U.S. Directoryof Health Coverage      Options
How to use this Directory:     Use the Income Worksheet(page “iii”) to determine the Federal Poverty Level     percentage ...
U.S. Directoryof Health Coverage      OptionsA state-by-state guide to helping Americans navigate their        public and ...
table of contents    Acknowledgments	                       ii      New Mexico	                   61    Income Worksheet 	...
I want to dedicate this book to the thousands of workers in the private and public health insurance systemsacross the coun...
iNCOME WORKSHEET      Step One      Use this worksheet to calculate your family or household total income after deductions...
Federal Poverty Level Chart                                   Your Federal Poverty Level (FPL)                            ...
Demographic                  Private Health Insurance                                                      Individuals    ...
Publicly-Sponsored Programs                                                                                               ...
Demographic                   Private Health Insurance                                                      Individuals   ...
Publicly-Sponsored Programs                                                                                               ...
Demographic                   Private Health Insurance                                                                    ...
Publicly-Sponsored Programs                                                                                               ...
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
Guide to All States Gov\'t and Private Health Insurance Plans
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Guide to All States Gov\'t and Private Health Insurance Plans

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Comprehensive guide on all 50 states government sponsored and private insurance major medical plans

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Guide to All States Gov\'t and Private Health Insurance Plans

  1. 1. U.S. Directoryof Health Coverage Options
  2. 2. How to use this Directory: Use the Income Worksheet(page “iii”) to determine the Federal Poverty Level percentage of you or the person whom you are trying to assist. This percentage usually determines if an individual is eligible for various public programs. Find your state’s Health Coverage Options Matrix for a complete list of private and public health coverage programs, along with additional valuable resources. Consult the Appendices for our QR code, state-by-state program contact information, uninsured statistics for each state, as well as the glossary of terms found within this book. Foundation for Health Coverage Education 101 Metro Drive, Suite 250 • San Jose, CA 95110 • www.CoverageForAll.org ISBN-13: 978-1-42432862-8 © Copyright 2012 by Philip Lebherz & Foundation for Health Coverage Education All Rights Reserved. Updated February 2012 For the most up-to-date version, please visit: www.CoverageForAll.org.iv
  3. 3. U.S. Directoryof Health Coverage OptionsA state-by-state guide to helping Americans navigate their public and private health coverage options Created by Phil Lebherz Foundation for Health Coverage Education
  4. 4. table of contents Acknowledgments ii New Mexico 61 Income Worksheet iii New York 63 Federal Poverty Level Chart iv North Carolina 65 Health Care Options Matrices by State North Dakota 67 Alabama 1 Ohio 69 Alaska 3 Oklahoma 71 Arizona 5 Oregon 73 Arkansas 7 Pennsylvania 75 California 9 Rhode Island 77 Colorado 11 South Carolina 79 Connecticut 13 South Dakota 81 Delaware 15 Tennessee 83 Florida 17 Texas 85 Georgia 19 Utah 87 Hawaii 21 Vermont 89 Idaho 23 Virginia 91 Illinois 25 Washington 93 Indiana 27 Washington, D.C. 95 Iowa 29 West Virginia 97 Kansas 31 Wisconsin 99 Kentucky 33 Wyoming 101 Louisiana 35 Maine 37 Appendices Maryland 39 Other Services (by State) 103 Massachusetts 41 State-by-State Comparison 110 Michigan 43 The Uninsured In America 111 Minnesota 45 Glossary of Terms 112 Mississippi 47 Missouri 49 About FHCE 115 Montana 51 Nebraska 53 Nevada 55 New Hampshire 57 New Jersey 59i
  5. 5. I want to dedicate this book to the thousands of workers in the private and public health insurance systemsacross the country who are attempting to reach our goal of lowering the number of uninsured people inAmerica. I especially want to thank Leonard Schaeffer who provided his knowledge, inspiration, and visionto this project. - Phil LebherzAcknowledgmentsThe following individuals and associations generously donated their time, energy, and resources tocreating this resource:Aetna Foundation Health Coverage Foundation, Inc. Professional ExchangeAlain Enthoven Health Net of California Service CorporationBeere & Purves, Inc. Kaiser Foundation Rio Grande AssociationBlue Shield of California Los Angeles Unified School District Saint Joseph Health Center FoundationCAHU Charitable Larry GlasscockCommunity Foundation Schmitt Family Foundation Leonard & Pamela SchaefferCal Locket San Diego Office of Education LISICAHU Sharp Health Plan NAHU (& State Chapters)California State Legislators Spahr Insurance Peter & Renuka PatelCathay Post No. 384 The Rauser Agency Peter FarrellDavid & Nancy Helwig Family The Sugg Group Pfizer, Inc.Fund Word & Brown Philip & Vivian ReedDickerson Employee Benefits, Inc. Warner Pacific Placer County Office of EducationErnie Ramirez WellPoint Foundation Poizner Family TrustGeorge & Clare SchmittCollaborative EffortsWe would like to recognize the following organizations for their collaborative efforts in helping lower theranks of the uninsured by using FHCE’s resources:Aetna Inc. California Department of Insurance NAICAmerican Cancer Society Community Medical Centers Sharp HealthCareAmerican Diabetes Association Daughters of Charity Health Systems United Way-211 Call CentersAmerican Heart Association eHealthInsurance United Health CareAmerican Lung Association Google, Inc. WellPoint, Inc.Dignity Health NAHUAppreciated Media SupportFHCE’s resources have had over 4 billion media impressions thanks to the following media outlets:AARP Hospital Access Management San Francisco Business TimesABC News Kiplinger’s Personal Finance San Francisco ChronicleAmerican Medical News KFWB 980 AM Self MagazineBecker’s Hospital Review KTLA TV Channel 5 Smart Money, AOL Money &CBS Bay Sunday Los Angeles Times FinanceChicago Tribune Men’s Health Magazine The Angie Strader ShowCNN Modern Healthcare The New York TimesConsumer Digest MSNBC The Wall Street JournalCostco Connection New York Daily News The Washington PostDailyFinance Parenting.com USA TodayHealth Affairs Parents Magazine U.S. News & World Report ii
  6. 6. iNCOME WORKSHEET Step One Use this worksheet to calculate your family or household total income after deductions. Step Two Look for the income amount closest to the number in step one within the chart on the opposite page to determine which percentage of the Federal Poverty Level (FPL) you are. Step Three Remember this percentage, as it will help you determine for which public programs you are eligible. Your monthly income + __________________ Spouse’s monthly income + __________________ TOTAL INCOME = __________________ Please fill in the following information, separate from amount that you just calculated: Begin with $0. For each working parent in the household, add $90. + __________________ If you pay for childcare for children under the age of 2, add $200 for each child. + __________________ If you pay for childcare for children over the age of 2, or for a child with disabilities, add $175 for each child. + __________________ If you receive child support, add $50 for each child. + __________________ If you pay alimony and/or child support, enter the amount. + __________________ Total Deductions = __________________ Now, subtract your Total Deductions from your Total Income. TOTAL INCOME __________________ TOTAL DEDUCTIONS - __________________ T OTAL INCOME AFTER DEDUCTIONS =________________ Find an amount closest to this total within the chart on the opposite page to determine your Federal Poverty Level (FPL) percentage. Note: This income worksheet is only intended to serve as a guide. Some factors in determining your eligibility may not be represented above. Deductions listed here are typical for most public programs, but may vary by agency.iii
  7. 7. Federal Poverty Level Chart Your Federal Poverty Level (FPL) Based on monthly family gross income Family Size (House- 100% 133% 175% 200% 250% 300% 400% hold) 1 $931 $1,238 $1,629 $1,862 $2,327 $2,793 $3,723 2 $1,261 $1,677 $2,206 $2,522 $3,152 $3,783 $5,043 3 $1,591 $2,116 $2,784 $3,182 $3,977 $4,773 $6,363 4 $1,921 $2,555 $3,361 $3,842 $4,802 $5,763 $7,683 5 $2,251 $2,994 $3,939 $4,502 $5,627 $6,753 $9,003 6 $2,581 $3,433 $4,516 $5,162 $6,452 $7,743 $10,323 7 $2,911 $3,871 $5,094 $5,822 $7,277 $8,733 $11,643 8 $3,241 $4,310 $5,671 $6,482 $8,102 $9,723 $12,963 Based on yearly family gross income 1 $11,170 $14,856 $19,548 $22,340 $27,925 $33,510 $44,680 2 $15,130 $20,123 $26,478 $30,260 $37,825 $45,390 $60,520 3 $19,090 $25,390 $33,408 $38,180 $47,725 $57,270 $76,360 4 $23,050 $30,657 $40,338 $46,100 $57,625 $69,150 $92,200 5 $27,010 $35,923 $47,268 $54,020 $67,525 $81,030 $108,040 6 $30,970 $41,190 $54,198 $61,940 $77,425 $92,910 $123,880 7 $34,930 $46,457 $61,128 $69,860 $87,325 $104,790 $139,720 8 $38,890 $51,724 $68,058 $77,780 $97,225 $116,670 $155,560• A pregnant woman counts as two for the purpose of this chart.• Add $330/month for each additional family member after eight.• ontact individual programs for deduction allowances on child/dependent care; working parent’s work expenses; C alimony/child support received or court ordered amount paid.The following figures are the 2012 HHS poverty guidelines as of January 26, 2012. (Source: http://aspe.hhs.gov/poverty/12poverty.shtml)Monthly percentage data calculated by FHCE and rounded to the nearest dollar.Please visit www.CoverageForAll.org for further details and updates on the 48 continuous states, Hawaii and Alaska FPL charts. ReminderThere is no universal administrative definition of income that is valid for all programs that use thepoverty guidelines. The office or organization that administers a particular program or activity isresponsible for making decisions about the definition of income used by that program (to the extentthat the definition is not already contained in legislation or regulation). To find out the specific definitionof income used by a particular program or activity, you must consult the office or organization thatadministers that program. iv
  8. 8. Demographic Private Health Insurance Individuals Individuals with Low-Income Small Businesses Recently Covered Individuals Pre-Existing, Severe, Individuals (2-50 Employees) by an Employer Families or Chronic Medical Families Health Plan Conditions Group Plans COBRA Individual Plans Alabama Health Medicaid National Association of Health Then convert to a plan under: National Association of Insurance Plan (AHIP) (SOBRA MLIF) Underwriters Health Underwriters Alabama Health 334-242-5000 703-276-0220 703-276-0220 Insurance Plan SOBRA: 800-362-1504 www.nahu.org HIPAA www.nahu.org 866-833-3375 MLIF: 800-362-1504 Health Insurance Portability 334-263-8311 insurealabama.adph.state.al.us Accountability Act www.alseib.orgProgram 866-487-2365 www.dol.gov Pre-Existing Condition Insurance Plan (PCIP) HIPP Run by the U.S. Department of Health Insurance Premium Health and Human Services Payment Program 866-717-5826 334-242-3722 www.PCIP.gov www.medicaid.state.al.us There is a maximum 6-month COBRA: Coverage available for Assorted plans depending on AHIP: Two plans offered: indemnity Medicaid (SOBRA and MLIF): Among look-back/12-month 18–36 months depending on medical needs. and managed care. Both cover some of the services: Ambulatory exclusionary period for qualifying events. Benefits Prescription drugs, Outpatient surgical center, Birth center pre-existing conditions on are what you had with your There is a maximum look- and in-patient care, Durable services, Child health check- enrollees that do not have prior previous employer. back period of 60 months medical equipment, Mental up, Chiropractic care, Durable coverage. and a maximum exclusion health, Substance abuse, and medical equipment and supplies, HIPAA: Benefits are based on period of 24 months for Away-from-home emergency care. Federally qualified health centers, Benefits will vary depending program selected. There is no pre-existing conditions on Managed care also covers Labs, Home health, Hospital inpatient/Coverage on the chosen plan. expiration of coverage. enrollees that do not have X-rays, Transplants, Maternity, and outpatient care, Laboratory, prior coverage. Rehabilitation care. Licensed midwife, Physician, Pre-Existing Health HIPP: Benefits are the same Podiatry, Prescriptions, Rural health Conditions Covered as what you had with your Elimination riders are PCIP: Covers broad range of clinics, Therapy, and X-rays. previous employer, HIPP is a permitted. benefits, including primary and premium assistance program. specialty care, hospital care, and SOBRA: Pregnant women ONLY Limits on Pre-Existing Health prescription drugs. get pregnancy related services Pre-Existing Health Conditions May Apply covered. Conditions Covered Pre-Existing Health Conditions Covered Pre-Existing Health Conditions Covered GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE Company size 2-50 employees. COBRA: Available for employees Eligibility is subject to AHIP: You must have chosen to Medicaid (SOBRA and MLIF): Must be who work for businesses with medical underwriting. extend coverage under COBRA, a U.S. citizen or legal alien and an Eligible employees must work 20 or more employees. Have 60 group health plan, government Alabama resident. at least 30 hours a week. days from date of termination If you are denied coverage plan, or church plan and to sign up for COBRA coverage. for a medical condition, you exhausted those benefits and Income limits: Owner can count as an may be eligible for AHIP, or submitted your application employee. HIPAA: Must have had 18 months PCIP. within 63 days of your last day of Pregnant Women: 133% FPL. of continuous coverage and coverage to sign up for AHIP. Children (ages 0–5): 133% FPL. Owner name on business completely exhausted COBRA Must be a permanent Alabama license must draw wages from or state continuation coverage. resident with at least 18 months Children (ages 6–18): 100% FPL. the company. Must not have lost coverage of continuous coverage withoutEligibility due to fraud or non-payment of being terminated due to fraud or Parents/caretakers living with premiums. You have 63 days to failure to pay. children ages 0–18: 24% FPL. enroll in a HIPAA-eligible plan. Aged, blind and disabled: Singles AHIP is specifically aimed at those with incomes up to 75% FPL and HIPP: You may be eligible for HIPP who have purchased coverage asset limit of $2,000, and couples if you have a high-cost health from their employer and whose with incomes up to 83% FPL with condition. benefits have run out. asset limit of $3,000. PCIP: Must have been uninsured for at least 6 months prior to applying. SOBRA: Must not be eligible for ALL Must prove being a U.S. citizen or Kids. legal U.S. resident, an Alabama resident, and having problems getting insurance due to a pre- existing condition. Costs depend on employer COBRA: Premiums range from Costs for individual coverage AHIP: Traditional Indemnity Plan Medicaid: $0–$3 for office visits, contribution and ± 20% of the 102%–150% of group health vary. There are no rate caps. premiums could range between prescription drugs and some other insurance company’s index rates. $147 to $1,150 depending on age, services. rate. sex, smoker or non-smoker, and planMonthly Cost HIPAA: Premiums will depend you choose. SOBRA: $50 co-payment for each on plan chosen. inpatient hospital stay. Managed Care Plan premiums could HIPP: $0 or minimal share of range between $283 to $1,068 cost. depending on age, sex, and smoker or non-smoker. PCIP: Monthly premiums range from $110 to $471 depending on your age.21 Alabama
  9. 9. Publicly-Sponsored Programs Demographic Children in Trade Dislocated Moderate Income Women Seniors Disabled Workers Veterans Families (TAA Recipients) ALL Kids Breast and Cervical Medicare Health Coverage VA Medical 888-373-5437 334-206-5568 Cancer Early 800-633-4227 www.medicare.gov Tax Credit Benefits Package 877-774-9521 Detection Program 866-628-4282 www.irs.gov 877-222-8387 www.va.gov insurealabama.adph.state.al.us (ABCCEDP) Medicare (Search: HCTC) or 877-252-3324 www.adph.org/allkids www.adph.org/earlydetection Prescription Drug Program Program AL Child Caring Plan First 800-633-4227 (Family Planning) Program 888-737-2083 800-726-2289 www.adph.org/planfirst Alabama State insurealabama.adph.state.al.us www.accf.net Health Insurance Assistance Program Note: AL Child Caring Program 800-243-5463 closed on January 1, 2011. The children in the program have been referred to Medicaid and ALL Kids. ALL Kids: Coverage will begin ABCCEDP: Pelvic exam, Pap Medicare offers Part A, Inpatient and outpatient care Comprehensive preventive and on the first day of the month smear, Clinical breast exam, inpatient care in hospitals and (lab tests, x-rays, etc.), Doctor primary care, outpatient and after application is received. Mammogram, and Diagnostic rehabilitative centers; Part B, visits, Preventive and major inpatient services. Benefits include 12 months services, such as an ultrasound, doctor and some preventive medical care (surgery, physical continuous coverage, doctor colonoscopy, or biopsy, if services and outpatient care; therapy, Durable medical Pre-Existing Health visits, check-ups, hospital and needed. Part C allows Medicare benefits equipment, etc.), Mental health Conditions Covered physician care, immunizations, through private insurance and substance abuse care, and prescriptions, dental and vision Plan First: Yearly family planning (Medicare Advantage); Part C Prescription drugs. Coverage care, emergency services, and exams, Care support from a includes Parts A, B, and C not mental health/substance abuse social worker or nurse, Some covered by Medicare. Part D Pre-Existing Health services with dedicated phone types of birth control (such covers prescription drugs. Conditions Covered number available 24 hours a as birth control pills and day, 7 days a week. Depo-Provera shots), Tubal ASHIAP is a Medicare counseling ligation (tube tying) for women service. AL Child Caring Program: 21 years or older, Lab work Outpatient services only. (pregnancy and STD testing), Pre-Existing Health and Family planning help. Conditions Covered Pre-Existing Health Conditions Covered GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE Both: Must be under the age of ABCCEDP: Women without Medicare and ASHIAP: Must be Must be receiving TAA (Trade ”Veteran status” = active duty 19 and an Alabama resident, insurance or who are U.S. citizen or permanent U.S. Adjustment Assistance), or in the U.S. military, naval, or air not be covered by any other underinsured ages 40–64, resident, and: service and a discharge or release health insurance, and be earning up to 200% FPL. Must be 55 years or older and from active military service ineligible for Medicaid. 1) If 65 years or older, you or receiving pension from the under other than dishonorable Women under age 40 who your spouse worked for at least Pension Benefit Guaranty conditions. ALL Kids: Must be a U.S. citizen or have problems with their 10 years in Medicare-covered Corporation (PBGC). eligible immigrant, not be in an breasts can undergo a clinical employment, or Certain veterans must have institution. Children 0–5 years breast exam to determine if Must not be enrolled in certain completed 24 continuous months old must have family incomes they are eligible to receive a 2) You have a disability or end- state plans, or in prison, or of service. of 133%–300% FPL. Children free breast cancer screening stage renal disease (permanent receiving 65% COBRA premium Eligibility 6–18 years old must have family through the program. kidney failure requiring dialysis reduction, or be claimed as a incomes of 100% - 300% FPL. or transplant) at any age. dependent in tax returns. Plan First: Must be a U.S. citizen AL Child Caring Program: Must not or legal alien and an Alabama Must be enrolled in qualified be eligible for ALL Kids and resident. Must be a woman health plans where you pay all other plans; be enrolled in between the ages of 19 and 55 more than 50% of the premiums. school (if of age). with an income limit of 133% FPL and have not had surgery Individuals who are eligible to prevent pregnancy. for the federal Health Care Tax Credit can also use their credit funds to purchase a private health insurance product developed by Blue Cross Blue Shield of Alabama. Both: $0 or small co-pays. ABCCEDP: $0 or minimal share Medicare and ASHIAP: $0 and 20% of the insurance $0 and share of cost and of cost. share of cost for certain premium including COBRA co-pays depending on income ALL Kids: Yearly costs range services; deductibles for premium if employer from $50 to $100 per child up to Plan First: $0 for family certain plans. Part A: $0–$450 level. Monthly Cost contributes less than 50%. the first 3 children (no cost for planning services only. based on length of Medicare- additional children). Small co- covered employment; Part B: pays are required at the time of $96.40–$369.10 depending on service. There are no co-pays for annual income; Part C: Based on preventive services. provider; Part D: Varies in cost and drugs covered. Alabamawww.CoverageForAll.org 2
  10. 10. Demographic Private Health Insurance Individuals Individuals with Small Businesses Recently Covered Individuals Pre-Existing, Low-Income Children (2-50 Employees) by an Employer Families Severe, or Chronic Families Health Plan Medical Conditions Group Plans COBRA Individual Plans Alaska Medicaid Comprehensive 907-465-3347 800-780-9972 Alaska Association of Health Alaska Association of Health Underwriters Then convert to a plan under: Underwriters Health Insurance www.hss.state.ak.us www.alaskaahu.org www.alaskaahu.org Association (ACHIA) (Search: Medicaid) Program HIPAA 888-290-0616 Health Insurance Portability www.achia.com Accountability Act 866-487-2365 Pre-Existing www.dol.gov Condition Insurance Plan (PCIP) Federal program run by the ACHIA 877-505-0510 www.PCIP.gov www.achia.com/ACHIA-FED There is a 6-month look- COBRA: Coverage available for Assorted deductible and plan ACHIA: Offers 6 different Inpatient and outpatient hospital back/12-month exclusionary 18–36 months depending on design options for selection. comprehensive PPO plans with services, Mental health and period for pre-existing qualifying events. Benefits are different deductibles. Offers substance abuse care, Rural conditions if enrollee had what you had with your previous There are no limits to look-back one traditional non-PPO plan health clinics, Nurse, Midwife, no prior coverage, or if prior employer. and exclusionary periods for paying 80% of the allowed Dentist, Optometrist, Physician coverage had a break of more pre-existing conditions. charges after the $1,000 annual care, Prescription drugs, Physical than 63 days. HIPAA: Benefits are based on deductible is satisfied. After therapy, Medical equipment and program selected. There is no Limits on Pre-Existing Health deductible and out-of-pocket devices (prosthetics, eyeglasses, Group coverage as selected by expiration of coverage. Conditions May Apply maximum have been satisfied, dentures, etc.), Preventive care employer with a variety of plan ACHIA will pay claims at 100%. and diagnostic services, Family designs available. Pre-Existing Health planning, Labs and x-rays, Home Coverage Conditions Covered PCIP: Inpatient and outpatient health services (such as nursing Pre-Existing Health hospital services, physician services, home health aides). Conditions Covered services, prescription drugs, skilled nursing, home health, Pre-Existing Health Conditions hospice, chemotherapy, Covered anesthesia, prosthesis, durable medical equipment, x-rays and laboratory services, oral surgery, physical therapy, substance abuse treatment, mental health services, ambulance, maternity, PKU formula, Pap smear and mammograms. Pre-Existing Health Conditions Covered GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE Company size 2–50. COBRA: Available for employees Eligibility is subject to medical ACHIA: Must be a U.S. citizen Must be U.S. citizen or qualified alien who work for businesses with 20 underwriting. or legal resident living in and Alaska resident. Eligible employees must work or more employees. You have 60 Alaska and at least one of the at least 30 hours a week. days from date of termination to If you are denied coverage following: 1) You were rejected Income limits: sign up for COBRA coverage. for a medical condition, you for health insurance in the last 6 Owner can count as an may be eligible for an Alaska months, or received restrictive Family: 185% FPL. employee. Proprietor name on HIPAA: Must have had 18 months Comprehensive Health riders that reduced coverage, Working disabled: 250% FPL. license must draw wages. of continuous coverage and Insurance Association plan, or or 2) You have a qualified completely exhausted COBRA PCIP. See next column. pre-existing condition, or 3) Aged, blind, and disabled: Singles or state continuation coverage. You had exhausted COBRA, are with incomes up to 109% FPL and Must not have lost coverage uninsured, not eligible for any asset limit of $2,000, and couples Eligibility due to fraud or non-payment of group coverage from private or with incomes up to 120% FPL and premiums. You have 63 days to public sources (e.g. Medicaid, asset limit of $3,000. enroll in a HIPAA-eligible plan. Native Health Care, etc.), and you were covered under a For pregnant women and children, group health plan in the prior see “Moderate Income Children 18 months with no break of Families” column. more than 90 days, or 4) You Contact your local Division of are receiving Trade Adjustment Public Assistance office or your Assistance (TAA). community’s village fee agent for more information. PCIP: Must have been uninsured for at least 6 months prior to applying. Must prove being a U.S. citizen or legal U.S. resident, an Alaska resident, and having problems getting insurance due to a pre-existing condition. Costs depend on employer contribution and ± 35% of the COBRA: Premiums range from 102%-150% of group health rates. Costs vary dependent on age and medical underwriting. ACHIA: Premiums range from $107–$2,950 depending on your $0 for families below 100% FPL. Monthly Cost insurance company’s index There are no rate caps. age and plan chosen. rate. HIPAA: Premiums will depend on $50–$200 per day for hospital plan chosen. PCIP: Monthly premiums range admission (except for mental from $452 to $1,806 . institutions).43 Alaska
  11. 11. Publicly-Sponsored Programs Demographic Trade Dislocated Moderate Income Adults with Chronic Native American Seniors Disabled Workers Children Families Medical Conditions Indians (TAA Recipients) Denali Kid Care Chronic and Acute Indian Health Medicare Health Coverage Toll Free Outside Anchorage 888-318-8890 Medical Assistance Services (IHS) 800-633-4227 www.medicare.gov Tax Credit (Alaska Area) 866-628-4282 Anchorage Area (CAMA) 907-729-3686 www.irs.gov 907-269-6529 800-780-9972 www.ihs.gov Medicare (Search: HCTC) Program www.hss.state.ak.us www.hss.state.ak.us (Search: Alaska) (Search: Denali Kid Care) (Search: CAMA) Prescription Drug Or contact the Division of Public For eligibility information visit: Program www.ihs.gov 800-633-4227 Assistance office nearest you or (Search: Eligibility) the fee agent in your community. Prevention and treatment Prescription drugs and medical IHS services are provided Medicare offers Part A, Inpatient and outpatient care services such as: Doctors visits, supplies, limited to 3 prescriptions directly and through tribally- inpatient care in hospitals and (lab tests, x-rays, etc.), Doctor Check-ups and screenings, per month and no more than a 30- contracted and operated health rehabilitative centers; Part B, visits, Preventive and major Vision exams and eyeglasses, day supply of any drug. programs. From private care doctor and some preventive medical care (surgery, physical Dental checkups, Cleanings sources, tribal health programs services and outpatient care; therapy, Durable medical and fillings, Hearing tests Physician services which are purchase services for Native Part C allows Medicare benefits equipment, etc.), Mental health and Hearing aids, Speech directly related to the medical American patients in areas through private insurance and substance abuse care, and therapy, Physical and Mental condition that qualifies you for where IHS facilities or services (Medicare Advantage); Part C Prescription drugs. health therapy, Substance CAMA. are not readily available. includes Parts A, B, and C not abuse treatment, Chiropractic covered by Medicare. Part D Pre-Existing Health care, Foot doctor’s services, Chemotherapy and radiation IHS-funded, tribally-managed covers prescription drugs. Conditions Covered Coverage Hospital care, Laboratory tests, services for a recipient with hospitals are located in Prescriptions, and Medical cancer requiring chemotherapy, if Anchorage, Barrow, Bethel, Pre-Existing Health transportation. provided in an outpatient setting. Dillingham, Kotzebue, Nome Conditions Covered and Sitka. There are 37 tribal Pre-Existing Health Outpatient laboratory and x-ray health centers, 166 tribal Conditions Covered services. community health aide clinics and five residential substance Pre-Existing Health abuse treatment centers. Conditions Covered Pre-Existing Health Conditions Covered GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE Must be a U.S. citizen and Alaska Must be a U.S. citizen or legal alien Must exhaust all private, state, Must be U.S. citizen or Must be receiving TAA (Trade resident. and resident of Alaska, and have and other federal programs. permanent U.S. resident, and: Adjustment Assistance), or one of following: a terminal illness; Income limits: cancer requiring chemotherapy; Must be regarded by the local 1) If 65 years or older, you or Must be 55 years or older and chronic diabetes or diabetes community as an Indian; is a your spouse worked for at least receiving pension from the Children 0–18 with health insipidus; chronic seizure disorders; member of an Indian or Alaska 10 years in Medicare-covered Pension Benefit Guaranty insurance: 150% FPL. chronic mental illness; chronic Native Tribe or Group under employment, or Corporation (PBGC). Children 0–18 with no health hypertension. Must have no other Federal supervision; resides insurance: 175% FPL. resources to meet the health care on tax-exempt land or owns 2) You have a disability or end- Must not be enrolled in certain you need. restricted property; actively stage renal disease (permanent state plans, or in prison, or P regnant with proof of participates in tribal affairs; kidney failure requiring dialysis receiving 65% COBRA premium Eligibility pregnancy from your health Income limit per household: any other reasonable factor or transplant) at any age. reduction, or be claimed as a care provider with or without At or less than $300 a month for indicative of Indian descent; is dependent in tax returns. health insurance: 175% FPL. one person. a non-Indian woman pregnant At or less than $400 a month for with an eligible Indian’s child for Must be enrolled in qualified two people. the duration of her pregnancy health plans where you Add $100 for each additional through post-partum (usually pay more than 50% of the person. 6 weeks); is a non-Indian premiums. member of an eligible Indian’s You must have $500 or less in household and the medical countable resources that could officer in charge determines be used to pay medical bills: cash, that services are necessary to bank/credit union accounts, or control a public health hazard personal property. CAMA does or an acute infectious disease not count your home, one vehicle, which constitutes a public income-producing property, health hazard. property that is used for your job (boat, fishing gear, etc.), or a fishing permit. $0 for eligible children, teens, $0 and $1 per prescription or $0 or minimal share of cost. $0 and share of cost for 20% of the insurance and pregnant women. medical supply. certain services; deductibles for premium including COBRA Monthly Cost certain plans. Part A: $0–$450 premium if employer 18-year-olds may be required to based on length of Medicare- contributes less than 50%. share a limited amount of the cost for some services. covered employment; Part B: $96.40–$369.10 depending on annual income; Part C: Based on provider; Part D: Varies in cost and drugs covered. Alaskawww.CoverageForAll.org 4
  12. 12. Demographic Private Health Insurance Individuals with Individuals Recently Low-Income Small Businesses Individuals Pre-Existing, Severe, Covered by an Families (2-50 Employees) Families or Chronic Medical Employer Health Plan Adults Conditions Group Plans COBRA Individual Plans Medical Expense AHCCCS National Association National Association Deduction(MED) Arizona Health Care Cost Then convert to a plan under: Containment System of Health Underwriters of Health Underwriters Program (Arizona’s Medicaid) 703-276-0220 703-276-0220 Run by the Arizona Health 602-417-4000 www.nahu.org HIPAA www.nahu.org Care Cost Containment 800-654-8713 Health Insurance Portability System(AHCCCS) www.ahcccs.state.az.usProgram Health Care Group of Arizona Accountability Act 602-417-4000 (HCG) 866-487-2365 800-352-8401 www.hcgaz.com www.dol.gov www.ahcccs.state.az.us 602-417-6755 (Search: Medical Expense Deduction Program) Pre-Existing Condition Insurance Plan (PCIP) Run by the U.S. Department of Health and Human Services 866-717-5826 www.PCIP.gov There is a 6-month look- COBRA: Coverage available for 18–36 Up to $5M. Assorted MED: Provides medical coverage Some benefits include back/12-month exclusionary months depending on qualifying deductibles depending on for individuals who do not qualify Preventive care, Doctor’s period for pre-existing events. Benefits are what you had with age and ZIP code. for other AHCCCS programs due visits, Hospital services, Lab conditions on enrollees that do your previous employer. to income. May be eligible if and x-rays, Emergency care, not have prior coverage. There are no limits to the they have medical expenses in Family planning, Dialysis, HIPAA: Benefits are based on program look-back and exclusion the month of application (or the Surgery, Behavioral health Benefits will vary depending on selected. There is no expiration of periods on pre-existing previous month) that reduce their services, Podiatry, pregnancy, the chosen plan. coverage. conditions. monthly income to 40% FPL. immunizations, physical exams, annual well-woman exams, Pre-Existing Health Pre-Existing Health Elimination riders are PCIP: Covers broad range of specialist care, PrescriptionCoverage Conditions Covered Conditions Covered allowed. benefits, including primary and drugs for non-Medicare specialty care, hospital care, and recipients. Children under 21 Limits on Pre-Existing prescription drugs. also receive dental, vision, Health Conditions May hearing services, and Early and Apply Pre-Existing Health Periodic Screening Diagnosis Conditions Covered and Treatment (EPSDT). Pre-Existing Health Conditions Covered GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE Company size 2–50 employees. COBRA: Available for employees who Eligibility is subject to MED: Must be an Arizona resident. Must be an Arizona resident work for businesses with 20 or more medical underwriting. Must not be eligible for other and a U.S. citizen or permanent Eligible employees must work employees. You have 60 days from AHCCCS programs. Monthly resident. at least 20 hours a week. date of termination to sign up for If you are denied coverage income cannot exceed $735 for COBRA coverage. for a medical condition, a family of four, after deducting Income limits: Owner can count as an you may be eligible for medical expenses, childcare, and employee. HIPAA: Must have had 18 months the Medical Expense each person employed. Resources Children ages 0–5: Family of continuous coverage and Deduction (MED) program cannot exceed $100K. Only $5K income up to 133% FPL. Owner name on business completely exhausted COBRA or run by the AHCCCS, or PCIP. may be liquid assets: cash, bank Children ages 6–19: Family license must draw wages from state continuation coverage. Must To learn more, see next accounts, stocks, bonds, etc. Home income up to 100% FPL. the company. not have lost coverage due to fraud column. equity is counted toward theEligibility or non-payment of premiums. You resource limit, but one vehicle is Pregnant women: Up to 200% have 63 days to enroll in a HIPAA- not counted. FPL. eligible plan. PCIP: Must have been uninsured Childless adults: Up to 100% for at least 6 months prior to FPL. applying. Must prove being a Parents/caretakers living with U.S. citizen or legal U.S. resident, their children ages 0–18: Up to an Arizona resident, and having 100% FPL. problems getting insurance due to a pre-existing condition. Aged, blind, and disabled: Up to 100% FPL. Costs depend on employer COBRA: Premiums range from Costs for individual MED: $0 or minimal share of cost. $0–$5 co-pay for officeMonthly Cost contribution and ± 60% of the 102%–150% of group health rates. coverage vary. There are no insurance company’s index rate visits. based on the health status of HIPAA: Premiums will depend on plan rate caps. PCIP: Monthly premium of $104 to the group. chosen. $450 depending on your age and $30 for non-emergency visits plan chosen. to ER.65 Arizona
  13. 13. Publicly-Sponsored Programs Demographic Children in Pregnant Native American Moderate Income Women Women Seniors Disabled Indians Families Children KidsCare Well Woman Health Baby Arizona Indian Health Medicare 877- 764-5437 602- 417-5437 Check Program 800-833-4642 Services (IHS) 800-633-4227 www.medicare.gov Run by the Arizona Department www.babyarizona.gov www.kidscare.state.az.us of Health Services Navajo (An enrollment cap is in place 888-257-8502 928-871-4811 Medicare Prescription www.wellwomanhealthcheck.org www.ihs.gov/Navajo for KidsCare due to a lack Drug Program Program of funding. Individuals and Phoenix Area 800-633-4227 families can still apply and be 602-364-5179 placed on a waiting list, and www.ihs.gov/Phoenix they will be contacted when funding becomes available.) Tucson Area 520-295-2405 www.ihs.gov/Tucson A wide array of medical services Cancer screening for women Gives prenatal care to pregnant Available programs vary Medicare offers Part A, inpatient including behavioral health such as clinical breast exams, women while they wait to see depending on health center care in hospitals and rehabilitative services. mammograms, pelvic exams if they are eligible for AHCCCS and may include primary and centers; Part B, doctor and some and Pap smear tests. Health Insurance. Staff will put child care, prenatal and post preventive services and outpatient Pre-Existing Health the woman in touch with a delivery care, family planning care; Part C allows Medicare benefits Conditions Covered Provides financial help to doctor in her area that will help (birth control), minor through private insurance (Medicare women who are diagnosed her apply for AHCCCS Health surgical and orthopedic Advantage); Part C includes Parts A, with breast cancer through Insurance. care, pharmacy, dental and B, and C not covered by Medicare. the program and are unable to orthodontics, optometry, Part D covers prescription drugs. qualify for other assistance or Pre-Existing Health nursing, mental health, Coverage to pay for treatment on their Conditions Covered laboratory and radiology. Pre-Existing Health own. Conditions Covered Pre-Existing Health Pre-Existing Health Conditions Covered Conditions Covered GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE GUARANTEED COVERAGE Must be an Arizona resident Must be a woman with income Must be an Arizona resident Must exhaust all private, Must be U.S. citizen or permanent and U.S. citizen or a qualified at or below 250% FPL. Must and U.S. citizen or qualified state, and other federal U.S. resident, and: immigrant, under age 19, with have no insurance, or have non-citizen. programs. income at or below 200% insurance that does not cover 1) If 65 years or older, you or your FPL, be ineligible for no-cost preventive services or that For pregnant women, the Must be regarded by the spouse worked for at least 10 years in Medicaid or employer-based has a high deductible (as income limit is 150% FPL. local community as an Medicare-covered employment, or coverage, with no health determined by the program). Indian; is a member of an insurance for the last 3 months If the mother ends up NOT Indian or Group under 2) You have a disability or end- at time of application. Parents For breast cancer screening, qualified for AHCCCS due to Federal supervision; resides stage renal disease (permanent with incomes of 200% FPL can patient must be at least 40 on tax-exempt land or kidney failure requiring dialysis or also qualify. years old or any age with income, then it’s possible to get owns restricted property; transplant) at any age. Eligibility qualifying symptoms. coverage from KidsCare (see actively participates in tribal “Children in Moderate Income affairs; any other reasonable For cervical cancer screening, Families” column). factor indicative of Indian patient must be at least 18 descent; is a non-Indian years old. woman pregnant with an eligible Indian’s child for the Women screened by the Well duration of her pregnancy Woman HealthCheck Program through post-partum (usually that are under age 65, who are 6 weeks); is a non-Indian legal residents of the U.S. and member of an eligible do not have credible coverage Indian’s household and the may qualify for treatment medical officer in charge through AHCCCS. determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard. $10 to $50 a month for $0 or minimal share of cost. $0 when women begin $0 or minimal share of cost. $0 and share of cost for certain Monthly Cost one child or $15–$70 a month prenatal care while eligibility is services; deductibles for certain for two or more children. processed. If found ineligible, plans. Part A: $0–$450 based then coverage can be found on length of Medicare-covered from KidsCare (see “Children employment; Part B: $96.40–$369.10 depending on annual income; Part C: in Moderate Income Families” Based on provider; Part D: Varies in column). cost and drugs covered. Arizonawww.CoverageForAll.org 6

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