Jane Dotson
Basic Health Programs are a form of health insurance that provides essential health benefits to people who are otherwise unable to qualify for Medicaid. These programs are funded by the federal government, which provides funding to states that elect to establish a Basic Health Program. The Affordable Care Act has made it easier than ever to apply for health insurance. Depending on your state, you can apply for health insurance by contacting an insurer directly, speaking with a licensed insurance agent, or using your state's health insurance marketplace.
| Characteristics | Values |
|---|---|
| How to apply | Contact an insurer directly, speak with a licensed insurance agent, or use your state's health insurance marketplace |
| Who can apply | Health insurers cannot deny your application |
| Cost | You usually pay a premium every month, and your health insurance plan pays part of the bill when you need a service from a doctor or another provider |
| What it covers | Most health insurance covers doctors' visits, prescription drugs, medical and surgical services, and mental health issues |
| Preventative care | Most policies are required to cover certain preventative health benefits without any out-of-pocket cost to you |
| Pre-existing conditions | Insurers cannot charge you more if you have a pre-existing health condition |
| Public programs | Many people get health coverage through public programs like Medicaid and Medicare |
| State-specific programs | Some states have specific programs, such as the Senior Health Insurance Program (SHIP) in Illinois, or the Basic Health Program (BHP) in Oregon, New York, and Minnesota |
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What You'll Learn
Public programs like Medicaid and Medicare
Step 1: Understand the Programs
Medicaid is a joint federal and state program that provides health coverage for low-income individuals and families. Eligibility and benefits can vary by state, so it is essential to check with your state's Medicaid agency. On the other hand, Medicare is a federal program that provides health coverage for people aged 65 and older, as well as younger people with disabilities.
Step 2: Check Your Eligibility
To enrol in Medicaid, you must meet certain income and asset limits, which vary by state. For example, in some states, an individual must not have an income above a certain amount to be eligible for Medicaid. Additionally, factors such as age, pregnancy, or disability can also impact your eligibility. For Medicare, eligibility is typically based on age, but certain disabilities or medical conditions can also make you eligible.
Step 3: Gather Required Documentation
You will need to provide specific documentation to enrol in these programs. This may include proof of identity, such as a driver's license or passport, as well as proof of income, residency, and citizenship or immigration status. Some states may also require additional documentation, such as medical records or proof of disability.
Step 4: Complete the Application Process
You can apply for Medicaid through your state's agency, either online, in person, or by mail. The application process for Medicare is similar, and you can apply online through the Social Security Administration website or by visiting your local Social Security office. During the application, you will need to provide information about your income, household size, and other relevant details.
Step 5: Wait for Processing and Enrolment
After submitting your application, you will need to wait for it to be processed. The time frame for this can vary, but you should receive a response within a reasonable period. If your application is approved, you will be enrolled in the program and can start accessing the benefits, including essential health services, preventive care, and more.
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Contact an insurer directly
If you are looking to get on basic medical insurance, one option is to contact an insurer directly. You can do this by either speaking with a licensed insurance agent or by reaching out to a health insurance company.
Licensed Insurance Agents
Licensed insurance agents can help you navigate the wide range of insurance options and enroll in the best health insurance plan for you. They are paid on commission by insurers, so you do not have to pay any fees when working with them. To find a licensed insurance agent, you can use the federal government's Find Local Help tool to set up in-person, phone, or email appointments. You can also enter your phone number or email address to be contacted by an agent to discuss plan choices.
Health Insurance Companies
If you are self-employed, you can get coverage directly from a health insurance company. You can apply for and enroll in a Marketplace plan through an approved enrollment partner, such as an insurance company or online health insurance seller. You will receive eligibility results in the mail within two weeks.
When choosing an insurance company, it is important to understand the rules and limitations of their health care benefits. For example, some companies may require you to use a pharmacy in their network. Additionally, each company may have different requirements for receiving care, such as needing a primary care physician to oversee your medical care and provide referrals to specialists.
Public Programs
In addition to private insurance companies, you can also contact government programs such as Medicare or Medicaid to see if you are eligible for coverage. These programs offer comprehensive health coverage and are available to individuals with disabilities or those who meet certain income requirements.
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Speak with a licensed insurance agent
When considering basic medical insurance, speaking with a licensed insurance agent can be very helpful. These agents are trained to help you understand your options, including the various Medicare plans available in your area, such as Medicare Advantage, Medicare Supplement, and Medicare Part D Prescription Drug plans.
Before reaching out to an agent, it is beneficial to understand how insurance companies are structured and how they operate. Each person you interact with at an insurance company has a specific level of authority to settle your claim. Adjusters typically have the lowest settlement authority, while Home Office executives have the highest. Therefore, when communicating with your insurance company, it is advisable to start with the adjuster and then contact their superiors if necessary.
When interacting with your insurance company, it is crucial to remain professional and cooperative. Avoid yelling or losing your temper, as it will not help resolve your concerns. Instead, be assertive and give the agent an opportunity to assist you before escalating the issue. It is also important to document all your communications with the insurance company. Keep a diary or notebook to record the dates and details of your conversations, as well as the names and employee identification numbers of the agents you speak with.
Additionally, be proactive and provide your insurer with proof of your losses, clearly stating the amounts you are entitled to. If you have specific questions about your mental health coverage, you can contact the Consumer Hotline at the Department of Insurance for assistance. They can provide you with information regarding equal coverage for mental and physical health issues and ensure that your insurer does not charge you more for mental health services.
By following these guidelines and seeking the expertise of a licensed insurance agent, you can make informed decisions about your basic medical insurance options and navigate the complexities of the insurance landscape with greater ease.
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Apply for premium tax credits
To apply for premium tax credits, you must first check if you are eligible. The premium tax credit is a benefit offered by the Affordable Care Act, which helps lower your premium—the amount you pay each month for your insurance plan.
To be eligible, you must meet the following requirements:
- You cannot file a tax return with the status of 'Married Filing Separately'. However, an exception is made for certain victims of domestic abuse and spousal abandonment.
- You cannot be claimed as a dependent by another person.
- You must have health insurance coverage through a Health Insurance Marketplace.
- You are unable to get affordable coverage through an eligible employer-sponsored plan that provides minimum value.
- You are not eligible for coverage through a government program like Medicaid, Medicare, CHIP, or TRICARE.
If you meet these requirements, you can apply for premium tax credits by filling out an application online. The application will ask for basic information about yourself and any family members applying for coverage, including your Social Security number and citizenship or immigration status. It will also ask for employment and income information, including your most recent income tax return.
Once you have submitted the application, the Marketplace will determine if you are eligible for advance payments of the premium tax credit, also called advance credit payments or APTC. These are amounts paid directly to your insurance company on your behalf to lower your out-of-pocket costs for health insurance premiums.
If you qualify for advance payments of the premium tax credit, it is important to report any life changes to the Marketplace as they happen. This includes changes to your household, income, or family size, as these may affect the amount of your premium tax credit and your tax refund.
For tax years other than 2020, if you receive advance credit payments or plan to claim the premium tax credit, you must file a federal income tax return with Form 8962, Premium Tax Credit (PTC), attached. Filing your return without reconciling your advance credit payments may affect your eligibility for future advance credit payments.
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Understand what's covered
Understanding what basic medical insurance covers is essential when choosing a plan that fits your needs. Typically, basic medical insurance covers essential health benefits, which include a range of services and items deemed necessary for maintaining good health. Here's a breakdown of what's generally included:
Hospitalization: Basic medical insurance usually covers inpatient care, which means if you're admitted to the hospital for treatment, your room, meals, nursing care, and other related expenses are covered. This also includes emergency room visits and surgeries.
Outpatient care: Outpatient services provided at hospitals or clinics, such as doctor's visits, diagnostic tests, and treatments, are generally covered. This can include routine check-ups, vaccinations, and screenings.
Preventive care: Services aimed at disease prevention and health promotion, such as annual physical exams, immunizations, cancer screenings, and wellness visits, are often covered. Many plans also offer coverage for counseling services and mental health assessments.
Prescription drugs: Basic medical insurance typically includes coverage for prescription medications. This generally involves generic and brand-name drugs, but brand-name drugs may have higher copayments or require prior authorization.
Rehabilitation services: Physical therapy, speech therapy, and occupational therapy are often covered by basic medical insurance plans. These services aid individuals recovering from injuries, strokes, or conditions impacting their physical or cognitive abilities.
Mental health services: In addition to counseling, basic medical insurance may cover treatment for mental health disorders. This includes psychotherapy, behavioral health treatment, and inpatient mental health services.
Laboratory services: Basic plans often cover clinical laboratory tests, including blood work, urinalysis, and other diagnostic tests, which are crucial for detecting and treating medical conditions.
Pregnancy and childbirth: Prenatal care, delivery, and postnatal care are typically covered. This includes routine doctor's visits during pregnancy, hospital stays for delivery, and medical care for newborns.
Pediatric services: Basic medical insurance usually covers essential health benefits for children, such as oral and vision care, routine check-ups, immunizations, and treatments for common childhood illnesses and injuries.
Remember that specific coverage details can vary across insurance providers and plans. Always review the summary of benefits, exclusions, and limitations provided by the insurer to fully understand the scope of covered services and reimbursement levels.
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Frequently asked questions
There are several ways to get basic medical insurance. You can get coverage through public programs like Medicaid and Medicare, or you can buy health insurance on your own through the individual market. You can also contact an insurer directly, speak with a licensed insurance agent, or use your state's health insurance marketplace (for example, Covered California). Additionally, if your income is low, you may be eligible for your state's Basic Health Program (BHP).
The BHP is a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. States have the option to create a BHP to provide more affordable coverage for individuals whose income fluctuates above and below Medicaid and Children's Health Insurance Program (CHIP) levels.
Basic medical insurance typically covers doctors' visits, prescription drugs, and medical and surgical services. Most health insurance also covers a range of essential health benefits, including preventive care, which helps you stay healthy and catch potential health problems early.
The cost of basic medical insurance can vary depending on the provider and your specific plan. Typically, you will pay a premium every month, and in return, your health insurance plan will pay a portion of your medical bills when you need a service. You may also have to pay a co-pay or a percentage of each medical bill, up to a certain amount.
To apply for basic medical insurance, you can fill out an application on your own or with the help of a local organization or insurance company. You can search for organizations that can help by city, state, or ZIP code. Once you have submitted your application, you will receive eligibility results within a few weeks.
