Affordable Health Care
Many programs may help you get and pay for health care. This is a summary of the programs available but may not cover all of them. You can get more information on all these programs—we tell you how after each section below.
Medicaid is a health insurance program for low-income people. Applicants must meet income and asset guidelines. The coverage can be free or a ‘spend-down’ must be met. Medicaid covers most office visits, prescription drugs, tests, hospital and nursing home costs.
Medicaid is available to:
- persons with income below 138% of the federal poverty guidelines;
- children with household income below 200% of the federal poverty guidelines;
- OWF and SSI recipients, and;
- Low-income pregnant women and parents/caretakers of minor children.
You can get more information and apply for Medicaid at your county Department of Job and Family Services. You can also apply online at www.Benefits.Ohio.gov.
Medicare is a public health insurance program for workers who are 65 or older, or disabled. Medicare does not cover as much as Medicaid. Medicare eligibility does not depend on your income or assets.
Medicare has three parts. Part A is free and covers the costs of hospitalization, skilled nursing care, hospice and some in-home care. Part B is extra coverage that you may choose to purchase—it is not free. Part B covers doctor bills, outpatient services, tests, and medical equipment. Part D is limited prescription medication coverage. It’s also not free.
You can get more information and apply for Medicare through your local Social Security Administration office.
Private Insurance under the Affordable Care Act
The Affordable Care Act (ACA) set up a market place for private health insurance. It allows you to compare insurance plans before you buy. It’s an ‘apples to apples’ comparison. All health insurance plans must cover doctor visits, hospital costs and prescriptions. Preventive care is free. You cannot be denied coverage due to a pre-existing condition.
Many households can receive financial help to cover the costs. But to get help you must get insurance through the ACA market place. You can get more information at www.getcoveredAmerica.org. Apply online at www.healthcare.gov. Or call 1-800-318-2596 available 24/7 (except Federal holidays). You can also get free help to apply. A list of ‘navigators’ is available at either of these websites. Need more help finding help? See communitylegalaid.org.
The Veterans Administration provides health services in hospital and clinics throughout the U.S. Certain procedures and services may be free, others may require a co-pay.
The VA health system is available to veterans who have served a full term of active duty, disabled veterans, and many others. All low-income veterans should apply.
Find more information at http://www.va.gov/healthbenefits/resources/epublications.asp. Apply on-line at www.va.gov or at your local Veterans Service Commission office.
DA Medical is health coverage for disabled individuals who receive DFA. DFA is income for persons who have a physical or mental disability. The disability must be so severe as to prevent employment for at least nine months.
You can get more information and apply for DFA at your county Department of Job and Family Services. If your application is denied and you don't know why, call the Legal Helpline.
Public Health Care Clinics
Public health care clinics (PHCs) provide services on a sliding-fee scale basis (the less you earn, the less you pay). PHCs must provide certain services free of charge. Call 211 or your local information and referral agency to see if there is a PHC in your area.
Hospital Care Assurance Program (HCAP) and Hospital Charity Care
Some hospitals offer free or reduced cost treatment to individuals and families. Household income must be below a certain level. HCAP is a program that requires hospitals to offer free treatment. Low-income individuals must have household income below the federal poverty level.
Charity care covers many hospital services. It does not cover doctor's bills or take-home prescriptions. For example, it will cover the cost of a hospital room but not your surgeon’s fee.
You can get more information and apply through your hospital's billing department. Or ask the hospital's social worker. Your doctor may also offer free care.
Covered employees and their families who received health insurance through work are allowed to buy that same coverage. There are restrictions. The coverage is limited to 18 or 36 months. The employee must have quit, been fired or changed jobs and lost health insurance. COBRA coverage is also available if a divorce results in lost coverage. Employers must inform their employees of this program.
If you or a family member recently lost health insurance that had been provided by a job, you should call the company and ask for a COBRA notice. If they refuse to give you this notice, call the Legal Aid Helpline at 1-800-998-9454.
Free Prescription Programs
Many drug companies offer free or low-cost prescription drugs. These programs differ from company to company. If you take a medication every month, ask your doctor about any offer to lower your costs. Ask your doctor or druggist to call the Pharmaceutical Manufacturers Association (PMA) for information on drug savings programs. The PMA can be reached toll-free at 1-800-PMA-INFO.
Ohio’s Best Rx
Is open to all Ohioans. The program saves participants money through negotiated drug prices and manufacturer rebates. Uninsured participants save the most. A Best Rx participant pays the "Best Rx price." Apply online at “Ohio’s Best Rx.”
Local and County Health Departments
Health departments provide many different services for low or no cost. Services may include physicals, immunizations, blood tests, health screening and wellness education. Call your health department to find out what services they will provide.
Other local Health Care Options
There may be other health care options. Contact your local 211 or information and referral agency to find out. Some doctors volunteer to help through a free clinic.
This article is meant to give you general information and not specific legal advice.Prepared by Community Legal Aid Services, Inc. Updated November, 2014. CE-59-F186-CLAS