Finding Coverage, Accessing Care: Resources & Options in Pennsylvania

Community Health Centers in PA.pdf

Where to Go--Health Care Resources in PA (Jan. 2012).pdf

Finding affordable, quality health insurance that you can count on isn't easy (it can be a bit of a nightmare, especially if you have a pre-existing health condition), and that's why PHAN was committed to fighting for the Patient Protection and Affordable Care Act, and why we'll be gearing up to ensure that the new consumer protections and coverage expansions brought by the Patient Protection and Affordable Care Act are implemented and strengthened in Pennsylvania.

>> Click here to view a current overview of all existing programs, options, and protections in Pennsylvania, including health clinics, state coverage options, new resources and information on charity care.

The Affordable Care Act opens up several new coverage options for working people and people with pre-existing conditions who were previously shut out from getting the care they need due to skyrocketing costs and discriminatory practices by insurance companies. Most of these coverage expansions--a new, competitive health insurance marketplace where individuals, families and small businesses can purchase affordable, quality plans with income-based subsidies, and an expansion of Medicaid to individuals making up to 133% of the federal poverty level ($14,400 for an individual or $29,300 for a family of 4 in 2010 dollars)--are still a few years away.

There are, however, several new options and resources for the uninsured that are already in effect:

PA Fair Care

PA Fair Care is a new health plan for uninsured adults with pre-existing conditions. Premiums are $283/month, with additional co-pays and co-insurance (out-of-pocket costs are capped at $5000, which does not include the $1000 deductible). To be eligible for PA Fair Care, you must:

• Be a resident of the Commonwealth of Pennsylvania.
• Be a citizen or national of the United States or lawfully present in the United States.
• Have been uninsured for six months prior to the date you are applying for coverage into the program.
• Have a pre-existing condition.

Applications are accepted online, and on a first-come, first-serve basis. The program has limited funding, and will only be accepting around another 1,000 participants in the next year. It is expected to cover up to 5,600 by 2014 and will end in 2014 when the new health insurance marketplace and Medicaid expansions will offer folks alternative coverage.

Click here for a summary of covered services and here for additional FAQ's. 

Questions about enrollment and eligibility can be directed to Highmark, which administers the coverage at 1-888-767-7015, Monday thru Friday, 8:30 a.m. to 4:30 p.m.

If you've applied and are enrolling in PA Fair Care, please share your story with us! The more we can show that folks are being by reform, the more power we'll have to defend and implement it at the state level. Contact PHAN Staff to share your story today!

Early Retiree Reinsurance Program

Rising health care costs have made it incresingly difficult for employers and unions to provide quality, affordable health coverage for workers and retirees. In fact, the percentage of large firms providing health coverage to retirees dropped from 66% in 1988 to 29% in 2009.

This has left thousands of Pennsylvanians who retire before they're eligible for Medicare in serious jeopardy--having to exhaust their life savings to pay for insurance or being outright denied the opportunity to buy insurance over a pre-existing condition. Health insurance premiums for older Americans are over four times more expensive than those for young adults, and deductibles are almost four times greater than those within an employer-sponsored insurance plan.

The Affordable Care Act creates a new program called the Early Retiree Reinsurance Program to help address this serious problem facing early retirees. The Early Retiree Reinsurance Program (ERRP) provides much-needed financial relief to businesses, schools and other educational institutions, unions, state and local governments, and non-profits, in order to help retirees and their families continue to have quality, affordable health coverage.Participating employers receive reinsurance for the claims of high-cost retirees and their families, and can use these funds to provide premium relief and other health care cost relief to their retirees and workers and their families. The program helps employers pay some costs of early retirees’ health insurance claims, but does not make payments to or insure retirees directly.

Click here for a list of all participating employers in PA. If your employer is one of them, talk to them about how to sign up. If your employer is not on this list, encourage them to apply! Again, tell us your story if you've been able to sign up for coverage through your employer--we'd love to hear from you!

Young Adults Up to Age 26 Can Re-Join Parents' Insurance Plan

Before health care reform, many young adults lost their insurance the minute they turned 19 or graduated from college, leaving them vulnerable to devastating out-of-pocket costs and dissuading them from seeking important preventive care and regular checkups to stay healthy. But, as of Sept. 23rd, 2010, young adults up to age 26 can re-join their parents' health insurance plan thanks to the Affordable Care Act.

Plans that offer dependent coverage now must offer coverage to enrollees’ adult children until age 26, even if the young adult no longer lives with his or her parents, is married, is not a dependent on a parent’s tax return, or is no longer a student.

This applies to all plans in the individual market, new employer plans, and existing employer plans (although with existing employer plans, the young adult cannot rejoin their parents' plan if they are offered job-based insurance through their employer; in 2014, this changes, and the young adult can choose to rejoin their parents' plan even if they are offered coverage through their job).

Some insurers began re-enrolling young adults immediately after 9/23, while others did not start until the plan's new benefit year renewed. Your plan is required to provide a 30-day period—no later than the first day of your plan’s next plan year that begins on or after 9/23—to allow you to enroll your adult child. Your plan must notify you of this enrollment opportunity in writing. This is different for all plans, depending on when the plan year starts, so check with your insurer if you have questions about re-enrolling your child on your plan.

More information is available here. Have you already brought your adult child back on your insurance? Let us know--share your story!

Increased Funding for Community Health Centers to Help Expand Services to Uninsured

Community Health Centers are a critical lifeline for folks that are uninsured. They provide essential services and access to basic health care at an affordable rate (most charge based on your ability to pay and work with folks individually to ensure that no one is turned away for financial hardship). Some even have in-house pharmacies, and most include dental and vision services, in addition to general internal/family care.

The Affordable Care Act provides $29 Billion in new funding this year to help Community Health Centers expand and care for the folks who may not be able to obtain health insurance before the largest coverage expansions take effect in 2014.

Click here to find a health center near you, or call 1-866-944-2273 to learn more about accessing primary care and other services through one of PA's Federally Qualified Health Centers.

Click here to find a Volunteer-in-Medicine clinic near you. These clinics offer the same services as FQHC's, but are staffed by volunteer physicians and practitioners.

Most FQHC health centers and VIM health clinics have sliding-scale fees, and no one is turned away over the cost. If you between jobs, underemployed and otherwise lack access to health insurance (or you have severely limited insurance, or a plan that's cost prohibitive to use), the clinics are a great source for primary care. 

HealthCare.gov

One of the greatest new resources post-health reform is a new, user-friendly website, HealthCare.gov. The site was created by a team of experts from the Department of Health and Human Services, and finally provides a clear, easy to use way to investigate public and private health insurance plans in your area. Thanks to the new transparency provisions, you can now see the how insurers treat folks with pre-existing conditions by looking at the percentage of folks who were denied coverage and the percentage who were charged higher rates due to health status.

You can also follow all the latest health reform news and developments on their HealthCare Notes blog, learn about key provisions of the Affordable Care Act, listen to webcasts by HHS Secretary Kathleen Sebelius and other department staff, and download fact sheets about the new law. You can also compare hospitals, nursing homes, home health agencies and dialysis facilities on important quality measures. Data is now available for hospitals on 44 quality of care measures, for health inspection reports, staff ratios and ratings for nursing homes, and quality measures and services provided for home health agencies and dialysis facilities. This will be helpful in making more informed choices about where you seek care. Also, you can keep up with all the latest state information on implementation to track Pennsylvania's progress in implementing the Affordable Care Act.

Contact us with any questions/problems/run-arounds you encounter when investigating private insurance options. We may be able to help, or point you in the right direction.