Hosting for this Website Graciously Donated by XMISSION

Bookmark and Share



Utah's Uninsured

This Taylorsville family was contemplating dropping their health insurance because it was too expensive, even though they have a baby on the way...

Struggling to pay for health insurance with a baby on the way…

Worry is not a feeling you want to have with a baby on
the way, but S.M. and his wife worry a lot about health insurance and how they are going to pay for the care they need. They bought insurance because they knew they wanted to have a child, but they are realizing that the coverage they have is unaffordable. Now they have to choose whether to drop their coverage and try to apply for Medicaid or keep struggling to pay the bill.

S.M. and his wife are expecting their first child! But, they spend a lot of time worrying about health insurance. When S.M. and his wife decided they wanted to start their family, they were uninsured. As students, they had relied on school health clinics for primary care and otherwise went without real insurance. But they knew they should have coverage for the pregnancy. Three months before they got pregnant, they applied to various individual plans. They were accepted to only one and enrolled immediately. Now, they pay $300 a month for a plan with a $5,000 deductible. “All of our money is going towards this pregnancy and deductible,” says S.M. “We are not quite clear on what the insurance is actually going to cover.”

Cash flow is tight for their family right now, and they are struggling to pay the insurance bill. They are thinking of dropping their coverage and qualifying for Medicaid. “It’s hard enough to find the money to buy food, let alone everything we need for the baby,” S.M. says. He just started work at a big company with great benefits, but he doesn’t qualify for the insurance for about 6 months. That could be an option for them in the future, but right now they are caught between a rock and a hard place, with a baby on the way.

The Patient Protection and Affordable Care Act helps S.M. in the following ways:

Starting in March 2010:

  • Increased funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years.  Community Health Centers charge a sliding fee scale based on income, thus making care more affordable for Merce.

In June 2010: There will be new standards for non-profit hospitals to protect uninsured patients.

  • Lower income Utahns will be eligible for subsidies to help them purchase coverage through the high-risk pool.  This interim high-risk pool has consumer protections to ensure you get quality insurance.  The plan must cover at least 65% of a patient care costs and cap out of pocket charges at $5,950 a year for an individual or for a family, $11,900.  The plan cannot exclude coverage of pre-existing conditions or charge older Utahns more than younger people.

In 2014: Adults can now obtain insurance even with their pre-existing conditions.

  • Individuals buy insurance through a new online, state-based marketplace called an exchange and premiums will no longer be based on health status
  • Families may receive subsidies to help buy coverage from your state’s health insurance exchange.  Based on income, there will be a cap to the amount charged for premiums and out-of-pocket expenses will also be capped.
  • Medicaid will expand to families making up to 133 percent of the poverty level.
If S.M. still cannot afford to buy insurance, he could apply for a hardship waiver and subsidies will be provided to families with incomes of up to 400 percent of the poverty level.