Health Insurance/Financial Aids
Understanding Your Health Insurance
Insurance Terms to Understand
Deductible: How much you must pay for care first, before your insurer pays anything
Co-pay: Your cost for services to which your deductible does not apply
Co-insurance: The portion you must pay for care after you’ve met your deductible
Out-of-pocket maximum: The most you will pay each year
Types of Health Insurance Providers
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point-of-Service Plan
Fee for Service Plan
Exclusive Provider Organization (EPO)
Health Savings Account (HSA)
Things to Think About No Matter Which Type of Insurance You Have
- Which hospitals can you use?
- Does the plan allow you to use the providers that you need?
- Does the policy cover the type of medicines you need?
- Does the plan cover the treatment and therapies you need?
- Does the plan limit the amount per year that a service will be covered?
- Does the plan cover assistive technology and durable medical equipment?
- Does the policy cover mental health care?
Making Your Policy Work For Your Special Needs
- Contact your insurance company and ask to work with one case manager. This helps both you and the company by having one person that knows your needs and can manage your claims. It is best for the individual or family to communicate with this person on an ongoing basis.
- Don't hesitate to appeal denials; see Appealing Funding Denials.
- If you are denied coverage for a therapy, treatment, or a device that you know you need, don't take "no" for an answer. Ask for the exact reason for the denial. Then collect all documentation that explains the need for treatment and consult your insurance company for the proper way to appeal. Request that your insurance company and health care providers supply all information related to the claim in writing so you have proper documentation.
- Keep detailed, written records of everything related to your condition. This will be very helpful for taxes and in all stages of appeals.
- Ask your employer if there is a way to change the benefits in your plan if the current benefits exclude what you need.
What is the Consolidated Omnibus Budget Reconciliation Act (COBRA) ?
Inadequate or No Medical Coverage
Medicaid
Medicaid Waiver
Medicare
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
- Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Medicare Part B (Medical Insurance) covers certain doctors' services, outpatient care, medical supplies, and preventive services.
- Medicare Part D (prescription drug coverage) adds
prescription drug coverage to:
- Original Medicare
- Some Medicare Cost Plans
- Some Medicare Private-Fee-for-Service Plans
- Medicare Medical Savings Account Plans
- Medicare Part C (also known as Medicare Advantage is and “all in one” alternative to Original Medicare. These all in one plans include Part A, Part B and usually Part D. Medicare Advantage plans may also offer prescription drug coverage.
Non-Medical Benefits from the Social Security Administration Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Resources
Information & Support
For Parents and Patients
Health Insurance Marketplace (HealthCare.gov)
Sometimes known as the health insurance exchange, the new Health Insurance Marketplace helps uninsured people find health
coverage that meets their needs and budget. Part of the Affordable Care Act.
www.benefits.gov
Free, confidential tool that helps you find government benefits and assistance.
Medicaid
Official U.S. government site for Medicaid services.
Medicare
Official U.S. government site for Medicare services.
Medical Bills Page (Care Notebook) ( 88 KB)
A form to log medical bills including the date, provider, service performed, cost, insurance paid, amount the family owes,
and more. This is part of the Care Notebook Health Coverage Section.
Services for Patients & Families Nationwide (NW)
Service Categories | # of providers* in: | NW | Partner states (5) (show) | | NM | NV | OH | RI | UT | |
---|---|---|---|---|---|---|---|---|---|---|
Adolescent Health Transition Programs | 2 | 5 | 2 | 2 | 3 | 6 | ||||
Health Insurance Counseling and Advocacy | 1 | 5 | 15 | 1 | 3 | 49 | ||||
Medical Care Expense Assistance | 34 | 39 | 60 | 34 | 38 | 51 | ||||
Public Health Services | 6 | 8 | 12 | 10 | 8 | 63 |
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Authors & Reviewers
Contributing Author: | Gina Pola-Money |
Reviewers: | Tina Persels |
Gina Pola-Money |
2008: revision: Alfred N. Romeo, RN, PhDR |
2005: first version: Robin PrattCA; Barbara Ward, RN BSCA; Joyce DolcourtCA; Kristine FergusonCA; Teresa Such-Neibar, DOCA; Lynn Foxx PeaseCA; Helen PostCA; Roz WelchCA |