Welcome to our third post! I hope this blog is providing helpful information for people living with cancer. Today, I want to dive into the Health Insurance Marketplace (sometimes simply called “the Marketplace”). Let me start by saying that using the Marketplace is a complicated process that can be confusing. If your cancer treatment team includes a financial counselor, nurse navigator or social worker, ask them to provide assistance.
For residents of most states, you can find information on the Marketplace at www.healthcare.gov or calling 1-800-318-2596. They even have a blog at https://www.healthcare.gov/blog/. If you live in California, Colorado, Connecticut, District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, or Washington, use this link to find your state’s website for health insurance https://www.healthcare.gov/marketplace-in-your-state/#:~:text=People%20in%20most%20states%20use,business%20health%20coverage%2C%20or%20both.
With all of these great opportunities for information, who needs to ask for assistance? You do! Like it or not, cancer treatment is expensive. Selecting a comprehensive health insurance policy is more important than ever. I can hear you thinking, “But, can I afford it?” Take my hand as we walk through some of your options.
Eligibility: Before getting into the weeds of applying for health insurance on the Marketplace, check to see if you are eligible for Medicaid, CHIP (Children’s Health Insurance Program) or a Special Enrollment Period on the Marketplace at www.healthcare.gov/screener.
If you are currently unemployed, or having trouble paying your existing household expenses, start out by checking your eligibility for Medicaid. You will need to submit your zip code, estimated household income, and household members’ ages. Additional questions include physical disability, mental health condition, requiring assistance with bathing and dressing, and residing in a nursing home or medical facility. The website will generate a message if you are eligible for Medicaid.
Yes, I am eligible for Medicaid: This is great news! If you are reading this page while you are in the hospital, contact the hospital’s financial office. Certain hospitals may be able to enroll eligible individuals in short-term Medicaid coverage through Hospital Presumptive Eligibility (PE). This is a temporary policy that usually starts on the first day of hospitalization.
If you are home, you will need to submit the application for Medicaid either online or by phone. It usually takes a few weeks to receive your identification card. If you need to start treatment as soon as possible, talk with your cancer treatment team first. They may be able to expedite this process.
No, I am not eligible for Medicaid: If you are not eligible for Medicaid, the website will offer a link entitled: “See if you qualify for a special enrollment period.” Here are some things to consider and understand if you use that link:
Think about these few questions:
⦁ If you are currently working, will you be able to maintain your same work hours and income through your cancer treatment?
⦁ Will your current health insurance coverage continue despite a decrease in work hours or income?
⦁ If you do not have health insurance, has it been more than 60 days since you lost coverage?
⦁ If you are not working, has it been more than 60 days since you stopped working?
If you answered “No” to any of the above questions, you may qualify for a Special Enrollment Period. However, not all changes in income qualify for a Special Enrollment Period.
What is a Special Enrollment Period? According to Healthcare.gov, a special enrollment period is “a time outside the yearly Open Enrollment Period when you can sign up for health insurance.” Open Enrollment is typically in November. You qualify for a Special Enrollment Period if you have had certain life events, including losing health coverage, change of income, change of primary place of living (including students), etc.
“Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan. If you miss your Special Enrollment Period window, you may have to wait until the next Open Enrollment Period to apply. You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time of year, if you are eligible, whether you qualify for a Special Enrollment Period or not.” (Healthcare.gov)
Click on the link “See if you qualify for a special enrollment period” and answer the questions to determine eligibility. If you have recently lost health insurance coverage or had a change in income, you may qualify for a special enrollment period. The following questions for eligibility for a special enrollment period are from https://www.healthcare.gov/screener/marketplace.html
My next post will move us through the next steps. I hope this information is helpful. If you would like to continue this conversation, please click on the “subscribe” button at the top of the “Blog” page. I would love to hear your comments as well as the resources that have worked for you. Please share this information with your family and friends.
Keeping you in my prayers,
Jackie