Case: Chaim Steinberg is a Loan Officer at a busy mortgage firm and earns $80,000 a year. His wife is a part-time teacher and has a yearly salary of $20,000. With 6 children and a total household income of $100,000, Chaim’s friends assume that he easily covers his living expenses, but in reality Chaim is drowning. His biggest expense is health insurance, which costs an outrageous $22,000 a year, aside from copayments and deductibles which easily reach an additional $4,000 a year! Can he get any help?
Answer: The past few years have witnessed a tremendous upheaval in the health care system. While our politicians work to fix America’s struggling heath care system, one fact remains true for the vast majority of the American public: health insurance is expensive, very expensive. Chaim’s case is frighteningly common. Otherwise financially stable families watch their bank account devastated by $30,000 a year of payments for a mediocre health insurance plan.
With an income of $100,000, Mr. Goldberg is not eligible for Medicaid, however there are two other programs that can significantly help him.
The government created a children’s healthcare program called CHIP with much higher limits then Medicaid. CHIP offers comprehensive health insurance for minors with low monthly premiums and copayments. For example, the income limit for a family of 7 is a generous $135,100 a year and would require up to $145 a month of premiums to cover all the children in the family. Co-payments would be between $5 and $35, depending on the service.
This sounds amazing, but there is currently a major issue with this program. A person will not be approved for CHIP as long as they are enrolled in another health insurance plan when they apply. This means that Mr. Goldberg will have to cancel the insurance plan currently protecting his children before applying and wait – uninsured – until the application is approved and the policy takes effect. It is important to be aware that during the time that his children are not insured, they have the option is to go to a health center (such as CHEMED) or a hospital and apply for ‘Emergency Medicaid’. Emergency Medicaid will allow a person in Chaim’s situation to receive medical attention in any state approved facility. Call the facility and request an appointment with the financial assistance department to apply for Emergency Medicaid before the doctor sees your child.
Even higher income families are often eligible for help paying for their insurance plan, as long as they purchase their plan through healthcare.gov AKA ‘The Marketplace.’ It is important to understand that there could be a large price difference between buying insurance through The Marketplace and buying a plan directly from the insurance company or through a broker. If the plans on the Marketplace fulfill your medical needs, then it is usually advantageous to purchase the plan through The Marketplace. Plans purchased through The Marketplace are eligible for cost-sharing and tax credit benefits to help cover the cost of health insurance. These benefits are not available for plans purchased outside The Marketplace. Even if you are currently ineligible to receive assistance it may be worthwhile to purchase a plan through The Marketplace. After all, your income or situation may change during the year, allowing you to take advantage of governmental assistance when you file your tax return, an option that is not available if you did not purchase the plan through The Marketplace.
A common myth is that health care plans purchased through The Marketplace are somehow ‘inferior’, and have less of a chance of being accepted by doctors. This is false. If a health care provider accepts a particular plan, then they will accept it irrelevant of where it was purchased. For example, a Horizon Omnia Plan (one of the most common insurance choices today) bought through The Marketplace is identical in every way to a Horizon Omnia Plan purchased from a broker.
Insider’s Perspective: The NJ FamilyCare County office on Hooper Avenue is staffed by a relatively limited number of people. Because of this, it is important to avoid inadvertently causing a chilul Hashem. For example, if you speak to a case worker who tells you that your application is in process, do not e-mail an hour later for an update. They will likely know that they just spoke with you and resent the extra work that you are creating. Also, keep in mind that the same case workers answering the phones and e-mails are also processing cases, so repeated inquiries will only delay the general processing time. In general, it is advisable to give them time to process applications before following up. The LRRC is always available to help advocate for urgent situations, feel free to call us to discuss your situation.