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Getting and Keeping Health Insurance in Pennsylvania

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Title: How to Get Affordable Health Care in New York City Author: Registered User Last modified by: Owner Created Date: 9/24/2007 3:29:26 PM Document presentation format – PowerPoint PPT presentation

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Title: Getting and Keeping Health Insurance in Pennsylvania


1
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
  • jbrown_at_actorsfund.org
    212-221-7300 x265

2
http//www.ahirc.org
3
How can I get health insurance in Pennsylvania?
  • Employment-related coverage
  • Private, direct-purchase plans
  • Government-subsidized programs

4
What are my protections and 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

5
What are my protections and 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

6
Current healthcare reform protections
  • PCIP (for the uninsured with pre-existing
    conditions)
  • Children under age 19 cant be denied coverage
  • Adults up to age 26 can stay under parents plan
  • Insurers cant rescind coverage if you get sick

7
Current healthcare reform 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

8
Words to know
  • Co-pay
  • Co-insurance
  • Deductible
  • HMO
  • PPO
  • HSA
  • Federal Poverty Level
  • Premium
  • Reasonable customary charges

9
Employment-related options
  • Job or spouse/domestic partners 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)

10
Employment-related options
  • Mini-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)

11
Employment-related options
  • Small 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

12
Employment-related options
  • Unions
  • Actors Equity
  • Screen Actors Guild
  • AFTRA
  • Writers Guild (East)
  • Directors Guild
  • Society of Motion Picture and TV Engineers

13
School-related options
14
I can afford private insurance, but I dont know
what type of 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

15
Private insurance rates https//www.ehealthinsura
nce.com
16
Ill be traveling/going on tour. Will I be
covered while on the road?
  • Check with insurer
  • International travel
  • http//www.medhealthinsurance.com/traveler.htm

17
I have a pre-existing condition. 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

18
I have a pre-existing condition. 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

19
I cant afford insurance. Are there government
programs I qualify for? Federal Poverty Levels
2012
20
Government programs
  • Medicaid
  • 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/Compass.Web/
    CMHOM.aspx

21
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/mo
  • Eligibility
  • Cannot be enrolled in or eligible for private or
    government insurance
  • Meet income guidelines 1 person 21,660
  • 1-866-282-2702

22
Government programs for children
  • CHIP
  • 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

23
Non-insurance options
  • Sliding-scale clinics
  • Health Center Program http//findahealthcenter.hr
    sa.gov
  • Be Well website http//bewellpgh.org/category/fre
    esliding-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.concentraurgentca
    re.com

24
I have a special health condition. Are there any
programs that 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/healthcaremed
    icalassistance/aidswaiverprogram/specialpharmaceut
    icalbenefitsprogram/S_000352

25
I have a special health condition. Are there any
programs that 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

26
Im 65. Are there any programs for people my age
or 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

27
I need mental health care but I dont have
insurance. Where can I go?
  • SAMHSA mental health locator http//store.samhsa.
    gov/mhlocator
  • PMHCC (215)-546-0300
  • www.pmhcc.org

28
I have dental problems but no 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

29
How can I get cheap or free 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

30
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
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