EOISODE 3
Today’s program: MEDICAL DEBT: THIS IS THE THRID EDITION FOCUSING ON SOLUTIONS. OUR FIRST SOLUTION IS HOW TO USE MEDICAID AND CHIPS PROGRAMS TO ELEMINATE MEDICAL DEBT and IF YOU LOST MEDICAID COVERAGE DUE TO THE REVISED PANDEMIC RULES, WE HAVE TIPS on How to Navigate Losing Medicaid Coverage.
I’m Gary and I’m Jay and we will be hosting today’s program.
- We are not Clinical people.
- We are experienced in the Business of Healthcare with over 50 years of combined experience.
- We bring an Insiders view of how healthcare works.
- Our goal is to share our knowledge with consumers.
GP: Career in spans managing hospital and physician revenue cycle operations that include
Pt Admission, Precertification, Ins verification, billing and medical collections
JH: Chief Financial Officer for several large healthcare systems
Here we go with today’s program: IDENTIFYING MEDICAL DEBT SOLUTIONS
First, let’s recap: What is Medical Debt?
Medical debt is debt incurred by individuals due to health care costs and related expenses. Medical debt is different from other forms of debt, because it is usually unplanned, accidental, or faultless. Medical debt can have negative impacts on households, such as reducing their spending on other essential items, or preventing them from seeking needed medical care or treatment. Medical debt can also lead to bankruptcy.
Do you have a Medical Bill?
If yes, medical debt can indeed be a significant financial burden for individuals and families. When someone incurs medical expenses that are not fully covered by insurance or you do not have insurance, you may end up owing money to healthcare providers. This debt can accumulate due to various factors, such as high deductibles, copayments, out-of-network charges, or uncovered services.
LET’S START WITH MEDICAID AND THE CHILDREN HEALTH INSURANCE PROGRAM (CHIPS) PROGRAM
Medicaid provides health insurance for people with a low income. The Children’s Health Insurance Program (CHIP) covers children. Let’s Learn about eligibility and how to apply.
First, Find out if you are eligible for Medicaid
Medicaid provides free or low-cost medical benefits to eligible:
- Adults with a low income
- Children
- People who are pregnant
- People age 65 or over
- People with disabilities
Find and check with your state’s Medicaid agency to see if you or your family members are eligible. Each state has its own requirements.
In general, eligibility depends on at least one or a combination of:
- Age
- Income level
- Number of people in your family
- If you are pregnant or have a disability
How to apply for Medicaid
You can apply for Medicaid any time of year in one of the following ways:
- Find and check with your state’s Medicaid agency to apply. You must be a resident of the state where you are applying for benefits.
- Create an account with the Health Insurance Marketplace and fill out an application. If it looks like anyone in your household qualifies for Medicaid, your information will be sent to your state agency. They will contact you about enrollment.
Find out if your child is eligible for CHIP
If your income is too high for Medicaid, your child may still qualify for the Children’s Health Insurance Program (CHIP). It covers medical and dental care for uninsured children and teens up to age 19.
CHIP qualifications are different in every state. In most cases, they depend on income.
How to apply for CHIP
You can apply for CHIP in one of the following ways:
- Find a CHIP program by state.
- Create an account with the Health Insurance Marketplace and fill out an application. If it looks like anyone in your household qualifies for CHIP, your information will be sent to your state agency. They will contact you about enrollment.
Find a doctor or care provider who accepts Medicaid or CHIP
Not every provider accepts Medicaid. To locate a Medicaid or CHIP medical provider, find and check with your state’s Medicaid agency
IMPORTANT TAKE AWAYS
Applying for these programs to find out if you are eligible costs you nothing other than your time. We suggest you find out, you could eliminate a significant amount od medical debt.
How to Navigate Losing Your Medicaid Coverage
Up to 15 million people are expected to lose their insurance in the coming months. Children, young adults and Black and Hispanic people are most likely to be affected.
A pandemic-era rule that protected people from losing their Medicaid coverage has expired, putting millions of peoples’ health insurance coverage at risk.
Medicaid provides free health insurance to people with low incomes.
Usually, Medicaid recipients need to renew their coverage every year, and if they are no longer eligible, they lose their coverage. But lawmakers passed a rule in 2020 that kept people automatically enrolled in the government program, even if they no longer met the requirements for coverage.
That protection has ended leaving up to 15 million people at risk of losing their health insurance, according to an estimate from KFF, a nonprofit research organization formerly known as the Kaiser Family Foundation. Some 95 million people in the U.S. are currently enrolled in Medicaid and CHIP, which provides low-cost coverage to children, according to KFF.
Here’s what to do if you get a notice that your Medicaid coverage is ending. The first step is to find out why.
Medicaid provides healthcare coverage to more than 85 million Americans with low incomes. Getting notice that your coverage is ending can send you looking for answers — and alternative healthcare coverage.
In response to COVID-19, the federal government provided additional Medicaid funding to prevent people on the program from losing healthcare coverage. But now that this additional funding has ended, millions of people may lose Medicaid benefits or have to re-enroll between now and mid-2024.
Here’s what to do if you receive a notice about your coverage ending.
Reasons for termination of coverage
- income increases, including receiving a gift or inheritance
- a move out of state
- pregnancy or parenting status change
- family status change, like getting married
- a change in disability status
- turning 26 and aging out of foster care eligibility
Find out why you lost coverage
Medicaid is funded by both federal and state governments. But each state sets its own eligibility rules, so you’ll need to contact your state agency for answers to your eligibility questions.
Programs are required to notify Medicaid participants of changes to their coverage. These notices might go undelivered if you’ve moved to a new address or changed your email address. You might find answers to your questions by logging into your online account. Otherwise, contact your local Medicaid office to ask.
When you call, have eligibility information handy. You might also need to verify your address, number of people in the household, and household income.
Determine your eligibility
If you’re unsure whether you still qualify for Medicaid benefits, this online tool can give you a quick assessment.
It’s common for people to go in and out of eligibility as their income changes. If you get a temporary boost in income, such as through seasonal employment or an inheritance, you might become ineligible for Medicaid assistance. You’ll have to reapply each time you become eligible.
If you received a notice to verify your eligibility, check whether the letter is requesting information. In some cases, you may just need to fill out a form or verify your income to continue receiving Medicaid benefits.
Find another health insurance or healthcare option
If you’re no longer eligible for Medicaid health coverage, you may have other options. But don’t delay. Some options come with limited enrollment periods:
- ACA plans for people under 65: You can check healthcare.gov for Affordable Care Act (ACA) plans available in your area. Tax credits to help cover the cost are available for those who qualify. To enroll in an ACA plan, you must apply within 60 days of the date Medicaid coverage was lost.
- Medicare for people over 65: If you’re 65 or older, you may qualify for Medicare. Visit medicare.gov to learn more and explore plan options. You have 6 months from the date Medicaid coverage ends to enroll in a Medicare plan.
- Plans for residents of New York or Minnesota: Residents of these states can apply for a basic health program that offers stability to people whose income sometimes disqualifies them from Medicaid. Other states are considering similar programs.
- Short-term health plans: These plans bridge the gap between losing Medicaid coverage and regaining it or access to Medicare or an employer’s health plan. Rules for short-term health plans vary by state. These plans do not have the same protection as ACA plans, so pre-existing conditions might not be covered. Purchase these plans through private insurance companies.
- Community health centers: People without health insurance can get reduced-price medical care at community health centers. Find one near you at nachc.org or find free and charitable clinics at nafcclinics.org.
- Emergency departments: Emergency departments are required to stabilize people regardless of their ability to pay. Many hospitals also provide free or reduced-price care to people who are unable to pay. Ask your hospital about charity care if you need help paying for services.
Reach out to a healthcare advocate
Navigating insurance and care in the healthcare system can be confusing, but help is available. Healthcare advocates, also known as ombudsmen, case managers, or health navigators, are often on staff at medical centers, senior living facilities, and health insurance companies.
Healthcare advocates can:
- review medical charges
- negotiate bill payments
- find programs to help with payment
- explain insurance policy terms
- help you get the most out of your health plan’s benefits
- advise you on your rights
- help schedule healthcare visits and arrange transportation
- help you find a health insurance product that fits your needs
Keep in mind that advocates work for the organization that employs them. Their allegiance might be to the healthcare system or insurance company they work for.
You can also hire your own patient advocate. You can find a patient advocate using one of the following directories:
- Patient Advocate Foundation
- National Association of Healthcare Advocacy
- Umbra Health Advocacy
- Healthcare.gov
Consider possible tax deductions
The government offers a little extra help for individuals or families with high healthcare expenses. If the cost of qualifying medical and mental health care adds up to more than 7.5% of your adjusted gross income, you can deduct those expenses from federal taxes.
This includes the cost of care and supplies for dependents. Make sure to keep receipts for the expenses and talk with a tax preparer for more information.
Appeal the decision
If you disagree with a Medicaid program’s decision, you have the right to appeal. If you think you were deemed ineligible by mistake, file an appeal.
To appeal a decision, follow your state’s process. The appeal has to be filed in a timely manner. For some states, the window is as short as 20 days. Other states may allow up to 90 days.
Some states require that requests for appeals hearings be made in writing and either mailed, faxed, or hand-delivered. You might be able to request that your Medicaid coverage remains in place during the appeal process, but make sure to make the request before the date coverage is set to expire.
Bottom line
Medicaid provides healthcare coverage to millions of Americans. But if you lose eligibility, you have options. A few basic steps can help you get the healthcare you need and deserve.
HCNC is your healthcare partner that offers healthcare consumers information to navigate the healthcare maze via our website.
The program and take away information of the program will be available on our website www.healthcareconsumernavigatorcenter.com.
REMEMBER: THIS IS OUR 3RD YOUTUBE PROGRAM IN THIS SERIES, SEVERAL MORE TO FOLLOW
Our next program topic will be: HOW TO USE CHARIY PROGRAMS TO REDUCE MEDICAL DEBT
This concludes our program MEDICAL DEBT SOLUTIONS, and we hope the program explained telehealth care and has answered some of your questions.