Special to The Washington Post
First appeared in print and online Tuesday, October 16, 2007; HE01
Barbra Lancelot has a master’s in education and a long career working with special-needs children. Until recently, she also had a good health insurance plan and prescription drug coverage, provided by her employer. But late last year, the 58-year-old College Park resident lost her job. Coverage was extended to her under COBRA, the law that guarantees temporary continuance of employer-provided insurance but requires the worker to pay the full premium.
It soon became a choice between paying rent or shelling out $350 a month for insurance premiums and another $800 a month for the eight prescription medications Lancelot takes for a variety of chronic conditions, including depression and fibromyalgia.
She chose to keep a roof over her head.
And as Lancelot quickly found, there aren’t many options available for people like her who make a small income and are not fully disabled.
Estimates vary widely, but according to the University of Michigan, about 66 million people were uninsured for some part of 2004.
A more recent study by the Washington-based advocacy group Families USA estimates that roughly one in three people in this region were uninsured at some point last year, and did not qualify for Medicare, the federal health insurance program for people older than 65 and those who are permanently disabled.
From losing a job as Lancelot did to finding employer-provided coverage too expensive, almost anyone can suddenly become uninsured.
“If you think this will never happen to you, think again,” said Karen Pollitz, project director of the Health Policy Institute at Georgetown University. Here are some options to look into:
Buying from an insurer or health plan:
People seeking insurance coverage within 63 days of leaving a group health plan are guaranteed by law (the Health Insurance Portability and Accountability Act) to be offered a policy, and preexisting conditions have to be covered. But the cost can be prohibitive.For those who have not been part of a group, buying an individual policy can also be expensive — if they are even offered one. “This market is hard for healthy people, and it is impossible if you’re not healthy or just a little bit unhealthy,” Pollitz said.During the application process, companies will ask about health history. People with preexisting conditions are often turned down or told those conditions won’t be covered. Sometimes the condition that triggers a denial is seemingly innocuous, such as acne.Insurers sometimes offer low-cost premiums with high deductibles, the amount you have to pay out-of-pocket before the insurance kicks in. Other low-premium policies might cover only a few doctors’ visits per year, or a very small percentage of a hospitalization, leaving you with a high level of risk.
If you’re rejected by insurance companies:
The Maryland Health Insurance Program is an insurer of last resort for the state’s adults who have been rejected for an individual policy, who are too young or not disabled enough to qualify for Medicare, and who are too wealthy to qualify for Medicaid. Thirty-three other states have similar programs. (Virginia and the District do not.)Launched four years ago, MHIP has 11,812 enrollees — ranging from millionaires to people with incomes below the poverty line, said Richard Popper, the program’s executive director. They see physicians and go to hospitals that are part of the CareFirst network.It is not a panacea, Popper said, acknowledging that premiums, which range from $135 to $500 per month depending on age, income and health, are too high for many. Also, a condition diagnosed in the six months before joining MHIP generally won’t be covered for the first two months, though enrollees can pay higher premiums for those two months to get the condition covered.The District’s City Council has been talking to MHIP officials about setting up a similar program for Washington, Popper said.In Virginia, the not-for-profit CareFirst and Anthem Blue Cross/Blue Shield are required by law to offer a policy to an individual who applies for one, but the insurers can exclude coverage for a preexisting condition for up to a year, and there’s no limit on the premium cost.
The Medicaid safety net:
Medicaid is for U.S. citizens and legal immigrants living at or below poverty level.Eligibility rules vary widely, however. In Maryland, for example, working adults without children can get Medicaid coverage for themselves only if they make less than 38 percent of the federal poverty level — that is, 38 percent of $10,210, or $3,880 a year.
SCHIP for Children:
In all three local jurisdictions, children who lack coverage may be eligible for the State Children’s Health Insurance Program. President Bush recently vetoed a bill to extend the program from the 6 million children nationwide who receive benefits to as many as 4 million more. Maryland’s SCHIP currently covers children in families earning up to 300 percent of the federal poverty level, or about $60,000 for a family of four.
Other options:
In Washington, people who don’t qualify for Medicaid but still have a low income — 200 percent of the federal poverty level, or $27,380 for a family of two — can receive free medical care and prescriptions through the DC HealthCare Alliance. The medical care has to be given by participating physicians and hospitals. And the alliance does not cover mental health or alcohol or substance abuse services.A free primary care program, Maryland Primary Adult Care Program, serves Maryland adults who meet eligibility criteria; Virginia does not offer any such plans.A federal program offers free breast and cervical cancer screenings; states set their own eligibility rules, usually based on income.The Maryland Pharmacy Assistance Program subsidizes the cost of prescription drugs; there is no similar plan in Virginia. Wal-Mart has a program through which most generic drugs can be purchased for $4.
Paying out-of-pocket:
If you must pay for health care out-of-pocket, you should ask about fees before a medical visit or inquire as to whether installment payments or other financing is available.Lancelot now carries a note in her wallet. Printed on it are words President Bush spoke in July. Americans have access to health care, he said. “After all, you just go to an emergency room.”While emergency departments must treat anyone who walks in, regardless of insurance status or citizenship, the physicians’ duty is to stabilize the person, not offer ongoing medical care. And hospitals do expect payment.Having experienced what it is like for an uninsured person to try to get care for chronic conditions, Lancelot has come to live by a different, unwritten rule: “That any agency or organization you call is guaranteed to do one thing for you — and that is to give you three more phone numbers to call,” she said.
Alicia Ault is a frequent contributor to the Health section.