Health Insurance Gap for Millions

The health insurance debate is far from over. You are going to hear a lot more about it in the next few years; during the presidential debate, as cases work their ways through the courts and the Supreme Court, and as more major provisions become effective that aren’t now.

I’ve listened to much of the rhetoric from both sides and actually sympathize with all of them.  One of the things that I have heard is that there are options for the uninsured, but on the other hand, I have heard that there are not. Truth is both are right. A few days ago I worked with someone who had a health condition, but not many viable options. Helping her explore them was revealing to me about this issue, and might be to you too. The purpose of this article is to illustrate the gap, to help you explore options if you are in the same gap, and for you to respond if you know of other options. The following is our discussion, changing some of the facts to protect confidentially.

Question #1: My doctor says that it is necessary to have surgery that will cost $20,000, and we don’t have health insurance, how do I pay for the surgery if I can’t afford it? With the debate about National Health Care, I’ve heard that hospitals can’t refuse to cover me.

Answer: Those without health insurance must pay for the surgery with their own money, either by saving it, borrowing, or asking friends and relatives for help. There are instances that Hospital’s can’t turn you away, for example if you were in critical condition following an accident, or your go to the emergency room because you are very ill.

Question #2: What are our options to purchase health insurance?

Answer: Personal health insurance can be purchased, however if you do so by regular means, the health insurance company will underwrite you, so you could be rejected for your health condition, rated a high premium (rates will be high at your age anyway), the condition may be excluded entirely or only covered after a pre-existing condition period has expired (this varies by state).

Question #3: The premium and underwriting seem like barriers for us to acquire personal health insurance, are there any other health insurance options?

Answer: Most states offer some type of guaranteed issue program, or uninsurable pool however rates may still be prohibitively high for many people.

Question #4: In the case of an emergency or being in need of immediate care to relieve considerable pain, for saving of one’s life, or if very sick the hospital must provide some care for me, but how would the medical bills be paid?

Answer: The medical bills can be paid for after care, either with money you have saved, or by working out a payment plan with the hospital. If you contact the hospital right away they are usually very good at working out a payment plan that you can afford. In addition, on the back of most hospital bills, is hardship form you can fill out. If you qualify you may get a reduction, sometimes small other times large, of the bill.

Question #5: My condition is medically necessary, but not an emergency and my doctor feels that if untreated the condition could cause other problems. However care isn’t required today to save my life or relieve considerable pain, so how can I schedule the surgery if I don’t have the means (income or savings) to pay for it?

Answer: There may be several options for people to receive financial help with your health condition:

  • Medicare may help, one of the conditions of qualifying for care prior to the age of 65 is being disabled, coverage usually can begin in 29 months from the date of Social Security Disability
  • Medicaid provides coverage for some people below the poverty guidelines, in your instance, a family of two, your income must fall below $15,130.
  • The Hospital Care Assurance Program (HCAP) is Ohio’s version of the federally required Disproportionate Share Hospital program. According to the Ohio Revised Code 5101:3-2-07.17, to those who are “not a recipient of the Medicaid program and whose income is at or below the federal poverty line.” The income is calculated using the preceding three and twelve months of income. This plan will be different for you state, including poverty guidelines.

Question #6: Our incomes exceed $15,130 using both calculation methods in the Code. These numbers seem very low, if you consider if the minimum wage is $7.50 in my state and if both of us worked minimum wage jobs, our total household income would be $31,200. Without health insurance it looks like we would never qualify for Medicaid or HCAP.  What other options do we have?

Answer: You can request assistance from friends or relatives, your place of worship, and ask your doctor for a discount. Any one of them separate or combined may provide the help you need.

Question #7: We have not been attending a church regularly lately so we may not qualify, and our friends and relatives are tapped out, so those may not be options for us. In addition, due to slow work and mounting debt, we have very little money for car, mortgage, gasoline, utilities, auto insurance payment and food, let alone to save up for the surgery. So are we out of options?

Answer: I am not sure, but one possibility may be for your husband to seek full-time employment from an employer that provides health insurance. The wage may be modest, you may have to wait 90 days or so for the health insurance to start, and there may be a pre-existing condition clause, but you may still qualify for medical treatment in this situation, but medical bills not covered may be handled other ways, see Question #4.

Question #8: I recently lost my job and wonder about continuing my group health insurance through my employer?

Answer: If you worked for a company that employed 20 or more people, they must offer you COBRA continuation of coverage, under Federal regulations. This can usually cover you for up to 18 months, and longer for example if you are disabled. You are required to pay 102% of the premium, and pre-existing conditions are covered. Group insurance isn’t cheap, but for those with health history it may be the best option. You have a 60 day window from the day you were given notice that you were COBRA eligible for you to accept, reject, or change your mind. You then have 45 days to pay the premium. This intended loophole of 105 days allows you to evaluate your options, and perhaps allow enough time for a new employer to provide coverage. Careful planning is required, so contact your human resources department for more information. If you work for a company that employs fewer than 20 employees, your state may provide similar continuation of coverage regulations.

Question #9: You are a financial guy, are you versed in all of the options, and do you have any other suggestions?

Answer: I am far from being an expert in this area. In Ohio I recently heard about UHCAN 614-456-0060 ext. 233,, you should call them and see if there are additional options for you. For people with severe financial difficulty that you may be facing, one option may be to delay making payments on your debt, including your mortgage. Through full-time employment plus side self-employment work, looking at your budget you may be able to save enough money for the surgery, either in part or through payments with a down payment may be enough. Lenders may work with you through special payments, deferment or some other means.  When the surgery is complete, you can resume payments, or explore other re-payment options. Bankruptcy is also an option. Whatever way you go, please get a lot of prayer for the tumor to be healed or paid for miraculously, and to seek the advice of many counselors.

I hope this information is helpful. Please send me other options that you know about to continue this discussion