More than a half million people in Virginia, nearly 9 percent of the state’s population, have no health insurance. Employer-sponsored private insurance is the primary source of health care coverage for nearly three-quarters of Virginia adults under age 65, and about 69 percent of all employers in the state offered health insurance to employees in 2004. The main reasons millions of Americans lack health insurance are job loss or their employers don’t provide coverage.
Can I keep my current insurance if I recently lost my job?
Under COBRA, you have the right to stay in the health plan you had with that job, if your employer had a least 20 workers. For more information regarding COBRA see the section, Consumer Protection.
Is there a program available if I lost my job because of trade policy for example increased imports or jobs moving overseas?
The Trade Adjustment Assistance Reform Act may pay 65 percent of the cost of health insurance for up to three years. You might qualify if your employer laid off workers because its products are being replaced by products from other companies or it’s using more workers in other countries.
Contact the Health Coverage Tax Credit (HCTC) customer contact center at 866.628.HCTC or visit http://www.irs.gov/pub/irs-utl/06_04_program_kit.pdf.
What's available if I'm an early retiree who has lost health coverage?
The same law that helps workers who lose their jobs because of trade policy may help you. If you are a retiree age 55 or older, your former employer no longer provides your pension, and your pension benefit is paid by the federal Pension Benefit Guaranty Corporation, you can receive help with 65 percent of your health insurance cost until you’re eligible for Medicare. For more information visit http://www.pcgc.gov.
What's available if I still find health insurance unaffordable?
You or your family members may qualify, even if you work, for programs such as Medicaid and FAMIS in Virginia. Generally, you can get coverage if you’re pregnant, a parent with a child living at home, a person with a disability, or a person who spends most of your income on health care. Children can often get coverage, even if their parents don’t quality. In Virginia, children can get coverage if their family income is less than the amounts shown below.
Size of Family |
2 |
3 |
4 |
Income |
$25,669 |
$32,180 |
$38,700 |
If you’re pregnant and meet the income limits below, you can get coverage during the pregnancy and for up to 60 days after the baby is born. Often, the baby will then have guaranteed coverage for at least one year.
Size of Family
(including unborn baby) |
2 |
3 |
4 |
Income |
$17,064 |
$21,400 |
$25,736 |
If you are not a U.S. citizen, you might be able to qualify, depending on your immigration status and how long you have lived in the United States.
Income rules are complex
So it’s best to apply rather than try to guess whether you are eligible. Contact Virginia Medicaid at 800.643.2273. For help in working with the system, call Legal Services Corporation of Virginia Inc. at 804.782.9438, or visit http://www.valegalaid.org or http://www.lsc.gov/fundprog.htm.
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What's available if I have a serious medical condition or disability?
You might qualify for Medicare even if you’re under age 65, if you have a disability that’s expected to last at least one year or expected to cause your death. You have to apply for Social Security Disability Insurance and receive it for 24 months before you can enroll in Medicare. Until then, you will have to find other coverage, such as with COBRA or Medicaid.
Contact
Social Security Administration: 800.772.1213 (800.325.0778 TTY), or visit http://www.ssa.gov/disability.
Medicare: 800.MEDICARE (633.4227), or visit http://www.medicare.gov.
For legal representation and other advocacy services (under all federal and state laws, to all people with disabilities), contact the Virginia Office for Protection & Advocacy at 804.225.2042 or http://www.vopa.state.va.us.
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If you’re blind or have a disability and your income is low or you spend most of your income on health care, you may qualify for Medicaid. People with a disability usually qualify because they receive Supplemental Security Income (SSI), or you may be able to get Medicaid while waiting to find out if you’re eligible for SSI. Even if you don’t qualify for SSI, you may still be able to get health insurance through Medicaid. The rules are complex, and many people are turned down the first time they apply. You can appeal.
Is there insurance available if I can't get it through my job?
You can seek coverage in the private health insurance market. Coverage and costs vary from insurer to insurer.
Important Questions to Ask
What medical services are covered? How much deductible must I pay before the insurance starts to help pay for services? After I reach my deductible, how much do I pay for services and how much does the insurance company pay? Does the plan cover health problems I already have? If it doesn’t cover these problems right away, when will it begin covering them? Are the doctors I want to see covered in this policy? If not, would I have to pay extra to see my doctors because they’re not in the network? (Ask your doctor if he or she will accept this insurance.)
Talk with a health insurance agent in your area to help you think about the right policy for the right price.
Important Things to Consider
Be careful about plans that don’t offer insurance coverage but only discounts on the cost of health care services. Generally such plans aren’t a good buy. Be sure to find out if the insurer has been licensed in Virginia and if there have been any complaints. -
Know your rights under federal and state laws. For more information on your rights, see HIPAA in the section, Consumer Protection. Virginia has laws that control whether an insurance company must offer you a policy, what conditions must be covered, and how high the premiums can be.
To find out if an insurer has received consumer complaints call the Virginia State Corporation Commission Bureau of Insurance at 877.310.6560.
For federal and state protections, visit http://www.healthinsuranceinfo.net. There’s a separate site for each state.
For Virginia laws regarding coverage, call the Virginia State Corporation Commission Bureau of Insurance at 877.310.6560.
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If I still can't find health insurance, what options do I have if I need medical care?
A local community health clinic may be able to help you get low-cost primary health care, in addition to health services on a sliding-scale basis. If you have a planned hospital stay, you may be able receive help with the bills at a nonprofit hospital. Also, some states require hospitals to provide free or discounted care to people who are eligible. Many hospitals have financial assistance programs; ask to speak with a financial counselor or patient advocate. You might be able to negotiate a lower bill or better payment plan.
For community health clinics in your area
Contact the Virginia Primary Care Association at 804.378.8801 or the U.S. Department of Health and Human Services Bureau of Primary Health Care at http://www.bphc.hrsa.gov.
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You may qualify for State Pharmacy Assistance Programs in Virginia that can help with drug costs and health care or other expenses. The services are mostly for people 65 and older, but some programs are available to younger individuals. Visit http://www.benefitscheckup.org.
Some pharmaceutical companies offer free or discount prescription drug programs to patients who have been prescribed their drugs. Visit http://www.needmymeds.com.
Veterans may be entitled to care and prescription drug coverage through a Virginia medical facility if they served at least 180 days active duty and have an honorable or general discharge. Call the VA Health Benefits call center at 877.222.VETS
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Part 1: Insurance Basics