Where do you go if you need health insurance or health care and can’t get coverage either due to medical condition, employment issues, or financial issues? (In many cases, it can be a combination of all three!)
Well if it a medical condition that is stopping you and not financial issues, then thanks to the Obama health reform law, there is guaranteed issue coverage from all insurers, and in most states there is some kind of state risk pool. So essentially, if you can afford the $200-400 per month for these plans you can get coverage. If you fall into this category go ahead and read on to the High Risk Pool section below.
If it is financial issues (it could be both) that preclude you from getting coverage than you will need to jump down below to our section for people with financial issues.
High Risk Pool Plans
The Pre-Existing Condition Insurance Plan (PCIP) was a program offered in every state under the Affordable Care Act, though it is now closed for business. It could be administered by either states or the Federal government. The PCIP program might have been able to help you if you had been locked out of the insurance market while the nation transitioned to 2014.
Where it got confusing was if there was a PCIP program and a High Risk Pool in some states. And the answer is no. Your state either has PCIP or the High Risk Pool. Essentially, the states with their own risk pool elected to administer the PCIP program themselves (probably because they had been running an existing high risk pool prior to the PCIP program launch).
Now that the health reform law is in place, you no longer need to apply with a risk pool if you have a medical condition, but if there is one offered in your state, it may be a better option than the exchanges depending on what you can afford.
How to qualify for the risk pool or PCIP
The PCIP is closed for enrollment, but while it was available, you could qualify for this health coverage option if you had been uninsured for at least six months, you had a pre-existing condition, and you had been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company.
PCIP covered major-medical and prescription drug expenses. You were responsible for paying premium, deductible, copayments, and coinsurance amounts. PCIP wouldn’t cost you more just because of your medical condition. PCIP wasn’t based on income eligibility like Medicaid.
To qualify you must be a citizen or national of the United States or lawfully present in the United States.
What about People that Can’t Afford Health Insurance or PCIP?
Obviously, your state has a Medicaid program, however that program can be harder to get into than a Justin Beiber concert (if this reference is dated please fill out our contact form so I can update that joke to recognize the current boy band hotties). In other words, you really need to below the poverty line to qualify or have some sort of disability unless you live in a Medicaid expansion state.
Additionally, the health insurance exchanges are available for those who exceed the cutoff for Medicaid in some states, and otherwise earn a poverty-level income. Financial assistance in the form of tax credits can help you pay for a private-public health plan, administered by the government and sold by health insurance companies on the exchange, also called the marketplace.
Luckily, there is the The Health Resources and Services Administration (HRSA), which is an agency within the U.S. Department of Health and Human Services. Tens of millions of Americans get affordable health care and other help through HRSA programs.
Find a Health Center
Health centers provide primary medical and dental care to people of all ages, whether or not they have health insurance. Services are provided on a sliding fee scale, based on your ability to pay. In certain circumstances, the care can be provided free of charge. These programs are often subsidized by state governments.
Find Free or Reduced Cost Care at Hill-Burton Obligated Facilities
About 200 hospitals, nursing homes and other facilities across the U.S. are required to provide a specific amount of free or reduced-cost health care to people unable to pay.
Ryan White HIV/AIDS programs connect people living with HIV/AIDS health care and support services.
Anyone can get care at a health center or Hill-Burton obligated facility. Your eligibility for free or reduced cost care depends on your income and whether or not you have health insurance.
Diseases & Conditions
Black Lung Clinics
Black Lung Clinics provide services to coal miners, whether they are currently involved in mining or not. Services are available to patients and their families regardless of their ability to pay.
The National Vaccine Injury Compensation Program (VICP) was established to ensure an adequate supply of vaccines, stabilize vaccine costs, and maintain a forum for individuals injured by certain vaccines.
Organ Donation & Transplantation
Each organ and tissue donor saves or improves the lives of as many as 50 people. The Organ Procurement and Transplantation Network ensures fair distribution of donated organs in the United States.
Bone Marrow and Cord Blood Donation & Transplantation
Transplants can save lives. The C.W. Bill Young Cell Transplantation Program provides support to patients who need transplants from unrelated donors and helps people who wish to donate.
Traumatic Brain Injury
The Federal Traumatic Brain Injury Program helps State and local agencies develop resources so that all individuals with TBI and their families will have appropriate services and supports.
Public Health Resources
The Poison Help website teaches people about poisons, poison safety and prevention, and when to contact a poison center. It also provides resources for health professionals, and organizations.
Healthy Living Guides
These “Bright Futures” materials help women of all ages achieve better physical, emotional, social, and spiritual health by encouraging healthy practices.
Women, Infants & Children
The HRSA Maternal and Child Health Bureau improves the health of mothers, children and their families.