Options for health insurance and aid for unemployed
EMILY C. DOOLEY AND LOUIS LLOVIO TIMES-DISPATCH STAFF WRITERS
Published: May 17, 2009
For individuals and families facing unemployment and no insurance to cover health-care costs, there are several options.
These include state and federal programs; free health clinics; clinics that provide care on a sliding payment scale; negotiating fees with doctors, hospitals or employers; and short-term or temporary insurance. A look at a few of the offerings:
Getting care for children should not be as difficult as for adults.
Medicaid provides benefits to children under age 6 whose family income is up to $29,327, which is 133 percent of the federal poverty level for a family of four.
For families who make too much to get Medicaid, another option is FAMIS, which stands for Family Access to Medical Insurance Security.
Eligible children must be under age 19, and their family income can not exceed 200 percent of the federal poverty level, or $44,100 for a family of four.
Adults whose family income is less than the same 200 percent of the federal poverty level can turn to free clinics. There are six in the Richmond region that are part of the Virginia Association of Free Clinics.
"We are seeing people who have never been without health
insurance," said L.M. "Lou" Markwith, executive director of the association. "They've lost their job. Their company has closed. They have no benefits.
"We become the place that can treat them."
Free clinics act almost as general practitioners and can provide prescriptions. Some also provide dental services, counseling and food pantries.
If you are not sure you qualify, the best thing to do is call the local free clinic, which may refer you to other resources, Markwith said.
If you make too much to go to a free clinic but can not afford health insurance, consider going to one of several federally funded community health centers, which charge on a sliding scale based on what you can afford.
There are 11 in the Richmond area. Stimulus money has prompted the Virginia Community Health Care Association to plan for two more clinics in the area.
"Too many people may avoid health care because they feel like they can't afford it," said Rick Shinn, the association's director of public affairs. "You still need to maintain your health so you can go out there and take care of your family."
Should you end up at the hospital, many health-care organizations are willing to negotiate fees and set up payment plans. They also will do financial screenings to see if people are eligible for Medicaid or indigent care.
At Virginia Commonwealth University Health System, billing agents can give 25 percent discounts to people who are self-paying. An additional 5 percent discount is added when people pay in a lump sum, said Linda McLaughlin, director of financial and governmental services for the health system.
Payment plans are also available.
"This is a tough time," McLaughlin said. "We understand that. The biggest thing is to communicate with us. Just because you can't pay, don't let it go to collections."
Meg O. Wagner-Diggs, director of communications at the Richmond Human Resource Management Association, said it is not uncommon for people to negotiate payment terms or ask for the "cash price."
But negotiating doesn't have to be limited to the doctors and pharmacists, she said.
"If you're getting laid off, my advice is negotiate your severance agreement with your employer," she said. One thing to ask for, she said, is extended insurance coverage. But to get more insurance, you may have to give up something else, even some pay.
Preparing for a layoff and looking at alternate policies before being laid off can save time and money later.
Wagner-Diggs said people who are worried they might lose their jobs should begin exploring options. That can include looking into professional associations that offer group coverage or looking at sources including AARP .
People should also look at a spouse's policies to see if they can piggyback on those.
Jackie Myers, who oversees the life and health division of the Virginia Bureau of Insurance, said people need to be aware of what the spouse's employer's enrollment policies are.
"Some employers have open enrollment periods, some depend on timelines, and others will not allow it if there are other coverage options," she said.
Those type of policies have a limited time period in which to sign up, so you should know how long you have.
But several experts said more and more companies are doing insurance audits to see if the people on their policies belong there.
The best advice though, Wagner-Diggs said, is putting money away for health care.
Short-term, temporary insurance is a viable alternative for some but not all.
"It's important that people who have existing . . . problems really take a look at buying individual coverage," said Jill A. Hanken, staff attorney at the Virginia Poverty Law Center.
Investigate any plan and consider the deductible, what is covered and any exclusions, she said. Nongroup coverage, as it is called, can be more costly, and there are no federal limits on premiums.
In 2005, the latest year available, nearly three in five adults who considered nongroup coverage had trouble finding an affordable plan, according to a March 2009 study by the Kaiser Commission on Medicaid and the Uninsured.
Even for people without pre-existing conditions, the costs can prohibitive.
Experts recommend either buying policies with high deductibles on smaller procedures to keep costs down or buying catastrophic coverage. While not providing the same amount of coverage, these policies can help handle major illnesses.
Myers of the insurance bureau recommends that people with pre-existing conditions look at individual policies that waive underwriting if purchased within 63 days of their previous policy expiring.
If you need prescriptions, there are ways to get some discounts.
All Virginians can use the Virginia Drug Card, a free prescription-drug card program that offers name brand-name and generic drugs, some up to 75 percent off.
Free clinics also have access to donated medicines, as do some national drug companies. Pfizer said last week that it will give its drugs free for nine months to newly unemployed people. Pharmacies, including at Wal-Mart and Target, offer deep discounts for generic drugs and even more savings for three-month supplies.
Samples also may help. When Sally Compton got laid off from her job as a project coordinator for a general contractor, she took a look at her prescriptions.
A doctor gave her samples of one medicine, and she switched to a generic that costs $4 for a three-month supply. She also decided to take a break from another medicine.
Contact Emily C. Dooley at (804) 649-6016 or email@example.com
Contact Louis Llovio at (804) 649-6348 or LLLovio@timesdispatch.com