State offers multiple low-cost health insurance programs

from The Ithaca Journal

By Linda Stout
Journal staff

Although many people have no insurance or inadequate health care coverage, some options exist for low- or no-cost health care coverage. There's a discount prescription plan available to every Tompkins County resident, and people with no health insurance can see a doctor through the Ithaca Free Clinic.

Medicaid, the state-administered federal program mostly for people with the lowest incomes, is perhaps the most well-known option. Private health insurance plans may also be available, but Medicare benefits coordinators say people have been misled and should be careful to examine details about deductibles, what's covered and whether their doctor is in the plan.

Following is a list of some programs, questions and answers, contact information and people who can help navigate health insurance questions:

Medicaid
Medicaid is health insurance administered by states and available primarily to people with income well below the federal poverty guidelines. Some higher income people with high medical bills or to those who receive Supplemental Security Income through the Social Security Administration may also receive Medicaid.

Medicaid programs have stringent income limits. For instance, a single person's income must be below $700 per month, which is lower than the poverty line. Recipients may own a house, car and have up to $4,200 in savings, according to an eligibility chart at the New York State Department of Health Web site, www.health.state.ny.us/health_care/medicaid/#definition. Medicaid income caps are less restrictive for children and pregnant women and when extremely high medical bills are accrued.

You may find the thick Medicaid applications in a number of places such as a doctor's office, or those seeking Medicaid may pick up applications and arrange application appointments at the Tompkins County Department of Social Services, 320 W. State St., Ithaca, by calling 274-5359.

Social services workers will also help applicants who don't qualify for Medicaid look into other programs, and they can explain differences between regular Medicaid and Medicaid Managed Care programs.

Will we lose the house if I get Medicaid?
The state can put a lien on the property of Medicaid recipients 55 or older or those permanently in a medical institution and recover assets of an estate when the recipient dies. There is, however, also a provision that permits a spouse to remain in the home, with some income, if a partner goes into a nursing home. Refer to the Medicaid Web site listed above or call the Department of Social Services at 274-5359.

Medicaid Spend-down Program
The Medicaid Excess Income Program, also known as the Medicaid Spend-down Program or the Medicaid Surplus Income Program, offers coverage to individuals whose net monthly income is above Medicaid income limits and who meet all other eligibility requirements such as having savings less than $4,200. People enrolled in this program submit receipts from medical expenses, and once those are “spent down” to the Medicaid eligibility requirements, Medicaid covers their care.

This can help uninsured people who don't meet Medicaid's low cap if they are, for instance, in a car accident or hospitalized and if their savings don't exceed $4,200 per person or $5,400 per couple (excluding a $1,500 burial fund). People with little savings might also benefit by including planable medical care such as checkups and dental work within a month's period.

The spending down happens only when there is medical spending to meet Medicaid income requirements.

In addition to calling the local Department of Social Services office, at 274-5359, information is available by calling (800) 343-8859 or visiting www.health.state.ny.us/health_care/medicaid.

Medicaid Buy-in Program for People with Disabilities
Working people with disabilities, including those who are self-employed, may qualify for the relatively new Medicaid Buy-in Program, instituted three years ago in New York as one of a few pilot programs. Now this program is available nearly nationwide.

The Medicaid Buy-in Program provides an employment incentive, said Kevin Nickerson, the Disability Program Navigator at Tompkins Workforce New York.

This program could apply to many Americans.

Although a person might not be receiving Social Security Disability, they should meet Social Security disability guidelines for this Medicaid Buy-In program. Nickerson said a disabled worker can make about $50,000 a year and still get this insurance. A brochure for this program notes that not all income or assets are counted, for instance, a home, car and some savings.

For more information about this in Tompkins County, workers or employers may call Nickerson at 272-7570 ext. 136 or e-mail kevinn@aboutchallenge.org.

People may apply for this program at the Department of Social Services or some other service providers.

Medicaid for moms and babies
The Tompkins County Health Department administers Medicaid Obstetrical Maternal Services (MOMS), a state program for pregnant women who meet certain income guidelines. It provides full medical care for the duration of their pregnancy and up to two months after and a full year for the baby. For more information, visit http://co.tompkins.ny.us/health/ chs/moms.htm or call 274-6622.

Family Health Plus and Child Health Plus
In addition to handling Medicaid Managed Care programs, Total Care administers Family Health Plus and Child Health Plus, which are similar to Medicaid but have higher income guidelines, for instance, $851 a month ($10,210 a year, same as the federal poverty level) for a single adult. Higher income levels are allowed for children. Although there's no charge to enroll and no deductibles for Family Health Plus and Child Health Plus, there are small co-payments for services. To enroll, call the county's Department of Social Services at 274-5359. Unlike Medicaid, payments are not retroactive, and it could take two months or more from the time of application to delivery of services from the managed care health plan you choose.

Healthy New York
Healthy NY is designed to reach the uninsured who do not qualify for Medicaid. Monthly income limit examples are $2,107 before taxes for a single person and $2,832 for a family of two. Pregnant women count as two people under Healthy New York, which has programs for small businesses (with some income limits). Income requirements are the same for sole proprietors. High deductible programs are also available. Mental health care and some other medical care are not covered by Healthy NY.

Visit www.ins.state.ny.us/website2/hny/english/hny.htm or call (866) 432-5849.

Medicare
Medicare is available for people 65 and older who are eligible for Social Security or Railroad Retirement benefits and is not limited to only low-income people. It's also the insurance used by disabled people after two years on Social Security Disability.

For free help in navigating the services and prescription plans, contact Sarah Jane Blake at Lifelong, 119 W. Court St., Ithaca, 273-1511, www.tclifelong.org/HIICAP.htm or call the Tompkins County Office for the Aging provide at 274-5482 and ask for Regina McGriff or Trina Schickle, aging services specialists. The Office for the Aging is in the basement of the Tompkins County Courthouse, 320 N. Tioga St.

McGriff and the Office for the Aging Web site cite warnings about private insurers misleading people about coverage. Also see this site for more information: www.medicarerights.org/ help.html.

Medicare is divided into parts:

* Medicare Part A is the hospital insurance program with a deductible of $992 per benefit period for hospitalizations.

Enroll through the social security office, 127 W. State St. or by calling 256-3651;find more information at www.ssa.gov.

* Medicare Part B is medical insurance for seeing doctors, outpatient services, tests and medical equipment. Deductibles are $131 a year, with premiums of $93.50 to $161.40 per month depending on income.

* There are various Medicare Part D prescription drug programs and some low-income subsidies called Better Extra Help and Some Extra Help. Free assistance is available from the Office for the Aging or from the Health Insurance Information Counseling and Assistance Program at Lifelong.

Sign up at the Social Security Administration; forms are online at www.ssa.gov or pick up a hard copy at the Social Security Administration, 127 W. State St. in Ithaca.

Help for ‘starving' artists, freelancers
Sometimes organizations for artists, freelancers, professionals and some trade unions may make low-cost medical insurance available or provide financial help for some medical care.

For example, a New York City-based artists' organization called Fractured Atlas is looking into making low-cost health insurance available in Tompkins County, said Marie Ortiz, the program director for health care. In some cases, according to the Fractured Atlas Web site, medical care short of insurance is made available for its members. So far, health insurance is only serving this group's members in the New York City area. Read more at www.fracturedatlas.org/site/healthcare/state/NY, or call (212) 277-8020.

Insurance for freelance workers might also be accessible through an organization called the Freelancers Union, www.freelancersunion.org.