Q. I have coverage for my cancer treatment under the Affordable Care Act and am nervous it could be in jeopardy after President Obama leaves office. Can you provide some information and resources that could help me?
With a new, very different administration just a few weeks away, many in our community are worried about their insurance coverage and what this change will mean for the health care landscape.
First, the good news: although the president-elect and Republican leaders have signaled that they would like to repeal the Affordable Care Act (ACA) as early as January or February of 2017, it is unlikely they will be able to repeal certain key aspects of it, such as the ban on denying coverage due to pre-existing conditions. We do not anticipate any changes to the system that will directly affect you in 2017. Republican leaders have indicated a replacement is probably 2-3 years away.
Now, the not-so-good news: many of the changes that have been proposed may have serious consequences for your ability to access affordable, quality health insurance. For example, if the ACA is repealed, insurers would no longer be required to cover the 10 essential health benefits – such as hospitalization, maternity coverage, medications, and mental health services – and could impose annual dollar caps on your benefits. In addition, the ACA currently limits how much you have to pay per year for deductibles, co-insurance and copays, in the form of your “out-of-pocket maximum”. The current maximum for an individual is $7150. In the event of a repeal, there would no limit to the out of pocket costs to consumers. The organization Raising Women’s Voices has created a handy, one-page outline of what is at stake.
At this point, these changes are conjecture, since the new administration has yet to take office. It may be that opposition to these changes will prevent them from happening.
In the meantime, you can contact your elected officials and share your health insurance concerns. To find your elected officials, visit votesmart.org/officials. Social media contact information for current members of Congress can be found on triagecancer.org/congressional-twitter-handles.
Q. I think I may have cancer but I don't have any insurance and I'm not sure I can afford it. What can I do?
I understand your concern about the cost, but if you think you have cancer, you can’t afford not to visit the doctor. Cancer responds to treatment better when it’s caught early, and if it turns out that you don’t have it, you will have peace of mind.
There are 5 main ways to get health insurance:
Your, or your spouse’s, employer or union. If you or your spouse has a job that offers health insurance, ask if you’re eligible to receive it or buy into it. If you had insurance but lost your job within the last 60 days, ask if you’re eligible for COBRA. COBRA is a law that lets you keep your insurance for 18 months, sometimes longer. You pay the full cost.
Your school. If you are currently a full-time or part-time student, check with your college or university to see if you can get coverage through them.
Purchase it on your own. You can buy insurance either directly through an insurance company, or through your state’s Marketplace/Exchange. If you buy it directly through an insurance company, you will not be eligible for discounts based on your income. If you buy it through your state’s Marketplace/Exchange, your income will be taken into account, and you may receive an immediate subsidy, which will lower the cost of your premiums, and possibly your deductibles and co-pays as well. To find your state’s Marketplace, go to www.healthcare.gov. Please note: whether you buy it directly from an insurance company or through the Marketplace, you can only buy insurance during Open Enrollment. Open Enrollment occurs once a year, generally between November and January. There are a few exceptions to this rule – if you lose your job-based coverage mid year, get married, have a baby, move to another county or state, or become eligible for Medicaid, you are eligible for a “special enrollment period”. For more information on special enrollment periods, visit www.healthcare.gov.
Medicaid. Medicaid is a state-administered health insurance program that provides free or low-cost coverage to millions of Americans. In the 30 states that have chosen to “expand” Medicaid, it covers all children and adults below 138% of the Federal Poverty Level, which for 1 person in 2016 is approx.. $16,240. In the remaining 20 states, it only covers low-income families with children, pregnant women, the blind, and the disabled. To see if your state has expanded Medicaid, and to apply, visit www.healthcare.gov.
Medicare. If you are 65 or over, or have been deemed disabled by the Social Security Administration for 2 years, you may be eligible for Medicare. Contact www.medicare.gov for more information.
If you are unable to afford insurance and are ineligible for Medicaid or Medicare, ask about charity care and sliding scale programs (fees based on your income) at hospitals and clinics. Some hospitals are required to see patients who are uninsured. Contact your local department of public health, social services, or business office of your hospital of choice for more information.
Finally, if you are concerned about either breast or cervical cancer, the National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured women access to screening and diagnostic services to detect breast and cervical cancers. Women who are subsequently diagnosed with cancer may be immediately eligible for limited Medicaid.
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