How Will I Pay for Treatment?

Paying for treatment

Navigating Insurance

There are 133 million adult Americans living with at least one chronic illness. But despite this, Americans faced being rejected for health coverage for any one of 400 different medical conditions until the Affordable Care Act Law became law.

While plenty of people with chronic illness are relieved that they have now guaranteed health coverage, navigating the world of insurance can be still confusing and time-consuming. It’s also important to note that choosing the least expensive insurance plan may not provide the most long-term savings when it comes to referral policies, drug plans and cost sharing.

To help reduce costs and improve your quality of care, learn more about the various forms of insurance that are available and what you should be looking when selecting a plan.

Forms Of Insurance

Standard health insurance: This includes signing up with any number of providers such as Aetna or Blue Cross Blue Shield, or simply going with the plan that your employer provides. These plans will usually ensure you get quality coverage and allow you to visit doctors both in and out of your network.

Obamacare: This more affordable health insurance marketplace provided financial assistance to more than 87% of those who selected a marketplace plan for 2015. The majority of plans run for $200-300 per month, while one in six Americans obtained a plan for less than $100 per month with financial assistance. Most do not provide for care out of network,, but out-of-network emergency services are covered through this plan.

Medicaid: For those with limited income and resources, this joint federal and state program can help cover certain medical costs. You must call your state’s Medicaid program to learn if you qualify and how to apply. Find contact information here.

Medicare: This insurance plan is available for seniors over age 65. Visit Medicare.gov to learn more.

Disability income insurance: Your employer may provide some form of disability income insurance if you’re not able to work. This could include a short-term policy that provides income benefits for 12 or 24 months, or a long-term policy that pays for a longer period.

Social Security disability: Social security benefits are paid to people who are expected to not be able to work for at least one year due to their condition. Although this won’t be enough to live off, the money will be a welcome relief for those who aren’t able to produce income. Learn more about how to apply here.

What to Look For

Networks that include your doctor: There’s likely at least one doctor on your healthcare team who you rely on and trust. If you’d like to keep them without paying exorbitant costs, it’s important to ensure that they’re in your health plan provider’s network. If they are, your insurer will pay their charges under a negotiated rate.

High benefit levels: People with chronic conditions are more likely to reach their deductible due to ongoing health services. Instead of focusing on the cheapest monthly plans, look for ones with lower out-of-pocket costs. They may cost more monthly, but will cover more and will help you save more in the long run.

Extensive list of covered drugs: Make sure any medications you’re taking are on the list of covered drugs for your health plan. If they aren’t, a single prescription could cost several hundred dollars per month. You should also confirm in your health plan if your health plan uses co-pays (the amount you pay for each of your prescriptions after the deductible) or co-insurance (anywhere from 10-40 percent of the drug’s cost, depending on your plan).

Health management perks: The majority of health plans offer wellness initiatives such as smoking cessation aids or a gym membership. They may also include a free care management plan to help you manage your condition. Review any plan that you’re considering to find out what perks you’re eligible for.

How To Obtain Insurance

Start researching: Look at websites that clearly lay out the important concepts and terminology relating to health insurance. Two good sites are healthinsuranceinfo.net and healthcarecoach.com.

Get estimates: Several web-based brokerages sell health insurance online including HealthInsurance.com and eHealthInsurance.com. By providing a relatively small amount of information (which is done anonymously), you will receive a list of health insurance plans that might work for your needs.

Work with an agent: Agents who specialize in health insurance represent several major insurers. They are paid through commission by insurers for each policy they sell, which could range from 3% to 20%. A quality agent should ask about your health issues and financial limitations in order to steer you towards a quality insurer that is likely to accept it. Many agents will also help you fill out the application.

Apply online: Once you’ve found an insurance plan that’s right for you, you should be able to apply with that specific provider through their website.

Video Resources

For more information on important insurance concepts, as well as how to purchase and obtain medical care and prescription drugs through your insurance plan, visit this video resource from the Kaiser Family Foundation.