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SPECIAL INTRODUCTION FOR THE AGE OF REFORM
Thanks to passage of federal health reform on March 23, 2010, most Utahns will gain access to decent and affordable healthcare coverage—eventually. Most of the coverage expansions will not go into effect until 2014. Learn more about how—and when—the reforms will impact you or your business at UHPP’s Implementation Station.
In the meantime, you should try to find health care coverage at the right price. Health insurance does two things:
- protects you from potential financial loss if you or a family member becomes very ill or has an accident;
- ensures you have timely access to care when you need it.
Yet, until the new health reform law is fully implemented, insurance may be too expensive for many people. Depending on your household income level and situation, you and your family may qualify for one or more of the following options for coverage and premium assistance:
MEDICAL ASSISTANCE PROGRAMS
There are several resources to help low-wage individuals and families gain coverage. Eligibility for these programs is based on household income. To know where your income level puts you on the poverty scale, see the Poverty Guidelines at right. Yet the best way to find out if you qualify for medical assistance or premium assistance is to apply.
Children’s Health Insurance Program (CHIP) helps families earning less than 200% of the poverty line provide coverage to their children. For more information on the CHIP program, visit: http://www.health.utah.gov/chip/. To apply: call 1-877-KIDS-NOW or go online: https://utahhelps.utah.gov/erepprodpub/en/ISS_LandingOnlineAppPage.do?
Medicaid helps people earning less than 100% of the poverty line provide health coverage to their children. It also provides health coverage to parents earning less than 44% of the poverty line, and to persons with disabilities and senior citizens with income less than 100% of the poverty line. For more information on Medicaid visit: http://health.utah.gov/medicaid/. To apply: call 1-877-817-1800 or go online: https://utahhelps.utah.gov/erepprodpub/en/ISS_LandingOnlineAppPage.do?
Primary Care Network (PCN) helps individuals and parents earning less than 150% of the poverty line access primary and wellness care (note: coverage for hospital care and specialty care is not covered). For more information on PCN visit: http://health.utah.gov/pcn/. To apply: call 1-877-817-1800 or go online: http://health.utah.gov/pcn/apply.html. Note: enrollment for PCN opens and closes according to the number of people in the program. The next open enrollment period (for parents only) starts on May 10, 2010. If PCN is closed, check back for the next open enrollment period.
Utah Premium Partnership (UPP) helps kids earning less than 200% of the poverty line and adults earning less than 150% of the poverty line purchase private health insurance by providing premium subsidies on a sliding fee scale. For more information on UPP visit: http://health.utah.gov/upp/. To apply online: http://health.utah.gov/upp/howtoapply.htm. UPP is also approved to help low-income individuals and families pay for thier COBRA coverage. If eligible for or already enrolled in COBRA, you may qualify to receive up to $150 per person each month to help subsidize their montly premium payment. For more information, click here.
PRIVATE INSURANCE OPTIONS
The private market includes both employer-based and individual coverage. Employers and individuals can generally purchase insurance directly from a health plan or through a health insurance broker or agent. A list of health plans can be found at www.insurance.utah.gov/health/HealthConsumerInfo.htmlYou may also find options and broker information on Utah’s new Utah Health Exchange at http://exchange.utah.gov/.
Small business employers will soon have a new option at the state level: the ability to purchase insurance directly through the Utah Health Exchange, an internet based, defined contribution market. To learn more about Utah’s Exchange go to http://exchange.utah.gov/.
To learn about how federal health reforms will help small businesses (starting with the 35% tax credits in 2010), click here.
Individuals can also purchase insurance online at a variety of comparative shopping sites. The Utah Health Exchange has a list of these sites at http://exchange.utah.gov/ . Depending on your medical history, an insurance company may decide you are uninsurable. If this happens you may be eligible for insurance through the state’s high risk pool, the Utah Comprehensive Health Insurance Pool (HIPUtah). To learn more or to apply for subsidies to help pay the program’s hefty premiums go to www.insurance.utah.gov/hiputah/index.html.
Please note: Federal health reforms actually start with more affordable access to the high-risk pool in June of 2010. To learn more, check back here or at one of the links above.
While we wait for federal health reforms to be fully implemented, beware of the many scams out there! There are two scams in particular, health discount plans and health discount cards. Information on these and other scams can be found at: www.insurance.utah.gov/health/HealthConsumerInfo.html.
Complaints? If you are having problems with your private insurance, call Utah’s Office of Consumer Health Assistance at 801-538-3805 or toll free 1-866-350-6242, or visit their website at www.insurance.utah.gov/complaint/index.html. The website has information on what action you can and should take if you have a complaint and how to file an official complaint. If OCHA can’t help you resolve your issue, please call us at UHPP: (80) 433-2299.
For a full list of consumer and small business information on shopping for health insurance and other questions go towww.insurance.utah.gov/health/index.html. Federal health reforms will include additional resources to help consumers and small businesses find affordable insurance—stay tuned!
THE HEALTH CARE SAFETY NET
For those who cannot find affordable coverage, there may be options for low-cost or free care in the state’s extensive health care safety net. Safety net providers play an important role in providing basic health care services to thousands of Utahns. The health care safety net includes medical providers, dental providers, mental health providers, and eligibility assistance.
To learn about safety net options visit: http://www.health.utah.gov/safetynet/index.htm (note: this list is not complete). Utah Cares is another tool to find affordable health care. This resource walks you through the options in your county: https://utahcares.utah.gov/erepucpub/en/ScreenReferralHomePage.do?__o3rpu=screeningMainPage.do
PRESCRIPTION DRUG ASSISTANCE (new section!)
There are several tools to help you get the prescriptions you need. First and as a general rule, be on the lookout for generic medications. They work just as well as brand name drugs—and you can’t beat the price! Almost all generics are available at Walmart, CostCo, and Smith’s for $4 or less for a 30-day supply, so check there first. Your local pharmacy or health insurance plan (if you are insured) may also offer deeper discounts through mail order.
To find discounted generic drugs on the web, visit www.genericsarepowerful.org/learn?id=0007
Many pharmacies offer prescription medicines for as little as $4 per month. Here is a list of some of the major drug and retail stores that offer generics at discounted prices. Also, check your local pharmacies and call your health insurance plans which may offer even lower prices through mail order pharmacies.
Generics are Powerful Medicine provides the following links for informational purposes only. We do not endorse or recommend any particular program or pharmacy. Drug prices change frequently, and pharmacy programs often change which medications they cover. So we cannot guarantee the accuracy of any of the information on the sites linked below. If you are aware of other pharmacy programs for discounted generic drugs that should be included here, please let us know by clicking on Contact Us below.
Consumer Reports article: Generic Drugs: Shop around for the best deal: http://www.consumerreports.org/health/prescription-drugs/generic-drugs-11-06/overview/1106_drug_ov_1.htm>
Other tips from Consumer Reports on comparison shopping for prescription drugs http://www.consumerreports.org/health/prescription-drugs/generic-drugs-11-06/overview/1106_drug_ov_1.htm
Smith’s Food and Drug: http://www.smithsfoodanddrug.com/generic
Target: <http://sites.target.com/site/en/health/page.jsp?contentId=PRD03-004319&ref=tgt_adv_XSHA3201&AFID=googlestr&CPNG=genericdrugs&LNM=generic_drugs&LID=>
Walgreens: <http://www.walgreens.com/help/genericfacts.jsp>
Walmart: http://www.walmart.com/catalog/catalog.gsp?cat=546834 $4 for 1-month supply, $10 for 90 day supply (Stores nationwide): http://www.walmart.com/catalog/catalog.gsp?cat=546834
RxConnect Utah is a great place to start, a 1-stop shop for more links and prescription drug assistance resources for Utah residents.
Patient Assistance Programs through Pharmaceutical Companies
Partnership for Prescription Assistance: http://pparx.org. Clearinghouse of more than 475 public and private patient assistance programs; matches individual to programs that meet their needs.
NeedyMeds.org: http://needymeds.org - Search for assistance programs, download applications, find local help: http://needymeds.org
RxAssist: http://RxAssist.org - Search a database of medications to find discount programs, get tips & other info: http://RxAssist.org
Rx Outreach: http://RxOutreach.com - discounted generic drugs for eligible consumers
http://RxOutreach.com
Together Rx Access is a prescription savings program supported by many of the nation’s leading pharmaceutical companies to help individuals and their families who have no prescription drug coverage and are not eligible for Medicare gain access to the medicines they need to take care of their health. Or, to learn more, go to www.togetherrxaccess.com.
Source for some of above: Community Catalyst.
CLOSING STATEMENT: Get Involved in Implementing Health Reform!
Federal health reform is happening—and not a moment too soon. What we know from states with reforms already underway is that passing the legislation is only the first step. From there, we need to make sure our state takes full advantage of the many reform options available. Then, when the time comes to roll out a new program or expansion, we must help our friends and neighbors make good use of the new options. Visit our Implementation Station to learn more about all the health reform changes and how they will help all of us get (or keep) access to affordable, quality health care coverage.
We will know we have succeeded when the reforms make it possible for all of us to take charge of our health and live a long and healthy life.
How you can become involved:
You can learn more about current reform efforts, share your health care story, or get more involved at www.healthpolicyproject.org or call 801-433-2299.
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