Dear Friend,
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.
Sincerely,
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.
Conversion Policies
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.
HMOs
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.
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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
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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.
Medicare
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.
Medicaid
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.
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.