Lately, we have been working with many folks regarding their health insurance needs here in San Antonio, Texas and beyond. The situation with COVID-19 has resulted in lots of life changes for many of us and health insurance is certainly one of those areas impacted.
Our task is to do a comprehensive fact-finding analysis with each and every customer we work with and sometimes we run into folks whose incomes are little to non-existent. The question then asked to us is what do we do now? If the goal is ACA health insurance coverage, we first look to see if one qualifies for a Special Enrollment Period (SEP) if outside of the regular, Open Enrollment Period (OEP), which occurs between November 1st-December 15th. This usually is easily doable if someone recently lost health insurance coverage through an employer, for example. Then we determine if a subsidy is a possibility, which is dependent on the current year income. If below a certain threshold, such as $12,760 for a single individual in Texas for 2020, the Health Insurance Marketplace tries to route you to Medicaid coverage with the state you live in, or if someone still wants an ACA plan, they can get one but unfortunately will have to pay full-price, the same as someone with a high income. The reasoning behind this basically boils down to decisions made when the ACA was first enacted and subsequent rulings by the Supreme Court on Medicaid expansions being voluntary with states.
If someone does not want or can’t pay full price for an ACA plan, the next logical step would be to apply for Medicaid with the state they reside in. If by chance Medicaid denies you, there may be alternatives depending on where you live.
One such alternative that we route folks to if necessary locally here in San Antonio, Texas is a program by the University Health System called “Carelink”. This is a financial assistance program open to San Antonio or Bexar County residents who do not have private or public health insurance, and meet other criteria such as income limits or resources. If someone qualifies, they get access to the University Health System at a very reasonable cost and then can use this service to get the care they need.
Many hospital systems or community clinics may do similar programs depending on where you live, so our advice is to check around and see what is available. You may be surprised at what you find. Being limited on income should not be a barrier to getting the care you need and having some form of health insurance coverage in place is crucial, so we hope this blog post was helpful in driving that message across.
If we can be of service to you or your family, please reach out to us for a free analysis of your situation. We always give you the straight-scoop and operate by the Golden Rule in business, “treat others the way you want to be treated.”
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Sources: Healthcare.gov, Texas Medicaid, University Health System