This article addresses issues that primarily affect individuals with commercial (private) health insurance.
We are facing tough economic times. Job loss has resulted in large income losses for many people. Others have lost income or assets through a reduction in work hours, loss of a home due to foreclosure, loss of home property value, or loss in value of regular and retirement investments.
This bad economic news also affects health insurance and the ability to pay medical bills. With job loss or reduced work hours, employer health insurance is often lost, too. With reduced income, it becomes harder to pay medical bills.
Medical bills may be even more financially challenging because out-of-pocket costs keep going up. Since medical costs exceed general inflation, employers and insurers pass costs on to employees and policyholders through increased deductibles, co-pays and co-insurance.
People with bleeding disorders such as hemophilia are affected more than the general population because they use insurance more often and their medical costs are greater. So how can the person with a bleeding disorder manage medical costs and health insurance in these tough economic times? There are no guarantees, but here are a few suggestions.
Paying Medical Bills with Less Income
- It is best to have a financial plan to pay medical bills for each calendar year (or your insurance plan’s benefit year). If you are already part way through the year, develop a partial-year financial plan.
- Estimate your annual medical costs. Focus in particular on your factor costs.
- Know what costs your insurance will and will not pay. Unless you have other insurance or program coverage, the uncovered amount is the balance you owe.
- Budget for uncovered bills. Make a monthly budget and determine your ability to pay your bills. If your income has been reduced, make an adjusted budget.
- Contact the patient accounts department for each medical and drug provider (i.e., your home care company, hemophilia treatment center [HTC], doctor, clinic) to which you owe money or will owe money. If you can afford to pay off your bills, make a payment plan.
- If you cannot afford to pay your bills, ask if the provider has a financial needs program. (To learn more about patient assistance programs, read “Patient Assistance Programs” HemAware March/April 2009.) Such programs reduce patient out-of-pocket liability based on need and will reduce your balance. If the provider has such a program, fill out an application.
- Review your eligibility for other programs to help pay your medical and drug bills, including: state hemophilia program, Children with Special Health Care Needs Program, Medicaid, Social Security disability programs and manufacturer assistance programs.
Note: A reduction in income may increase your ability to meet eligibility requirements. Most programs are not retroactive. Approval will usually help to reduce future bills only.
For help, contact your HTC, social worker, NHF’s HANDI, your local chapter of NHF, or other hemophilia organizations. You can also try calling the reimbursement departments of your home care company or factor product manufacturer or ACCESS (Advocates for Chronic Conditions, Entitlements and Social Services), a program that helps families navigate state and federal entitlement programs, as well as eligibility for health insurance through state high-risk pools and other alternatives.
- If approved for any of these programs, contact providers to set up a revised coverage and/or payment plan.
- Review your employer insurance plan for 2010. Estimate your out-of-pocket expenses.
Consider enrolling in an employer flexible spending account (FSA), if available. An FSA allows employees to set aside money on a pre-tax basis to pay for health, drug and dental expenses.
Health Insurance Management
In anticipation of a job loss or reduction in work hours, know how your health insurance eligibility may be affected. Will you continue to be eligible for employer health insurance? Who pays? How much will you have to pay? Do you have any other health insurance options?
Review your eligibility for health insurance through COBRA (or a state-sponsored insurance continuation plan), a state high-risk plan, an individual plan (usually sponsored by your state), Medicaid, Medicare, or other programs. For help understanding your options, call the experts listed in the previous section and the office of the commissioner of insurance in your state. For help paying health insurance premiums, contact Patient Services, Inc. (PSI).
Understand the specific benefits of the American Recovery and Reinvestment Act (ARRA) signed into law on February 17, 2009.
- ARRA helps employees who were involuntarily terminated from their jobs between September 1, 2008, and December 31, 2009, by providing a 65% subsidy for monthly individual or family COBRA premiums for a period of nine months. To be eligible, terminated employees must: have been enrolled in their employer health plan; have COBRA coverage now; have had COBRA coverage but terminated it; or have been eligible for COBRA coverage, but did not take it. In addition, the terminated employee must attest that annual income will not exceed $125,000 for an individual or $250,000 for a family.
- The law also provides an increase in federal matching dollars to states for Medicaid from October 1, 2008, through December 31, 2010. Each state will determine how to expand benefits for its Medicaid recipients. Since expanded benefits mean expanded eligibility, Medicaid is an insurance option you should investigate.
Even with a tough economy, there are options for paying bills and maintaining health insurance. Don’t be afraid to ask for help. We are fortunate to have many good resources in the bleeding disorders community.