Lost Your Health Insurance? Some Resources

Lindsay Lyon

Before the U.S. government decided to kick in 65 percent of the premium for people who extended their employee group health insurance after being laid off, many experts considered the COBRA provision to be a "cruel option."

Without the subsidy, for example, average monthly COBRA premiums for family coverage ($1,111) would devour close to 84 percent of the average person's monthly unemployment check, according to a report released in December by the nonprofit Families USA. Even with it, the 65 percent cushion, which has no doubt been a boon for many Americans--especially those with pre-existing health conditions--a family policy could still cost $300 to $400 a month, "and that's a lot more than a lot of people have," says Karen Pollitz, a research professor at Georgetown University Health Policy Institute. "(It's) like offering a 10-foot rope to someone who is in a 20-foot pit."

Whether you can still make use of the COBRA subsidy or not, anyone suffering a job loss will undoubtedly be looking to save money on healthcare. Here are some ideas to consider if you're interested in finding other insurance coverage or in accessing more-affordable care:

AFFORDABLE COVERAGE

--After COBRA.

With or without the subsidy, if you chose COBRA, there's an option once your benefits dry up (or your company goes under and you lose your group coverage): special conversion individual plans protected by the Health Insurance Portability and Accountability Act, or HIPAA, says Ankeny Minoux, president of the Foundation for Health Coverage Education, a nonprofit. And if you qualify, either because you've exhausted your COBRA benefits or your company failed and you've had coverage for the previous 18 months, you can't be denied insurance because of your medical history, she adds.

-- "Mix and match."

Many people don't realize that it's not all or nothing with COBRA; you don't have to elect it for everyone in your family who was covered under your former employer's group plan, says Minoux. If one person (or more) has a health condition and needs ongoing care, you can elect COBRA coverage for him and find alternatives for the rest of the family. That may be one way to save, she says.

--On your own.

Looking for coverage in the private market may offer savings, says Minoux, although she advises sticking with the main carriers so as not to be scammed. Websites like ehealthinsurance.com allow people to do side-by-side comparisons of different plans from many carriers and, if the wish, apply online. But being accepted is no slam-dunk, cautions Pollitz. Except for in a "handful" of states, that insurance is medically underwritten, meaning you'll have to fill out an extensive questionnaire about your health status and history. "Literally, just a hair out of place could be trouble," she says. "People get turned down for hay fever, for acne." If you do get sick and make a claim, "there's been a terrible problem with (cancellation)," she adds. Whatever you do, advises Minoux, don't lie on your application, as you could be denied down the road if the lie is revealed.

--So-called high-deductible plans linked to a health-savings account may be appealing, since monthly premiums are typically lower and pretax money can be put away to accumulate and go towards medical expenses. But if you don't have the money to pay for care until you meet the deductible--when insurance kicks in--you could be on the hook for a lot more than you bargained for, warns Cheryl Fish-Parcham, Families USA's deputy director of health policy. As funds become available, however, you can reimburse yourself from your HSA, says Minoux: Individuals are permitted to contribute up to $3,050 and families up to $6,150 pretax each year. If not spent, funds roll over and accrue year-to-year, she says.

--Pre-existing health conditions.

If you have a pre-existing health condition and can't get coverage in the individual market, numerous states guarantee coverage through their high-risk pools. However, premiums can be as high as or even higher than under COBRA, depending on the state, experts say. This guide from the Kaiser Family Foundation has more information.

--Other public programs.

Of the roughly 46 million Americans without health insurance, approximately 12 million are eligible for public programs such as Medicaid but just aren't signed up, Minoux says, citing Congressional Budget Office data. It can be a slog to figure out if you qualify, and programs vary by state, says Minoux, whose foundation has made that a bit simpler. Take its five-question eligibility quiz to get a personalized list of your options. The Foundation for Health Coverage Education's Health Care Options Matrix will chart out all the public and private options available in your state. Click on your state in this map. Families USA also has state-by-state guides for help. Additional information can be found on this consumer website from Pollitz's group.

If you don't qualify for public assistance, your kids might still be eligible for the Children's Health Insurance Program, or CHIP. Last year, President Obama signed a bill to expand CHIP, which is expected to extend coverage to an extra 4 million kids by 2013.

--State pays the premium.

Certain states have a program called HIPP, or the Health Insurance Premium Payment, where the state will actually pay your premium for you if you can't afford it, says Minoux. That means staying on the same insurance plan you were on instead of going on a public program, like Medicaid, she says. Who is this option ideal for? "First of all, you have to live in one of those states, you would have had to have lost your employer-sponsored coverage and had a reduction of income, and now you're underneath the federal poverty guidelines," she says. Details vary by state.

GETTING CARE

--Federally funded health centers.

For "backbone" primary care (not for emergencies), federally funded health centers offer services on a sliding fee scale based on a person's ability to pay, says David Bowman, a spokesperson for the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services. These centers also see people who don't have the means to pay at all. Offerings can be pretty comprehensive, including dental care at some locations, he says. (Find one nearby on HRSA's website: http://findahealthcenter.hrsa.gov/)

Anecdotally, Bowman says community clinics have noted an uptick in the number of people coming through their doors for services, as many folks have been hit by hard times. Likewise, Planned Parenthood clinics "have been under considerable financial strain during the recession," U.S. News's Deborah Kotz wrote in January, "as more women flock to them for free Pap smears, breast exams, and gynecological checkups." Planned Parenthood also offers services on a sliding fee scale, according to a spokesperson. (Information on free health clinics can be found here.)

--In-store clinics.

Staffed with nurse practitioners and physician's assistants, in-store clinics are equipped to offer basic acute care. Take Care Clinics, for example, are found in roughly 360 Walgreens stores across the country. People with insurance are likely covered for their visit with a copay, while the uninsured can pay out-of-pocket. Most treatments for common ailments, such as strep throat, sinus infections, and minor burns, start at $65, while vaccinations and physical exams are priced differently. MinuteClinic, owned by CVS Caremark Corp. and tucked in roughly 500 CVS stores across the country, are a similar option; treatments range between $30 to about $110, according to its website, and are covered by most insurance plans.

--Cash-only or direct-pay medical practices.

These medical practices "cater to the uninsured" and "people with high-deductible health plans," according to a story by U.S. News's January Payne. The idea of doing away with third-party billing is that it's possible to offer flat and more-affordable rates to all. Before leaving, patients pay in full.

--Cheaper medicines.

Stores like Wal-Mart and Target offer $4 generic prescription drugs for a wide variety of conditions. Consult their websites to see which medications are on their prescription lists. ("If you (get) cancer, you will not find drugs for $4 at Wal-Mart or anywhere else," notes Georgetown's Pollitz.)

And stores like Publix, Giant, and Stop & Shop advertise that a prescription is all people need to get generic oral antibiotics for free. (In a press release issued last year, the Infectious Diseases Society of America called these giveaways an "unhealthy promotional gimmick," due to health experts' concerns over promoting antibiotic resistance through inappropriate use of the drugs.)

Many drug companies also offer prescription drugs at a discount for people who qualify, according to literature compiled by Families USA. The organization directs people to the following resources to learn more about such programs: RxAssist.org: NeedyMeds.org; PPARx.org.

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Healthcare - Lost Your Health Insurance? Some Resources | Lindsay Lyon