Tag Archives: Health

Healthy NY – Subsidized Health Insurance for Low-Income Workers – New York Health Access, income

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Healthy NY – Subsidized Health Insurance for Low-Income Workers

Bad News: As of January 1, 2012, Healthy NY enrollment is now limited to the High Deductible Health Plan (HDHP). New enrollees can no longer enroll in the standard plan. The HDHP has a deductible of $1,200 for an individual, $2,400 for a family.

Good News: An optional prescription drug benefit is still available and due to federal health care reform, there is no longer an annual limit. There is also no longer a separate prescription drug deductible because all new enrollees get the HDHP.

The above information courtesy of Eric Hausman of National Government Services, for NYC HIICAP.

Overview

Healthy NY is a reduced cost health insurance program available to uninsured workers whose monthly income is above the limits for Medicaid and Family Health Plus. See N.Y. Ins. L. В§ 4326; 11 N.Y.C.R.R. В§ 362-1.1, et seq. The program is offered throughout the state through HMOs. HMOs are required to offer the same benefit package without any additions or subtractions. However the HMOs are allowed to charge different premiums. Therefore, it is necessary to shop and compare between the different insurers. To find out which HMOs are available in a particular area and their premium rates, call toll free at 1-866-HEALTHY NY (1-866-432-5849) or visit the Healthy New York website at http://healthyny.com.

Who is Eligible for Healthy NY?

Working uninsured individuals who meet the following eligibility requirements:

  1. Health Insurance. Employer does not currently provide applicant with health insurance and has not provided group health insurance during the twelve-month period preceding application.
  2. Medicare. Applicant must be ineligible for Medicare.
  3. Residency. Applicants must be New York State residents.
  4. Employment. Applicants must be employed on a full-time, part-time or episodic basis.
  5. Income. Gross household income level is at or below 250% of the gross federal poverty level.

The HealthNY website contains a screening tool to help you figure out if you are eligible for HealthyNY.

What Does Healthy NY Cover?

Healthy NY covers essential health needs including inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic and x-ray services, emergency services, and a limited prescription benefit. Many services are not covered. The following services are not covered – Mental health services, including treatment and medication for ADHD, depression, and anxiety; Alcohol and substance abuse treatment; Chiropractic coverage; Hospice care; Ambulance, dental care, vision care, durable medical equipment

Covered services are subject to a co-payment. All care is provided “in-network” only, except for emergency services or where care is not available through a health care plan’s providers. Otherwise, the health care plan’s network of providers must be used. Unlike Medicaid, CHPlus A and B, and FHPlus, coverage pursuant to the Healthy NY program is provided subject to a pre-existing condition waiting period. Applicants who have been uninsured for more than 63 days should check with the individual health plans to find out how long the waiting period is for coverage of pre-existing conditions. See N.Y. Ins. L. §§ 4318, 3232.

Co-payments and Deductibles for Covered Services

There is significant cost sharing for enrollees in this program. Covered services are subject to a co-payment at the time services are received. Additionally, for prescription drugs there is an annual deductible.

The amounts of the co-payments and deductible are the same for each health plan. The applicable co-payments are *:

  • Inpatient hospital services: $500 co-pay.
  • Surgical services: 20% or $200 co-pay.
  • Outpatient surgical facility: $75 co-pay.
  • Emergency services: $50 co-pay, waived if admitted to the hospital.
  • Prescription drugs: Maximum benefit of $3,000 per individual per year; $100 deductible per calendar year; generic drugs have a $10 co-pay; brand name drugs have a $20 co-pay plus the difference in cost between the brand name drug and generic equivalent.
  • Prenatal services: $10 co-pay
  • All other services: $20 co-pay

*There are no co-payments for routine well-child visits and necessary immunizations.

How to Apply for Healthy NY

Applicants for Healthy NY coverage apply directly to a health plan. All HMOs licensed in New York State are required to offer Healthy NY coverage; other insurers may choose to offer it. Application forms are provided by participating insurers. The HealthyNY website contains a list of participating HMOs and premium rates by county. In addition to filling out an application, applicants will have to provide documentation of their residence, household income, and employment status.

This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

Income based health insurance


Income-based Subsidies vs, income based health insurance.#Income #based #health #insurance

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Income-based Subsidies vs. Tax Credits Under Trumpcare

When President Obama first tried to sell the Affordable Care Act to the American public, he indicated that there would be tax subsidies to help low-income families to pay their insurance premiums. Obama knew that insurance companies were not going to help keep costs down, so he pushed the burden to the American taxpayer.

While the idea of making taxpayers foot the bill for health insurance costs sounds invasive, it was actually successful. Thanks to those subsidies, nearly 16 million Americans were able to afford healthcare and prevent hospitals from taking significant financial hits. The overall effect was positive as hospitals had more patients with insurance, and that prevented hospitals from having to absorb lost revenue due to uninsured patients.

But president-elect Donald Trump looks at Obama’s tax subsidies much differently. Trump sees ACA subsidies as socialism that are destroying the national economy. Trump claims that subsidies given out based on income put an unfair burden on taxpayers, regardless of the long-term positive effects.

What are the Obamacare Tax Subsidies?

The Obamacare subsidies come in four different types:

  • Premium Tax Credits: used when you file your federal income taxes to help compensate for the cost of health insurance premiums
  • Cost-Sharing Subsidies: used to help keep out-of-pocket costs out of control for certain portions of the population
  • Medicaid: Obamacare significantly altered the funding for Medicaid in every state
  • Children’s Health Insurance Program (CHIP): another state-run program bolstered by federal money

If your income falls at a level that is less than 400 percent over the Federal Poverty Line (FPL), then you can get Premium Tax Credits. There is a chart that shows you how much of a credit you get for your income level. People who make 250 percent or less over the FPL can get access to the Cost-Sharing Subsidies if they are on silver marketplace plans. In order to benefit from Obamacare subsidies, you must be on a marketplace plan.

Trumpcare’s Tax Subsidies

Based on what we’ve seen and heard so far, Donald Trump is no fan of giving people tax subsidies to help pay their health insurance cost. The popularity of the Obama subsidies made them a political hot potato during the campaign that Trump did not want to touch. Instead of addressing the tax subsidy issue head-on, Trump offered vague information and implications that can help us to understand what his plans could be.

The part of his health care plan that Donald Trump did publicize was his intention to allow everyone to write off the portion of their health care premiums that they pay on their federal taxes. It sounds great, but it does not offer the same level of financial assistance that the Obamacare subsidies did. People who earn more – and can therefore afford to buy higher-cost health insurance – will benefit most from this system since their premiums are already higher.

Trump also plans to significantly alter Medicaid and CHIP. His plan will give states block grants for Medicaid, which will in turn allow each state to administer its own Medicaid program independently. He will remove the strict guidelines Obamacare created, but he offers no way of making sure that the grants will be proportionally correct to each state’s need.

To really understand where Trump is headed with tax subsidies, you need to read between the lines in a November 11, 2016 article that appeared on the HIT Consultant website. Trump’s subsidies will be used to motivate people to get coverage while they are young and healthy instead of waiting until they get older. This could imply that subsidies under Trumpcare will be based on age and health status instead of income.

If Trump alters the subsidies, he will price health insurance out of the affordable range for millions of Americans. While Trump’s idea of allowing everyone to write off the cost of their premiums will mitigate this to some extent, it will only be a real benefit to people who pay very high premiums. If Trump guts Obamacare, he will likely remove the tax penalty for not having health insurance. If he does that, then low-income families can go back to not having health insurance without the fear of a tax penalty. But nothing in Trump’s plan helps those families to actually get insurance to write off.

When Donald Trump is inaugurated as president on January 20, 2017, the country can expect a stream of announcements regarding the changes the new Republican president and Congress will make to health care laws. Right now, it looks like many of those changes benefit the young and wealthy citizens of the country and leave low-income families uncertain about their future.


MDHHS – Help Finding Health Care, income based health insurance.#Income #based #health #insurance

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You are here

  1. MDHHS
  2. Assistance Programs
  3. Health Care Coverage
  4. Help Finding Health Care

  • How Can This Site Help? This site has links to other web pages with information and phone numbers for places with low cost or free health care, or help with health insurance. Income based health insurance

For example, if you are looking for a doctor or clinic that will help you even though you don’t have insurance, look in the box that says: “What Type of Health Care Help Do You Need?” at the top. Then click on the link that says: “Free or Low Cost Care from a Doctor or Nurse.”

If you need health insurance, look in the box that says: “Do You Need Help Finding Health Insurance?” at the top. Click on the links in that box to find out what help might be available to you.

Many links on this page help you find resources in your county or close to your address. If you cannot find the help you need here, please contact Mary Anne Tribble at 517-241-7185, or [email protected]

If you find a link that doesn’t work, please contact the Health Planning and Access to Care Section at [email protected]

What Type of Help with Health Care Do You Need?

This section has information on primary care clinics that will help people with low income or no health insurance.

  • Free or Low Cost Mental Health Care This section can help you contact your local Community Mental Health Agency and other places offering mental health care.
  • Free or Low Cost Care from a Dentist This section has information on how to find a dentist that treats low income people, elderly people, or people with special needs.
  • Free or Low Cost Prescription Medication

    This section has information on low cost prescription drugs.

  • Free or Low Cost Testing and Treatment for Sexually-Transmitted Infections This section can help you locate your local health department or other clinics with free or low cost testing and treatment for sexually-transmitted infections (STIs).
  • Free or Low Cost Family Planning Services This section has information on family planning services and clinic locations.
  • Free or Low Cost Testing and Treatment for Breast or Cervical Cancer This section can help low income women get tests or treatment for breast or cervical cancer
  • Help with a Chronic Disease

    This section has links to information on managing chronic diseases like diabetes or heart disease.

    This section has links that may help if you can t find your answer above.


  • Healthy NY – Subsidized Health Insurance for Low-Income Workers – New York Health Access, income

    by ,

    Healthy NY – Subsidized Health Insurance for Low-Income Workers

    Bad News: As of January 1, 2012, Healthy NY enrollment is now limited to the High Deductible Health Plan (HDHP). New enrollees can no longer enroll in the standard plan. The HDHP has a deductible of $1,200 for an individual, $2,400 for a family.

    Good News: An optional prescription drug benefit is still available and due to federal health care reform, there is no longer an annual limit. There is also no longer a separate prescription drug deductible because all new enrollees get the HDHP.

    The above information courtesy of Eric Hausman of National Government Services, for NYC HIICAP.

    Overview

    Healthy NY is a reduced cost health insurance program available to uninsured workers whose monthly income is above the limits for Medicaid and Family Health Plus. See N.Y. Ins. L. В§ 4326; 11 N.Y.C.R.R. В§ 362-1.1, et seq. The program is offered throughout the state through HMOs. HMOs are required to offer the same benefit package without any additions or subtractions. However the HMOs are allowed to charge different premiums. Therefore, it is necessary to shop and compare between the different insurers. To find out which HMOs are available in a particular area and their premium rates, call toll free at 1-866-HEALTHY NY (1-866-432-5849) or visit the Healthy New York website at http://healthyny.com.

    Who is Eligible for Healthy NY?

    Working uninsured individuals who meet the following eligibility requirements:

    1. Health Insurance. Employer does not currently provide applicant with health insurance and has not provided group health insurance during the twelve-month period preceding application.
    2. Medicare. Applicant must be ineligible for Medicare.
    3. Residency. Applicants must be New York State residents.
    4. Employment. Applicants must be employed on a full-time, part-time or episodic basis.
    5. Income. Gross household income level is at or below 250% of the gross federal poverty level.

    The HealthNY website contains a screening tool to help you figure out if you are eligible for HealthyNY.

    What Does Healthy NY Cover?

    Healthy NY covers essential health needs including inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic and x-ray services, emergency services, and a limited prescription benefit. Many services are not covered. The following services are not covered – Mental health services, including treatment and medication for ADHD, depression, and anxiety; Alcohol and substance abuse treatment; Chiropractic coverage; Hospice care; Ambulance, dental care, vision care, durable medical equipment

    Covered services are subject to a co-payment. All care is provided “in-network” only, except for emergency services or where care is not available through a health care plan’s providers. Otherwise, the health care plan’s network of providers must be used. Unlike Medicaid, CHPlus A and B, and FHPlus, coverage pursuant to the Healthy NY program is provided subject to a pre-existing condition waiting period. Applicants who have been uninsured for more than 63 days should check with the individual health plans to find out how long the waiting period is for coverage of pre-existing conditions. See N.Y. Ins. L. §§ 4318, 3232.

    Co-payments and Deductibles for Covered Services

    There is significant cost sharing for enrollees in this program. Covered services are subject to a co-payment at the time services are received. Additionally, for prescription drugs there is an annual deductible.

    The amounts of the co-payments and deductible are the same for each health plan. The applicable co-payments are *:

    • Inpatient hospital services: $500 co-pay.
    • Surgical services: 20% or $200 co-pay.
    • Outpatient surgical facility: $75 co-pay.
    • Emergency services: $50 co-pay, waived if admitted to the hospital.
    • Prescription drugs: Maximum benefit of $3,000 per individual per year; $100 deductible per calendar year; generic drugs have a $10 co-pay; brand name drugs have a $20 co-pay plus the difference in cost between the brand name drug and generic equivalent.
    • Prenatal services: $10 co-pay
    • All other services: $20 co-pay

    *There are no co-payments for routine well-child visits and necessary immunizations.

    How to Apply for Healthy NY

    Applicants for Healthy NY coverage apply directly to a health plan. All HMOs licensed in New York State are required to offer Healthy NY coverage; other insurers may choose to offer it. Application forms are provided by participating insurers. The HealthyNY website contains a list of participating HMOs and premium rates by county. In addition to filling out an application, applicants will have to provide documentation of their residence, household income, and employment status.

    This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

    Income based health insurance


    Income-based Subsidies vs, income based health insurance.#Income #based #health #insurance

    by ,

    Income-based Subsidies vs. Tax Credits Under Trumpcare

    When President Obama first tried to sell the Affordable Care Act to the American public, he indicated that there would be tax subsidies to help low-income families to pay their insurance premiums. Obama knew that insurance companies were not going to help keep costs down, so he pushed the burden to the American taxpayer.

    While the idea of making taxpayers foot the bill for health insurance costs sounds invasive, it was actually successful. Thanks to those subsidies, nearly 16 million Americans were able to afford healthcare and prevent hospitals from taking significant financial hits. The overall effect was positive as hospitals had more patients with insurance, and that prevented hospitals from having to absorb lost revenue due to uninsured patients.

    But president-elect Donald Trump looks at Obama’s tax subsidies much differently. Trump sees ACA subsidies as socialism that are destroying the national economy. Trump claims that subsidies given out based on income put an unfair burden on taxpayers, regardless of the long-term positive effects.

    What are the Obamacare Tax Subsidies?

    The Obamacare subsidies come in four different types:

    • Premium Tax Credits: used when you file your federal income taxes to help compensate for the cost of health insurance premiums
    • Cost-Sharing Subsidies: used to help keep out-of-pocket costs out of control for certain portions of the population
    • Medicaid: Obamacare significantly altered the funding for Medicaid in every state
    • Children’s Health Insurance Program (CHIP): another state-run program bolstered by federal money

    If your income falls at a level that is less than 400 percent over the Federal Poverty Line (FPL), then you can get Premium Tax Credits. There is a chart that shows you how much of a credit you get for your income level. People who make 250 percent or less over the FPL can get access to the Cost-Sharing Subsidies if they are on silver marketplace plans. In order to benefit from Obamacare subsidies, you must be on a marketplace plan.

    Trumpcare’s Tax Subsidies

    Based on what we’ve seen and heard so far, Donald Trump is no fan of giving people tax subsidies to help pay their health insurance cost. The popularity of the Obama subsidies made them a political hot potato during the campaign that Trump did not want to touch. Instead of addressing the tax subsidy issue head-on, Trump offered vague information and implications that can help us to understand what his plans could be.

    The part of his health care plan that Donald Trump did publicize was his intention to allow everyone to write off the portion of their health care premiums that they pay on their federal taxes. It sounds great, but it does not offer the same level of financial assistance that the Obamacare subsidies did. People who earn more – and can therefore afford to buy higher-cost health insurance – will benefit most from this system since their premiums are already higher.

    Trump also plans to significantly alter Medicaid and CHIP. His plan will give states block grants for Medicaid, which will in turn allow each state to administer its own Medicaid program independently. He will remove the strict guidelines Obamacare created, but he offers no way of making sure that the grants will be proportionally correct to each state’s need.

    To really understand where Trump is headed with tax subsidies, you need to read between the lines in a November 11, 2016 article that appeared on the HIT Consultant website. Trump’s subsidies will be used to motivate people to get coverage while they are young and healthy instead of waiting until they get older. This could imply that subsidies under Trumpcare will be based on age and health status instead of income.

    If Trump alters the subsidies, he will price health insurance out of the affordable range for millions of Americans. While Trump’s idea of allowing everyone to write off the cost of their premiums will mitigate this to some extent, it will only be a real benefit to people who pay very high premiums. If Trump guts Obamacare, he will likely remove the tax penalty for not having health insurance. If he does that, then low-income families can go back to not having health insurance without the fear of a tax penalty. But nothing in Trump’s plan helps those families to actually get insurance to write off.

    When Donald Trump is inaugurated as president on January 20, 2017, the country can expect a stream of announcements regarding the changes the new Republican president and Congress will make to health care laws. Right now, it looks like many of those changes benefit the young and wealthy citizens of the country and leave low-income families uncertain about their future.


    Millions who buy health insurance brace for double-digit increases – CBS News, income based health

    by ,

    CBS News Logo

    Millions who buy health insurance brace for double-digit increases

    Income based health insurance

    WASHINGTON — Millions of people who buy individual health insurance policies and get no financial help from the Affordable Care Act are bracing for another year of double-digit premium increases , and their frustration is boiling over.

    Some are expecting premiums for 2018 to rival a mortgage payment.

    What they pay is tied to the price of coverage on the health insurance markets created by the Obama-era law, but these consumers get no protection from the law’s tax credits, which cushion against rising premiums. Instead they pay full freight and bear the brunt of market problems such as high costs and diminished competition.

    On Capitol Hill, there’s a chance that upcoming bipartisan hearings by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., can produce legislation offering some relief. But it depends on Republicans and Democrats working together despite a seven-year health care battle that has left raw feelings on both sides.

    The most exposed consumers tend to be middle-class people who don’t qualify for the law’s income-based subsidies. They include early retirees, skilled tradespeople, musicians, self-employed professionals, business owners, and people such as Sharon Thornton, whose small employer doesn’t provide health insurance.

    “We’re caught in the middle-class loophole of no help,” said Thornton, a hairdresser from Newark, Delaware. She said she’s currently paying about $740 a month in premiums, and expects her monthly bill next year to be around $1,000, a 35 percent increase.

    “It’s like buying two new iPads a month and throwing them in the trash,” said Thornton, whose policy carries a deductible of $6,000. “To me, $1,000 a month is my beach house that I wanted to have.”

    A suggestion that she could qualify for financial assistance by earning less only irritates her more. “My whole beef is that the government is telling me: ‘If you work less, we’ll give you more,'” said Thornton, who’s in her 50s.

    If people such as Thornton drop out, they not only gamble with their own health. Their departure also means the group left behind gets costlier to cover as healthier customers bail out. That’s counter to the whole idea of insurance, which involves pooling risk.

    It wasn’t supposed to be this way.

    Buying health insurance has always been a challenge for people getting their own policies outside the workplace. Before “Obamacare,” insurers could turn away those with health problems or charge them more. Former President Barack Obama sold his plan as the long-awaited fix.

    It would guarantee coverage regardless of health problems, provide tax credits and other subsidies for people of modest means, and generate competition among insurers to keep premiums in check for all. The overhaul sought to create one big insurance pool for individual coverage in each state, no matter whether consumers bought plans through HealthCare.gov or traditional middlemen such as insurance brokers.

    But an influx of sicker-than-expected customers drove up costs for insurers, while many younger, healthier people stayed on the sidelines. Political opposition from Republicans complicated matters by gumming up the law’s internal financial stabilizers for insurers.

    The result was a 25 percent average increase in the price of a midlevel plan on HealthCare.gov heading into this year. Many states expect a similar scenario for 2018, but this time insurers say uncertainty about the Trump administration’s intentions is driving up their bids ahead of the Nov. 1 start of open enrollment.

    About 17.6 million people buy individual health insurance policies, and half of them get no subsidies under the law, according to estimates by the nonpartisan Kaiser Family Foundation. The number of unsubsidized customers with ACA plans outside the health insurance marketplaces dropped by 20 percent this year, after the big premium increases.

    “The unsubsidized part of the market outside the exchanges has shrunk noticeably as premiums have increased,” said Kaiser’s Larry Levitt. “It’s likely that the people dropping out of the market are healthier overall. So the pool has potentially deteriorated.”

    It’s time to shift focus in the health care debate, said Sen. Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, which plans hearings beginning this coming week.

    “The people who are really getting hammered – they are the ones we need to help,” said Alexander, R-Tenn. “We’ve got a few weeks to come to consensus in this seven-year-old partisan stalemate and if we don’t break it, some people will be priced out and badly hurt.”

    Alexander envisions limited legislation that guarantees disputed subsidies for copayments and deductibles another year, while giving states more leeway to design less-costly plans. Democrats are looking for financing to help insurers with high-cost cases. Experts say that guaranteeing the subsidies should lead to an immediate cut in premiums in many states.

    Thornton, the Delaware hairdresser, said she doesn’t know what to believe anymore. She said she voted for Donald Trump – her first time for a Republican – partly out of frustration with her health care costs.

    “I’m ready to stomp on the White House lawn,” she said. “I am fuming.”


    Healthy NY – Subsidized Health Insurance for Low-Income Workers – New York Health Access, income

    by ,

    Healthy NY – Subsidized Health Insurance for Low-Income Workers

    Bad News: As of January 1, 2012, Healthy NY enrollment is now limited to the High Deductible Health Plan (HDHP). New enrollees can no longer enroll in the standard plan. The HDHP has a deductible of $1,200 for an individual, $2,400 for a family.

    Good News: An optional prescription drug benefit is still available and due to federal health care reform, there is no longer an annual limit. There is also no longer a separate prescription drug deductible because all new enrollees get the HDHP.

    The above information courtesy of Eric Hausman of National Government Services, for NYC HIICAP.

    Overview

    Healthy NY is a reduced cost health insurance program available to uninsured workers whose monthly income is above the limits for Medicaid and Family Health Plus. See N.Y. Ins. L. В§ 4326; 11 N.Y.C.R.R. В§ 362-1.1, et seq. The program is offered throughout the state through HMOs. HMOs are required to offer the same benefit package without any additions or subtractions. However the HMOs are allowed to charge different premiums. Therefore, it is necessary to shop and compare between the different insurers. To find out which HMOs are available in a particular area and their premium rates, call toll free at 1-866-HEALTHY NY (1-866-432-5849) or visit the Healthy New York website at http://healthyny.com.

    Who is Eligible for Healthy NY?

    Working uninsured individuals who meet the following eligibility requirements:

    1. Health Insurance. Employer does not currently provide applicant with health insurance and has not provided group health insurance during the twelve-month period preceding application.
    2. Medicare. Applicant must be ineligible for Medicare.
    3. Residency. Applicants must be New York State residents.
    4. Employment. Applicants must be employed on a full-time, part-time or episodic basis.
    5. Income. Gross household income level is at or below 250% of the gross federal poverty level.

    The HealthNY website contains a screening tool to help you figure out if you are eligible for HealthyNY.

    What Does Healthy NY Cover?

    Healthy NY covers essential health needs including inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic and x-ray services, emergency services, and a limited prescription benefit. Many services are not covered. The following services are not covered – Mental health services, including treatment and medication for ADHD, depression, and anxiety; Alcohol and substance abuse treatment; Chiropractic coverage; Hospice care; Ambulance, dental care, vision care, durable medical equipment

    Covered services are subject to a co-payment. All care is provided “in-network” only, except for emergency services or where care is not available through a health care plan’s providers. Otherwise, the health care plan’s network of providers must be used. Unlike Medicaid, CHPlus A and B, and FHPlus, coverage pursuant to the Healthy NY program is provided subject to a pre-existing condition waiting period. Applicants who have been uninsured for more than 63 days should check with the individual health plans to find out how long the waiting period is for coverage of pre-existing conditions. See N.Y. Ins. L. §§ 4318, 3232.

    Co-payments and Deductibles for Covered Services

    There is significant cost sharing for enrollees in this program. Covered services are subject to a co-payment at the time services are received. Additionally, for prescription drugs there is an annual deductible.

    The amounts of the co-payments and deductible are the same for each health plan. The applicable co-payments are *:

    • Inpatient hospital services: $500 co-pay.
    • Surgical services: 20% or $200 co-pay.
    • Outpatient surgical facility: $75 co-pay.
    • Emergency services: $50 co-pay, waived if admitted to the hospital.
    • Prescription drugs: Maximum benefit of $3,000 per individual per year; $100 deductible per calendar year; generic drugs have a $10 co-pay; brand name drugs have a $20 co-pay plus the difference in cost between the brand name drug and generic equivalent.
    • Prenatal services: $10 co-pay
    • All other services: $20 co-pay

    *There are no co-payments for routine well-child visits and necessary immunizations.

    How to Apply for Healthy NY

    Applicants for Healthy NY coverage apply directly to a health plan. All HMOs licensed in New York State are required to offer Healthy NY coverage; other insurers may choose to offer it. Application forms are provided by participating insurers. The HealthyNY website contains a list of participating HMOs and premium rates by county. In addition to filling out an application, applicants will have to provide documentation of their residence, household income, and employment status.

    This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

    Income based health insurance


    Project MUSE – The Impact of Health Insurance in Low- And Middle-Income Countries, income based

    by ,

    The Impact of Health Insurance in Low- And Middle-Income Countries

    edited by Maria-Luisa Escobar, Charles C. Griffin, and R. Paul Shaw

    Publication Year: 2010

    Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.

    Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers’ productivity, and change the population’s health care use patterns, mirroring the development of health systems in most OECD countries.

    Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations —and if so, how to do it —or to serve them through other means.

    Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.


    Healthy NY – Subsidized Health Insurance for Low-Income Workers – New York Health Access, income

    by ,

    Healthy NY – Subsidized Health Insurance for Low-Income Workers

    Bad News: As of January 1, 2012, Healthy NY enrollment is now limited to the High Deductible Health Plan (HDHP). New enrollees can no longer enroll in the standard plan. The HDHP has a deductible of $1,200 for an individual, $2,400 for a family.

    Good News: An optional prescription drug benefit is still available and due to federal health care reform, there is no longer an annual limit. There is also no longer a separate prescription drug deductible because all new enrollees get the HDHP.

    The above information courtesy of Eric Hausman of National Government Services, for NYC HIICAP.

    Overview

    Healthy NY is a reduced cost health insurance program available to uninsured workers whose monthly income is above the limits for Medicaid and Family Health Plus. See N.Y. Ins. L. В§ 4326; 11 N.Y.C.R.R. В§ 362-1.1, et seq. The program is offered throughout the state through HMOs. HMOs are required to offer the same benefit package without any additions or subtractions. However the HMOs are allowed to charge different premiums. Therefore, it is necessary to shop and compare between the different insurers. To find out which HMOs are available in a particular area and their premium rates, call toll free at 1-866-HEALTHY NY (1-866-432-5849) or visit the Healthy New York website at http://healthyny.com.

    Who is Eligible for Healthy NY?

    Working uninsured individuals who meet the following eligibility requirements:

    1. Health Insurance. Employer does not currently provide applicant with health insurance and has not provided group health insurance during the twelve-month period preceding application.
    2. Medicare. Applicant must be ineligible for Medicare.
    3. Residency. Applicants must be New York State residents.
    4. Employment. Applicants must be employed on a full-time, part-time or episodic basis.
    5. Income. Gross household income level is at or below 250% of the gross federal poverty level.

    The HealthNY website contains a screening tool to help you figure out if you are eligible for HealthyNY.

    What Does Healthy NY Cover?

    Healthy NY covers essential health needs including inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic and x-ray services, emergency services, and a limited prescription benefit. Many services are not covered. The following services are not covered – Mental health services, including treatment and medication for ADHD, depression, and anxiety; Alcohol and substance abuse treatment; Chiropractic coverage; Hospice care; Ambulance, dental care, vision care, durable medical equipment

    Covered services are subject to a co-payment. All care is provided “in-network” only, except for emergency services or where care is not available through a health care plan’s providers. Otherwise, the health care plan’s network of providers must be used. Unlike Medicaid, CHPlus A and B, and FHPlus, coverage pursuant to the Healthy NY program is provided subject to a pre-existing condition waiting period. Applicants who have been uninsured for more than 63 days should check with the individual health plans to find out how long the waiting period is for coverage of pre-existing conditions. See N.Y. Ins. L. §§ 4318, 3232.

    Co-payments and Deductibles for Covered Services

    There is significant cost sharing for enrollees in this program. Covered services are subject to a co-payment at the time services are received. Additionally, for prescription drugs there is an annual deductible.

    The amounts of the co-payments and deductible are the same for each health plan. The applicable co-payments are *:

    • Inpatient hospital services: $500 co-pay.
    • Surgical services: 20% or $200 co-pay.
    • Outpatient surgical facility: $75 co-pay.
    • Emergency services: $50 co-pay, waived if admitted to the hospital.
    • Prescription drugs: Maximum benefit of $3,000 per individual per year; $100 deductible per calendar year; generic drugs have a $10 co-pay; brand name drugs have a $20 co-pay plus the difference in cost between the brand name drug and generic equivalent.
    • Prenatal services: $10 co-pay
    • All other services: $20 co-pay

    *There are no co-payments for routine well-child visits and necessary immunizations.

    How to Apply for Healthy NY

    Applicants for Healthy NY coverage apply directly to a health plan. All HMOs licensed in New York State are required to offer Healthy NY coverage; other insurers may choose to offer it. Application forms are provided by participating insurers. The HealthyNY website contains a list of participating HMOs and premium rates by county. In addition to filling out an application, applicants will have to provide documentation of their residence, household income, and employment status.

    This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

    Income based health insurance


    Community-based health insurance in low-income countries: a systematic review of the evidence, Health Policy and

    by ,

    Community-based health insurance in low-income countries: a systematic review of the evidence

    Björn Ekman; Community-based health insurance in low-income countries: a systematic review of the evidence, Health Policy and Planning, Volume 19, Issue 5, 1 September 2004, Pages 249–270, https://doi.org/10.1093/heapol/czh031

    Download citation file:

    2017 Oxford University Press

    Abstract

    Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.