The need for universal health care is more acute than ever. As an increasing number of people lose their jobs, the number of uninsured grows, adding to the already alarming number of individuals without health coverage. This recession has made it even more clear that the American health care system, whereby most insurance is provided through employers, leaves too many people uninsured or underinsured. Even those who are fortunate to have insurance are struggling under the weight of mounting costs for health insurance premiums, which on average have risen 87 percent since 2000 – far exceeding the increase in wages. Everyone deserves to have access to quality health care regardless of their employment status and/or their ability to pay for it. This is why I have long been an advocate for single-payer health care.
Single-payer refers to a way of financing health care where a single entity, in this case the government, would be responsible for both the collection of money for health care and the reimbursement of providers for health care costs. Such a health care system would ensure that all Americans receive comprehensive medical benefits because care would be based on need, not on ability to pay. Our current health care system is outrageously expensive and highly inefficient, largely because private insurance bureaucracy and paperwork consume one-third of every health care dollar. In fact, the U.S. spends twice as much as other industrialized nations on health care, yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
With over 2.5 million New Yorkers without health insurance, New York would greatly benefit from a single-payer health insurance system. As part of my continuing work for such a health care system in New York State, I am a co-sponsor of a measure called New York Health Plus that would offer comprehensive publicly-sponsored health coverage to all New Yorkers. Unfortunately, until a more comprehensive health coverage system is realized, many New Yorkers will continue to be left behind, a situation certain to be exacerbated by current economic difficulties.
If you recently lost your job and/or are among the many New Yorkers who do not have health insurance, there could be help for you. Although not as comprehensive and affordable as single-payer national health care, one of the following programs may be able to provide you with health care coverage or reduce some of your health care costs.
Deborah J. Glick
Extending Employer-Provided Coverage
Subsidized COBRA Premiums
What it is: If you were laid off from your job at a company with more than 20 employees between September 1, 2008 and December 31, 2009, you may be eligible to have 65 percent of your COBRA premiums subsidized for a nine month period, thanks to the federal economic stimulus bill enacted in February 2009. You pay only the remaining 35 percent of the premium cost for this period.
Eligibility: You must be involuntarily terminated from your job between September 1, 2008 and December 31, 2009.
How to enroll: If you did not opt for COBRA prior to the implementation of the credit in February 2009, you have a second opportunity to take advantage of this program. Your group insurance administrator should notify you of the subsidy option, giving you 60 days in which to select coverage. If you believe you are eligible for COBRA or a COBRA premium reduction and did not receive a notice, contact your employer and insurer.
What it is: New York Insurance law requires health plans to offer individuals who lose eligibility for employer-sponsored benefits “conversion rights,” or the ability to “convert” their group policies to individual policies. Conversion, which predates COBRA, was once an extremely valuable benefit for consumers because it allowed them to purchase individual policies, regardless of the state of their health, when they lost job-based coverage. COBRA, New York’s own insurance reforms (which guarantee issuance of comprehensive, individual policies to all residents without regard to their health), and the limited benefits permitted under some conversion policies make conversion rights relatively less valuable now. Still, exercising conversion rights, either in place of COBRA or to continue coverage when COBRA expires, may be a good option for some consumers losing job-based coverage.
Eligibility: Employees (and their dependents) who have been covered for at least three months under an employer-sponsored health plan are eligible for conversion if their eligibility for the employer-sponsored plan is terminated for any reason. Unlike COBRA, conversion policies do not expire.
How to enroll: Contact your insurer and/or employer. Employees have 45 days after the date their employer-based coverage ends to elect conversion coverage and send in the initial premium. Note that consumers lose the ability to opt for conversion after 90 days, whether or not proper notice has been given by the health plan or the employer.
Purchasing Private Coverage
The New York State Legislature has fought hard to put in place strong laws guaranteeing state residents the right to purchase comprehensive coverage regardless of their age, sex, occupation, or medical status. Individuals with pre-existing medical conditions cannot be denied coverage on this basis, and are entitled to continue full benefits from a plan after they have been covered for one year, regardless of existing or new medical conditions.
What it is: All HMOs in the state must offer two standardized individual HMO policies to state residents. The first option requires that all care be obtained from HMO networks of participating providers. The second, known as a “Point of Service” plan, allows consumers to use out-of-network providers, but for higher premiums and out-of-pocket costs. Both types of policies offer comprehensive coverage with low out-of-pocket costs and options for prescription drug benefits.
How to enroll: For a description of benefits and a list of premium rates for the health plans offering coverage, see the New York State Insurance Department Web site at http://www.ins.state.ny.us or call 800-342-3736.
Hospital Only Policies
What it is: Some health insurance companies sell “hospital only” policies for individuals in some areas at lower rates than for comprehensive coverage. These policies provide year-round benefits for care delivered at hospital facilities, but limit or do not cover many other types of care such as doctor visits, many prescription drugs, or outpatient diagnostic tests among others.
How to enroll: Contact New York State Insurance Department Web site at http://www.ins.state.ny.us or call 1-800-342-3736.
Coverage for Freelancers and Proprietors
There are some resources available for freelancers and proprietors in need of health care coverage, including.
If you work in one of a select number of occupations as an independent contractor, an association policy through the Freelancers Union might be an option. For more information, www.freelancersunion.org/insurance/index.html or call 800.856.9981
If you are the proprietor of or a sole employee of a small business and a member of the local chamber of commerce, you may be eligible to purchase a small group policy from a private insurer at a premium no more than 15% above small group rates. For more information, see New York City-based HealthPass at http://healthpass.com or call 212-252-8010.
Securing Public Coverage
New York State offers a menu of publicly subsidized health care programs for individuals. These programs limit eligibility based on income and often limit the amount of “resources” or assets (e.g. bank accounts, investments, etc.) a family can hold. Income determinations are based on the income of the entire household for the month preceding the program application. Care is usually provided through Managed Care Organizations (MCOs) that contract with the state to provide the benefits.
What it is: Medicare is basic health insurance for older Americans that covers medical expenses such as doctor’s visits, hospital stays, drugs and other treatment. It is a federal health insurance program for people age 65 and older and certain disabled individuals. Medicare is the first payer of health care costs for most older people and for many disabled people.
Eligibility: All Americans age 65 or older and people with certain disabilities.
Cost: Premiums, co-payments or deductibles may apply.
For more information: http://www.medicare.gov or call 800-633-4227.
What it is: Medicaid is the largest health insurance program for low-income families and individuals with limited assets.
Eligibility: People 19 to 64 years old with low-incomes; pregnant women, certain low-income people 65 and older receiving Medicare; persons with disabilities. Income limits are based on family size and the age of the enrollees, but begin at $706 per month for single adults. Higher income limits apply for pregnant women and children, and special allowances are made for individuals with high medical bills or who are receiving Supplemental Security Income (SSI).
For more information and to enroll: Visit any one of the Medical Assistance Program Offices at:
Bellevue Hospital Medicaid Office
462 First Avenue “G” Link (Ground Floor); at 28th Street • 212-679-7424
Chinatown Medicaid Office
115 Chrystie Street (5th floor); between Grand & Broome Streets • 212-334-6114
Note: Offices are open from: 9:00 AM to 5:00 PM Monday through Friday
Family Health Plus
What it is: Family Health Plus (FHP) provides comprehensive coverage, including prevention, primary care, hospitalization, prescriptions and other services for adults with slightly higher incomes than allowed for Medicaid. There are minimal co-payments for some FHP services.
Eligibility: Individuals 19 to 64 years of age. FHP is available to single adults, couples without children, and parents who are residents of New York State and are United States citizens or fall under one of many immigration categories. Income and resource limits range from $903 monthly income for single adults, to $2,757 monthly income for a family of four.
For more information and to enroll: See http://www.health.state.ny.us, call 877-934-7587, or visit:
Bellevue Hospital Medicaid Office – (see address above)
Child Health Plus
What it is: Child Health Plus (CHP) provides free or affordable health coverage for children under 19 depending on household income.
Eligibility: Children under age 19 who are New York State residents who are not eligible for Medicaid and have little or no health insurance. A family of four with a monthly income of $2,939 or less is eligible for free coverage for kids. Families of four earning between $2,940 and $7,350 per month can get coverage for a monthly fee of $9 to $40 per child, with a maximum of $120 per family.
For more information and to enroll: Call the NYS Health Department’s CHPlus hotline 800-698-4543 (or TTY 877-898-5849). Information is also available at www.nyhealth.gov/nysdoh/chplus.
Healthy NY (HNY)
What it is: A program designed to make reduced-cost, comprehensive health insurance available to eligible individuals whose employers do not provide insurance coverage, those who recently became employed, or individuals who are sole proprietors. Premium rates are significantly lower than for individual HMO policies, due to a state subsidy and scaled-back benefits. Ambulance, mental health, vision and dental services are not covered. Note that all Health Maintenance Organizations (HMOs) in New York State must offer Healthy NY, and many non-HMO plans choose to offer it as well.
Eligibility: The individual must be a resident of New York State; the individual or spouse must either be currently employed or lost their job during the past 12 months; the individual must not be eligible for Medicare and the individual must not have had health insurance for the past 12 months or have lost that coverage due to a specific event (as listed on the Healthy NY web site). HNY has the highest income limit of public programs for adults ($2,257 a month for individuals and $4,594 for a family of four) and no asset test. Note that sole proprietors may deduct business expenses to calculate income.
For more information: See http://www.healthyny.com or call 1-866-432-5849.
Neighborhood Health Centers
Non-profit neighborhood health centers receive certain kinds of federal funding and are required to provide primary and preventive care services to uninsured patients. All New Yorkers without health insurance, including people who are undocumented, can receive primary health care from the City’s Child and Family Health Clinics or Community Health Centers and cannot be turned away. They offer a sliding fee scale based on family size and income(depending on your income, you may pay nothing). These health centers and clinics also help patients apply for public health insurance programs. For a list of these health centers, see http://home2.nyc.gov/html/doh/html/hardr/clinics.html#manhattan, call 311, or call my office to have one mailed to you.
State law requires that hospitals that accept state funding for treating uninsured patients are required to provide discounts to uninsured patients within certain income limits, limit interest payments on unpaid bills, and offer agreements to stretch payments out over time. For more information, see http://nyc.gov/html/hhc/downloads/pdf/hhc-options-10-2008-en.pdf, call 311, or call my office to have more information mailed to you.
Elderly Pharmaceutical Insurance Coverage (EPIC)
What it is: A New York State program that helps seniors save an average of 90 percent on prescription medications. The Elderly Pharmaceutical Insurance Coverage (EPIC) program is even available to seniors enrolled in Medicare Part D or other drug coverage and helps pay Medicare Part D or other deductibles and co-payments required by an existing drug plan. In this year’s budget, I fought to preserve EPIC so that prescription medications remain affordable for thousands of New York seniors.
Eligibility: You may be eligible for EPIC if you are a New York State resident age 65 or older with an income of $35,000 or less per year if single or $50,000 per year or less if married.
Cost: Premiums, co-payments or deductibles may apply.
For more information and to enroll: Call the state’s EPIC hotline at 1-800-332-3742 or visit their Web site at http://www.health.state.ny.us/health_care/epic.
New York State Prescription $aver Card
What it is: The Prescription $aver Card is a pharmacy discount card that helps eligible New Yorkers afford their prescription medications. This card can be used at participating pharmacies to save as much as 60 percent on generics and 30 percent on brand name drugs.
Eligibility: Individuals age 50 to 64 or determined disabled by the Social Security Administration who have annual income under $35,000 if single and $50,000 if married and who do not receive Medicaid or EPIC.
For more information and to enroll: Visit https://nyprescriptionsaver.fhsc.com or call 1-800-788-6917 (TTY 1-800-290-9138). Applications are also available at participating pharmacies. A list of these pharmacies is available at the web site above or you can call my office to have a list mailed to you.
Partnership for Prescription Assistance
What it is: The Partnership for Prescription Assistance program brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. PPA offers a single point of access to more than 475 public and private patient assistance programs, including nearly 200 programs offered by pharmaceutical companies that provide free or reduced-cost medications.
Eligibility: Varies by program but is generally designed to assist low and moderate-income individuals and/or those who have specific healthcare issues and need help with particular prescription medications.
For more information and to enroll: Call 1-888-477-2669 or use their online screening and referral system at https://www.pparx.org/Intro.php.
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