Health care|September 12, 2009 11:06 PM

How can I find health insurance?

First the job disappears, then the health insurance.

What to do, beyond praying that no one in the family gets sick?

Hundreds of thousands of Colorado adults fall in a gap – they have too much money to qualify for government subsidies, but they can’t afford the insurance premiums in the costly individual market. The prospect of an expensive illness scares them nearly to death.

Still, there are more places for a soft landing than meets the eye – if one knows where to look.

Some government-subsidized insurance programs are based on current income, so if you are suddenly unemployed, you may qualify. Alternatively, private insurance may be cheaper than you think for healthy children and young adults.

Government-subsidized options for the uninsured are often limited to narrow groups – one program for children, another for people with a certain disease, another for those of a certain income, age or place of residence. There’s even financial help for people who saw their jobs move to Mexico. Trying to find the one program that fits you isn’t easy.

To find a government program in Colorado, try calling your county health department and asking for a “health navigator,” says one of them, Michelle Adams of the Tri-County Health Department., which serves Adams, Arapahoe and Douglas counties. Her formal title is family health coordinator, and she helps residents find and qualify for the best options. Here is a list of county health departments.

It’s particularly easy for your children to get coverage. A family of three with an income of as much as $37,536 can get discounted government insurance for just the children, sometimes immediately, through the Children’s Health Insurance Plan Plus.

Government-paid insurance for the parents is much more difficult to obtain. For the adults in that family of three to obtain Medicaid, the income limit is about $24,000 a year.

For a single adult, with no children, it’s really tough. The income limit for Medicaid is about $6,000 a year.

Government-subsidized insurance

Parents with suddenly sparse incomes can get their children covered through Child Health Plan Plus of Colorado.

That’s what many suddenly jobless parents did earlier this summer at a health-care fair. They came armed with birth certificates, pay stubs, affidavits and passports – and some of them had to come back again with the required documents. But for many the persistence paid off, and they got their children covered at almost no cost.

One thing not to do: Don’t assume that you don’t qualify for, or somehow don’t deserve, government help because you aren’t a member of the chronic underclass. If no money is coming in these days, you’re entitled to some help, and you certainly aren’t alone.

Adams, the family health coordinator for Tri-County Health Department is seeing an influx of middle-class families in her caseload.

More often these days, Tri-County Health is hearing from families in Highlands Ranch, Greenwood Village and other upper-scale neighborhoods – families that have never sought help from the government before.

“Usually, the husband worked, the mother stayed at home, and suddenly the husband lost his job,” she said.

They shuffle in sheepishly, seeking medical coverage for their kids or themselves, searching for answers and some lost dignity.

“Their fear is that they have to be completely broke” to qualify for CHP or Medicaid “and that isn’t true,” Adams said.

Neither is it true that it always takes weeks or months to get a family member eligible for government help. Some families may be approved for immediate help.

Adams has seen tears of sorrow, but also tears of joy.

“We had an enrollment fair and a woman came in that day,” Adams recalled. “She talked to one of our volunteers and then I saw her crying.

“I walked over to her and asked her if anything was wrong,” Adams recalled.   “She said, ‘I just found out that my kids are eligible for health coverage.’”

It was the first good news she’d had in more than a year. Her husband had lost his job 18 months ago, which led to the loss of their home and the unraveling of their marriage.

She was working but not earning enough to be able to purchase health care.

“She had been terrified of the consequences if one of her kids would get sick,” Adams said. “So when she found out that she was presumptively eligible, she was just overwhelmed with tears.

“That’s a story that is becoming much more typical than it was five years ago. People think that to be eligible they have to be living in skid row or in a dumpster,” she said. “It’s not true.”

Carol Lovseth, director of enrollment services at Denver Health and Hospitals, concurs.

“You don’t have to have been poor for quite a while” to be eligible, she said. If there’s a job loss and there is no money coming into the household, the family could find itself eligible for Medicaid or CHP, even if they still have nice cars and money in the bank.

The Colorado Indigent Care Program provides help to people with higher incomes, but only if assets are limited. In that program, it’s not enough that no one in the family is working. If there is money in the bank, that money has to be spent down before the family is eligible. But the household can have one car worth up to $4,500 and can remain living in the house.

“We approve them or deny them right there,” Lovseth said. Denver Health can grant presumptive eligibility to pregnant women on the spot, too.

Denver residents who need help should call Denver Health on a Monday and make an appointment to talk to someone at 990 Bannock St. Or, they can go to Denver Health’s neighborhood clinics and ask there. Some discounts are only for Denver residents.

“We’ve had quite a few situations recently where both the husband and wife lost their jobs and they have an immediate health need,” Lovseth said. “Maybe they’ve lost all their benefits, she finds out she’s pregnant and they are at a loss as to what to do.

“I don’t know how people find their way to Denver Health to get the benefits, but fortunately they do.

“A lot of times people are sheepish or reluctant because they’ve never really had to apply for public assistance before,” she said. “It’s a little bit difficult for them to admit their need. But when you’re pregnant and need prenatal care …” need overcomes pride.

“The people are always really grateful, though,” because the enrollment teams place a priority on respecting everyone, regardless of circumstance, she said.

Finding private health insurance you can afford

While older adults in the private insurance market may find themselves stunned to discover they are uninsurable in the open market, younger people don’t usually have that problem.

Younger people are unlikely to have a history of illness or health insurance claims that would cause insurers to reject their parents.

Insurance companies know the young are generally healthy, so you might be able to afford premiums for your children, if not for yourself.

For example, parents in parts of Colorado can buy catastrophic health insurance for a 6-month-old boy for just $27 a month from Humana. That policy has a $5,000 deductible. But Colorado requires insurance companies to cover well-baby visits and vaccinations before the deductible, according to Ellen Laden of UnitedHealthcare’s Golden Rule Insurance Co.

Her firm’s Plan 100 pays 100% after a lower deductible of $1500, and costs $129 a month in metro Denver for the 6-month old. But the premium drops to $79 for a two-year-old because “he’s old enough to have a health history, and we know the child is healthy,” she said. Insurance prices also vary by zip code, because people in some areas use more health care than people in other locations, she said.

Most health insurers in Colorado offer low-premium, high-deductible plans, and they are also affordable for healthy young adults.

James Sasaki, a recent University of Colorado graduate who lost his insurance when his father lost his job, found a price he could afford in a Blue Cross plan called Thrill Seeker.

“You live life on the edge and happily go for it,” reads the web ad for the Thrill Seeker plan.

For $75 in monthly premiums, Sasaki gets $20 doctor visits and $10 prescriptions. After meeting a hefty $5,000 deductible, he gets almost unlimited free care at hospitals, surgery centers and the like.

“I haven’t been to the doctor yet,” said Sasaki, 22, who enrolled in June. “But it’s been good. My prescriptions are less expensive than on my earlier plan.”

Thrill Seeker is aimed at adults 19 to 29, but the company will take applications from people up to age 65.

If you lost your insurance when you lost your job, you have a right to continue your employer’s insurance for 18 months under the federal law called COBRA as well as Colorado state law.

COBRA prices are often high, but they may be the only possibility for older workers. Don’t reject COBRA until you’ve found alternative health insurance.

This year’s federal stimulus law provides a 65 percent discount on Cobra premiums for many newly laid-off.

But COBRA doesn’t work for everyone.

“We were eligible for COBRA, but it would have cost us $1,200 a month for the family, which is ridiculous,” said John Rebchook, who lost his job and his health insurance in April.

Rebchook wasn’t eligible for the 65 percent COBRA discount because his wife’s plan allowed her to enroll a spouse. “Her company offers terribly expensive health care, but that doesn’t matter – it was the fact that I was eligible for it” that made him ineligible for the COBRA discount. His wife’s company health insurance “would have cost us about $750 a month.”

The family settled on a Kaiser-Permanente family plan at just $450 a month but with an $8,000-per-year deductible.

“That wouldn’t have made sense either, but I’m able to put about $7,000 a year into a Health Savings Account,” said Rebchook.

The money put in an HSA is tax-free. In fact, Rebchook put about $3,000 of it into one fund for anticipated medical expenses, and about $4,000 into an investment fund that has earned about 25 percent, and that can be tapped if medical expenses soar.

An HSA is a good option if you’ve lost your job, but have enough in savings to start a rainy-day fund.

He hopes everyone stays healthy, and then his HSA will build up over time.

“That way I can use it when I get old, and my medical expenses are a lot higher.”

If you can’t find a private insurer to cover you, Colorado has a last-ditch option called CoverColorado.

It has a website that can provide an instant estimate of what CoverColorado insurance will cost you, given your age, gender, smoking habits and income.

But even CoverColorado has restrictions. One woman quit her job to work on a political campaign, rejected Cobra as too expensive, and then found she was uninsurable, said Dede de Percin of the Colorado Consumer Health Initiative. When the woman finally went to CoverColorado, she found she was out of luck, because she’d rejected Cobra.

For a general guide to health insurance, try this site produced by Families USA, an organization pushing health care reform. It includes information on help if your job moved overseas.

Rebchook mused: “Wouldn’t it be funny if the Obama Health Plan was passed and made all of this moot?”

But even if a bill radically changing US health care and health insurance is approved by Congress this year, many changes in proposed bills are phased in. Your options may not change for years to come.

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