Transcript Philadelphia Health Insurance CFEVA.ppt

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@actorsfund.org 212-221-7300 x265
http://www.ahirc.org
How can I get health insurance in
Pennsylvania?
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Employment-related coverage
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Private, direct-purchase plans
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Government-subsidized programs
What are my protections and limitations?
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Elimination riders permitted
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Group market:
◦ 6 month look back period/ 12 month preexisting condition exclusion
◦ Credit for coverage if less than 63 day lapse in
policies
What are my protections and limitations?
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No right to insurance
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Right to receive care in a life-threatening
emergency at any hospital regardless of insurance
status
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Individual market:
◦ 5 year look back period/ 3 year pre-existing
condition exclusion
◦ No credit for prior coverage
Current healthcare reform protections
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PCIP (for the uninsured with pre-existing
conditions)
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Children under age 19 can’t be denied coverage
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Adults up to age 26 can stay under parents’ plan
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Insurers can’t rescind coverage if you get sick
Current healthcare reform protections
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Lifetime dollar limits on medical coverage are
banned
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Medicare and new private plans must cover certain
preventive services for free
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Medicare recipients in donut hole receive 50% off
brand-name drugs
Words to know
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Co-pay
Co-insurance
Deductible
HMO
PPO
HSA
Federal Poverty Level
Premium
Reasonable & customary charges
Employment-related options
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Job or spouse/domestic partner’s job
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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)
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)
Employment-related options
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Small business insurance (2-50 workers)
◦ Guaranteed access to coverage
◦ Check with local Chamber of Commerce
◦ http://www.ehealthinsurance.com
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Self-employed: association plans
◦ e.g., Greater Philadelphia Cultural Alliance
(GPCA)
www.philaculture.org
Employment-related options
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Unions
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Actors Equity
Screen Actors Guild
AFTRA
Writers Guild (East)
Directors Guild
Society of Motion Picture and TV Engineers
School-related options:
I can afford private insurance, but I don’t
know what type of plan to get.
Consider your medical & financial risk
limits
 Choose carrier & type of policy
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 HMO
 HSA + high deductible plan
 Min deductible: $1200; max OOP: $5950
 PPO
 Short-term insurance
Private insurance rates
https://www.ehealthinsurance.com
I’ll be traveling/going on tour. Will I be
covered while on the road?

Check with insurer
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International travel
 http://www.medhealthinsurance.com/travel
er.htm
I have a pre-existing condition. What do I
do?
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HIPAA
◦ 18 mo prior coverage, last day of which was
through group plan
◦ Have exhausted COBRA
Not eligible for public programs or jobrelated insurance
◦ Receive your HIPAA certificate!
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Medicaid, CHIP, Special Pharmaceutical
Benefits Program, COBRA
I have a pre-existing condition. What do I
do?
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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
I can’t afford insurance. Are there government
programs I qualify for?
Federal Poverty Levels 2012
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
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“Special Care”
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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…
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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
Government programs for children
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CHIP
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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
Non-insurance options
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Sliding-scale clinics
Health Center Program:
http://findahealthcenter.hrsa.gov
◦ Be Well website:
http://bewellpgh.org/category/freesliding-scaleclinics/
◦ PA Association of Community Health Centers:
http://www.pachc.com/health_find.html
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Retail clinics in pharmacies
◦ Minute Clinic http://www.minuteclinic.com
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Urgent care facilities
◦ Concentra Urgent Care
http://www.concentraurgentcare.com
I have a special health condition. Are
there any programs that cover it?
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SelectPlan for Women
◦ Free reproductive-related services
◦ Eligibility: age 18-44, not pregnant, no or limited insurance,
income under 185% FPL
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Special Pharmaceutical Benefits Program
◦ Covers HIV/AIDS medications & lab work
◦ Must have income below 337% FPL
◦ http://www.dpw.state.pa.us/foradults/healthcareme
dicalassistance/aidswaiverprogram/specialpharmac
euticalbenefitsprogram/S_000352
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I have a special health condition. Are
there any programs that cover it?
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Healthy Woman Program
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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
I’m 65. Are there any programs for
people my age or older?
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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
I need mental health care but I don’t have
insurance. Where can I go?
SAMHSA mental health locator:
http://store.samhsa.gov/mhlocator
 PMHCC: (215)-546-0300
www.pmhcc.org
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I have dental problems but no insurance.
What do I do?
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Dental clinics
◦ http://www.padental.org
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University of Pittsburgh School of Dentistry
http://www.dental.pitt.edu/patients/index.php
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Negotiate with your dentist
How can I get cheap or free drugs?
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The Partnership for Prescription Assistance
◦ http://www.pparx.org
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$4 Generic Drug programs
◦ Walmart
◦ Target
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PACE and PACENet
◦ For low-income seniors
◦ http://www.aging.state.pa.us
Links & Resources
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Pennsylvania Department of Health
◦ Info on facilities, providers, insurers, health
care programs, diseases, etc…
◦ http://www.health.state.pa.us/
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Families USA
◦ http://www.familiesusa.org
 Federal Health Care Reform website
◦ http://www.healthcare.gov