When the financial world took a downturn, we lost our health insurance obtained through employment. I knew nothing about health insurance, thinking I could just call up any company, similar to buying insurance for a car, and ask, “What can you sell me and what does it cost?”
That is what I did, and encountered dismay on the other end of the line from several insurance agencies. I learned that it doesn’t work that way. There is work-related Cobra offered for six months if you can afford it. When the financial world takes a turn for the worst, however, who can afford $1200 a month (if lucky) for family insurance? My husband and I did without.
The one gem I did find was that my son would be covered through Child Health Plus (CHP), the New York State health insurance program for children under the age of 19. When I told the office people at my son’s pediatrician that we had lost our insurance, they pointed me to a representative. My son was ten at the time, and it was a relief knowing he would be covered at an affordable price.
During this time, I was trying to obtain my own health insurance through private means. The end result opened into a nightmare of eligibility refusals for various reasons. Eventually I found health insurance through the Arts Society of Kingston just for myself because we could not afford it for two. My husband, the healthier person, went without.
My insurance cost nearly $400 a month and had a deductible of $3500 and no prescription coverage. Because I had lagged between insurance companies, any pre-existing condition would not be treated until I paid into the insurance for a year. Jumping through hoops of fire was optional.
By the way, any therapy care due to the stress of trying to find insurance was not covered. Sorry.
CHP provides a subsidy by using yearly or monthly gross income. Because we are freelance, we sometimes had zero premiums and sometimes we did not qualify for the subsidy. The monthly premium without the subsidy was under $200. If you are at four times the poverty level, you do not qualify. There are premium caps on the subsidy if you have multiple children. If you don’t qualify for the subsidy, however, it’s full premium for each child. That can get pricey.
There are no out-of-pocket expenses. Everything, and that includes dental, vision, and prescription, is covered. Well care, emergency care, surgical, hospice, substance abuse, mental health are all covered. CHP provided coverage for mental health and substance abuse even before a federal mandate required it.
Over the years my son had medical hiccups along the way that needed special attention. We never had a problem with refusal to treatment. I spoke to other parents who used CHP and their experiences were similar. The only concern I came across was a waiting period for a new mother with individual insurance to get her child enrolled in CHP. It appears the state fixed this so it would roll over. My advice to a new mom about to give birth is to make sure you have your insurance ducks lined up. Make calls, be informed, and have peace of mind that this stuff has been taken care of.
CHP is now folded into the Affordable Care Act (ACA). Nothing has changed about it, except sign-up can be online or through an “enroller,” according to its website (health.ny.gov). Before the ACA, I would use an enroller because the Internet was not an option. Over the years my enroller and I met at Barnes and Noble over books and coffee, my house for tea, or a diner for lunch. I think we met in an office once because my enroller needed to make copies. It was always a pleasant experience.
You can also go to the New York Marketplace (nystateofhealth.ny.gov), put in your income, and see whether your children qualify. A sign in blue may tell you to call a number. I did a quick check by using one child with an income ranging from $50,000-to-$70,000 and was flagged as possibly eligible for Child Health Plus.
The New York State children’s health program, begun around 1990, was so successful it became a template for the National Children’s Health Insurance Program (CHIP) passed in 1997. Senator Edward Kennedy (D) was the sponsor and senator Orrin Hatch (R) the co-sponsor. Hillary Clinton pushed the CHIP program, securing $24 billion in the Senate instead of the $16 billion approved by the House. The bill allows matching federal-state funds for children’s health care and targets families not eligible for Medicaid but unable to afford regular insurance.
Under the ACA, the program was to expanded to more insurance companies. Currently, CDPHP, Fidelis, Hudson Health, United Healthcare and Wellcare carry CHP. With the future of the ACA in question it’s heartening to know CHP is under a separate piece of legislation. It appears to have its own strong legs. At least our children will be taken care of.