A traumatic injury will cause financial problems irregardless of the individual’s current income level. Health insurance helps to buffer some of the high bills that are associated with receiving medical care. Many people in the United States do not currently have health insurance. The Affordable Care Act has opened up new options for people who are in this situation. There are a number of steps that a person should take immediately if they are suddenly injured and with out healthcare.
A worker may have their employer coverage end. They will want to check with their Human Resource Manager to see if they are eligible for continuing health insurance from the employer under the Consolidated Omnibus Budget Reconciliation Act (COBRA). The former employee will have the option of continuing coverage for themselves and/or family members under this law.
The health plan will continue for a limited time under COBRA up to 18 months when the worker has been terminated or hours reduced. The amount that the worker pays each month will vary depending on the company, and some people will find that the cost is too high to afford. Other individuals are going to pay a small amount and will want to stay covered under COBRA.
State subsidized health insurance is called Medi-Cal in California. The Department of Health Care Services (DHCS) oversees the Medi-Cal program. It is available to people who are considered low income. Adults, children, seniors, a person formerly in the foster care system up to age 26 and disabled individuals may qualify for free or low cost health insurance through this program. There are several ways to apply. A new applicant can complete the form online at www.CoveredCA.com, or they can go into a local county office.
A successful Medi-Cal applicant with receive their health insurance card referred to as a Benefits Identification Card (BIC) in the mail. The recipient will be able to use their insurance plan immediately to receive care. The individual or family will also receive a packet so that they can select their insurance from available plans. The county agency may contact the applicant when more information is needed to verify that they qualify for Medi-Cal. It will be important that this request by the county is completed in a timely manner.
An individual may still have sufficient income that makes them ineligible for Medi-Cal. They will want to look at healthcare options under Covered California. The annual open enrollment period for these health insurance plans happens in the fall for most people, but there are also special enrollment periods all year long. A person will qualify for a special enrollment when they experience a life changing event.
Losing heath coverage, such as employer health insurance ending, will give a person a special enrollment. Other reasons will include change in income, change in residency or becoming a citizen. The full list of qualifying life events that give a person a special enrollment may be viewed at www.coveredca.com. This option needs to be looked into immediately since the consumer will have only 60 days from the event to get their enrollment completed.
A personal injury may also lead to long term health issues. The consumer will want to apply for Social Security Disability. People can qualify for Medicare if they have received SSDI for a continuous period of 24 months and are under age 65. They will automatically be enrolled in Medicare after this time. Medicare covers hospital under Part A, and the person’s doctor is covered under Part B. The client will have to get a separate prescription drug plan also called Part D plans. Extra help for prescriptions is available for some people, and the individual should call Medicare or Social Security for more information.
Medicare will cover 80%, and the individual will be responsible for the other 20%. Many people will need to get a Medicare supplemental plan, or they can see if a Medicare Advantage plan is offered in their area. A Medicare Advantage plan will bundle the Part A & Part B benefits together, and all benefits are administered via the health insurance carrier’s plan. A supplemental plan helps the insured pay for some or all of the 20% they are responsible for depending on the plan selected.
An individual can also continue to have Medi-Cal and Medicare in some instances. Dual eligible clients will need to speak to their county social worker prior to enrolling into any plan. The insured will want to avoid inadvertently enrolling in a plan that cancels their current subsidized insurance.