Getting and Keeping Getting and Keeping Health Insurance in Health Insurance in Pennsylvania 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 [email protected]212-221-7300 x265
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Getting and Keeping Health Insurance in Pennsylvania
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 [email protected] 212-221-7300 x265. - PowerPoint PPT Presentation
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Getting and Keeping Getting and Keeping Health Insurance inHealth Insurance in
PennsylvaniaPennsylvania
The Center for Emerging Visual Artists February 28, 2013
Artists Health Insurance Resource CenterA program of The Actors Fund
Presenter: Jim Brown, Director of Health Services [email protected] 212-221-7300 x265
http://www.ahirc.org
How can I get health insurance How can I get health insurance in Pennsylvania?in Pennsylvania?
Employment-related coverage
Private, direct-purchase plans
Government-subsidized programs
What are my protections and What are my protections and limitations?limitations?
Elimination riders permitted
Group market: ◦6 month look back period/ 12 month
pre-existing condition exclusion◦Credit for coverage if less than 63 day
lapse in policies
What are my protections and What are my protections and limitations?limitations?
No right to insurance
Right to receive care in a life-threatening emergency at any hospital regardless of insurance status
Individual market:◦5 year look back period/ 3 year pre-
existing condition exclusion◦No credit for prior coverage
Current healthcare reform Current healthcare reform protections protections
PCIP (for the uninsured with pre-existing conditions)
Children under age 19 can’t be denied coverage
Adults up to age 26 can stay under parents’ plan
Insurers can’t rescind coverage if you get sick
Current healthcare reform Current healthcare reform protections protections
Lifetime dollar limits on medical coverage are banned
Medicare and new private plans must cover certain preventive services for free
Medicare recipients in donut hole receive 50% off brand-name drugs
Words to knowWords to knowCo-payCo-insuranceDeductibleHMOPPOHSAFederal Poverty LevelPremiumReasonable & customary charges
Employment-related Employment-related optionsoptionsJob or spouse/domestic partner’s job
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)
I’ll be traveling/going on tour. I’ll be traveling/going on tour. Will I be covered while on the Will I be covered while on the road?road?
Check with insurer
International travel http://www.medhealthinsurance.c
om/traveler.htm
I have a pre-existing condition. I have a pre-existing condition. What do I do?What do I do?
HIPAA◦18 mo prior coverage, last day of
which was through group plan◦Have exhausted COBRA
Not eligible for public programs or job-related insurance
◦Receive your HIPAA certificate!Medicaid, CHIP, Special
Pharmaceutical Benefits Program, COBRA
I have a pre-existing condition. I have a pre-existing condition. What do I do?What do I do?
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 I can’t afford insurance. Are there government programs I qualify for? government programs I qualify for?
Federal Poverty Levels 2012Federal Poverty Levels 2012
Government programsGovernment programsMedicaid
◦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
I have a special health condition. I have a special health condition. Are there any programs that Are there any programs that cover it?cover it?
Healthy Woman Program◦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 I’m 65. Are there any programs for people my age or programs for people my age or
older?older?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 I need mental health care but I don’t have insurance. Where can don’t have insurance. Where can I go?I go?SAMHSA mental health locator: