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BACKGROUND
The best way to get ongoing, reliable medical care is through health insurance coverage. 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 insurance is becoming too expensive for many people. Depending on your household income levels 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 50% 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. 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.
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 employers have a new option: the ability to purchase insurance directly through the Utah Health Exchange, an internet based, defined contribution market. To learn more about the Exchange go to http://exchange.utah.gov/.
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.
As a consumer you must 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.
For a full list of consumer and small business information on shopping for health insurance and other questions go to www.insurance.utah.gov/health/index.html.
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
CLOSING STATEMENT: Get Involved in Health Reform!
The reality is that not enough of us qualify for affordable, quality health care coverage. As costs continue to rise, individuals and families are increasingly finding that they cannot afford coverage and care. This is why it is so important for Utah and the nation to reform its health care system now.
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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