension programs that extend that time limit. Disabled individuals may also be able to extend their COBRA benefits.
For more information, see here.
Government programs may provide you the opportunity to purchase insurance or receive free coverage for yourself or for your children. What might be available to you depends on where you live, but generally speaking, these programs are aimed at the elderly, lower income individuals, and children. Many states also offer expecting mothers prenatal care. The most popular of these programs are Medicare for the elderly, Medicaid for lower income individuals, and the State Children's Health Insurance Program (SCHIP), for children whose parents earn too much to qualify for Medicaid but not enough to purchase a private health plan.
Additionally, 33 states offer high-risk insurance pools (HIPs) that allow high-risk patients who cannot qualify for private insurance to enroll at higher rates in state administered programs. These programs have limited enrollments and may or may not be available in your state. For a listing of various governmental programs or to search for a benefits program, click here.
For more information on which states offer HIPs, click here.
Catastrophic coverage is just as it sounds. You will be protected financially in the event of a major medical emergency but will still have to pay for your own routine care. Catastrophic plans are for short-term coverage only and tend to have high deductibles. You can purchase these through insurers. Catastrophic insurance might be particularly useful if you're between jobs or insurance plans.
Discount medical plans organizations (DMPOs) are like membership clubs: they pool the power of many members to negotiate lower cash prices from doctors, dentists, chiropractors, pharmacies and other providers. Most of these discount plans have a monthly per-member fee while a few plans, particularly prescription only ones, are free. Once you enroll, you get a membership card with a unique member ID, which you present to approved providers to get an immediate discount on treatment. It is important to note that Discount Medical Plans are not health insurance - you pay all the provider fees and charges yourself - and you will not be reimbursed by the DMPO. In other words, you pay all costs, but get the benefit of paying negotiated group rates.
Approximately 18 states currently regulate DMPOs. When researching a DMPO, make sure it has a wide provider network in your area.
Walk-in clinics/convenient care clinics can save time and money. Typically staffed by nurses and located in malls, pharmacies and convenience stores, walk-in clinics are typically less expensive than physician visits or hospital visits, and do not require appointments. Depending on the state, some providers at walk in clinics can write prescriptions for basic ailments. They cannot, however, provide emergency or comprehensive care, and primary care may often be provided by a nurse practitioner or other Master’s level provider rather than a board licensed physician. Retail clinic licensing varies by state, but most states require some kind of affiliation with a medical doctor, whether by always being on-site or by being available by phone for consultation. For more information or to find a convenient care clinic, click here.
Charity care may not always be available, but non-profit organizations from Planned Parenthood to churches often offer free or reduced cost treatment. Hospitals also designate some cases as charity cases. You should ask your hospital about how to qualify for charity care. To find a free or reduced cost clinic in your area, click here.
