An estimated 5.4 million Americans lost health care coverage along with their jobs because of the coronavirus pandemic, but a consumer’s group has advice for accessing insurance.
Do you qualify for Medicaid?
“The first line of defense, if you’ve lost your job, lost income, is finding out whether or not you qualify for Medicaid,” Jason Resendez said. “You can go to HealthCare.gov to navigate that eligibility process.”
Resendez is a Consumers for Quality Care Board Member and health care strategist.
What about kids?
Even if you’re unable to get a health plan for adults in your family, you still may be able to get coverage for children, especially if you’ve lost income or lost your job.
“Check out InsureKidsNow.gov to see if your child is eligible for a CHIP (Children’s Health Insurance Program) program, which is a Medicaid program for children,” he said.
If you don’t qualify for Medicaid, know that Nov. 1 through Dec. 15 is the open enrollment period for the Affordable Care Act.
Important things to watch out for when choosing a new health care plan include options that can lead to surprise medical bills; notice whether they are short-term limited duration insurance plans or include copay adjustment programs.
Fleshing out those considerations, Resendez explains:
- Co-pay adjustment programs now being incorporated into a growing number of plans no longer allow coupons that share the cost of drugs to be counted toward a patient’s deductible or capped on total out-of-pocket costs. “So, they limit your ability to use a coupon at the counter to limit your costs for prescription medicines.” And, make it hard to meet your deductible.
- Short-term limited duration insurance plans are “junk,” Resendez said, because they can exclude coverage for pre-existing conditions. They have high-dollar value limits on covered services and they’re not required to cover preventive services.
- As for surprise bills due to opt-in narrow networks: The health care system is a patchwork of networks. You might find yourself going to a hospital you chose specifically because it is in your network only to find that you get treated by an anesthesiologist who is out of network and you get a big bill. To avoid that situation, you might call your insurer and the hospital and ask that everything is in the same network. “You have to keep an eye out. Plan as much as possible, which I know is impossible all of the time.”
“It’s important to understand when you’re selecting a plan what a network looks like and whether you’re covered in terms of your current provider within that network,” Resendez said.
If you ever end up getting stuck with an unexpected bill, Resendez recommends pushing back and appealing for intervention. He said that can lead to bills being reduced or in some cases getting waived entirely.
“Don’t be afraid to push back, ask questions and speak up,” he said.
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