U S Directory of Health Care Optionslearning.rxassist.org/sites/default/files/Health Care... ·...

A state-by-state guide to helping Americans navigate their

public and private health coverage options

U.S. Directory of Health Care

Options

The U.S. Directory of H

ealth Coverage Options

Vol. IV, July 2010FH

CE

Foundation for Health Coverage Education “Coverage for All !rough Education”

© Copyright 2010 by Philip Lebherz and the Foundation for Health Coverage Education

Use the Income Worksheet(page “v”) to determine the Federal Poverty Level percentage of you or the person whom you are trying to assist. This percentage usually determines if an individual is eligible for various public programs.

Find your state’s Health Care Options Matrix for a complete list of private and public health coverage programs, along with additional valuable resources.

Consult the Appendices for COBRA subsidy information, state-by-state program contact information, uninsured statistics for each state, as well as the glossary of terms found within this book.


OptionsA state-by-state guide to helping Americans navigate their


CREATED BY

Phil Lebherz2010

Dedication

I want to dedicate this book to the thousands of workers in the private and public health insurance systems across the country who are attempting to reach our goal of lowering the number of uninsured people in America. I especially want to thank Leonard Schae!er who provided his knowledge, inspiration, and vision to this project. - Phil Lebherz

i

Acknowledgements ii

About the FHCE iii

Income Worksheet iv

Federal Poverty Level Table v

Health Care Options Matrices by StateAlabama 1

Alaska 3

Arizona 5

Arkansas 7

California 9

Colorado 11

Connecticut 13

Delaware 15

Florida 17

Georgia 19

Hawaii 21

Idaho 23

Illinois 25

Indiana 27

Iowa 29

Kansas 31

Kentucky 33

Louisiana 35

Maine 37

Maryland 39

Massachusetts 41

Michigan 43

Minnesota 45

Mississippi 47

Missouri 49

Montana 51

Nebraska 53

Nevada 55

New Hampshire 57

New Jersey 59

New Mexico 61

New York 63

North Carolina 65

North Dakota 67

Ohio 69

Oklahoma 71

Oregon 73

Pennsylvania 75

Rhode Island 77

South Carolina 79

South Dakota 81

Tennessee 83

Texas 85

Utah 87

Vermont 89

Virginia 91

Washington 93

Washington, D.C. 95

West Virginia 97

Wisconsin 99

Wyoming 101

AppendicesHow to Understand the COBRA Subsidy 104

Other Services (by State) 105

State-by-State Comparison 112

"e Uninsured In America 113

Glossary of Terms 114

TABLE OF CONTENTS

ii

ACKNOWLEDGEMENTS!e following individuals and associations generously donated their time, energy, and resources to creating this book:

Aetna Foundation

Alain Enthoven

Anthem Blue Cross Foundation

Beere & Purves, Inc.

Blue Shield of California

CAHU Charitable Community Foundation

Cal Locket

California Association of Health Underwriters

California State Legislators

Cathay Post No. 384

David and Nancy Helwig

Dickerson Employee Bene#ts, Inc.

Ernie Ramirez

Florida Association of Health Underwriters

George and Clare Schmitt

Greater Washington Association of Health Underwriters

Health Coverage Foundation, Inc.

Health Net of California

Kaiser Foundation

Los Angeles Uni#ed School District

Larry Glasscock

Leonard Schae!er

LISI

Massachusetts Association of Health Underwriters

National Association of Health Underwriters

North Nevada Association of Health Underwriters

Oregon Association of Health Underwriters

Peter and Renuka Patel

Peter Farrell

P#zer, Inc.

Philip and Vivian Reed

Placer County O$ce of Education

"e Poizner Family Trust

Portland Association of Health Underwriters

Professional Exchange Service Company Inc.

Rio Grande Association

Saint Joseph Health Center Foundation

Schmitt Family Foundation

San Diego O$ce of Education

Sharp Health Plan

Spahr Insurance

"e Rauser Agency

"e Sugg Group

Word and Brown

Warner Paci#c

Washington Association of Health Underwriters

WellPoint Foundation

Collaborative E!ortsWe would like to recognize the following organizations for their collaborative e"orts in helping lower the ranks of the uninsured by referring individuals to FHCE’s resources:

Aetna Inc.American Cancer SocietyAmerican Diabetes AssociationAmerican Heart AssociationAmerican Lung AssociationAnthem Blue Cross of CaliforniaBlue Shield of California

Catholic Healthcare West HospitalsCalifornia Department of InsuranceCommunity Medical CentersDaughters of Charity HospitalsE-Health InsuranceGoogle, Inc.NAHU

NAICRobert Wood Johnson FoundationSharp Health CareUnited Way of the Bay AreaUnited Health CareWellPoint, Inc.

Appreciated Media Support!e FHCE’s resources have had over 2 billion media impressions thanks to the following media outlets:

AARPABC View From "e BayABC NewsAmerican Medical NewsCBS Bay SundayChicago TribuneCNNConsumer DigestCostco ConnectionKiplinger’s Personal Finance

KTLA TV Channel 5Los Angeles TimesMen’s Health MagazineMSNBCNew York Daily NewsParenting.comParents MagazineSan Francisco Business TimesSan Francisco ChronicleSelf Magazine

Smart Money, AOL Money & Finance"e Angie Strader Show"e New York Times"e Wall Street Journal"e Washington PostUSA TodayU.S. News & World Report

iii

FHCE is a non-pro#t 501(c)3 organization with a mission to provide simpli#ed public and private health insurance information in order to help more people access coverage. We o!er a variety of health coverage resources to help consumers, health care professionals, employers, and the uninsured navigate the complex health insurance system.

"is directory of Matrices from all 50 states and the District of Columbia represents the entire health insurance system in our country. Di!erent states have di!erent approaches to insurance. Certainly California, with a population of 37 million, has di!erent needs than Idaho where approximately 1.5 million people reside.

"e FHCE views the uninsured as a humanitarian issue, as well as a public health issue. Proper education of the public could improve our country’s health and save our health care system billions of dollars in claims. We have the infrastructure and capacity to take care of everyone. "e U.S. has world class providers, hospitals and technology. We need to improve the administration, #nancing and distribution of publicly-funded programs, so that everyone who is eligible signs-up for health coverage. Together, we can lower the ranks of the uninsured.

FHCE Resources

U.S. Uninsured Help Line™"e U.S. Uninsured Help Line (800-234-1317) provides live, one-on-one assistance to individuals with questions about their health coverage options. "e Help Line is sta!ed 24/7 with friendly information specialists and interpreters who speak over 140 languages and provide basic screening for both public and private health coverage.

CoverageForAll.orgAll of FHCE’s resources and guides, including the Health Care Options Matrix, are available to download for free on CoverageForAll.org. "e online Health Coverage Eligibility Quiz provides visitors with a personalized list of the public and private health coverage options for which they may qualify, along with each program’s sign-up check list and application link.

Disclaimer: An online version of this Directory is updated regularly for your convenience. Download the most recent version on www.CoverageForAll.org.

THE FOUNDATION FOR HEALTH COVERAGE EDUCATION !FHCE"

iv

INCOME WORKSHEET

Your monthly income + _________________

Spouse’s monthly income + _________________

TOTAL INCOME = _________________

Please fill in the following information, separate from amount that you just calculated:

Begin with $0. For each working parent in the household, add $90. + _________________

If you pay for childcare for children under the age of 2, add $200 for each child. + _________________

If you pay for childcare for children over the age of 2, or for a child with disabilities, add $175 for each child. + _________________

If you receive child support, add $50 for each child. + _________________

If you pay alimony and/or child support, enter the amount. + _________________

TOTAL DEDUCTIONS = _________________

Now, subtract your Total Deductions from your Total Income. TOTAL INCOME _________________

TOTAL DEDUCTIONS - _________________

TOTAL INCOME AFTER DEDUCTIONS = _______________

Find an amount closest to this total within the chart on the opposite page to determine your Federal Poverty Level (FPL) percentage.

Note: This income worksheet is only intended to serve as a guide. Some factors in determining your eligibility may not be represented above. Deductions listed here are typical for most public programs, but may vary by agency.

Step One Use this worksheet to calculate your family or household total income after deductions.

Step TwoLook for the income amount closest to the number in step one within the chart on the opposite page to determine which percentage of the Federal Poverty Level(FPL) you are.

Step "reeRemember this percentage, as it will help you determine for which public programs you are eligible.

v

FEDERAL POVERTY LEVELYour Federal Poverty Level (FPL)

Based on monthly family gross income

Family Size (House-

hold)100% 133% 175% 200% 250% 300% 400%

1 $903 $1,200 $1,579 $1,805 $2,256 $2,708 $3,610

2 $1,214 $1,615 $2,125 $2,428 $3,035 $3,643 $4,857

3 $1,526 $2,029 $2,670 $3,052 $3,815 $4,578 $6,103

4 $1,838 $2,444 $3,216 $3,675 $4,594 $5,513 $7,350

5 $2,149 $2,858 $3,761 $4,298 $5,373 $6,448 $8,597

6 $2,461 $3,273 $4,306 $4,922 $6,152 $7,383 $9,843

7 $2,773 $3,687 $4,852 $5,545 $6,931 $8,318 $11,090

8 $3,084 $4,102 $5,397 $6,168 $7,710 $9,253 $12,337

Based on yearly family gross income

1 $10,830 $14,404 $18,953 $21,660 $27,075 $32,490 $43,320

2 $14,570 $19,378 $25,498 $29,140 $36,425 $43,710 $58,280

3 $18,310 $24,352 $32,043 $36,620 $45,775 $54,930 $73,240

4 $22,050 $29,327 $38,588 $44,100 $55,125 $66,150 $88,200

5 $25,790 $34,301 $45,133 $51,580 $64,475 $77,370 $103,160

6 $29,530 $39,275 $51,678 $59,060 $73,825 $88,590 $118,120

7 $33,270 $44,249 $58,223 $66,540 $83,175 $99,810 $133,080

8 $37,010 $49,223 $64,768 $74,020 $92,525 $111,030 $148,040

alimony/child support received or court ordered amount paid.

Source: Federal Registerwww.coverageforall.org for further details and updates on the 48

Reminder"ere is no universal administrative de#nition of income that is valid for all programs that use the poverty guidelines. "e o$ce or organization that administers a particular program or activity is responsible for making decisions about the de#nition of income used by that program (to the extent that the de#nition is not already contained in legislation or regulation). To #nd out the speci#c de#nition of income used by a particular program or activity, you must consult the o$ce or organization that administers that program.

1 800.234.1317

Dem

ogra

phic PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMS

Dem

ographic

Small businesses(2-50 employees)

Individuals recently covered by an employer

health plan

Individuals & families

Individuals with pre-existing, severe or chronic medical

conditions

Low-income individuals & families

Children in moderate income

familiesWomen Seniors and

Disabled

Trade Dislocated Workers

(TAA recipients)Veterans

Prog

ram

U.S. Uninsured Help Line

800-234-1317

Group HealthUnderwriters703-276-0220

www.nahu.orgwww.alanahu.org

COBRA

HIPAA Health Insurance Portability

www.dol.gov

HIPP(Health Insurance Premium

Payment Program)334-242-3722

www.medicaid.state.al.us

U.S. Uninsured Help Line800-234-1317

Individual PlansHealth Underwriters

703-276-0220www.nahu.org

www.alanahu.org

AHIP

Insurance Plan866-833-3375334-263-8311

www.alseib.org

Medicaid (SOBRA & MLIF)

334-242-5000800-362-1504

https://insurealabama.adph.state.al.us

ALL Kids888-373-KIDS888-373-5437334-206-5568 877-774-9521


or www.adph.org/allkids

AL Child Caring Program800-726-2289

https://insurealabama.adph.state.al.us/

Breast and Cervical Cancer Prevention

877-252-3324 www.adph.org/earlydetection

Medicare

800-633-4227www.medicare.gov

Medicare Prescription Drug

Program800-633-4227

Alabama State Health Insurance

Assistance Program800-243-5463

Health Coverage Tax Credit

866-628-4282

VA Medical Bene!ts Package

877-222-8387www.va.gov Program

Cove

rage

If uninsured for previous 1-6 months, a waiting period

conditions may apply

Bene!ts will vary depending on the chosen plan

Pre-Existing Health Conditions Covered

COBRA: up to 18 months depending onqualifying events, must have 20employees or more. Bene!tsare the same as what you hadwith your previous employer

COBRA Subsidy: 15 months of

premium

HIPAA: Bene!ts are based on the program selected and there is

HIPP: Bene!ts are the same aswhat you had with your previous employer, HIPP is a premium assistance program


medical needs

There is a 6-month look-back

conditions in traditional individual market health insurance products in

Limits on pre-existing health conditions may apply

Two plans are available for member and certain dependents - a Blue

Traditional Indemnity Plan and a

Both plans provide doctor visits, prescription drugs, outpatient and in-hospital care, maternity,

rehabilitation, durable medical equipment, and mental health and substance abuse, also emergency care while away from home and more


ambulatory surgical center, birth center services, child health check-up, chiropractic care, durable medical equipment and supplies, federally quali!ed health centers, home health, hospital inpatient/outpatient care, laboratory, licensed midwife, physician, podiatry, prescriptions, rural health

SOBRA:get pregnancy related services covered


All Kids: regular check-ups and immunizations, sick child doctor visits, prescriptions, dental and vision care, hospital and physician services, limited mental health/substance abuse services, and a toll-free 24 hour nurse line for health questions, and more

AL Child Caring Program: outpatient services only


for a mammogram if 50 and over

needed, such as ultrasound, diagnostic mammogram, colonoscopy or biopsy

Medicare o"ers two standard

Insurance and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also o"ers a prescription drug program called Medicare Part D

ASHIAP is a Medicare counseling service


Will cover 80% of your

contributes less than 50% (or spouses’ employer)

Will cover individual insurance in which you were enrolled for


primary care, outpatient and inpatient services


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

Two employees must work for at least 6 months out of the year, and work 20 hours per week for coverage

employee

license must draw wages from the company

GUARANTEED COVERAGE

COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you

subsidy from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign up

HIPAA:

had 18 months of continuouscoverage and your company went out of business, you may

conditions. You have 63 days from the date you lost your previous coverage to sign up for

HIPP: You may be eligible for HIPP if you have a high-cost health condition

medical underwriting

If you are denied coverage for a medical condition, you may

column

GUARANTEED COVERAGE

health plan, government plan, or

bene!ts and submitted your application within 63 days of your last day of coverage to sign up

resident with at least 18 months of continuous healthcare coverage without being terminated due to fraud or failure to pay

who have purchased coverage from their employer and whose bene!ts have run out.

GUARANTEED COVERAGE

MedicaidPregnant Women-133% of FPL

FPL

of FPLSupplemental Security Income

Working Parents-19% of FPLNon-Working Parents-13% of FPL

SOBRA: Must not be in an

for dependent coverage under state employees' insurance (including Public Schools)

GUARANTEED COVERAGE

Both: Be Under the age of 19

be covered by any other health

Medicaid

All Kids: Be a U.S. citizen or

between 101-200% FPL

AL Child Caring Program: Not be

of age)

GUARANTEED COVERAGE

Women age 40 - 64

Women under age 40 who havea problem with their breast can

to determine if they are eligibleto receive a free breast cancerscreening through the program

Income eligibility at or below 200% of FPL

Women without insurance or who are underinsured

GUARANTEED COVERAGE

Disabled people of all ages

Disease (permanent kidney failure requiring dialysis or a kidney transplant)

GUARANTEED COVERAGE

Must not have access to employer plan that pays 50% of coverage cost

Not enrolled in certain state plans

Individuals who are eligible

funds to purchase a private health insurance product

GUARANTEED COVERAGE

”Veteran status” = active duty in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions

completed 24 continuous months of service Eligibility

Mon

thly

Cos

t

contribution and ± 20% of the COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium

COBRA, HIPAA: Premiums range from 102%-150% of

coverage may be less

HIPP: $0 or minimal share of cost

variesTraditional Indemnity Plan premium could range between $169 to $957

non-smoker, and plan you choose.Managed Care Plan premium could range between $247 to $862

or non-smoker.

Medicaid: $0 to $3.00 for o#ce visits, prescription drugs and some other services

SOBRA: $50 co-payment for each inpatient hospital stay

Both: $0 or small co-pays

All Kids: Yearly costs range from $50 to $100 per child, per year up to the !rst 3 children (no cost for additional children). Small co-pays are required at the time of service. There are no co-pays for preventive services

$0 or minimal share-of-cost $0 and share of cost for

certain plans

20% of the insurance premium

$0 and share of cost and co-pays depending on income level

Monthly Cost

Alabama

www.coverageforall.org 2

Dem

ogra


Dem

ographic



health plan



conditions




Disabled



Prog

ram


800-234-1317


www.nahu.orgwww.alanahu.org

COBRA


www.dol.gov

HIPP(Health Insurance Premium

Payment Program)334-242-3722

www.medicaid.state.al.us




www.alanahu.org

AHIP

Insurance Plan866-833-3375334-263-8311

www.alseib.org

Medicaid (SOBRA & MLIF)

334-242-5000800-362-1504


ALL Kids888-373-KIDS888-373-5437334-206-5568 877-774-9521


or www.adph.org/allkids

AL Child Caring Program800-726-2289

https://insurealabama.adph.state.al.us/


877-252-3324 www.adph.org/earlydetection

Medicare



Program800-633-4227

Alabama State Health Insurance

Assistance Program800-243-5463


866-628-4282



Cove

rage





COBRA: up to 18 months depending onqualifying events, must have 20employees or more. Bene!tsare the same as what you hadwith your previous employer


premium


HIPP: Bene!ts are the same aswhat you had with your previous employer, HIPP is a premium assistance program


medical needs


conditions in traditional individual market health insurance products in


Two plans are available for member and certain dependents - a Blue

Traditional Indemnity Plan and a

Both plans provide doctor visits, prescription drugs, outpatient and in-hospital care, maternity,

rehabilitation, durable medical equipment, and mental health and substance abuse, also emergency care while away from home and more


ambulatory surgical center, birth center services, child health check-up, chiropractic care, durable medical equipment and supplies, federally quali!ed health centers, home health, hospital inpatient/outpatient care, laboratory, licensed midwife, physician, podiatry, prescriptions, rural health

SOBRA:get pregnancy related services covered


All Kids: regular check-ups and immunizations, sick child doctor visits, prescriptions, dental and vision care, hospital and physician services, limited mental health/substance abuse services, and a toll-free 24 hour nurse line for health questions, and more

AL Child Caring Program: outpatient services only


for a mammogram if 50 and over

needed, such as ultrasound, diagnostic mammogram, colonoscopy or biopsy



ASHIAP is a Medicare counseling service








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:

had 18 months of continuouscoverage and your company went out of business, you may

conditions. You have 63 days from the date you lost your previous coverage to sign up for




column

GUARANTEED COVERAGE

health plan, government plan, or

bene!ts and submitted your application within 63 days of your last day of coverage to sign up

resident with at least 18 months of continuous healthcare coverage without being terminated due to fraud or failure to pay

who have purchased coverage from their employer and whose bene!ts have run out.

GUARANTEED COVERAGE

MedicaidPregnant Women-133% of FPL

FPL

of FPLSupplemental Security Income

Working Parents-19% of FPLNon-Working Parents-13% of FPL

SOBRA: Must not be in an

for dependent coverage under state employees' insurance (including Public Schools)

GUARANTEED COVERAGE

Both: Be Under the age of 19

be covered by any other health

Medicaid

All Kids: Be a U.S. citizen or

between 101-200% FPL

AL Child Caring Program: Not be

of age)

GUARANTEED COVERAGE

Women age 40 - 64

Women under age 40 who havea problem with their breast can

to determine if they are eligibleto receive a free breast cancerscreening through the program

Income eligibility at or below 200% of FPL

Women without insurance or who are underinsured

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Individuals who are eligible

funds to purchase a private health insurance product

GUARANTEED COVERAGE



Mon

thly

Cos

t


full premium




variesTraditional Indemnity Plan premium could range between $169 to $957

non-smoker, and plan you choose.Managed Care Plan premium could range between $247 to $862

or non-smoker.

Medicaid: $0 to $3.00 for o#ce visits, prescription drugs and some other services

SOBRA: $50 co-payment for each inpatient hospital stay

Both: $0 or small co-pays

All Kids: Yearly costs range from $50 to $100 per child, per year up to the !rst 3 children (no cost for additional children). Small co-pays are required at the time of service. There are no co-pays for preventive services


certain plans



Monthly Cost

Alabama

3 800.234.1317

Dem

ogra

phic PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMS D

emographic



health plan


Individuals with pre-existing,

severe or chronic medical conditions

Low income children and

families

Moderate income children and

families

Adults with chronic medical conditions

Native American Indians

Seniors and Disabled


(TAA recipients)

Prog

ram


800-234-1317

Group Health703-276-0220

www.nahu.org

Consumer Info then Find an Agent/Member

COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Plans703-276-0220

www.nahu.org

Alaska Comprehensive

Health Insurance Association

888-290-0616www.achia.com

Medicaid907-465-3347800-780-9972

www.hss.state.ak.us/dpa/programs/medicaid

Denali Kid Care

888-318-8890

269-6529 www.hss.state.ak.us/dhcs/

CAMA

800-780-9972www.hss.state.ak.us/

dhcs/cama

the fee agent in your community

Indian Health Services

907-729-3686 www.ihs.gov/FacilitiesServices/

For eligibility information visit: www.ihs.gov/GeneralWeb/

elig.asp

Medicare



Program800-633-4227


866-628-4282 Program

Cove

rage

employer with a variety of plan designs available

If uninsured for previous 63 - 90 days, a waiting period



COBRA: 18 to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer, but paid by the individual


premium



design options for selection


di"erent deductibles

80% of the allowed chargesafter the $1,000 annualdeductible has been satis!ed.

at 100%


Inpatient and outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning and supplies, rural health clinic, home health care for persons eligible for skilled-nursing,

and family nurse practitioner, nurse-midwife, early and periodic screening, diagnostic,

for children under age 21


of prevention and treatment services such as: doctor's visits, check-ups & screenings,

dental checkups, cleanings & !llings, hearing tests & hearing aids, speech therapy, physical and mental health therapy, substance abuse treatment, chiropracty, foot doctor's services, hospital care, laboratory tests, prescriptions, medical transportation


Prescription drugs and medical supplies, limited to 3 prescriptions per month and no more than a 30-day supply of any drug

Physician services

services for a recipient with cancer requiring chemotherapy, if provided in an outpatient setting

services


IHS services are provided directly and through tribally contracted and operated health programs. Health services also include health care purchased from more than 9,000 private providers annually. The Federal system consists of 36 hospitals, 61 health centers, 49 health stations, and 5 residential treatment centers. In addition,

provide a variety of health and referral services

HS-funded, tribally-managed hospitals are located in

Dillingham, Kotzebue, Nome and Sitka. There are 37 tribal health centers, 166 tribal community health aide clinics and !ve residential substance abuse treatment centers


Medicare o"ers to standard

and Part B: Medical Insurance, as wells several supplemental and advantage plans. It alsoo"ers a prescription drugprogram called Medicare Part D





high-risk health insurance pool,


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee, proprietor

Name on license must draw wages

No Guarantee Issue for group sized 50+

GUARANTEED COVERAGE


subsidy from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign up for

HIPAA:

had 18 months of continuous coverage and your company went out of business, you may convert

You have 63 days from the date you lost your previous coverage

underwriting

If you are denied coverage for a medical condition, you

GUARANTEED COVERAGE

Individuals unable to obtain private health insurance for

least 18 months of prior healthinsurance coverage without a90 day or more break in such

health insurance coverage was

eligible for other group healthinsurance coverage includingMedicare, Veteran’s bene!ts,

Your most recent healthinsurance coverage was notterminated due to nonpayment

You do not have other healthinsurance coverage

recipients

GUARANTEED COVERAGE

Family Income can be up to 185% of the FPL

Working Disabled - 250% of the FPL

community’s village fee agent for more information

GUARANTEED COVERAGE

You are a child 18 or younger

insurance < 150% FPL

Insurance < 175% FPL

You are pregnant and can provide proof of pregnancy from your health care providerPregnant Women with or without Health Insurance < 175% FPL

guidelines are based on family

to ask about the income guidelines

GUARANTEED COVERAGE

chronic hypertension

No other resources to meet the health care you need

Household income must be:< $300/mo. for one person< $400/ mo. for two people add $100 for each additional person< $500 in countable resources that could be used to pay medical bills: cash, bank/credit union accounts, or personal property, your home, one vehicle, income producing property, property that is used for

or a !shing permit

GUARANTEED COVERAGE

Must be regarded by the local community as an Indian or

Tribe or Group under Federal

reasonable factor indicative of

woman pregnant with an eligible Indian's child for the duration of her pregnancy through post partum (usually

member of an eligible Indian's household and the medical o#cer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and ± 35% of the COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium



and medical underwriting plan selection

average standard risk rate for

with similar bene!ts

$0 for families below 100% of the FPL

$0 for eligible children, teens and pregnant women

Youth who are 18 years-old may be required to share a limited amount of the cost for some services

$0 and $1 per prescriptions or medical supplies

$0 for an IHS quali!ed bene!ciary

$0 and share of cost for certain services: deductibles for certain plans


Monthly Cost

Alaska


Dem

ogra


emographic



health plan





families

Moderate income children and

families

Adults with chronic medical conditions




(TAA recipients)

Prog

ram


800-234-1317

Group Health703-276-0220

www.nahu.org

Consumer Info then Find an Agent/Member

COBRA

Then convert to


www.dol.gov


800-234-1317


www.nahu.org

Alaska Comprehensive

Health Insurance Association

888-290-0616www.achia.com

Medicaid907-465-3347800-780-9972

www.hss.state.ak.us/dpa/programs/medicaid

Denali Kid Care

888-318-8890

269-6529 www.hss.state.ak.us/dhcs/

CAMA

800-780-9972www.hss.state.ak.us/

dhcs/cama

the fee agent in your community



For eligibility information visit: www.ihs.gov/GeneralWeb/

elig.asp

Medicare



Program800-633-4227


866-628-4282 Program

Cove

rage

employer with a variety of plan designs available

If uninsured for previous 63 - 90 days, a waiting period



COBRA: 18 to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer, but paid by the individual


premium



design options for selection


di"erent deductibles

80% of the allowed chargesafter the $1,000 annualdeductible has been satis!ed.

at 100%


Inpatient and outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning and supplies, rural health clinic, home health care for persons eligible for skilled-nursing,

and family nurse practitioner, nurse-midwife, early and periodic screening, diagnostic,

for children under age 21


of prevention and treatment services such as: doctor's visits, check-ups & screenings,

dental checkups, cleanings & !llings, hearing tests & hearing aids, speech therapy, physical and mental health therapy, substance abuse treatment, chiropracty, foot doctor's services, hospital care, laboratory tests, prescriptions, medical transportation


Prescription drugs and medical supplies, limited to 3 prescriptions per month and no more than a 30-day supply of any drug

Physician services

services for a recipient with cancer requiring chemotherapy, if provided in an outpatient setting

services


IHS services are provided directly and through tribally contracted and operated health programs. Health services also include health care purchased from more than 9,000 private providers annually. The Federal system consists of 36 hospitals, 61 health centers, 49 health stations, and 5 residential treatment centers. In addition,

provide a variety of health and referral services

HS-funded, tribally-managed hospitals are located in

Dillingham, Kotzebue, Nome and Sitka. There are 37 tribal health centers, 166 tribal community health aide clinics and !ve residential substance abuse treatment centers



and Part B: Medical Insurance, as wells several supplemental and advantage plans. It alsoo"ers a prescription drugprogram called Medicare Part D





high-risk health insurance pool,


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee, proprietor


No Guarantee Issue for group sized 50+

GUARANTEED COVERAGE



HIPAA:



underwriting


GUARANTEED COVERAGE

Individuals unable to obtain private health insurance for

least 18 months of prior healthinsurance coverage without a90 day or more break in such

health insurance coverage was

eligible for other group healthinsurance coverage includingMedicare, Veteran’s bene!ts,

Your most recent healthinsurance coverage was notterminated due to nonpayment

You do not have other healthinsurance coverage

recipients

GUARANTEED COVERAGE

Family Income can be up to 185% of the FPL

Working Disabled - 250% of the FPL

community’s village fee agent for more information

GUARANTEED COVERAGE

You are a child 18 or younger

insurance < 150% FPL

Insurance < 175% FPL

You are pregnant and can provide proof of pregnancy from your health care providerPregnant Women with or without Health Insurance < 175% FPL

guidelines are based on family

to ask about the income guidelines

GUARANTEED COVERAGE

chronic hypertension

No other resources to meet the health care you need

Household income must be:< $300/mo. for one person< $400/ mo. for two people add $100 for each additional person< $500 in countable resources that could be used to pay medical bills: cash, bank/credit union accounts, or personal property, your home, one vehicle, income producing property, property that is used for

or a !shing permit

GUARANTEED COVERAGE

Must be regarded by the local community as an Indian or

Tribe or Group under Federal

reasonable factor indicative of

woman pregnant with an eligible Indian's child for the duration of her pregnancy through post partum (usually

member of an eligible Indian's household and the medical o#cer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



and medical underwriting plan selection

average standard risk rate for

with similar bene!ts

$0 for families below 100% of the FPL

$0 for eligible children, teens and pregnant women

Youth who are 18 years-old may be required to share a limited amount of the cost for some services

$0 and $1 per prescriptions or medical supplies

$0 for an IHS quali!ed bene!ciary

$0 and share of cost for certain services: deductibles for certain plans


Monthly Cost

Alaska

5 800.234.1317

Dem

ogra

phic

PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMS

Dem

ographic


Individuals recently covered by an

employer health plan



severe or chronic medical

conditions

Low income families

and adults


familiesWomen

Pregnant women &children



Prog

ram


800-234-1317

Group Health

of Health Underwriters480-292-7746

www.aahu.net

HCG

602-417-6755

COBRA

HIPAA Health Insurance Portability and

www.dol.gov

Conversion Policies


Individual Plans


www.aahu.net

AHCCCS

Deduction Program)800-352-8401

www.ahcccs.state.az.us

AHCCCS

In State: 602-542-9935

800-352-8401www.ahcccs.state.az.us

KidsCare877- 764-5437602- 417-5437

www.kidscare.state.az.us

of funding. Individuals andfamilies can still apply and beplaced on a waiting list, andthey will be contacted whenfunding becomes available)

Well Woman Health Check

888-257-8502

Baby Arizona800-833-4642

www.babyarizona.gov


Navajo928-871-4811

http://www.ihs.gov/

Phoenix Area602-364-5179

http://www.ihs.gov/

Tucson Area520-295-2405

http://www.ihs.gov/

Medicare



Program800-633-4227

Program

Cove

rage

carriers can impose a 6-month look-back/

enrollees that do not have prior creditable coverage



COBRA: 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer

COBRA Subsidy: 15 months of partially

HIPAA: Bene!ts are based on the program selected and there is no


Usually up to $5M, assorted deductibles depending on age and ZIP code


provides medical coverage for individuals who do not qualify

because their income is too

application (or the previousmonth) that reduce their monthly income to 40% of the Federal Poverty Level (FPL)

Pre-Existing HealthConditions Covered

prescription coverage


services including behavioral health services


Provides treatment for breastand/or cervical cancer or precancerous cervical lesions


Provides a simple, faster way for pregnant women to apply for

Make an appointment for a

your !rst visit, the o#ce sta" will assist you in completing an

take information with you to your !rst visit to show you are eligible


depending on health center and may include primary and child care, prenatal and post delivery care, family planning (birth control), minor surgical and orthopedic care, pharmacy, dental and orthodontics, optometry, nursing, mental health, laboratory and radiology.



and Part B: Medical Insurance, as wells several supplemental and advantage plans. It also o"ers a prescription drug program called Medicare Part D


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(or self-employed)


employee


GUARANTEED COVERAGE

COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are eligible

Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign up for

HIPAA:

months of continuous coverage and your company went out of business,

conditions. You have 63 days from the date you lost your previous coverage to


If you are denied coverage for a medical condition, you may be eligible for

Deduction program of

GUARANTEED COVERAGE

Must not be eligible for other

Monthly income can not

four, after deducting medical

include childcare and each person employed

assets: cash, bank accounts,stocks, bonds, etc.) Home equity is counted toward the resource limit, but one vehicle is not counted

GUARANTEED COVERAGE

Up to 100% FPL

Pregnant women - 150% FPL

GUARANTEED COVERAGE

Must be ineligible for no-cost Medicaid or employer-based coverage

No health insurance for the last three months at time of application

No limit on resources

Parents also qualify with a income of 200% of the FPL

GUARANTEED COVERAGE


resident

No access to other health insurance including Medicare

Women who are screened by

Health Services Well Women

Women’s Health Program,

GUARANTEED COVERAGE

Provides medical coverage to pregnant women, and children up to the age of 19 years.


No limit on resources or property that may be owned

GUARANTEED COVERAGE

Must be regarded by the local

member of an Indian or Group

factor indicative of Indian

pregnant with an eligible Indian’s child for the duration of her pregnancy through post

a non-Indian member of an eligible Indian’s household and the medical o#cer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution or health condition of self-employed and ± 60% of the insurance

COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.

responsible for full premium

COBRA, HIPAA: Premiums range from

individual coverage may be less

coverage varies$0 or minimal share-of-cost Both: $0 or minimal share-

of-cost$10 to $25 a month for one child or $15-$35 a month for two or more children

$0 or minimal share-of-cost $0 or share-of-cost $0 or minimal share-of-cost $0 and share of cost for certain services: deductibles for certain plans

Monthly Cost

Arizona


Dem

ogra

phic

PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMSD

emographic







conditions

Low income families

and adults


familiesWomen

Pregnant women &children



Prog

ram


800-234-1317

Group Health


www.aahu.net

HCG

602-417-6755

COBRA


www.dol.gov

Conversion Policies


Individual Plans


www.aahu.net

AHCCCS


www.ahcccs.state.az.us

AHCCCS

In State: 602-542-9935


KidsCare877- 764-5437602- 417-5437

www.kidscare.state.az.us

of funding. Individuals andfamilies can still apply and beplaced on a waiting list, andthey will be contacted whenfunding becomes available)

Well Woman Health Check

888-257-8502

Baby Arizona800-833-4642

www.babyarizona.gov


Navajo928-871-4811

http://www.ihs.gov/

Phoenix Area602-364-5179

http://www.ihs.gov/

Tucson Area520-295-2405

http://www.ihs.gov/

Medicare



Program800-633-4227

Program

Cove

rage









Usually up to $5M, assorted deductibles depending on age and ZIP code


provides medical coverage for individuals who do not qualify

because their income is too

application (or the previousmonth) that reduce their monthly income to 40% of the Federal Poverty Level (FPL)


prescription coverage


services including behavioral health services


Provides treatment for breastand/or cervical cancer or precancerous cervical lesions


Provides a simple, faster way for pregnant women to apply for

Make an appointment for a

your !rst visit, the o#ce sta" will assist you in completing an

take information with you to your !rst visit to show you are eligible


depending on health center and may include primary and child care, prenatal and post delivery care, family planning (birth control), minor surgical and orthopedic care, pharmacy, dental and orthodontics, optometry, nursing, mental health, laboratory and radiology.



and Part B: Medical Insurance, as wells several supplemental and advantage plans. It also o"ers a prescription drug program called Medicare Part D


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(or self-employed)


employee


GUARANTEED COVERAGE



HIPAA:


conditions. You have 63 days from the date you lost your previous coverage to



Deduction program of

GUARANTEED COVERAGE

Must not be eligible for other

Monthly income can not

four, after deducting medical

include childcare and each person employed

assets: cash, bank accounts,stocks, bonds, etc.) Home equity is counted toward the resource limit, but one vehicle is not counted

GUARANTEED COVERAGE

Up to 100% FPL


GUARANTEED COVERAGE


No health insurance for the last three months at time of application


Parents also qualify with a income of 200% of the FPL

GUARANTEED COVERAGE


resident


Women who are screened by

Health Services Well Women

Women’s Health Program,

GUARANTEED COVERAGE

Provides medical coverage to pregnant women, and children up to the age of 19 years.


No limit on resources or property that may be owned

GUARANTEED COVERAGE

Must be regarded by the local

member of an Indian or Group

factor indicative of Indian

pregnant with an eligible Indian’s child for the duration of her pregnancy through post

a non-Indian member of an eligible Indian’s household and the medical o#cer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.




coverage varies$0 or minimal share-of-cost Both: $0 or minimal share-

of-cost$10 to $25 a month for one child or $15-$35 a month for two or more children

$0 or minimal share-of-cost $0 or share-of-cost $0 or minimal share-of-cost $0 and share of cost for certain services: deductibles for certain plans

Monthly Cost

Arizona

7 800.234.1317

Dem

ogra


Dem

ographic

Small businesses

(2-50 employees)


health plan




Low income individuals and

families



Disabled



Prog

ram


Group Health


www.arkansas-ahu.org

COBRA/Mini-COBRA


www.dol.gov


Individual Plans



CHIPInsurance Plan)800-285-6477

www.chiparkansas.org

Medicaid800-482-8988800-482-5431501-682-8233

www.medicaid.state.ar.us

Safety Net Bene!ts Program800-540-7566

www.arhealthnetworks.com

ARKids First B

Insurance Plan)501-682-8269 888-474-8275

www.arkids!rst.com

Breast Care

877-670-2273501-661-2513

www.arbreastcare.com

Arkansas Mother-Infant Program

501-661-2154www.adhhomecare.org/

maternal.htm

Maternity Program501-661-2480

Medicare800-633-4227

www.medicare.gov


Program800-633-4227

Senior’s Health Insurance

Information Program (SHIIP)

800-224-6330501-371-2782

Health Coverage Tax Credit866-628-4282


877-222-8387www.va.gov

Program

Cove

rage

insurance carriers can impose a 6-month look-back/

conditions on enrollees that do not have prior creditable coverage



COBRA or Mini-COBRA: 12 to 18 months depending on qualifying

120 days. Bene!ts are the same as what you had with your previous employer


HIPAA: Bene!ts are based on the program

coverage


depending on medical needs

There is a 12-month look-back and 24-month


$1M lifetime bene!ts o"ering: comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, ambulance, labs

home health visits, maternity, preventive care, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, and physical and occupational therapy among other services


Medicaid & ARKids A: Family planning, home health inpatient, laboratory

facility outpatient, physician, ambulatory surgical center, hearing, chiropractic, dental durable medical equipment,

Prosthetics, Psychology Services,

with Mental Illness and Physical

Management, Transportation

Visual Services …and more

Safety Net Bene!ts: You get limited bene!ts each 12 months including:

outpatient services (emergency room

the o#ce), 6 physician o#ce visits,

annual bene!t of $100,000


Two plans that include many of the following: ambulance (emergency only), chiropractor, dental care (orthodontia included) durable medical

screens, family planning, hearing, home health, hospice, immunizations, inpatient hospital, inpatient, psych

outpatient mental and behavioral health, physician, psychology, podiatry, drugs, prescription therapy services (speech), occupational, and physical transportation, vision


Breast Care: Mammograms,

colonoscopy with biopsy. Free information about how to find breast and cervical cancer early

Arkansas Mother-Infant Program: Skilled home nursing visits for new mothers and infants to meet their medical, social and nutritional needs

Maternity Program: Prenatal and postpartum care including a medical, nutritional and social assessment and case management, education on pregnancy, nutrition, labor and delivery, infant care, reproductive




SHIIP is a Medicare counseling service








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees (including owner)



Most small group carriers also require 75% employee participation and accept employees who sign a waiver indicating other coverage as counting towards the 75%

GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are

the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to

with under 20 employees

HIPAA:

continuous coverage and your company went out of business, you may convert to a

the date you lost your previous coverage to

be eligible for Medicare or other public or group insurance programs


If you are denied coverage for a medical condition, you may be

GUARANTEED COVERAGE

least 90 days or resident for at least 30 days with evidence of coverage under a Quali!ed

Not be enrolled in or eligible for

be eligible for group coverage

programs (must have

May need to prove denial of coverage or o"er of higher premium

May also be federally-eligible

GUARANTEED COVERAGE

Medicaid: Pregnant women & children ages 0-19: 200% FPLSupplemental Security Income

Parents: 15% FPL

ARKids A:

covers children between 133 and 200% FPL who do not meet certain

Safety Net Bene!ts: Must live in

between the ages of 19-64, Must be a

of the FPL

GUARANTEED COVERAGE

children through age 18 with family income up to 200% FPL

GUARANTEED COVERAGE

All: No health insurance, or your health insurance does not cover the services

GUARANTEED COVERAGE

Both:


Disease (permanent kidney failure requiring dialysis or kidney transplant

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t

employer contribution and ± 25% of the insurance company’s

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.

for full premium

COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-150% of group health

coverage varies$1000 out-of-pocket deductible and $1000 out-

in-network care

Monthly rates are determined

Usage

$0 or minimal share-of-cost

Safety Net Bene!ts: $100 annual deductible (does not apply to o#ce

co-coverage will be required $1,000

including deductible

$0-$10 of durable medical equipment and inpatient hospital care, which both require a 20 percent coinsurance payment


certain plans



Monthly Cost

Arkansas


Dem

ogra


Dem

ographicSmall

businesses(2-50

employees)


health plan





families



Disabled



Prog

ram


Group Health



COBRA/Mini-COBRA


www.dol.gov


Individual Plans



CHIPInsurance Plan)800-285-6477

www.chiparkansas.org

Medicaid800-482-8988800-482-5431501-682-8233

www.medicaid.state.ar.us

Safety Net Bene!ts Program800-540-7566

www.arhealthnetworks.com

ARKids First B

Insurance Plan)501-682-8269 888-474-8275

www.arkids!rst.com

Breast Care

877-670-2273501-661-2513

www.arbreastcare.com

Arkansas Mother-Infant Program

501-661-2154www.adhhomecare.org/

maternal.htm

Maternity Program501-661-2480


www.medicare.gov


Program800-633-4227


Information Program (SHIIP)

800-224-6330501-371-2782



877-222-8387www.va.gov

Program

Cove

rage

insurance carriers can impose a 6-month look-back/

conditions on enrollees that do not have prior creditable coverage



COBRA or Mini-COBRA: 12 to 18 months depending on qualifying

120 days. Bene!ts are the same as what you had with your previous employer



coverage


depending on medical needs



$1M lifetime bene!ts o"ering: comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, ambulance, labs

home health visits, maternity, preventive care, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, and physical and occupational therapy among other services


Medicaid & ARKids A: Family planning, home health inpatient, laboratory

facility outpatient, physician, ambulatory surgical center, hearing, chiropractic, dental durable medical equipment,

Prosthetics, Psychology Services,

with Mental Illness and Physical

Management, Transportation

Visual Services …and more

Safety Net Bene!ts: You get limited bene!ts each 12 months including:

outpatient services (emergency room

the o#ce), 6 physician o#ce visits,

annual bene!t of $100,000


Two plans that include many of the following: ambulance (emergency only), chiropractor, dental care (orthodontia included) durable medical

screens, family planning, hearing, home health, hospice, immunizations, inpatient hospital, inpatient, psych

outpatient mental and behavioral health, physician, psychology, podiatry, drugs, prescription therapy services (speech), occupational, and physical transportation, vision


Breast Care: Mammograms,

colonoscopy with biopsy. Free information about how to find breast and cervical cancer early

Arkansas Mother-Infant Program: Skilled home nursing visits for new mothers and infants to meet their medical, social and nutritional needs

Maternity Program: Prenatal and postpartum care including a medical, nutritional and social assessment and case management, education on pregnancy, nutrition, labor and delivery, infant care, reproductive




SHIIP is a Medicare counseling service








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE





GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are

the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to

with under 20 employees

HIPAA:



be eligible for Medicare or other public or group insurance programs



GUARANTEED COVERAGE

least 90 days or resident for at least 30 days with evidence of coverage under a Quali!ed

Not be enrolled in or eligible for

be eligible for group coverage

programs (must have

May need to prove denial of coverage or o"er of higher premium

May also be federally-eligible

GUARANTEED COVERAGE

Medicaid: Pregnant women & children ages 0-19: 200% FPLSupplemental Security Income

Parents: 15% FPL

ARKids A:

covers children between 133 and 200% FPL who do not meet certain

Safety Net Bene!ts: Must live in

between the ages of 19-64, Must be a

of the FPL

GUARANTEED COVERAGE

children through age 18 with family income up to 200% FPL

GUARANTEED COVERAGE

All: No health insurance, or your health insurance does not cover the services

GUARANTEED COVERAGE

Both:


Disease (permanent kidney failure requiring dialysis or kidney transplant

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t

employer contribution and ± 25% of the insurance company’s

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.

for full premium


coverage varies$1000 out-of-pocket deductible and $1000 out-

in-network care

Monthly rates are determined

Usage

$0 or minimal share-of-cost

Safety Net Bene!ts: $100 annual deductible (does not apply to o#ce

co-coverage will be required $1,000

including deductible

$0-$10 of durable medical equipment and inpatient hospital care, which both require a 20 percent coinsurance payment


certain plans



Monthly Cost

Arkansas

9 800.234.1317

Dem

ogra


Dem

ographic

Small Businesses(2-50 employees)


health plan




Low income families &

medically needy

Children in low income families or

undocumented children

Pregnant women, infants, & moderate

income children

Adults without dependents

Immigrants awaiting legal

status

Adults in need of cancer

screening

Prog

ram


Group Plans


www.cahu.org

COBRA or Cal-COBRA

Then convert to

HIPAA (Health Insurance Portability

www.dol.gov

HIPP (Health Insurance

Premium Payment)www.dhcs.ca.gov/


Individual Plans


www.cahu.org

MRMIPInsurance Program)

800-289-6574www.mrmib.ca.gov

Due to changes in the program,

Medi-Cal800-952-5253888-747-1222

www.medi-cal.ca.gov

social services agency

www.dhs.ca.gov

AIM800-433-2611

www.aim.ca.gov

Healthy Kids Planswww.partnershiphp.org

CaliforniaKids818-755-9700

www.californiakids.org

Kaiser Permanente Child Health Plan

800-464-4000http://info.kp.org/childhealthplan/

Children Health and Disability Prevention

(CHDP)www.dhs.ca.gov/pcfh/cms/chdp/

Medi-Cal800-952-5253888-747-1222

www.medi-cal.ca.gov

AIM800-433-2611

www.aim.ca.gov

Healthy Families Program800-880-5305888-747-1222

www.healthyfamilies.ca.gov

County Medical Services Program

(CMSP)services agency

www.cmspcounties.org

Genetically Handicapped

Persons Program (GHPP)

916-327-0470800-639-0597

www.dhcs.ca.gov/services/ghpp

Restricted Medi-Cal

Program800-952-5253

www.medi-cal.ca.gov

Family PACT(Family planning)

916-650-0414www.familypact.org

For local programs contactwww.dhs.ca.gov

IMPACT800-409-8252

www.california-impact.org

Breast and Cervical Cancer

Screening & Treatment

800-824-0088www.dhs.ca.gov/cancerdetection

Program

Cove

rage

Di"erent plans cover di"erent medical services

Sometimes coverage is

often $5M and some plans have no limit

These factors a"ect the monthly premium and deductibles




COBRA or Cal-COBRA: 18 to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer



coverage

HIPP: Bene!ts are the same as what you had with your previous employer, HIPP is a premium assistance program


Di"erent plans will cover di"erent medical services

There may also be a

Limits on Pre-Existing Health Conditions May Apply

enroll in guaranteed coverage with private health plans

annual limit and $500 annual deductible

per year (with a $750K lifetime limit) once subscriber moves to a

insurance individual plan

medical services provided by

conditions.


Medi-Cal: vision, and prescription

health problems like breast cancer, kidney problems,

AIM: comprehensive medical care

coverage up to 60 days after

automatically enrolled in Healthy Families Program up to age 1


Healthy Kids, California Kids & KPCHP:programs o"er a variety of health, dental, and vision plans from which to choose, includes hospitalization

KPCHP: is now closed to new membership from

has not been determined.

CHDP:required for school, sports, etc. (Does not cover hospital, medicines, or any emergencies)


Medi-Cal: pregnancy related care (prenatal and delivery) is covered. Mothers are covered up to 60 days after delivery

AIM: comprehensive medical care for

mothers continue coverage up to 60

is automatically enrolled in Healthy Families Program up to age 1

Healthy Families Program: variety of health, dental, vision, and prescription plans from which to choose


CMSP: Program availability varies by county, Medically necessary physician and

Depending on county, may provide coverage for other services such as dental and

county, please refer to social services agency in county of residence

GHPP: Special care center services, hospital stay, outpatient medical care, pharmaceutical services, surgeries, nutrition products and medical foods, durable medical equipment, and other services

Restricted Medi-Cal: covers emergencies, pregnancy related care (prenatal and delivery), kidney dialysis, treatment for breast and cervical cancer

Family PACT: provides comprehensive family planning services


IMPACT: Provides men with radical

beam radiation therapy, hormone therapy, watchful waiting, brachytherapy, chemotherapy, counseling and more

BCCST: women can get screening and treatment


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


employee


GUARANTEED COVERAGE

COBRA or Cal-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May

subsidy from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of

Cal-COBRA: less than 20 employees

HIPAA:



HIPP: You may be eligible for HIPP if you have a high-cost health condition (e.g.,



GUARANTEED COVERAGE

was terminated for reasons other than non-payment of premium or fraud (such as a

Must prove denial of coverage or o"er of higher premium than

covered under Medicare)

Subscriber must select from health plan carriers that o"er

GUARANTEED COVERAGE

Medi-Cal: FPL

If you are pregnant, your income

parents: Up to 107% FPLIf you are elderly or disabled, your income can be up to 133% FPL

AIM:

bene!ts as of the application

private insurance costing $500 or less

GUARANTEED COVERAGE

Healthy Kids: Must be a resident of Solano,

be covered by an employer sponsored

must be between the ages of 0-18.

Undocumented children are eligible.

CaliforniaKids: Must not be eligible for other

Healthy Families Program

KPCHP:Kaiser or in county plan area. Must not be eligible for employer based coverage

CHDP: and age of 19 whose family is at 200% FPL

GUARANTEED COVERAGE

Medi-Cal: If you are pregnant, your income can be up to 200% FPL

AIM:

Part B bene!ts as of the application

payments over $500 may qualify you

Healthy Families Program:

Must be ineligible for no-cost Medi-

immigrants

GUARANTEED COVERAGE

CMSP: Must be between theages of 21-64, Must not be

reside in county where

income can be up to 200%

eligibility income standards vary, please refer to social services agency in county of residence

GHPP: Must be diagnosed with a genetic condition

must be 21 years of age or older (some persons younger than 21 years of

may be required to apply for

GUARANTEED COVERAGE

Restricted Medi-Cal:

If you are pregnant, your income can be up to 200% FPL

If you are elderly or disabled, your income can be up to 133% FPL

Family PACT: up to 200% FPL

No insurance or ineligible for

Insurance does not coverfamily planning or birthcontrol methods.

Have not met deductible ofcurrent insurance.

cost but you have not metyour share of cost.

GUARANTEED COVERAGE

IMPACT:resident over 18 years old, Little or no insurance, Up to 200%

prostate cancer

BCCST: 40 years old or older, with an income of 200% of the FPL, uninsured or have medical insurance that does not cover these

these services through

government-sponsored

25 and older can receive cervical cancer screening

Eligibility

Mon

thly

Cos

t employer contribution and ±10% of the insurance

COBRA or Cal-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.

for full premium

COBRA, Cal-COBRA, HIPAA: Premiums range from 102%-150% of group health


coverage varies

pocket limits per household (subscriber + dependents) is

Medi-Cal: $0 or minimal share of cost

AIM: 1.5% of family annual

Healthy Kids: $5 co-pay for most outpatient services.CaliforniaKids: $5-50 co-pays for servicesKPCHP: per family), co-pays range from $5-$35 for some services with a $250/child or $500

CHDP: $0 or minimal share of cost

Medi-Cal: $0 or minimal share of costAIM: 1.5% of family annual income

Healthy Families : $4-$24 per child depending on income and choice of

some check-ups are no-cost

CMSP: $0 or minimal share of cost

GHPP: Some clients may also be required to pay an annual enrollment fee to GHPP. The amount of enrollment fee is based on income and family size.

$0 or minimal share of cost $0 or minimal share of cost

Monthly Cost

California


Dem

ogra


Dem

ographic

Small Businesses(2-50 employees)


health plan





medically needy

Children in low income families or

undocumented children

Pregnant women, infants, & moderate

income children

Adults without dependents


status

Adults in need of cancer

screening

Prog

ram


Group Plans


www.cahu.org

COBRA or Cal-COBRA

Then convert to


www.dol.gov


Premium Payment)www.dhcs.ca.gov/


Individual Plans


www.cahu.org

MRMIPInsurance Program)

800-289-6574www.mrmib.ca.gov

Due to changes in the program,

Medi-Cal800-952-5253888-747-1222

www.medi-cal.ca.gov


www.dhs.ca.gov

AIM800-433-2611

www.aim.ca.gov

Healthy Kids Planswww.partnershiphp.org

CaliforniaKids818-755-9700

www.californiakids.org

Kaiser Permanente Child Health Plan

800-464-4000http://info.kp.org/childhealthplan/

Children Health and Disability Prevention

(CHDP)www.dhs.ca.gov/pcfh/cms/chdp/

Medi-Cal800-952-5253888-747-1222

www.medi-cal.ca.gov

AIM800-433-2611

www.aim.ca.gov

Healthy Families Program800-880-5305888-747-1222

www.healthyfamilies.ca.gov

County Medical Services Program

(CMSP)services agency

www.cmspcounties.org

Genetically Handicapped

Persons Program (GHPP)

916-327-0470800-639-0597

www.dhcs.ca.gov/services/ghpp

Restricted Medi-Cal

Program800-952-5253

www.medi-cal.ca.gov

Family PACT(Family planning)

916-650-0414www.familypact.org

For local programs contactwww.dhs.ca.gov

IMPACT800-409-8252

www.california-impact.org


Screening & Treatment

800-824-0088www.dhs.ca.gov/cancerdetection

Program

Cove

rage


Sometimes coverage is

often $5M and some plans have no limit

These factors a"ect the monthly premium and deductibles




COBRA or Cal-COBRA: 18 to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer



coverage




There may also be a


enroll in guaranteed coverage with private health plans

annual limit and $500 annual deductible

per year (with a $750K lifetime limit) once subscriber moves to a

insurance individual plan

medical services provided by

conditions.


Medi-Cal: vision, and prescription

health problems like breast cancer, kidney problems,

AIM: comprehensive medical care

coverage up to 60 days after

automatically enrolled in Healthy Families Program up to age 1


Healthy Kids, California Kids & KPCHP:programs o"er a variety of health, dental, and vision plans from which to choose, includes hospitalization

KPCHP: is now closed to new membership from

has not been determined.

CHDP:required for school, sports, etc. (Does not cover hospital, medicines, or any emergencies)


Medi-Cal: pregnancy related care (prenatal and delivery) is covered. Mothers are covered up to 60 days after delivery

AIM: comprehensive medical care for

mothers continue coverage up to 60

is automatically enrolled in Healthy Families Program up to age 1

Healthy Families Program: variety of health, dental, vision, and prescription plans from which to choose


CMSP: Program availability varies by county, Medically necessary physician and

Depending on county, may provide coverage for other services such as dental and

county, please refer to social services agency in county of residence

GHPP: Special care center services, hospital stay, outpatient medical care, pharmaceutical services, surgeries, nutrition products and medical foods, durable medical equipment, and other services

Restricted Medi-Cal: covers emergencies, pregnancy related care (prenatal and delivery), kidney dialysis, treatment for breast and cervical cancer

Family PACT: provides comprehensive family planning services


IMPACT: Provides men with radical

beam radiation therapy, hormone therapy, watchful waiting, brachytherapy, chemotherapy, counseling and more

BCCST: women can get screening and treatment


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


employee


GUARANTEED COVERAGE

COBRA or Cal-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May

subsidy from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of

Cal-COBRA: less than 20 employees

HIPAA:



HIPP: You may be eligible for HIPP if you have a high-cost health condition (e.g.,



GUARANTEED COVERAGE

was terminated for reasons other than non-payment of premium or fraud (such as a



Subscriber must select from health plan carriers that o"er

GUARANTEED COVERAGE

Medi-Cal: FPL

If you are pregnant, your income

parents: Up to 107% FPLIf you are elderly or disabled, your income can be up to 133% FPL

AIM:

bene!ts as of the application

private insurance costing $500 or less

GUARANTEED COVERAGE

Healthy Kids: Must be a resident of Solano,

be covered by an employer sponsored

must be between the ages of 0-18.

Undocumented children are eligible.

CaliforniaKids: Must not be eligible for other

Healthy Families Program

KPCHP:Kaiser or in county plan area. Must not be eligible for employer based coverage

CHDP: and age of 19 whose family is at 200% FPL

GUARANTEED COVERAGE

Medi-Cal: If you are pregnant, your income can be up to 200% FPL

AIM:

Part B bene!ts as of the application

payments over $500 may qualify you

Healthy Families Program:

Must be ineligible for no-cost Medi-

immigrants

GUARANTEED COVERAGE

CMSP: Must be between theages of 21-64, Must not be

reside in county where

income can be up to 200%

eligibility income standards vary, please refer to social services agency in county of residence

GHPP: Must be diagnosed with a genetic condition

must be 21 years of age or older (some persons younger than 21 years of

may be required to apply for

GUARANTEED COVERAGE

Restricted Medi-Cal:

If you are pregnant, your income can be up to 200% FPL

If you are elderly or disabled, your income can be up to 133% FPL

Family PACT: up to 200% FPL

No insurance or ineligible for

Insurance does not coverfamily planning or birthcontrol methods.

Have not met deductible ofcurrent insurance.

cost but you have not metyour share of cost.

GUARANTEED COVERAGE

IMPACT:resident over 18 years old, Little or no insurance, Up to 200%

prostate cancer

BCCST: 40 years old or older, with an income of 200% of the FPL, uninsured or have medical insurance that does not cover these

these services through

government-sponsored

25 and older can receive cervical cancer screening

Eligibility

Mon

thly

Cos

t employer contribution and ±10% of the insurance

COBRA or Cal-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.

for full premium

COBRA, Cal-COBRA, HIPAA: Premiums range from 102%-150% of group health


coverage varies

pocket limits per household (subscriber + dependents) is

Medi-Cal: $0 or minimal share of cost

AIM: 1.5% of family annual

Healthy Kids: $5 co-pay for most outpatient services.CaliforniaKids: $5-50 co-pays for servicesKPCHP: per family), co-pays range from $5-$35 for some services with a $250/child or $500

CHDP: $0 or minimal share of cost

Medi-Cal: $0 or minimal share of costAIM: 1.5% of family annual income

Healthy Families : $4-$24 per child depending on income and choice of

some check-ups are no-cost

CMSP: $0 or minimal share of cost

GHPP: Some clients may also be required to pay an annual enrollment fee to GHPP. The amount of enrollment fee is based on income and family size.

$0 or minimal share of cost $0 or minimal share of cost

Monthly Cost

California

11 800.234.1317

Dem

ogra


Dem

ographic

Small businesses (1-50 Employees)


health plan



conditions

Low Income Families and

Medically Needy

Low Income Children Women Native American

Indians



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA/Mini-COBRA

Then convert to


www.dol.gov

State Continuation Coverage


800-234-1317

Individual Plans800-930-3745 303-894-7490

www.dora.state.co.us/insurance

CoverColorado

Insurance Pool)303-749-1111888-770-1120

877-461-3811 (Billing)

www.covercolorado.org

Colorado Health Plan

(Medicaid)800-283-3221

www.chcpf.state.co.us

o#ces for Medicaid information in your county.

List of numbers can be found here:

www.cdhs.state.co.us/servicebycounty.htm

Child Health Plan Plus

800-359-1991www.cchp.org

Women’s Wellness Connection

303-692-2581

866-951-9355www.cdphe.state.co.us/

pp/cwcci



asp


866-628-4282



Cove

rage

Waiting periods for coverage on certain conditions may apply


COBRA or Mini-COBRA: available for 18 to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer


premium

HIPAA: Individual-plan conversion bene!ts are based on the program selected

coverage



There may also be a lifetime


deductible levels to choose from

Hospitalization, physician

prescription drugs, and some mental health care services

If you have not been insured within the past 90 days prior to

will not be covered for the !rst 6 months

If you have been insured, for at

within 90 days of application


Diagnosis (services to !nd out what is wrong), Physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services


Immunizations (shots),Prescriptions (medicine),

glasses, Hearing aids

Dental services up to $600

cleanings, and some otherservices


Some diagnostic services such as ultrasound, breast biopsy, surgical consultation, colonoscopy

women quali!ed through Medicaid

dental, optometry, nutrition, health education, community health nursing, mental health, social services, substance abuse, and environmental health services, well-child, chronic diseases, allergy, women's health, and podiatry. Pharmacy, laboratory and radiology services are all provided at the centers, including in-patient and specialty care with providers in neighboring areas


employer contributes less than 50% (or spouses’ employer)





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for coverage

employee

Proprietor-name on license must draw wages


conditions- not counting birth or adoption- may apply, (1-6 months respectively)

GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are eligible for

the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination

is for business with under 20 employees

HIPAA:



underwriting


GUARANTEED COVERAGE

You must have resided in

applying for coverage, unless you

from another state’s high risk

eligible for Medicaid, Medicare or

not have been terminated from

prior to your application or have received $1,000,000 in bene!ts

GUARANTEED COVERAGE

Pregnant women and children under the age of 6 income at or below 133% of the FPL

below 100% of the FPL

Parents income at or below 60% of the FPL

SSI Disabled income at or below 74% of the FPL

Some eligibility requirements change from county to county so contact your local county department

GUARANTEED COVERAGE

Must not be eligible for Medicaid

U.S. citizens or permanent U.S. residents (who have had an

at least 5 years)

Not covered by any other insurances

18 and younger

Household income of 200% FPL

GUARANTEED COVERAGE

Under-insured or uninsured

Income below 250% FPL

Must not have had pap or mammogram test in last 12 months

GUARANTEED COVERAGE

Ute Service Unit serves the Southern Ute and the Ute Mountain Ute Tribes

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and +10% or -25% of the insurance company’s

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium

COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-


county/zone

If you are self-employed and buy your own insurance you are eligible to deduct 100% of the cost of the premium from

Premiums vary based on the plan and deductible you choose and underwriting guidelines

$0 for children and pregnant $0 or small co-pays

$0 for most members

For those who have to pay, enrollment fee is $25 for one

are $2 - $15 per visit for routine medical care

$0 or small share of cost $0 or minimal share of cost 20% of the insurance premium

$0 and share of cost and co-pays depending on income level M

onthly Cost

Colorado


Dem

ogra


Dem

ographic



health plan



conditions

Low Income Families and

Medically Needy

Low Income Children Women Native American

Indians



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA/Mini-COBRA

Then convert to


www.dol.gov



800-234-1317

Individual Plans800-930-3745 303-894-7490

www.dora.state.co.us/insurance

CoverColorado

Insurance Pool)303-749-1111888-770-1120

877-461-3811 (Billing)

www.covercolorado.org

Colorado Health Plan

(Medicaid)800-283-3221

www.chcpf.state.co.us

o#ces for Medicaid information in your county.

List of numbers can be found here:

www.cdhs.state.co.us/servicebycounty.htm

Child Health Plan Plus

800-359-1991www.cchp.org

Women’s Wellness Connection

303-692-2581

866-951-9355www.cdphe.state.co.us/

pp/cwcci



asp


866-628-4282



Cove

rage

Waiting periods for coverage on certain conditions may apply




premium

HIPAA: Individual-plan conversion bene!ts are based on the program selected

coverage





deductible levels to choose from

Hospitalization, physician

prescription drugs, and some mental health care services

If you have not been insured within the past 90 days prior to

will not be covered for the !rst 6 months

If you have been insured, for at

within 90 days of application


Diagnosis (services to !nd out what is wrong), Physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services


Immunizations (shots),Prescriptions (medicine),

glasses, Hearing aids

Dental services up to $600

cleanings, and some otherservices




dental, optometry, nutrition, health education, community health nursing, mental health, social services, substance abuse, and environmental health services, well-child, chronic diseases, allergy, women's health, and podiatry. Pharmacy, laboratory and radiology services are all provided at the centers, including in-patient and specialty care with providers in neighboring areas


employer contributes less than 50% (or spouses’ employer)





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee




GUARANTEED COVERAGE




HIPAA:



underwriting


GUARANTEED COVERAGE

You must have resided in

applying for coverage, unless you

from another state’s high risk

eligible for Medicaid, Medicare or

not have been terminated from

prior to your application or have received $1,000,000 in bene!ts

GUARANTEED COVERAGE

Pregnant women and children under the age of 6 income at or below 133% of the FPL

below 100% of the FPL

Parents income at or below 60% of the FPL

SSI Disabled income at or below 74% of the FPL

Some eligibility requirements change from county to county so contact your local county department

GUARANTEED COVERAGE

Must not be eligible for Medicaid

U.S. citizens or permanent U.S. residents (who have had an

at least 5 years)

Not covered by any other insurances

18 and younger


GUARANTEED COVERAGE



Must not have had pap or mammogram test in last 12 months

GUARANTEED COVERAGE

Ute Service Unit serves the Southern Ute and the Ute Mountain Ute Tribes

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and +10% or -25% of the insurance company’s


full premium



county/zone


Premiums vary based on the plan and deductible you choose and underwriting guidelines

$0 for children and pregnant $0 or small co-pays

$0 for most members

For those who have to pay, enrollment fee is $25 for one

are $2 - $15 per visit for routine medical care

$0 or small share of cost $0 or minimal share of cost 20% of the insurance premium


onthly Cost

Colorado

13 800.234.1317

Dem

ogra

phic

PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMS

Dem

ographic



health plan





families

Low income persons ineligible

for other public programs

Children Women Adults Seniors and Disabled

Prog

ram


800-234-1317

Group PlansDepartment

800-297-3900800-203-3447

www.ct.gov/cid

COBRA/Mini-COBRA


www.dol.gov617-565-9600

State Conversion Policy


800-234-1317

Individual PlansDepartment

860-297-3900800-203-3447

www.ct.gov/cid

Connecticut Health Reinsurance Association

800-842-0004www.hract.org/hra

Medicaid800-842-1508

800-842-4524 (TDD/TYY) www.dss.state.ct.us

SAGA

866-361-7242www.chnct.org

services o#ce

HUSKYUninsured Kids and Youth)

877-284-8759800-656-6684

www.huskyhealth.com

Connecticut Breastand Cervical Cancer

Early DetectionProgram860-509-7804

www.dph.state.ct.us

Charter Oak Health Plan

877-772-8625www.ct.gov/coh/site/default.

asp

Medicare



Program800-633-4227

Connecticut CHOICES Program

(Medicare advice)800-994-9422

Program

Cove

rage

Mostly plans with co-pays, some with deductibles






premium






conditions)

conditions if you qualify)

the Special plan which does not cover out patient prescriptions


Diagnosis, physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services

Some services may need priorapproval


term care and non-emergency medical transportation


managed care program

and Husky B


Screening and Diagnostic Services Include: o#ce visits, mammograms, breast biopsies and ultrasounds, !ne needle aspirations, pap tests,

directed biopsies

o#ce visits, preventive care, ambulance, emergency room visit, prescription medication, durable medical equipment, behavioral health services, inpatient and outpatient services, pre- and post-natal

bene!t $100,000




Connecticut CHOICES Program is a Medicare counseling service


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

If in business 90 days or more, can usually qualify


license must draw wages

Twice annually, self-employed

health plan with guarantee issue

GUARANTEED COVERAGE




HIPAA:



underwriting


GUARANTEED COVERAGE

residents

Previous coverage terminated for reasons other than non-payment of premium or fraud

GUARANTEED COVERAGE

immigration status

Pregnant Women, Infants, and

Non-Working Parents: 100% of FPL

Working Parents: 107% of FPL

Medically Needy Individual: 80% or 66% of FPL

Supplemental Security Income

GUARANTEED COVERAGE

Ineligible for state or federal programs such as Medicaid

The income limit for anindividual ranges from$502.22 monthly to $610.61,depending on what regionof the state he or she lives in.The asset limit is $1,000 perhousehold

No categorical program

based on income and assets only. The income limit for an individual ranges from $476.19 monthly to $574.86, depending on what region of the state he/

is $1,000 per assistance unit

is not automatically linked to

GUARANTEED COVERAGE

Income level numbers, HUSKY

parents and other caregiverswith incomes under 185% ofthe federal poverty level. Italso covers pregnant womenwith incomes under 250% ofthe federal poverty level.

HUSKY B is only for childrenwith family incomes over 185%of poverty. There is no incomelimit for HUSKY B, so any childcan qualify.

Families with an income greater than 300% of the FPL can buy into a HUSKY plan

GUARANTEED COVERAGE

Be at or below 200% FPL

Women age 40 and older (35-39 if history or symptoms, age 19 and older may qualify for pap test)

Uninsured or insurance plan without diagnostic coverage

Have an insurance deductible of $1,000 or more

Be 40 to 64 years of age for Mammograms

GUARANTEED COVERAGE

ages of 19 to 64.

to this rule.

There are no income limits.

Depending on your income, your monthly premiums may be subsidized.

GUARANTEED COVERAGE

Disabled or age 65 and older or people under age 65 with certain disabilities, and people

Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Eligibility

Mon

thly

Cos

t

contribution and the Modi!ed COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium



county/zone

If you are self-employed and buy your own insurance you are eligible to deduct 100% of the cost of the premium from your

Premiums vary depending on the

family size,and plan chosen

law at a level between 150 and 200% of standard market rates

$0; may share in some costs $0 or minimal share of costHusky B: Families between 185-

family between 235%-300%

combination of co-pays and

into the plan at negotiated group price.

No co-pays or premiums $93-$296 for monthly premiums depending on your family income

$35 co-pay

$0 and share of cost for

certain plans Monthly Cost

Connecticut


Dem

ogra

phic

PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMSD

emographic



health plan





families

Low income persons ineligible

for other public programs

Children Women Adults Seniors and Disabled

Prog

ram


800-234-1317

Group PlansDepartment

800-297-3900800-203-3447

www.ct.gov/cid

COBRA/Mini-COBRA


www.dol.gov617-565-9600

State Conversion Policy


800-234-1317

Individual PlansDepartment

860-297-3900800-203-3447

www.ct.gov/cid

Connecticut Health Reinsurance Association

800-842-0004www.hract.org/hra


800-842-4524 (TDD/TYY) www.dss.state.ct.us

SAGA

866-361-7242www.chnct.org

services o#ce

HUSKYUninsured Kids and Youth)

877-284-8759800-656-6684

www.huskyhealth.com

Connecticut Breastand Cervical Cancer

Early DetectionProgram860-509-7804

www.dph.state.ct.us

Charter Oak Health Plan

877-772-8625www.ct.gov/coh/site/default.

asp

Medicare



Program800-633-4227

Connecticut CHOICES Program

(Medicare advice)800-994-9422

Program

Cove

rage

Mostly plans with co-pays, some with deductibles






premium






conditions)

conditions if you qualify)

the Special plan which does not cover out patient prescriptions


Diagnosis, physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services

Some services may need priorapproval


term care and non-emergency medical transportation


managed care program

and Husky B


Screening and Diagnostic Services Include: o#ce visits, mammograms, breast biopsies and ultrasounds, !ne needle aspirations, pap tests,

directed biopsies

o#ce visits, preventive care, ambulance, emergency room visit, prescription medication, durable medical equipment, behavioral health services, inpatient and outpatient services, pre- and post-natal

bene!t $100,000




Connecticut CHOICES Program is a Medicare counseling service


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

If in business 90 days or more, can usually qualify


license must draw wages

Twice annually, self-employed

health plan with guarantee issue

GUARANTEED COVERAGE




HIPAA:



underwriting


GUARANTEED COVERAGE

residents


GUARANTEED COVERAGE

immigration status

Pregnant Women, Infants, and

Non-Working Parents: 100% of FPL

Working Parents: 107% of FPL

Medically Needy Individual: 80% or 66% of FPL


GUARANTEED COVERAGE

Ineligible for state or federal programs such as Medicaid

The income limit for anindividual ranges from$502.22 monthly to $610.61,depending on what regionof the state he or she lives in.The asset limit is $1,000 perhousehold

No categorical program

based on income and assets only. The income limit for an individual ranges from $476.19 monthly to $574.86, depending on what region of the state he/

is $1,000 per assistance unit

is not automatically linked to

GUARANTEED COVERAGE

Income level numbers, HUSKY

parents and other caregiverswith incomes under 185% ofthe federal poverty level. Italso covers pregnant womenwith incomes under 250% ofthe federal poverty level.

HUSKY B is only for childrenwith family incomes over 185%of poverty. There is no incomelimit for HUSKY B, so any childcan qualify.

Families with an income greater than 300% of the FPL can buy into a HUSKY plan

GUARANTEED COVERAGE

Be at or below 200% FPL

Women age 40 and older (35-39 if history or symptoms, age 19 and older may qualify for pap test)

Uninsured or insurance plan without diagnostic coverage

Have an insurance deductible of $1,000 or more

Be 40 to 64 years of age for Mammograms

GUARANTEED COVERAGE

ages of 19 to 64.

to this rule.

There are no income limits.

Depending on your income, your monthly premiums may be subsidized.

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and the Modi!ed COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium



county/zone


Premiums vary depending on the

family size,and plan chosen

law at a level between 150 and 200% of standard market rates

$0; may share in some costs $0 or minimal share of costHusky B: Families between 185-

family between 235%-300%

combination of co-pays and

into the plan at negotiated group price.

No co-pays or premiums $93-$296 for monthly premiums depending on your family income

$35 co-pay


certain plans Monthly Cost

Connecticut

15 800.234.1317

Dem

ogra


emographic






Parents and children Children Adults Seniors and

Disabled



Prog

ram


800-234-1317

Group Health

of Health Underwriters 703-276-0220

www.nahu.org

COBRA


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

Medicaid302-255-9500 800-372-2022

www.dhss.delaware.gov/dhss/

Children and Families First

800-734-2388www.c"de.org

Delaware Healthy Children Program

800-996-9969www.dhss.delaware.gov/dhss/

Delaware Screening for Life

800-464-4357www.state.de.us/dhss/dph/

dpc/s$.html


www.medicare.gov


Program800-633-4227

ELDER Info800-336-9500



877-222-8387www.va.gov

Program

Cove

rage





COBRA: 12 to 18 months depending on qualifying events, bene!ts are the same as what you had with your previous employer


premium



medical needs

There are no restrictions on

conditions


Doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health and substance abuse services, X-rays, home health care,hospice care, dental care (up toage 21)


Special medical foster care, resource mothers program, counseling, education and more

Well-baby and well-child checkups, drug/alcohol abuse treatment, speech/hearing therapy, immunizations physical therapy, eye

prescription drugs, hospital care, physician services, X-rays, lab work, assistive technology, mental health counseling, limited home health and nursing care, case management and coordination, hospice care, and comprehensive dental service


cancer, pap tests, colorectal cancer screening tests recommended by your doctor, health education, help with coordinating associated care



Insurance and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also o"ers a prescription drug progam called Medicare Part D

ELDER Info is a Medicare counseling service that educates and assists Medicarebene!ciaries, those eligible forMedicare, and caregivers aboutMedicare, Medicaid, Medigap,prescription drug bene!ts, andother issues related to healthinsurance bene!ts.








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE

COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are

from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to

HIPAA:

18 months of continuous coverage and your company went out of business, you may convert to a

have 63 days from the date you lost your previous coverage to sign up

for Medicare or other public or group insurance programs

underwriting

GUARANTEED COVERAGE

Pregnant women and infants age 0-1: 200% FPL

Parents: 117% FPL

parents: 100% FPL (also aged, blind and disabled)

SSI recipients: 133% FPL

U.S. citizens or quali!ed legal residents

GUARANTEED COVERAGE

Low income in need of services

GUARANTEED COVERAGE

not have other comprehensive

U.S. citizen or quali!ed non-

of a permanent State employee

Waiting period may apply

GUARANTEED COVERAGE

You are between the ages of 18 and 64

and not eligible for Medicare or Medicaid

Underinsured: High, unmet

does not cover Pap tests, mammograms or colorectal screenings

with an abnormal clinical breast

colorectal screening

colorectal screening if noteligible for Medicare

GUARANTEED COVERAGE

Medicare: Disabled or age 65 and older or people under age 65 with certain disabilities, and

kidney failure requiring dialysis or a kidney transplant).

DE Screening: 65+ if not eligible for Medicare

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium

COBRA, HIPAA: Premiums range from 102%-150% of group health

column

variesNo premium no co-pay No premium no co-pay $10 to $25 monthly premium

and no co-pays depending on income. For every 3 months you pay in advance, you get the 4th month free.

$0 or share of cost $0 and share of cost for

certain plans



Monthly Cost

Delaware

www.coverageforall.org 16 Delaware

Dem

ogra


emographic






Parents and children Children Adults Seniors and

Disabled



Prog

ram


800-234-1317

Group Health

of Health Underwriters 703-276-0220

www.nahu.org

COBRA


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

Medicaid302-255-9500 800-372-2022

www.dhss.delaware.gov/dhss/

Children and Families First

800-734-2388www.c"de.org

Delaware Healthy Children Program

800-996-9969www.dhss.delaware.gov/dhss/

Delaware Screening for Life

800-464-4357www.state.de.us/dhss/dph/

dpc/s$.html


www.medicare.gov


Program800-633-4227

ELDER Info800-336-9500



877-222-8387www.va.gov

Program

Cove

rage







premium



medical needs

There are no restrictions on

conditions


Doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health and substance abuse services, X-rays, home health care,hospice care, dental care (up toage 21)


Special medical foster care, resource mothers program, counseling, education and more

Well-baby and well-child checkups, drug/alcohol abuse treatment, speech/hearing therapy, immunizations physical therapy, eye

prescription drugs, hospital care, physician services, X-rays, lab work, assistive technology, mental health counseling, limited home health and nursing care, case management and coordination, hospice care, and comprehensive dental service


cancer, pap tests, colorectal cancer screening tests recommended by your doctor, health education, help with coordinating associated care



Insurance and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also o"ers a prescription drug progam called Medicare Part D

ELDER Info is a Medicare counseling service that educates and assists Medicarebene!ciaries, those eligible forMedicare, and caregivers aboutMedicare, Medicaid, Medigap,prescription drug bene!ts, andother issues related to healthinsurance bene!ts.








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE



HIPAA:




underwriting

GUARANTEED COVERAGE


Parents: 117% FPL

parents: 100% FPL (also aged, blind and disabled)


U.S. citizens or quali!ed legal residents

GUARANTEED COVERAGE

Low income in need of services

GUARANTEED COVERAGE

not have other comprehensive

U.S. citizen or quali!ed non-

of a permanent State employee

Waiting period may apply

GUARANTEED COVERAGE


and not eligible for Medicare or Medicaid

Underinsured: High, unmet

does not cover Pap tests, mammograms or colorectal screenings

with an abnormal clinical breast

colorectal screening

colorectal screening if noteligible for Medicare

GUARANTEED COVERAGE


kidney failure requiring dialysis or a kidney transplant).

DE Screening: 65+ if not eligible for Medicare

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos



full premium


column

variesNo premium no co-pay No premium no co-pay $10 to $25 monthly premium

and no co-pays depending on income. For every 3 months you pay in advance, you get the 4th month free.

$0 or share of cost $0 and share of cost for

certain plans



Monthly Cost

17 800.234.1317

Dem

ogra


emographic



health plan





Children Women Seniors and Disabled



Prog

ram


800-234-1317

Group Health

Underwriterswww.fahu.org

COBRA and Mini-COBRA


www.dol.gov


800-234-1317

Individual Plans


Cover Florida

877-693-5236850-413-3089 (out of state)

www.cover$oridahealthcare.com


www.fdhc.state.$.us/Medicaid

Florida KidCareMediKids, Healthy Kids,

and Medicaid888-540-5437

877-316-8748 TTD www.$oridakidcare.org


800-227-2345www.doh.state.$.us/Family/bcc

Medicare



Program800-633-4227


866-628-4282


877-222-8387www.va.gov

Program

Cove

rage

assorted deductibles




COBRA or Mini-COBRA: available for 18 months depending on qualifying events, bene!ts are the same as what you had with your previous employer


premium



medical needs


traditional individual market health insurance products in Florida

not be considered for


27 creative health insurance

least two bene!t options – one with catastrophic and hospital coverage, and one without. Bene!ts include preventive services, screenings, o#ce visits, as well as o#ce surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.


ambulatory surgical center birth center services, child health check up chiropractic care, durable medical equipment and supplies, federally quali!ed health centers, home health hospital inpatient/outpatient care, laboratory, licensed midwives, physician, podiatry prescriptions, rural health clinics, therapy, X-rays


insurance coverage

Bene!ts vary based on the segment of the program in which a child participates—MediKids, Healthy Kids, or the

with special health care needs


Breast and cervical

(mammograms, pap smears

are provided as necessary case management is provided to all clients

and professional education is provided

Treatment for eligible women may be paid by Medicaid


B: Medical Insurance, as well as several supplemental and advantage plans


if employer contributes less than 50% (or spouses’ employer)




Pre-Existing Health Conditions Covered Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


Groups of one have open enrollment during limited times during the year

GUARANTEED COVERAGE



for business with under 20 employees

HIPAA:

had 18 months of continuous coverage and your company went out of business, you may

plan, even if you have pre-

days from the date you lost your previous coverage to sign up for


underwriting


GUARANTEED COVERAGE

without health insurance for

conditions. May also qualify if

employer-sponsored health bene!ts, lost of bene!ts under

from, a spouse who has provided employer-sponsored health bene!ts.

GUARANTEED COVERAGE

Pregnant Women: 185% FPL


Working Parents: 62% FPL Non-Working Parents: 23% FPL

Medically Needy: 25% FPL, there is an asset limit $5,000+ depending on family size

No asset or resource requirements for children or pregnant mothers

Florida resident

GUARANTEED COVERAGE

Under age 19 and uninsured

Have an income at or below 200% of the FPL

Be a U.S. citizen or quali!ed non-citizen

Not be the dependent of a state employee eligible for health insurance and not in a public institution

GUARANTEED COVERAGE

Uninsured and underinsured women 50 to 64 years of age, at or below 200% of FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE


completed 24 continuous months of service

Eligibility

Mon

thly

Cos

t

contribution and ± 15% of the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium



variesPremiums vary depending on the applicant’s age, gender and chosen bene!t options.

$0 or $1-3 co-pays, and coinsurance is limited to 5% up to $300 for each visit to the

No cost for pregnant women, children and certain others

Premium is based on household size and monthly income. Most families pay either $15 or $20 per family per

more. There may be co-payments required based on the service provided


certain plans



Monthly Cost

Florida


Dem

ogra


emographic



health plan








Prog

ram


800-234-1317

Group Health




www.dol.gov


800-234-1317

Individual Plans


Cover Florida

877-693-5236850-413-3089 (out of state)

www.cover$oridahealthcare.com


www.fdhc.state.$.us/Medicaid

Florida KidCareMediKids, Healthy Kids,

and Medicaid888-540-5437

877-316-8748 TTD www.$oridakidcare.org


800-227-2345www.doh.state.$.us/Family/bcc

Medicare



Program800-633-4227


866-628-4282


877-222-8387www.va.gov

Program

Cove

rage





COBRA or Mini-COBRA: available for 18 months depending on qualifying events, bene!ts are the same as what you had with your previous employer


premium



medical needs


traditional individual market health insurance products in Florida

not be considered for


27 creative health insurance

least two bene!t options – one with catastrophic and hospital coverage, and one without. Bene!ts include preventive services, screenings, o#ce visits, as well as o#ce surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.


ambulatory surgical center birth center services, child health check up chiropractic care, durable medical equipment and supplies, federally quali!ed health centers, home health hospital inpatient/outpatient care, laboratory, licensed midwives, physician, podiatry prescriptions, rural health clinics, therapy, X-rays


insurance coverage

Bene!ts vary based on the segment of the program in which a child participates—MediKids, Healthy Kids, or the

with special health care needs


Breast and cervical

(mammograms, pap smears

are provided as necessary case management is provided to all clients

and professional education is provided

Treatment for eligible women may be paid by Medicaid




if employer contributes less than 50% (or spouses’ employer)





Elig

ibili

ty

GUARANTEED COVERAGE


employee


Groups of one have open enrollment during limited times during the year

GUARANTEED COVERAGE



for business with under 20 employees

HIPAA:





underwriting


GUARANTEED COVERAGE

without health insurance for

conditions. May also qualify if

employer-sponsored health bene!ts, lost of bene!ts under

from, a spouse who has provided employer-sponsored health bene!ts.

GUARANTEED COVERAGE



Working Parents: 62% FPL Non-Working Parents: 23% FPL

Medically Needy: 25% FPL, there is an asset limit $5,000+ depending on family size

No asset or resource requirements for children or pregnant mothers

Florida resident

GUARANTEED COVERAGE

Under age 19 and uninsured

Have an income at or below 200% of the FPL

Be a U.S. citizen or quali!ed non-citizen

Not be the dependent of a state employee eligible for health insurance and not in a public institution

GUARANTEED COVERAGE

Uninsured and underinsured women 50 to 64 years of age, at or below 200% of FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium



variesPremiums vary depending on the applicant’s age, gender and chosen bene!t options.

$0 or $1-3 co-pays, and coinsurance is limited to 5% up to $300 for each visit to the

No cost for pregnant women, children and certain others

Premium is based on household size and monthly income. Most families pay either $15 or $20 per family per

more. There may be co-payments required based on the service provided


certain plans



Monthly Cost

Florida

19 800.234.1317

Dem

ogra

phic

PRIVATE HEALTH INSURANCE PUBLICLY SPONSORED PROGRAMS Dem

ographic



health plan



medically needyChildren

Infants and children with

developmental delays

Women Seniors and Disabled



Prog

ram


800-234-1317

Group Health

Health Underwriters703-276-0220

www.gahu.org

COBRA

Then convert to

HIPAA (Health Insurance Portability &

www.dol.gov

or

State Conversion Policies


800-234-1317

Individual Plans

Underwriters703-276-0220

www.gahu.org

Medicaid866-211-0950770-570-3373

http://dch.georgia.gov/00/channel_

PeachCare for Kids

877-427-3224www.peachcare.org

Women-Infants-Children (WIC)

404-657-2900800-228-9173

www.health.state.ga.us/

Babies Can’t Wait404-657-2726888-651-8224

www.babiescantwaitcentralga.org

Georgia Cancer Screening Program

404-657-6611 www.georgiacancer.org

Babies Born Healthy404-657-3147

www.health.state.ga.us/programs/perinatal

Medicare



Program800-633-4227

Georgia Cares800-669-8387


866-628-4282



Cove

rage

depending upon the type of





premium



Depends on plan

Plans are required by state to o"er certain bene!ts such as mammograms, childhood immunizations and automatic coverage for newborns or adopted children


Medical, dental and vision, prescriptions, hospitalization and more depending on program


PeachCare for Kids: Doctor visits, check-ups, immunizations, preventive care specialist care, dental care, vision care, hospitalization, emergency room services, prescriptions, and mental health care

WIC: Nutrition assessment, health screening, medical history, body measurement (weight and height), hemoglobin check, nutrition education, breast-feeding support and education, and vouchers for food supplements


primary care, outpatient and in-patient services


Georgia Cancer Screening Program:

pap tests if you’re older than40 years old. If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Medicaid

Babies Born Healthy:

prenatal services as early as possible in their pregnancy




Georgia Cares is a Medicare counseling service








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee

Proprietor name on license must draw wages

GUARANTEED COVERAGE



HIPAA:



Must be a Georgia resident

underwriting

There is a 12 month look back period during !rst two years of coverage. If condition is

period.

Must be resident of state or documented immigrant

GUARANTEED COVERAGE

Pregnant women at or below 200% FPL

Working parents up to 52% FPL

Non-working parents up to 29% FPL

Medically needy individual up to 35% FPL

Medically needy couple up to 41% FPL

Georgia resident or documented immigrant

GUARANTEED COVERAGE

PeachCare for Kids: Low income children up to age 19 under

citizens, certain quali!ed legal residents, refugees or asylees who reside in Georgia

WIC: Pregnant or postpartum women and children up to the age of 5 years with a family income at or below 185% of the

and be at nutritional or medical risk, as determined by a health professional.

GUARANTEED COVERAGE

Babies Can’t Wait: Generallychildren may qualify if they arevery far behind in learning tomove, talk or use their hands

eligible if they are diagnosedwith certain physical andmental conditions.

their third birthday

GUARANTEED COVERAGE

Georgia Cancer Screening Program: Must be Georgia resident and have legal immigration status For mammograms must be between 40 and 64 years of age

For cervical screening must be between 18 and 64 years of age

Must be uninsured or underinsured, ineligible for Medicaid with income under 200% of FPL

Babies Born Healthy: Pregnant women and newborns with a family income at or below

eligible for Medicaid.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium



Various price ranges depending on deductible and what plan you buy.

$0 or minimal share-of-cost PeachCare for Kids: $0 for children under age 6, $10-35

two or more children

WIC: $0 or minimal share-of-cost

$0 or share-of-cost and co-pays depending on income level

Georgia Cancer Screening Program: $0

Babies Born Healthy: $0 or minimal share-of-cost


certain plans



Monthly Cost

Georgia


Dem

ogra

phic


ographic



health plan




Infants and children with

developmental delays

Women Seniors and Disabled



Prog

ram


800-234-1317

Group Health


www.gahu.org

COBRA

Then convert to


www.dol.gov

or



800-234-1317

Individual Plans


www.gahu.org

Medicaid866-211-0950770-570-3373

http://dch.georgia.gov/00/channel_

PeachCare for Kids

877-427-3224www.peachcare.org

Women-Infants-Children (WIC)

404-657-2900800-228-9173

www.health.state.ga.us/

Babies Can’t Wait404-657-2726888-651-8224

www.babiescantwaitcentralga.org

Georgia Cancer Screening Program

404-657-6611 www.georgiacancer.org

Babies Born Healthy404-657-3147

www.health.state.ga.us/programs/perinatal

Medicare



Program800-633-4227

Georgia Cares800-669-8387


866-628-4282



Cove

rage






premium



Depends on plan





PeachCare for Kids: Doctor visits, check-ups, immunizations, preventive care specialist care, dental care, vision care, hospitalization, emergency room services, prescriptions, and mental health care

WIC: Nutrition assessment, health screening, medical history, body measurement (weight and height), hemoglobin check, nutrition education, breast-feeding support and education, and vouchers for food supplements


primary care, outpatient and in-patient services


Georgia Cancer Screening Program:

pap tests if you’re older than40 years old. If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Medicaid

Babies Born Healthy:

prenatal services as early as possible in their pregnancy




Georgia Cares is a Medicare counseling service








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Georgia resident

underwriting


period.


GUARANTEED COVERAGE

Pregnant women at or below 200% FPL



Medically needy individual up to 35% FPL

Medically needy couple up to 41% FPL

Georgia resident or documented immigrant

GUARANTEED COVERAGE

PeachCare for Kids: Low income children up to age 19 under

citizens, certain quali!ed legal residents, refugees or asylees who reside in Georgia



GUARANTEED COVERAGE

Babies Can’t Wait: Generallychildren may qualify if they arevery far behind in learning tomove, talk or use their hands

eligible if they are diagnosedwith certain physical andmental conditions.

their third birthday

GUARANTEED COVERAGE

Georgia Cancer Screening Program: Must be Georgia resident and have legal immigration status For mammograms must be between 40 and 64 years of age

For cervical screening must be between 18 and 64 years of age

Must be uninsured or underinsured, ineligible for Medicaid with income under 200% of FPL

Babies Born Healthy: Pregnant women and newborns with a family income at or below

eligible for Medicaid.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium




$0 or minimal share-of-cost PeachCare for Kids: $0 for children under age 6, $10-35

two or more children


$0 or share-of-cost and co-pays depending on income level

Georgia Cancer Screening Program: $0

Babies Born Healthy: $0 or minimal share-of-cost


certain plans



Monthly Cost

Georgia

21 800.234.1317

Dem

ogra


emographic



health plan



familiesChildren Women

Adults with substance abuse

problems




Prog

ram


800-234-1317

Group Health


COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Plans


Medicaid800-316-8005808-524-3370

www.med-quest.us

HMSA Children's Plan

Hawaii's Medical

800-620-4672www.coveringkids.com

Breast and Cervical Cancer Program

808-692-7460http://healthuser.hawaii.gov/

health/family-child-health/

html

Department of Health Alcohol and

Drug Abuse Division808-692-7506

www.hawaii.gov/health/substance-abuse/

Medicare



Program800-633-4227

Sage Plus888-875-9229


866-628-4282



Cove

rage

Hawaii does not have a statute that de!nes the size of their small group market. Most carriers de!ne it as 1-50 however some use the de!nition of 1-100

Individuals who attempt to obtain coverage as a business group of one must satisfy criteria set by the carrier




premium



applicant needs and plan selected


Depending on program, inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing services,

pediatric and family nurse practitioner services, nurse-midwife services and more


Basic care, preventive care, immunizations, doctor visits


test, follow-up diagnostic care for abnormal results

services to meet the treatment and recovery needs of individuals and families

Inpatient and out-patient programs




Sage is a Medicare counseling and application service








Coverage

Elig

ibili

ty

employee, proprietor-name on license must draw wages

to o"er coverage to most employees who work 20 hours per week

GUARANTEED COVERAGE



HIPAA:



Must be a Hawaii resident

look-back and a 12-month

GUARANTEED COVERAGE

HI resident and legal citizen or quali!ed immigrant


Parents or the blind, aged or disabled: 100% FPL

qualify for free health insurance

Family: between 250-300% FPL qualify for low cost.

Medically needy: 51% FPL

household of one, $3,000 for ahousehold of two

$250 per additional person

individuals under age 19, or to pregnant women for the duration of the pregnancy plus 60 days

GUARANTEED COVERAGE

national, lawful permanent

refugee, or citizen of the Marshall Islands, Federated States of Micronesia, or Palau

Must be ineligble for Medicaid

GUARANTEED COVERAGE

at or below 250% of the federal

under-insured

GUARANTEED COVERAGE

Treatment services have, as a requirement, priority admission for pregnant women and

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and rates must be approved by the state Department of Insurance


full premium



Various price ranges depending on deductible and what plan you buy

$0, minimal share of cost

between $15-60 per child per month

$55 per month $0 $0 depending on which program you choose.

$0 and share of cost for certain

plans

20% of the insurance premium $0 and share of cost and co-pays depending on income level

Monthly Cost

Hawaii


Dem

ogra


emographic



health plan




Adults with substance abuse

problems




Prog

ram


800-234-1317

Group Health


COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Plans


Medicaid800-316-8005808-524-3370

www.med-quest.us

HMSA Children's Plan

Hawaii's Medical

800-620-4672www.coveringkids.com

Breast and Cervical Cancer Program

808-692-7460http://healthuser.hawaii.gov/

health/family-child-health/

html

Department of Health Alcohol and

Drug Abuse Division808-692-7506

www.hawaii.gov/health/substance-abuse/

Medicare



Program800-633-4227

Sage Plus888-875-9229


866-628-4282



Cove

rage

Hawaii does not have a statute that de!nes the size of their small group market. Most carriers de!ne it as 1-50 however some use the de!nition of 1-100

Individuals who attempt to obtain coverage as a business group of one must satisfy criteria set by the carrier




premium





Depending on program, inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing services,

pediatric and family nurse practitioner services, nurse-midwife services and more


Basic care, preventive care, immunizations, doctor visits


test, follow-up diagnostic care for abnormal results

services to meet the treatment and recovery needs of individuals and families

Inpatient and out-patient programs




Sage is a Medicare counseling and application service








Coverage

Elig

ibili

ty


to o"er coverage to most employees who work 20 hours per week

GUARANTEED COVERAGE



HIPAA:



Must be a Hawaii resident


GUARANTEED COVERAGE

HI resident and legal citizen or quali!ed immigrant


Parents or the blind, aged or disabled: 100% FPL

qualify for free health insurance

Family: between 250-300% FPL qualify for low cost.

Medically needy: 51% FPL

household of one, $3,000 for ahousehold of two

$250 per additional person

individuals under age 19, or to pregnant women for the duration of the pregnancy plus 60 days

GUARANTEED COVERAGE

national, lawful permanent

refugee, or citizen of the Marshall Islands, Federated States of Micronesia, or Palau

Must be ineligble for Medicaid

GUARANTEED COVERAGE

at or below 250% of the federal

under-insured

GUARANTEED COVERAGE

Treatment services have, as a requirement, priority admission for pregnant women and

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and rates must be approved by the state Department of Insurance


full premium




$0, minimal share of cost

between $15-60 per child per month

$55 per month $0 $0 depending on which program you choose.

$0 and share of cost for certain

plans

20% of the insurance premium $0 and share of cost and co-pays depending on income level

Monthly Cost

Hawaii

23 800.234.1317

Dem

ogra

phic


ographic







Low-income individuals and



status



(TAA recipients)

Prog

ram


800-234-1317

Group HealthUnderwriters703-276-0220www.iahu.org

AHI866-326-2485

www.accesstohealthinsurance.idaho.gov

COBRA

Conversion Plans

Then


www.dol.gov


Individual PlansUnderwriters703-276-0220www.iahu.org

HRP

208-334-4250800-721-3272

www.doi.idaho.gov

Medicaid800-926-2588866-326-2485

TDD 208-332-7205www.healthandwelfare.

idaho.gov

welfare agency

Children’s Access Card

800-926-2588www.idahohealth.org

Women’s Health Check

800-926-2588www.healthandwelfare.

idaho.gov

Emergency Medicaid800-926-2588

TDD 208-332-7205866-326-2485

welfare agency


www.medicare.gov


Program800-633-4227

Health Coverage Tax Credit866-628-4282 Program

Cove

rage




program that makes health insurance more a"ordable for employees of quali!ed small businesses


COBRA: up to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer


premium



Up to $5M, assorted deductibles depending on age and ZIP code


plans cover the same health bene!ts but cost sharing varies.

plans. This standardization of bene!ts will help you compare the cost of coverage from

cover hospital and physician services, preventive care, maternity care, prescription drugs, and limited mental health and substance abuse treatment.


Four plans to choose from: Medicaid Standard Plan, Medicaid Basic Plan, Medicaid

the Medicare-Medicaid

and prescription coverage

Treatment for special health problems like breast cancer, kidney problems, nursing


Medical services, Dental, Mental health services, Vision, Pharmacy, Hearing, Hospitalization, and more


consecutive normal Pap tests,

cover one Pap test every three years

Diagnostic Services, if needed

emergencies, pregnancy-related care (prenatal and delivery), kidney dialysis, treatment for breast and cervical cancer









Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:





GUARANTEED COVERAGE

First, if you applied for individual health insurance and were turned down due to your health status or claims history, that insurer must o"er you the

Second, if an individual health insurer o"ered to sell you a policy at a surcharged premium, that insurer must o"er you the option to buy a

policy from any approved insurer in Idaho

You are also eligible to apply

within 90 days and if the lifetime

GUARANTEED COVERAGE

or below 133% of the FPL (co-payments vary depending on the families qualifying income)



Must be a U.S. citizen or legal non-citizen

GUARANTEED COVERAGE

Between 133-185% FPL


GUARANTEED COVERAGE

Women without health insurance that covers

Pap test in 5 years or longer or

eligible for Medicare, or does not have Medicare Part B


FPL


Non-Working Parents: 24% FPL

Working Parents: 31% FPL


U.S. citizenship not required

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium


varies region and program.$0 or minimal share of cost $0 or share of cost $0 or minimal share of cost $0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Idaho


Dem

ogra

phic


ographic







Low-income individuals and



status



(TAA recipients)

Prog

ram


800-234-1317

Group HealthUnderwriters703-276-0220www.iahu.org

AHI866-326-2485

www.accesstohealthinsurance.idaho.gov

COBRA

Conversion Plans

Then


www.dol.gov


Individual PlansUnderwriters703-276-0220www.iahu.org

HRP

208-334-4250800-721-3272

www.doi.idaho.gov

Medicaid800-926-2588866-326-2485

TDD 208-332-7205www.healthandwelfare.

idaho.gov

welfare agency

Children’s Access Card

800-926-2588www.idahohealth.org

Women’s Health Check

800-926-2588www.healthandwelfare.

idaho.gov


TDD 208-332-7205866-326-2485

welfare agency


www.medicare.gov


Program800-633-4227

Health Coverage Tax Credit866-628-4282 Program

Cove

rage




program that makes health insurance more a"ordable for employees of quali!ed small businesses




premium





plans cover the same health bene!ts but cost sharing varies.

plans. This standardization of bene!ts will help you compare the cost of coverage from

cover hospital and physician services, preventive care, maternity care, prescription drugs, and limited mental health and substance abuse treatment.


Four plans to choose from: Medicaid Standard Plan, Medicaid Basic Plan, Medicaid

the Medicare-Medicaid




Medical services, Dental, Mental health services, Vision, Pharmacy, Hearing, Hospitalization, and more


consecutive normal Pap tests,

cover one Pap test every three years

Diagnostic Services, if needed

emergencies, pregnancy-related care (prenatal and delivery), kidney dialysis, treatment for breast and cervical cancer









Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:





GUARANTEED COVERAGE

First, if you applied for individual health insurance and were turned down due to your health status or claims history, that insurer must o"er you the

Second, if an individual health insurer o"ered to sell you a policy at a surcharged premium, that insurer must o"er you the option to buy a

policy from any approved insurer in Idaho

You are also eligible to apply

within 90 days and if the lifetime

GUARANTEED COVERAGE

or below 133% of the FPL (co-payments vary depending on the families qualifying income)



Must be a U.S. citizen or legal non-citizen

GUARANTEED COVERAGE

Between 133-185% FPL


GUARANTEED COVERAGE

Women without health insurance that covers

Pap test in 5 years or longer or

eligible for Medicare, or does not have Medicare Part B


FPL





U.S. citizenship not required

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium


varies region and program.$0 or minimal share of cost $0 or share of cost $0 or minimal share of cost $0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Idaho

25 800.234.1317

Dem

ogra

phic


ographic



health plan




Low income families and individuals



(TAA recipients) Veterans

Prog

ram


800-234-1317

Group Healthwww.dol.gov/ebsa

866-444-3272

Illinois Association of Health


www.nahu.orgwww.isahu.com

COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Planswww.healthinsuranceinfo.net




CHIP

Health Insurance Plan)Main Number: 217-782-6333

General Information: 800-962-8384

851-2751800-545-2455 (TTY)www.chip.state.il.us


www.health.illinois.govwww.dhs.state.il.us

FamilyCare866-255-5437

www.familycareillinois.com

ALL Kids

866-255-5437www.allkids.com

Breast and Cervical Cancer ProgramIL Department of Public

Health’s Health-Line888-522-1282

www.cancerscreening.illinois.gov

Healthy Women800-226-0768

www.illinoishealthywomen.com

Medicare



Program800-633-4227

Illinois Cares Rx800-633-4227


866-628-4282


877-222-8387www.va.gov

Program

Cove

rage


conditions, (6-12 months respectively) will apply


Pre-Existing Health Conditions Covered with Some Limitations



premium



items, however Illinois does not require standardization.

carrier, but most o"er plans


Inpatient and outpatient care, doctor visits, surgery, preventive care, diagnostic care

skilled nursing care, hospice, transplant coverage, speech, physical and occupational therapy, mental health and chemical dependency, separate prescription drug card

You can now choose High Deductible Health Plans

number to !nd out more information on how to change to a HDHP.


Medicaid: Di"erent program variations covering medical, dental and vision, prescriptions, hospitalization and more depending on program. Programs for people with either MS, nursing home needs, kidney dialysis, breast and

alimentation, pregnancy

FamilyCare:visits, dental care, specialty medical services, hospital care, emergency services, prescription drugs and more


Doctor visits, hospital stays, prescription drugs, vision care, dental care and eyeglasses, covers regular checkups and immunization shots, special services like medical equipment, speech therapy and physical therapy for children who need them


BCCP:

Pap tests to eligible women

Healthy Women: planning (birth control) andcertain services provided at thefamily planning visit, such as

lab tests for family planning,testing and medicine for

found during a family planningvisit, and sterilization. IllinoisHealthy Women also coversmammograms, multivitaminsand folic acid if they areordered by the doctor duringthe family planning visit


Medicare:

Insurance and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also o"ers a prescription drug coverage program called Medicare Part D

Illinois Cares Rx: Provides state prescription drug assistance to people with and without Medicare








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:



Must be an Illinois resident

underwriting


period.



column

GUARANTEED COVERAGE


or government programs (must

Must prove denial of coverage or o"er of higher premium

Illinois resident

GUARANTEED COVERAGE

Medicaid: 133% FPL. Pregnant Women and Infants: 200% of the FPL if the mother is enrolled in Medicaid at the time of birth. If not, infants with family incomes of 133% FPL


SSI recipients: 40% FPLMedically Needy Individual: 40%

FamilyCare:coverage to parents living with their children 18 years old or

relatives who are caring for children in place of their parents. Must live in Illinois and have income up to 200% FPL, Must be U.S. citizens or meet immigration requirements

GUARANTEED COVERAGE

Illinois resident, 18 and under, uninsured for 12 months to be eligible regardless of income

If already insured, income limit

FPL.

GUARANTEED COVERAGE

BCCP: Illinois resident and documented immigrant For mammograms must be between 40 and 64 years of age

For pelvic and pap test must be between 35 and 64 years of age

May not have other health insurance and income under 200% of FPL

If Medicaid eligible you are not

Healthy Women: If you have lostregular medical bene!ts fromthe Illinois Department ofHealthcare and Family Services(HFS), if you are between 19-44,if you are a U.S. citizen or legalpermanent resident with aSocial Security number and ifyou live in Illinois, and are at200% FPL

GUARANTEED COVERAGE

Medicare: Disabled or age 65 and older or people under age 65 with certain disabilities, and people of all ages with

(permanent kidney failure requiring dialysis or a kidney transplant)

Illinois Cares Rx: Individuals with Medicare, people age 65 and older or people under age 65 with certain disabilities are

Income limits apply for certain groups

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium

COBRA & HIPAA: Premiums range from 102%-150% of


Various price ranges depending on deductible and what you buy.

rates charged individuals for

coverage by 5 or more of the largest insurance companies in the individual health insurance market.

Medicaid: $0 or minimal share of cost

FamilyCare: Small co-pays from $2 to $3 for doctor visits and prescriptions. Parents in

monthly premium from $15 to $40 depending on the number of family members covered

Monthly premium based on number of children in family, plus co-pay for each service with $100 limit

$0 Medicare: $0 and share of cost

for certain plans

Illinois Cares Rx: depending on whether applicant has Medicare or not



Monthly Cost

Illinois


Dem

ogra

phic


ographic



health plan








Prog

ram


800-234-1317

Group Healthwww.dol.gov/ebsa

866-444-3272




COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Planswww.healthinsuranceinfo.net




CHIP

Health Insurance Plan)Main Number: 217-782-6333

General Information: 800-962-8384

851-2751800-545-2455 (TTY)www.chip.state.il.us


www.health.illinois.govwww.dhs.state.il.us

FamilyCare866-255-5437

www.familycareillinois.com

ALL Kids

866-255-5437www.allkids.com

Breast and Cervical Cancer ProgramIL Department of Public

Health’s Health-Line888-522-1282

www.cancerscreening.illinois.gov

Healthy Women800-226-0768

www.illinoishealthywomen.com

Medicare



Program800-633-4227

Illinois Cares Rx800-633-4227


866-628-4282


877-222-8387www.va.gov

Program

Cove

rage


conditions, (6-12 months respectively) will apply





premium



items, however Illinois does not require standardization.



Inpatient and outpatient care, doctor visits, surgery, preventive care, diagnostic care

skilled nursing care, hospice, transplant coverage, speech, physical and occupational therapy, mental health and chemical dependency, separate prescription drug card

You can now choose High Deductible Health Plans

number to !nd out more information on how to change to a HDHP.


Medicaid: Di"erent program variations covering medical, dental and vision, prescriptions, hospitalization and more depending on program. Programs for people with either MS, nursing home needs, kidney dialysis, breast and


FamilyCare:visits, dental care, specialty medical services, hospital care, emergency services, prescription drugs and more


Doctor visits, hospital stays, prescription drugs, vision care, dental care and eyeglasses, covers regular checkups and immunization shots, special services like medical equipment, speech therapy and physical therapy for children who need them


BCCP:

Pap tests to eligible women

Healthy Women: planning (birth control) andcertain services provided at thefamily planning visit, such as

lab tests for family planning,testing and medicine for

found during a family planningvisit, and sterilization. IllinoisHealthy Women also coversmammograms, multivitaminsand folic acid if they areordered by the doctor duringthe family planning visit


Medicare:


Illinois Cares Rx: Provides state prescription drug assistance to people with and without Medicare








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:



Must be an Illinois resident

underwriting


period.



column

GUARANTEED COVERAGE



Must prove denial of coverage or o"er of higher premium

Illinois resident

GUARANTEED COVERAGE

Medicaid: 133% FPL. Pregnant Women and Infants: 200% of the FPL if the mother is enrolled in Medicaid at the time of birth. If not, infants with family incomes of 133% FPL


SSI recipients: 40% FPLMedically Needy Individual: 40%

FamilyCare:coverage to parents living with their children 18 years old or

relatives who are caring for children in place of their parents. Must live in Illinois and have income up to 200% FPL, Must be U.S. citizens or meet immigration requirements

GUARANTEED COVERAGE

Illinois resident, 18 and under, uninsured for 12 months to be eligible regardless of income

If already insured, income limit

FPL.

GUARANTEED COVERAGE

BCCP: Illinois resident and documented immigrant For mammograms must be between 40 and 64 years of age



If Medicaid eligible you are not

Healthy Women: If you have lostregular medical bene!ts fromthe Illinois Department ofHealthcare and Family Services(HFS), if you are between 19-44,if you are a U.S. citizen or legalpermanent resident with aSocial Security number and ifyou live in Illinois, and are at200% FPL

GUARANTEED COVERAGE



Illinois Cares Rx: Individuals with Medicare, people age 65 and older or people under age 65 with certain disabilities are

Income limits apply for certain groups

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium



Various price ranges depending on deductible and what you buy.

rates charged individuals for

coverage by 5 or more of the largest insurance companies in the individual health insurance market.

Medicaid: $0 or minimal share of cost

FamilyCare: Small co-pays from $2 to $3 for doctor visits and prescriptions. Parents in

monthly premium from $15 to $40 depending on the number of family members covered

Monthly premium based on number of children in family, plus co-pay for each service with $100 limit

$0 Medicare: $0 and share of cost

for certain plans

Illinois Cares Rx: depending on whether applicant has Medicare or not



Monthly Cost

Illinois

27 800.234.1317

Dem

ogra


emographic



health plan





Children with chronic medical

conditions

Pregnant women, children Women Adults Seniors and

Disabled

Prog

ram


800-234-1317

Group Health


www.nahu.orgwww.inahu.org

COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Plans



ICHIA

800-552-7921317-614-2133

www.ichia.org

Medicaid(Indiana Family and Social

800-889-9949www.in.gov/fssa

Children’s Special Health Care Services

800-475-1355www.in.gov/isdh/19613.htm

Hoosier Healthwise800-889-9949

www.in.gov/fssa/ompp/2544.htm

Indiana Breast and Cervical Cancer Early Detection Program

800-433-0746317-233-7405

www.in.gov/isdh/19851.htm

Healthy Indiana Plan

877-438-4479800-403-0864

www.in.gov/fssa/hip/

(Healthy Indiana Plan stillhas room for adults who

have children in their homes,but it has started putting

waiting list for the program)

Medicare



Program800-633-4227

Program

Cove

rage


Sometimes coverage is limited

and some plans have no limit

These factors a"ect the monthly premium and deductible






premium



items, however Indiana does not require standardization



inpatient hospital services, mental illness /substance abuse, prescription drugs, professional services, skilledhome health care, skilled nursing facility, surgical

Four annual deductible options $500, $100, $1500, or $2500

20% co-pay Preferred Provider

preferred provider network

Ineligible for Medicaid

dependents also available


Di"erent program variations covering medical, dental and vision, prescriptions, hospitalization and more depending on program

Programs for people with either MS, nursing home needs, kidney dialysis, breast and



Treatment for chronic medical conditions such as severe asthma, autism, cerebral palsy, arthritis, congenital heart disease, cystic !brosis, chromosomal disorders, renal disease seizures and more

Diagnostic evaluations,comprehensive well child andsick child care, specialty careand other services related tothe eligible medical conditions,immunizations, prescriptiondrugs, routine dental care,community referrals andinformation


Hoosier Healthwise is a healthinsurance program for Indianachildren, pregnant women, andlow-income families

up to age 1, care for mother up to 60 days

Families get check-ups, doctor visits, hospital care, dental and more


and pap tests for eligiblewomen, as well as diagnostictesting for women whosescreening outcome is abnormal

Screening, diagnostics, consultations and treatment


Services include: physician services, prescriptions,

health services, outpatient hospital, inpatient hospital, hospice, preventive services, family planning, and case and

health coverage, substance abuse treatment, inpatient, outpatient, and drugs





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be an Indiana resident

underwriting


period.



GUARANTEED COVERAGE

Must be considered




GUARANTEED COVERAGE

Under 100% FPL with assets less than $3K for one person (after

Parents of children living in

age 18

within three months (certain

Indiana resident or documented immigrant

GUARANTEED COVERAGE

Family income at or below 250% FPL

Severe chronic illnesses that have lasted or will last two years or conditions that require special devices or would produce disabling physical conditions if untreated

also apply for Medicaid

GUARANTEED COVERAGE

Income at or below 250% FPL

with a caretaker

No residency requirements for Medicaid

GUARANTEED COVERAGE

Must be Indiana resident and have legal immigration status For mammograms must be between 40 and 64 years of age



65 and older not enrolled in Medicare

GUARANTEED COVERAGE

19-64

Must have a family income at or below 200% of the FPL

Individuals must not have access to employer sponsored health insurance coverage.

Individuals must be uinsured for

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium




Based on the plan you choose, age, gender, and geographic

more than 150% of amount healthy person would pay

$0 or minimal share-of-cost $0 or minimal share-of-cost $0-$50 a month depending on family income and the number of family members covered

$0 2-5% of the families gross income depending on the applicants income.


certain plans

Monthly Cost

Indiana


Dem

ogra


emographic



health plan





Children with chronic medical

conditions

Pregnant women, children Women Adults Seniors and

Disabled

Prog

ram


800-234-1317

Group Health



COBRA

Then convert to


www.dol.gov


800-234-1317

Individual Plans



ICHIA

800-552-7921317-614-2133

www.ichia.org

Medicaid(Indiana Family and Social

800-889-9949www.in.gov/fssa

Children’s Special Health Care Services

800-475-1355www.in.gov/isdh/19613.htm

Hoosier Healthwise800-889-9949

www.in.gov/fssa/ompp/2544.htm

Indiana Breast and Cervical Cancer Early Detection Program

800-433-0746317-233-7405

www.in.gov/isdh/19851.htm

Healthy Indiana Plan

877-438-4479800-403-0864

www.in.gov/fssa/hip/

(Healthy Indiana Plan stillhas room for adults who

have children in their homes,but it has started putting

waiting list for the program)

Medicare



Program800-633-4227

Program

Cove

rage


Sometimes coverage is limited

and some plans have no limit

These factors a"ect the monthly premium and deductible






premium



items, however Indiana does not require standardization



inpatient hospital services, mental illness /substance abuse, prescription drugs, professional services, skilledhome health care, skilled nursing facility, surgical

Four annual deductible options $500, $100, $1500, or $2500

20% co-pay Preferred Provider

preferred provider network

Ineligible for Medicaid

dependents also available


Di"erent program variations covering medical, dental and vision, prescriptions, hospitalization and more depending on program

Programs for people with either MS, nursing home needs, kidney dialysis, breast and



Treatment for chronic medical conditions such as severe asthma, autism, cerebral palsy, arthritis, congenital heart disease, cystic !brosis, chromosomal disorders, renal disease seizures and more

Diagnostic evaluations,comprehensive well child andsick child care, specialty careand other services related tothe eligible medical conditions,immunizations, prescriptiondrugs, routine dental care,community referrals andinformation


Hoosier Healthwise is a healthinsurance program for Indianachildren, pregnant women, andlow-income families

up to age 1, care for mother up to 60 days

Families get check-ups, doctor visits, hospital care, dental and more


and pap tests for eligiblewomen, as well as diagnostictesting for women whosescreening outcome is abnormal

Screening, diagnostics, consultations and treatment


Services include: physician services, prescriptions,

health services, outpatient hospital, inpatient hospital, hospice, preventive services, family planning, and case and

health coverage, substance abuse treatment, inpatient, outpatient, and drugs





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:




underwriting


period.



GUARANTEED COVERAGE

Must be considered




GUARANTEED COVERAGE

Under 100% FPL with assets less than $3K for one person (after

Parents of children living in

age 18

within three months (certain

Indiana resident or documented immigrant

GUARANTEED COVERAGE

Family income at or below 250% FPL

Severe chronic illnesses that have lasted or will last two years or conditions that require special devices or would produce disabling physical conditions if untreated

also apply for Medicaid

GUARANTEED COVERAGE


with a caretaker

No residency requirements for Medicaid

GUARANTEED COVERAGE

Must be Indiana resident and have legal immigration status For mammograms must be between 40 and 64 years of age



65 and older not enrolled in Medicare

GUARANTEED COVERAGE

19-64

Must have a family income at or below 200% of the FPL

Individuals must not have access to employer sponsored health insurance coverage.

Individuals must be uinsured for

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium




Based on the plan you choose, age, gender, and geographic

more than 150% of amount healthy person would pay

$0 or minimal share-of-cost $0 or minimal share-of-cost $0-$50 a month depending on family income and the number of family members covered

$0 2-5% of the families gross income depending on the applicants income.


certain plans

Monthly Cost

Indiana

29 800.234.1317

Dem

ogra


emographic







conditions


Individuals and families with

moderate income


families


status



(TAA recipients)

Prog

ram


800-234-1317

Group Health


www.eiahu.org

COBRA or Mini-COBRA/ Conversion


Premium Payment)888-346-9562

Then convert toHIPAA

(Health Insurance Portability

www.dol.gov


800-234-1317

Individual Plans


www.eiahu.org

HIPIOWA(Health Insurance

Plan of Iowa)877-793-6880

www.hipiowa.com

Medicaid800-338-8366800-972-2017

www.ime.state.ia.us/Members

Department of Human Services

IowaCare800-338-8366515-725-1003


Hawk-i (Healthy and Well

Kids in Iowa)800-257-8563

888-422-2319 TDD




Indian Health Services605-226-7531www.ihs.gov


866-628-4282 Program

Cove

rage





COBRA or Mini-COBRA: available for 18 to 36 months depending on qualifying events, bene!ts are the same as previous employer’s plan


premium






comprehensive preferred provider plans each with a pharmacy bene!t to choose from and a medicare carveout plan


Inpatient and outpatient hospital services, physician services, medical and surgical dental services, nursing facility services for persons aged 21+, family planning services, nurse/midwife services, chiropractors, podiatrists, optometrists, psychologists, dental services, physical therapy, therapies for speech hearing and language disorders, occupational therapy, prescribed drugs, prosthetic devices, vision, mental health, hospice care and more


Inpatient and outpatient hospital, physician or advanced registered nurse practitioner, and dental

Services do not include checkups or pharmaceuticals,

those needed during and immediately following hospital

provided at local hospitals, not

not an entitlement, meaning that it depends on speci!c appropriations


all of his or her health care services through a health plan that has agreed to participate in the program: doctor visits, outpatient hospital services, vaccines and shots (immunizations) emergency care, inpatient hospital services, prescriptions, vision, dental, hospice, speech and physical therapy, nursing care services, chiropractic care mental health/substance abuse

health plans


Up to 3 days of Medicaid is available to pay for the cost of emergency services for aliens who do not meet citizenship, alien status, or social security number requirements. The emergency services must be provided in a facility such as a hospital, clinic, or o#ce that can provide the required care after the emergency medical condition has occurred.








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are eligible for a 65%

Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to

Mini-COBRA: with less than 20 employees

HIPAA: bene!ts or if you had 18 months of continuous coverage and your company went out of business, you

conditions. You have 63 days from the date you lost your previous


underwriting


period.



column

GUARANTEED COVERAGE

insurance coverage within the last nine months or reduction of limitation which substantially reduces bene!ts compared to bene!ts available to others

termination (other than non-payment)

Ineligible for public programs

Iowa residency required

GUARANTEED COVERAGE

Pregnant Women and Infants (ages 0-1): 200% FPL

Working Parents: 82% FPLNon-Working Parents: 33% FPL


Medically Needy Individual: 67% FPL

U.S. citizen and Iowa resident

GUARANTEED COVERAGE

19-64 in households with

percent of the federal poverty level (about $1,600/month for a family of two), who are not eligible for Medicaid, who do not have other health insurance, and who agree to pay a small premium

Pregnant women at or below 300% of the FPL (if their medicial costs can bring their monthly income to 200% of the FPL)

GUARANTEED COVERAGE

Be under 19 years old

Have no other health insurance

Be a citizen of the United States or a quali!ed alien

Family income must be at or below 200% of the FPL

State of Iowa employee

Medicaid cannot get Hawk-i

GUARANTEED COVERAGE






FPL

Service Units to provide health

Indians on reservations located in North Dakota, South Dakota,

nine hospitals, eight health centers, two school health stations, and several smaller health stations and satellite clinics

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and ± 25% of the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for

full premium

COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-150% of group

column


varies average rates charged individuals for comparable

by 5 or more of the largest insurance companies in the individual health insurance market.

$0 or minimal share of cost $1-$3 co-pays and monthly premium

$0 or minimal share of costdepending on your income. Noone pays more than $40

$0 or minimal share of cost $0 or minimal share of cost 20% of the insurance premium M

onthly Cost

Iowa


Dem

ogra


emographic







conditions


Individuals and families with

moderate income


families


status



(TAA recipients)

Prog

ram


800-234-1317

Group Health


www.eiahu.org

COBRA or Mini-COBRA/ Conversion


Premium Payment)888-346-9562



www.dol.gov


800-234-1317

Individual Plans


www.eiahu.org

HIPIOWA(Health Insurance

Plan of Iowa)877-793-6880

www.hipiowa.com

Medicaid800-338-8366800-972-2017



IowaCare800-338-8366515-725-1003


Hawk-i (Healthy and Well

Kids in Iowa)800-257-8563

888-422-2319 TDD






866-628-4282 Program

Cove

rage





COBRA or Mini-COBRA: available for 18 to 36 months depending on qualifying events, bene!ts are the same as previous employer’s plan


premium






comprehensive preferred provider plans each with a pharmacy bene!t to choose from and a medicare carveout plan


Inpatient and outpatient hospital services, physician services, medical and surgical dental services, nursing facility services for persons aged 21+, family planning services, nurse/midwife services, chiropractors, podiatrists, optometrists, psychologists, dental services, physical therapy, therapies for speech hearing and language disorders, occupational therapy, prescribed drugs, prosthetic devices, vision, mental health, hospice care and more


Inpatient and outpatient hospital, physician or advanced registered nurse practitioner, and dental

Services do not include checkups or pharmaceuticals,

those needed during and immediately following hospital

provided at local hospitals, not

not an entitlement, meaning that it depends on speci!c appropriations


all of his or her health care services through a health plan that has agreed to participate in the program: doctor visits, outpatient hospital services, vaccines and shots (immunizations) emergency care, inpatient hospital services, prescriptions, vision, dental, hospice, speech and physical therapy, nursing care services, chiropractic care mental health/substance abuse

health plans


Up to 3 days of Medicaid is available to pay for the cost of emergency services for aliens who do not meet citizenship, alien status, or social security number requirements. The emergency services must be provided in a facility such as a hospital, clinic, or o#ce that can provide the required care after the emergency medical condition has occurred.








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA: bene!ts or if you had 18 months of continuous coverage and your company went out of business, you



underwriting


period.



column

GUARANTEED COVERAGE

insurance coverage within the last nine months or reduction of limitation which substantially reduces bene!ts compared to bene!ts available to others

termination (other than non-payment)

Ineligible for public programs

Iowa residency required

GUARANTEED COVERAGE


Working Parents: 82% FPLNon-Working Parents: 33% FPL



U.S. citizen and Iowa resident

GUARANTEED COVERAGE

19-64 in households with

percent of the federal poverty level (about $1,600/month for a family of two), who are not eligible for Medicaid, who do not have other health insurance, and who agree to pay a small premium

Pregnant women at or below 300% of the FPL (if their medicial costs can bring their monthly income to 200% of the FPL)

GUARANTEED COVERAGE

Be under 19 years old

Have no other health insurance

Be a citizen of the United States or a quali!ed alien

Family income must be at or below 200% of the FPL

State of Iowa employee

Medicaid cannot get Hawk-i

GUARANTEED COVERAGE






FPL


Indians on reservations located in North Dakota, South Dakota,

nine hospitals, eight health centers, two school health stations, and several smaller health stations and satellite clinics

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium


column


varies average rates charged individuals for comparable

by 5 or more of the largest insurance companies in the individual health insurance market.

$0 or minimal share of cost $1-$3 co-pays and monthly premium

$0 or minimal share of costdepending on your income. Noone pays more than $40

$0 or minimal share of cost $0 or minimal share of cost 20% of the insurance premium M

onthly Cost

Iowa

31 800.234.1317

Dem

ogra


emographic

Small businesses

(2-50 Employees)


health plan




conditions

Low income families and children

Moderate income families

Children with special needs Women Low income

individualsSeniors and

Disabled

Prog

ram


Group HealthHealth Underwriters


COBRA/Mini-COBRA

Then


www.dol.gov


Individual PlansUnderwriters703-276-0220

www.nahu.org

KHIAKansas Health Insurance

800-362-9290 www.khiastatepool.com


785-291- 4414https://www.kmap-state-ks.us/

Women-Infant-Children (WIC)

800-332-6262785-296-1320

www.kdheks.gov/nws-wic

Health Wave800-792-4884

800-792-4292 TTYwww.kansashealthwave.org

Children with Special Health

Care Needs800-332-6262785-296-1313

www.kdheks.gov/cyshcn

Women’s Health Care and Family Planning

Services800-332-6262785-296-1307

www.kdheks.gov/c-f/womens.html

Early Detection Works

877-277-1368785-296-1207

http://www.kdheks.gov/edw/

MediKan800-766-9012785-296-3959

www.srskansas.org

agency

Medicare



Program800-633-4227

SHICKSenior Health Insurance

800-860-5260

Program

Cove

rage

Up to $5M lifetime

deductibles

If uninsured for previous 1-6 months, a waiting period for coverage of

may apply

There is a 6-month look-back/ 3-month



COBRA or Mini-COBRA: for 18 to 36 months depending on qualifying events, bene!ts are the same as what you had with your previous employer







of doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and

care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, among other services


Medicaid: Physical health services: o#ce visits, regular checkups, immunizations, hospital services, inpatient and outpatient hospital,

hearing services and speech, and

Dental health services for children: checkups, cleanings, sealants,

Services (Inpatient and outpatient): mental, behavioral and substance abuse services

WIC: Provides nutrition education and supplemental foods to infants, children and women who are pregnant, postpartum or are breastfeeding


screened for HealthWave 19 (Medicaid) !rst.

Some of the services covered are Physical health services: o#ce visits, regular checkups, immunizations, hospital services, inpatient and outpatient hospital, lab and

hearing services and speech, and physical and occupational therapy, dental health services for children (checkups,

!llings), mental health services - inpatient and outpatient


Diagnostic services and treatment services include medical specialists, outpatient care, hospitalization, surgery, durable medical equipment, reimbursement for transportation to medical specialty care, and interpreter

provided for eligible conditions

diagnosis, consultation, and follow-along care as close to the child's home as possible.

loss, orthopedic conditions, neurological impairment, cardiac diseases, and genetic diseases, counseling and planning services


Women’s Health Care and Planning Services: Services are provided by a physician or mid-level practitioner with assistance from public health nurses. In larger health departments social workers, health educators and nutritionists are available for consultation. If problems are discovered which are beyond the scope of the clinics, appropriate referrals will be made by the health care

appointments

Early Detection Works: Services include breast and cervical cancer screenings, treatment and possibly other services


Prescription drugs, mental health services and medical (doctor) coverage. We also cover inpatient hospital, hearing, dental, and eye-wear

managed care network serves many families and children. Program pays enrolled providers directly for the medically necessary services they perform

available



and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also includes a prescription drug program called Medicare Part D

SCHICK is a Medicare counseling service


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


employee


GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you

from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign up for


HIPAA:

continuous coverage and your company went out of business, you may convert to

days from the date you lost your previous



GUARANTEED COVERAGE

You are eligible if your previous coverage was terminated for reasons other than non-payment of premium or fraud (such as

stage renal disease” covered under Medicare)

applied for health insurance and been declined by two carriers because of a health condition

Must prove denial of coverage or o"er of higher

Live in KS and had 12 months of continuous coverage

GUARANTEED COVERAGE

Medicaid:

Women and Infants ages 0-1:150%

Medically needy couple:

citizen, Kansas resident

WIC: Women who are pregnant, Breastfeeding, up to baby’s !rst birthday, Non-breastfeeding

years old, Family income up to

enrolled in Food Stamp Program,

and Medicaid Program

GUARANTEED COVERAGE

screened for HealthWave 19 (Medicaid) !rst

Live in Kansas

list all household members, sign and date the application and provide all household income veri!cation for 3 months (2 months for renewals)

If self-employed, provide

including all schedules and attachments, or 3 months of business ledgers

GUARANTEED COVERAGE

Under age 22 living in Kansas

Youth with a medical condition covered by the program.

Up to 185% for SHS Program

Up to 300% for PKU Food

Kansas residents of any age with covered genetic and/or metabolic conditions

GUARANTEED COVERAGE

Women’s Health Care and Planning Services: Depends on facility

Early Detection Works:

Do not have insurance or have insurance that does not pay for these services or has insurance with a high deductible

Ineligible for Medicare Part B or Medicaid/MediKan

Income up to 250% FPL

GUARANTEED COVERAGE

Women, persons who are blind or disabled by Social Security rules, persons age 65 or older, persons receiving inpatient treatment for tuberculosis, low income families with children

assistance), Persons screened and diagnosed with breast or cervical cancer apply to all medical plans

and Immigrant Status- persons must be citizens or immigrants with a certain status. Some immigrants must wait 5 years before they can get coverage

GUARANTEED COVERAGE


kidney failure requiring dialysis or a kidney transplant)

Eligibility

Mon

thly

Cos

t

contribution and ± 25% of the insurance company’s

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15



variesPremium rates are determined according to

your age, gender, and tobacco use.

Medicaid & WIC: $0 or minimal share-of-cost

HealthWave 21: $0 for most

HealthWave19: $0 or small share of cost (There are minor co-pays for adults)

$0 or some people must pay a premium

$0 or minimal share-of-cost $0 or minimal share-of-cost $0 and share of cost for

certain plans

Monthly Cost

Kansas


Dem

ogra


emographic

Small businesses

(2-50 Employees)


health plan




conditions

Low income families and children

Moderate income families

Children with special needs Women Low income


Disabled

Prog

ram


Group HealthHealth Underwriters


COBRA/Mini-COBRA

Then


www.dol.gov


Individual PlansUnderwriters703-276-0220

www.nahu.org

KHIAKansas Health Insurance

800-362-9290 www.khiastatepool.com


785-291- 4414https://www.kmap-state-ks.us/


800-332-6262785-296-1320

www.kdheks.gov/nws-wic

Health Wave800-792-4884

800-792-4292 TTYwww.kansashealthwave.org

Children with Special Health

Care Needs800-332-6262785-296-1313

www.kdheks.gov/cyshcn

Women’s Health Care and Family Planning

Services800-332-6262785-296-1307

www.kdheks.gov/c-f/womens.html

Early Detection Works

877-277-1368785-296-1207

http://www.kdheks.gov/edw/

MediKan800-766-9012785-296-3959

www.srskansas.org

agency

Medicare



Program800-633-4227

SHICKSenior Health Insurance

800-860-5260

Program

Cove

rage

Up to $5M lifetime

deductibles


may apply











of doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and

care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, among other services


Medicaid: Physical health services: o#ce visits, regular checkups, immunizations, hospital services, inpatient and outpatient hospital,

hearing services and speech, and

Dental health services for children: checkups, cleanings, sealants,

Services (Inpatient and outpatient): mental, behavioral and substance abuse services

WIC: Provides nutrition education and supplemental foods to infants, children and women who are pregnant, postpartum or are breastfeeding


screened for HealthWave 19 (Medicaid) !rst.

Some of the services covered are Physical health services: o#ce visits, regular checkups, immunizations, hospital services, inpatient and outpatient hospital, lab and

hearing services and speech, and physical and occupational therapy, dental health services for children (checkups,

!llings), mental health services - inpatient and outpatient


Diagnostic services and treatment services include medical specialists, outpatient care, hospitalization, surgery, durable medical equipment, reimbursement for transportation to medical specialty care, and interpreter

provided for eligible conditions

diagnosis, consultation, and follow-along care as close to the child's home as possible.

loss, orthopedic conditions, neurological impairment, cardiac diseases, and genetic diseases, counseling and planning services


Women’s Health Care and Planning Services: Services are provided by a physician or mid-level practitioner with assistance from public health nurses. In larger health departments social workers, health educators and nutritionists are available for consultation. If problems are discovered which are beyond the scope of the clinics, appropriate referrals will be made by the health care

appointments

Early Detection Works: Services include breast and cervical cancer screenings, treatment and possibly other services


Prescription drugs, mental health services and medical (doctor) coverage. We also cover inpatient hospital, hearing, dental, and eye-wear

managed care network serves many families and children. Program pays enrolled providers directly for the medically necessary services they perform

available



and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also includes a prescription drug program called Medicare Part D

SCHICK is a Medicare counseling service


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


employee


GUARANTEED COVERAGE




HIPAA:





GUARANTEED COVERAGE

You are eligible if your previous coverage was terminated for reasons other than non-payment of premium or fraud (such as

stage renal disease” covered under Medicare)

applied for health insurance and been declined by two carriers because of a health condition

Must prove denial of coverage or o"er of higher

Live in KS and had 12 months of continuous coverage

GUARANTEED COVERAGE

Medicaid:

Women and Infants ages 0-1:150%

Medically needy couple:

citizen, Kansas resident

WIC: Women who are pregnant, Breastfeeding, up to baby’s !rst birthday, Non-breastfeeding

years old, Family income up to

enrolled in Food Stamp Program,

and Medicaid Program

GUARANTEED COVERAGE

screened for HealthWave 19 (Medicaid) !rst

Live in Kansas

list all household members, sign and date the application and provide all household income veri!cation for 3 months (2 months for renewals)

If self-employed, provide

including all schedules and attachments, or 3 months of business ledgers

GUARANTEED COVERAGE

Under age 22 living in Kansas

Youth with a medical condition covered by the program.

Up to 185% for SHS Program

Up to 300% for PKU Food

Kansas residents of any age with covered genetic and/or metabolic conditions

GUARANTEED COVERAGE

Women’s Health Care and Planning Services: Depends on facility

Early Detection Works:

Do not have insurance or have insurance that does not pay for these services or has insurance with a high deductible

Ineligible for Medicare Part B or Medicaid/MediKan


GUARANTEED COVERAGE

Women, persons who are blind or disabled by Social Security rules, persons age 65 or older, persons receiving inpatient treatment for tuberculosis, low income families with children

assistance), Persons screened and diagnosed with breast or cervical cancer apply to all medical plans

and Immigrant Status- persons must be citizens or immigrants with a certain status. Some immigrants must wait 5 years before they can get coverage

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t





variesPremium rates are determined according to

your age, gender, and tobacco use.

Medicaid & WIC: $0 or minimal share-of-cost

HealthWave 21: $0 for most

HealthWave19: $0 or small share of cost (There are minor co-pays for adults)

$0 or some people must pay a premium


certain plans

Monthly Cost

Kansas

33 800.234.1317

Dem

ogra

phic


ographic



health plan






Children with chronic

illnessesWomen Seniors and

Disabled Veterans

Prog

ram


800-234-1317

Group Health

502-564-3630800-595-6053

800-462-2081 TDDhttp://www.doi.state.ky.us/

COBRA Then


www.dol.gov

or

Kentucky Continuation

Coverage


800-234-1317

Individual Plans

502-564-3630800-595-6053


Kentucky Access866-405-6145

www.kentuckyaccess.com

Medicaid800-635-2570502-564-4321

www.chfs.ky.gov/dms

KCHIP

Insurance Program)877-524-4718

877-524-4719 TTYwww.kidshealth.ky.gov

Women-Infant-Children800-462-6122 502-564-3827

800-648-6056 TTYhttp://chfs.ky.gov/dph/mch/ns/

wic.htm

Commission for Children with Special Health

Care Needs

800-232-1160http://chfs.ky.gov/ccshcn/

Kentucky Women’s Cancer Screening

Program502-564-2154

http://chfs.ky.gov/dph/info/wpmh/cancerscreening.htm


www.medicare.gov


Program800-633-4227

State HealthInsurance Assistance

Program877-293-7447

http://chfs.ky.gov/dail/ship.htm



Cove

rage






premium


State conversion plans o"ered through private health insurance market will vary


In Kentucky all insurers are

plan” which o"ers the same bene!ts regardless of the insurer

Insurers are required to o"er certain bene!ts such as maternity stay and mammograms


bene!t plans: Traditional

plan).






KCHIP: dental care, hospitalization,outpatient hospital services,emergency services, primarycare services, psychiatrists,laboratory tests and X-rays,

mental health services,prescription medicines, glasses,immunizations, well-childcheckups, physical therapy,speech therapy, transportation,and many other services

WIC: Nutrition education

monthly food prescription of

maternal, prenatal and pediatric health-care services


Services are provided through a variety of specialty clinics held across the commonwealth

(Primary medical care is not covered)


If screened and diagnosed for breast or cervical cancer, may be eligible for complete health coverage through Medicaid, including dental, prescriptions etc.




SHIP is a Medicare counselingand application service




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Kentucky resident

Medical underwriting will determine eligibility


GUARANTEED COVERAGE

Individuals coming o" of group, governmental, church plan,

prove higher premium rates

high cost condition

If one family member is eligible other family members are eligible

Kentucky resident

GUARANTEED COVERAGE

Pregnant women and infants up to 185% FPL



Medically needy individuals up to 30%, couples 28%

Limits on family resources such as savings accounts, cash, etc. for all but children and pregnant women

GUARANTEED COVERAGE

KCHIP: Must not be eligible for any other insurance, including

resident and family income at

waiting periods for some children at certain income levels

WIC: pregnant woman or infant in the family who receives Medicaid, or have a member of your family

household income at or below 185 FPL%.

GUARANTEED COVERAGE

Kentucky resident less than 21 years old

usually responds to treatment provided by the program

Must meet !nancial guidelines

GUARANTEED COVERAGE

Must be Kentucky resident Under 64 years of age

Must be uninsured or underinsured, ineligible for Medicaid

Women younger than 40 areeligible to receive screeningservices only if they have afamily history of breast cancer

GUARANTEED COVERAGE

Disabled or age 65 and older and people under age 65 with certain disabilities, and people


GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



Depends on plan selecteddi"erently depending on age and gender, no family rates

$0 or nominal co-payment KCHIP: $0 or $20 monthly premium depending on income $1 to $3 for

for premiums

WIC: $0 to minimal share of cost

$0 or minimal share-of-cost $0 or nominal co-payment $0 and share of cost for

certain plans

$0 or share of cost and co-pays depending on income level

Monthly Cost

Kentucky


Dem

ogra

phic


ographic



health plan






Children with chronic

illnessesWomen Seniors and

Disabled Veterans

Prog

ram


800-234-1317

Group Health

502-564-3630800-595-6053


COBRA Then


www.dol.gov

or

Kentucky Continuation

Coverage


800-234-1317

Individual Plans

502-564-3630800-595-6053


Kentucky Access866-405-6145

www.kentuckyaccess.com

Medicaid800-635-2570502-564-4321

www.chfs.ky.gov/dms

KCHIP


877-524-4719 TTYwww.kidshealth.ky.gov

Women-Infant-Children800-462-6122 502-564-3827

800-648-6056 TTYhttp://chfs.ky.gov/dph/mch/ns/

wic.htm

Commission for Children with Special Health

Care Needs

800-232-1160http://chfs.ky.gov/ccshcn/

Kentucky Women’s Cancer Screening

Program502-564-2154

http://chfs.ky.gov/dph/info/wpmh/cancerscreening.htm


www.medicare.gov


Program800-633-4227

State HealthInsurance Assistance

Program877-293-7447

http://chfs.ky.gov/dail/ship.htm



Cove

rage






premium








bene!t plans: Traditional

plan).






KCHIP: dental care, hospitalization,outpatient hospital services,emergency services, primarycare services, psychiatrists,laboratory tests and X-rays,

mental health services,prescription medicines, glasses,immunizations, well-childcheckups, physical therapy,speech therapy, transportation,and many other services





Services are provided through a variety of specialty clinics held across the commonwealth

(Primary medical care is not covered)


If screened and diagnosed for breast or cervical cancer, may be eligible for complete health coverage through Medicaid, including dental, prescriptions etc.




SHIP is a Medicare counselingand application service




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Kentucky resident



GUARANTEED COVERAGE

Individuals coming o" of group, governmental, church plan,

prove higher premium rates

high cost condition

If one family member is eligible other family members are eligible

Kentucky resident

GUARANTEED COVERAGE

Pregnant women and infants up to 185% FPL



Medically needy individuals up to 30%, couples 28%

Limits on family resources such as savings accounts, cash, etc. for all but children and pregnant women

GUARANTEED COVERAGE

KCHIP: Must not be eligible for any other insurance, including

resident and family income at

waiting periods for some children at certain income levels

WIC: pregnant woman or infant in the family who receives Medicaid, or have a member of your family

household income at or below 185 FPL%.

GUARANTEED COVERAGE

Kentucky resident less than 21 years old

usually responds to treatment provided by the program

Must meet !nancial guidelines

GUARANTEED COVERAGE

Must be Kentucky resident Under 64 years of age


Women younger than 40 areeligible to receive screeningservices only if they have afamily history of breast cancer

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium




$0 or nominal co-payment KCHIP: $0 or $20 monthly premium depending on income $1 to $3 for

for premiums


$0 or minimal share-of-cost $0 or nominal co-payment $0 and share of cost for

certain plans

$0 or share of cost and co-pays depending on income level

Monthly Cost

Kentucky

35 800.234.1317

Dem

ogra


Dem

ographic



health plan






families

Children with special health care

needsWomen Seniors and

Disabled Veterans

Prog

ram


800-234-1317

Group Plans


www.la-ahu.org

COBRA/ Mini-COBRA

and then


www.dol.gov

LaHIPP888-695-2447

www.lahipp.dhh.louisiana.gov


800-234-1317

Individual Plans


www.la-ahu.org

LHPLouisiana Health Plan

800-736-0947

www.lahealthplan.org


www.dhh.state.la.us/o#ces/?ID=92

LaCHIPInsurance Plan

877-252-2447www.lachip.org


800-251-2229www.dhh.louisiana.gov/

o#ces/?ID=320

CSHS

Health Services504-896-1340

www.dhh.louisiana.gov/o#ces/?ID=256


888-342-6207504-218-2322

www.dhh.state.la.us/o#ces/page.asp?id=92&detail=3879

orhttp://labchp.lsuhsc.edu/

default.htm

LaMOMS 888-342-6207

TTD: 800-220-5404www.dhh.louisiana.gov/

o#ces/?id=137

Medicare


Medicare Prescription

Drug Program800-633-4227


877-222-8387 www.va.gov

Program

Cove

rage

6-month look-back/12-month






premium


LaHIPP: Bene!ts are the same as what you had with your previous employer, LaHIPP is a premium assistance program


medical needs


traditional individual market health insurance products in Louisiana


Four plans o"ering comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, ambulance, labs and

home health visits, transplants, rehabilitation, durable medical equipment, physical, speech and occupational therapy, vision care, and preventive care, among other services


Physician, hospital, laboratory,

cover services such as pharmacy and intermediate care facilities for the mentally retarded


LaCHIP: provides Medicaid coverage for doctor visits for primary care as well as preventive and emergency care, immunizations, prescription medications, hospitalization, home health care and many other health services



to maternal, prenatal and pediatric health-care services


Health care services, medical tests and procedures, hospitalization, therapies, home health services, medical equipment and supplies, parent/family support services (parent liaisons), medications and special diets, nursing, nutrition and social services follow-up, care coordination, case management, and resource development, or over

Fibrosis program

BCCP: Screening and/or diagnostic mammograms annually for women 50 years+, ultrasound. Fine needle aspiration of the breast and breast biopsy, if indicated,

18 years of age and older not already enrolled in a program that provides this service,

if indicated, follow-up and referral for abnormal Pap

LaMOMS: Pregnancy-related services, delivery and care up to 60 days after the pregnancy ends including doctor visits, lab work/tests, prescription medicines and hospital care






Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



Mini-COBRA: businesses with less than 20 employees

HIPAA:



LaHIPP: You may be eligible for HIPP if you have a high-cost health condition and have Medicaid

underwriting


column

GUARANTEED COVERAGE

health condition, or during the 12 months prior to applying for

insurance company, nonpro!t

for coverage substantially similar

without material underwriting restriction at a rate equal to or

Not be eligible or receiving health bene!ts under any federal or state program and not have received $500k in

any organization similar to the

Must be declined by two separate insurance carriers

There is a 6-month waiting

conditions

GUARANTEED COVERAGE

0-19 Income up to 200% FPL


Non-Working Parents:12% FPL



Legal Louisiana residents

GUARANTEED COVERAGE

LACHIP: age 19 and not covered by health insurance.

Family income cannot be more than 250% of the FPL Louisiana residents and able to document either U.S. citizenship or meet residency requirements

WIC: Live in Louisiana, Pregnant and postpartum women, infants, and children under age

$1,670, Family of 2 $2,247, Family of 3 $2,823, Family of 4 $3,400, $577 for each additional family member

GUARANTEED COVERAGE

in Louisiana, have a condition

from rehabilitation services, have a long-term condition that requires specialty care and a multi-disciplinary treatment team, and meet !nancial requirements may qualify for services

GUARANTEED COVERAGE

BCCP: U.S. citizens or quali!ed

uninsured and screened for breast or cervical cancer under


course of treatment ends or the criteria for the program are no longer met and may begin up to three months before the month a woman applies

be eligible to be paid back for services received up to three months before she applied if she used a Medicaid provider and if the service is covered by Medicaid

LaMOMS: Income up to 200% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and ± 35% of the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium




LaHIPP: $0 or minimal share of cost

variesFour plan options with deductible choices of $1000, $2000, $3500 and $5000

$0 LACHIP: $0-50 monthly premium depending on income



certain plans


onthly Cost

Louisiana


Dem

ogra


Dem

ographic



health plan






families



Disabled Veterans

Prog

ram


800-234-1317

Group Plans


www.la-ahu.org

COBRA/ Mini-COBRA

and then


www.dol.gov

LaHIPP888-695-2447

www.lahipp.dhh.louisiana.gov


800-234-1317

Individual Plans


www.la-ahu.org

LHPLouisiana Health Plan

800-736-0947

www.lahealthplan.org


www.dhh.state.la.us/o#ces/?ID=92

LaCHIPInsurance Plan

877-252-2447www.lachip.org


800-251-2229www.dhh.louisiana.gov/

o#ces/?ID=320

CSHS

Health Services504-896-1340

www.dhh.louisiana.gov/o#ces/?ID=256


888-342-6207504-218-2322

www.dhh.state.la.us/o#ces/page.asp?id=92&detail=3879

orhttp://labchp.lsuhsc.edu/

default.htm

LaMOMS 888-342-6207

TTD: 800-220-5404www.dhh.louisiana.gov/

o#ces/?id=137

Medicare


Medicare Prescription

Drug Program800-633-4227


877-222-8387 www.va.gov

Program

Cove

rage







premium


LaHIPP: Bene!ts are the same as what you had with your previous employer, LaHIPP is a premium assistance program


medical needs


traditional individual market health insurance products in Louisiana


Four plans o"ering comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, ambulance, labs and

home health visits, transplants, rehabilitation, durable medical equipment, physical, speech and occupational therapy, vision care, and preventive care, among other services


Physician, hospital, laboratory,

cover services such as pharmacy and intermediate care facilities for the mentally retarded


LaCHIP: provides Medicaid coverage for doctor visits for primary care as well as preventive and emergency care, immunizations, prescription medications, hospitalization, home health care and many other health services





Health care services, medical tests and procedures, hospitalization, therapies, home health services, medical equipment and supplies, parent/family support services (parent liaisons), medications and special diets, nursing, nutrition and social services follow-up, care coordination, case management, and resource development, or over

Fibrosis program

BCCP: Screening and/or diagnostic mammograms annually for women 50 years+, ultrasound. Fine needle aspiration of the breast and breast biopsy, if indicated,

18 years of age and older not already enrolled in a program that provides this service,

if indicated, follow-up and referral for abnormal Pap

LaMOMS: Pregnancy-related services, delivery and care up to 60 days after the pregnancy ends including doctor visits, lab work/tests, prescription medicines and hospital care






Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:



LaHIPP: You may be eligible for HIPP if you have a high-cost health condition and have Medicaid

underwriting


column

GUARANTEED COVERAGE

health condition, or during the 12 months prior to applying for

insurance company, nonpro!t

for coverage substantially similar

without material underwriting restriction at a rate equal to or

Not be eligible or receiving health bene!ts under any federal or state program and not have received $500k in

any organization similar to the

Must be declined by two separate insurance carriers

There is a 6-month waiting

conditions

GUARANTEED COVERAGE

0-19 Income up to 200% FPL


Non-Working Parents:12% FPL



Legal Louisiana residents

GUARANTEED COVERAGE

LACHIP: age 19 and not covered by health insurance.

Family income cannot be more than 250% of the FPL Louisiana residents and able to document either U.S. citizenship or meet residency requirements

WIC: Live in Louisiana, Pregnant and postpartum women, infants, and children under age

$1,670, Family of 2 $2,247, Family of 3 $2,823, Family of 4 $3,400, $577 for each additional family member

GUARANTEED COVERAGE

in Louisiana, have a condition

from rehabilitation services, have a long-term condition that requires specialty care and a multi-disciplinary treatment team, and meet !nancial requirements may qualify for services

GUARANTEED COVERAGE

BCCP: U.S. citizens or quali!ed

uninsured and screened for breast or cervical cancer under


course of treatment ends or the criteria for the program are no longer met and may begin up to three months before the month a woman applies

be eligible to be paid back for services received up to three months before she applied if she used a Medicaid provider and if the service is covered by Medicaid

LaMOMS: Income up to 200% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and ± 35% of the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium




LaHIPP: $0 or minimal share of cost

variesFour plan options with deductible choices of $1000, $2000, $3500 and $5000

$0 LACHIP: $0-50 monthly premium depending on income



certain plans


onthly Cost

Louisiana

37 800.234.1317

Dem

ogra


emographic



health plan


Low income families & medically

needy

Moderate income individuals,

familiesemployees

Children with special needs

Pregnant women and children Women Seniors and

Disabled Veterans

Prog

ram


800-234-1317

Group Health207-624-8475800-300-5000

TTY 888-577-6690Maine Bureau of Insurance

www.maine.gov/pfr/insurance

COBRA/Mini-COBRA

Then convert to


www.dol.gov

or

State Conversion Plans


800-234-1317

Individual Plans207-624-8475800-300-5000



MaineCare(Medicaid)

800-321-5557207-624-7539

207-287-3707 TTYwww.maine.gov/bms

Dirigo Choice(State-sponsored plan)

877-892-8391207-287-9900

www.dirigohealth.maine.gov

coverage is currently closed.

longer available to new enrollees)

Maine Children with Special Needs

Program207-287-5139 800-698-3624

TTD: 800-438-5514 www.maine.gov/dhhs/boh/

cshn

capped program enrollmentand will no longer be accepting

applications for payment ofservices)

CubCare/MaineCare800-442-6382

877-543-7669www.maine.gov/bms


800-437-9300207-287-3991

800-438-5514 (TTY)www.maine.gov/dhhs/wic/

Maine Breast and Cervical Health

Program800-350-5180207-287-8068

800-438-5514 (TTY)www.maine.gov/dhhs/

bohdcfh/bcp

Medicare



Program800-633-4227



Cove

rage


(6-12 month look back)





premium



Depends on plan chosen


There is a 6-12 month look-back

possible waiting periods




Three plans to choose from. Plans o"er doctor visits, hospital care and other preventative care


Medical treatment, including diagnostic, medical, surgical, corrective and other therapeutic interventions for:

Blood disorders, cardiac defects, childhood oncology craniofacial anomalies, gastrointestinal, metabolic ophthalmologic, orthopedic, neurological, neurosensory neuromuscular, respiratory

of care and referral services to families of infants, children, and adolescents with special health needs regardless of income.


Cubcare/MaineCare: Doctor visits, check-ups, immunizations, preventive care, dental, mental, hospitalization

WIC: Screening for growth and anemia, Healthy advice for families, Nutrition & Healthy Foods, Breastfeeding support, other referrals to other services


If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Medicaid







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE




HIPAA:



Must be a Maine resident

GUARANTEED COVERAGE

In Maine, no medical underwriting is allowed

GUARANTEED COVERAGE

Pregnant women at or below

working parents with children under the age of 18 at or below

Medically needy individuals qualify for spend down coverage. There is no income limit. Spend down !gures out what the medically needy person can a"ord by seeing how high their income is. The person pays a deductible and then begins their coverage.

waitlist for healthy, childless adults 21 to 64 is still in e"ect, and individuals could be on the waitlist anywhere from 3 months to a year

GUARANTEED COVERAGE

Individuals and employees under 300% of the FPL are

premiums and deductibles are not available to new enrollees

freeze for the Individual

discounted premiums and deductibles are not available to new enrollees

GUARANTEED COVERAGE

Must be Maine resident Infants, children, and adolescents who are at or below 225% of FPL

GUARANTEED COVERAGE

Cubcare/MaineCare: Low income children under age 18

No citizenship requirements for pregnant women and children

Maine residents

Income must be equal to or less than 200% of the FPL



GUARANTEED COVERAGE

Must be Maine resident

Under 250% FPL

Must be uninsured or underinsured, ineligible for

Medicare Part B

Limited openings for women age 35-39 who have seen a doctor and need additional tests for a possible breast or cervical cancer or if they have not had a Pap in 5 or more years

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and ± 20% of the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium



Premiums vary by 20% above and below community rating

$250-$1,500

$0 or minimal share of costof Maine, and coverage plan selected. Discounted premiums and deductibles are no longer available to new enrollees.

$0 or nominal co-payment Cubcare/MaineCare & WIC: $0 or small monthly premium

$0 or nominal co-payment $0 and share of cost for

certain plans


Monthly Cost

Maine


Dem

ogra


emographic



health plan


Low income families & medically

needy

Moderate income individuals,

familiesemployees



Disabled Veterans

Prog

ram


800-234-1317

Group Health207-624-8475800-300-5000



COBRA/Mini-COBRA

Then convert to


www.dol.gov

or



800-234-1317

Individual Plans207-624-8475800-300-5000



MaineCare(Medicaid)

800-321-5557207-624-7539

207-287-3707 TTYwww.maine.gov/bms

Dirigo Choice(State-sponsored plan)

877-892-8391207-287-9900

www.dirigohealth.maine.gov

coverage is currently closed.

longer available to new enrollees)

Maine Children with Special Needs

Program207-287-5139 800-698-3624

TTD: 800-438-5514 www.maine.gov/dhhs/boh/

cshn

capped program enrollmentand will no longer be accepting

applications for payment ofservices)

CubCare/MaineCare800-442-6382

877-543-7669www.maine.gov/bms


800-437-9300207-287-3991

800-438-5514 (TTY)www.maine.gov/dhhs/wic/

Maine Breast and Cervical Health

Program800-350-5180207-287-8068

800-438-5514 (TTY)www.maine.gov/dhhs/

bohdcfh/bcp

Medicare



Program800-633-4227



Cove

rage


(6-12 month look back)





premium



Depends on plan chosen


There is a 6-12 month look-back

possible waiting periods




Three plans to choose from. Plans o"er doctor visits, hospital care and other preventative care


Medical treatment, including diagnostic, medical, surgical, corrective and other therapeutic interventions for:

Blood disorders, cardiac defects, childhood oncology craniofacial anomalies, gastrointestinal, metabolic ophthalmologic, orthopedic, neurological, neurosensory neuromuscular, respiratory

of care and referral services to families of infants, children, and adolescents with special health needs regardless of income.


Cubcare/MaineCare: Doctor visits, check-ups, immunizations, preventive care, dental, mental, hospitalization










Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE




HIPAA:



Must be a Maine resident

GUARANTEED COVERAGE

In Maine, no medical underwriting is allowed

GUARANTEED COVERAGE

Pregnant women at or below

working parents with children under the age of 18 at or below

Medically needy individuals qualify for spend down coverage. There is no income limit. Spend down !gures out what the medically needy person can a"ord by seeing how high their income is. The person pays a deductible and then begins their coverage.

waitlist for healthy, childless adults 21 to 64 is still in e"ect, and individuals could be on the waitlist anywhere from 3 months to a year

GUARANTEED COVERAGE

Individuals and employees under 300% of the FPL are

premiums and deductibles are not available to new enrollees

freeze for the Individual

discounted premiums and deductibles are not available to new enrollees

GUARANTEED COVERAGE

Must be Maine resident Infants, children, and adolescents who are at or below 225% of FPL

GUARANTEED COVERAGE

Cubcare/MaineCare: Low income children under age 18

No citizenship requirements for pregnant women and children

Maine residents

Income must be equal to or less than 200% of the FPL



GUARANTEED COVERAGE

Must be Maine resident

Under 250% FPL

Must be uninsured or underinsured, ineligible for

Medicare Part B

Limited openings for women age 35-39 who have seen a doctor and need additional tests for a possible breast or cervical cancer or if they have not had a Pap in 5 or more years

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium



Premiums vary by 20% above and below community rating

$250-$1,500

$0 or minimal share of costof Maine, and coverage plan selected. Discounted premiums and deductibles are no longer available to new enrollees.

$0 or nominal co-payment Cubcare/MaineCare & WIC: $0 or small monthly premium


certain plans


Monthly Cost

Maine

39 800.234.1317

Dem

ogra


emographic







Low Income Families &

Medically Needy

Children and Pregnant Women Women Seniors and

Disabled



Prog

ram


800-234-1317

Group Health


www.marylandahu.com

COBRA

and then


www.dol.gov


800-234-1317

Individual Plans


www.marylandahu.com

Maryland Health Insurance Plan

MHIP888-444-9016

www marylandhealthinsuranceplan.

net

Medicaid410-767-5800800-492-5231

800-735-2258 TDD www.dhmh.state.md.us/

mma/mmahome.html

Medical Assistance

for Families800-456-8900

http://dhmh.state.md.us/ma4families/

MCHPHealth Program800-456-8900

800-735-2258 TTDwww.dhmh.state.md.us/

mma/mchp

MCHP Premium410-767-6883800-456-9800

800-735-2258 (TDD)


800-242-4942www.fha.state.md.us/wic/

Breast Cancer Screening Program

800-477-9774http://fha.maryland.gov/cancer/bccp_home.cfm

Breast and Cervical Cancer Diagnosis

and Treatment Program410-767-6787800-477-9774

www.fha.maryland.gov/cancer/bccdt_home.cfm

Medicare



Program800-633-4227


866-628-4282



Cove

rage









medical needs


conditions in traditional individual market health insurance products in Maryland


Four plans o"ering comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, maternity,

skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, and preventive care, and more

bene!t options


Medicaid: Doctor visits, prescriptions, hospital care (including emergency

planning, mental health services, substance abuse services, home health care, dental care, eye care, occupational therapy, physical and speech therapy, and more

Medical Assistance for Families:Low-cost or free prescriptions, doctor visits, emergency room visits,

services, and many other services


MCHP: Prenatal and post-partum doctor visits, hospital delivery bill, immunizations, lab work and tests, dental and vision care, prescription medicines (including vitamins), transportation to medical appointments, mental health services, substance abuse treatment, after delivery, family planning services

MCHP Premium: coverage through Healthchoice,

Program



Screening mammogram,

cervical biopsy, diagnosticmammogram, colonoscopies,surgical consultation, breastultrasound, breast biopsy,

therapy (chemotherapy,radiation therapy), home

(including prosthesis andbras), physical therapy,occupational therapy, wigsand breast reconstruction










Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:

of continuous coverage and your company went out of business, you may

have 63 days from the date you lost your

You cannot be eligible for Medicare or other public or group insurance programs



column

GUARANTEED COVERAGE


programs

Denied coverage due to a medical condition

insurance that provides

coverage for a speci!c medical condition or conditions

Families with an income at or below 300% of the FPL can qualify for discounted premiums also known as MHIP+

GUARANTEED COVERAGE

Medicaid: Pregnant Women

and children (ages 0-19):

elderly) at or below 74% of

below 300% of FPL

everyone but children or pregnant mothers

Maryland resident and quali!ed immigrant

Medical Assistance for Families:

121% FPL

GUARANTEED COVERAGE

MCHP:

women any age with income up to 250% FPL

MCHP Premium: Household income between

be without health insurance coverage

WIC: Live in Maryland, Pregnant and postpartum women, infants,

must be at or below 185% FPL

GUARANTEED COVERAGE

resident aged 50

Women aged 40- 49 who have symptoms of breast cancer, who have a personal history of breast cancer, or who have a mother or sister who developed breast cancer before menopause

Insurance: Uninsured or have health insurance which does not cover the screening procedures.

Income: Women with household incomes at or below 250% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and ± 40% of the COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.


COBRA & HIPAA: Premiums range from


varies150%

of the standard premium rate charged by commercial carriers.

$0 or minimal share of cost, no co-pays for emergency services and family planning services

MCHP: $0 or monthly premium payment depending on family income.

MCHP Premium: Monthly fee of $46 or $58 depending on family income.


$0 $0 and share of cost for

certain plans



Monthly Cost

Maryland


Dem

ogra


emographic








Medically Needy

Children and Pregnant Women Women Seniors and

Disabled



Prog

ram


800-234-1317

Group Health


www.marylandahu.com

COBRA

and then


www.dol.gov


800-234-1317

Individual Plans


www.marylandahu.com

Maryland Health Insurance Plan

MHIP888-444-9016

www marylandhealthinsuranceplan.

net

Medicaid410-767-5800800-492-5231

800-735-2258 TDD www.dhmh.state.md.us/

mma/mmahome.html

Medical Assistance

for Families800-456-8900

http://dhmh.state.md.us/ma4families/

MCHPHealth Program800-456-8900

800-735-2258 TTDwww.dhmh.state.md.us/

mma/mchp

MCHP Premium410-767-6883800-456-9800

800-735-2258 (TDD)


800-242-4942www.fha.state.md.us/wic/

Breast Cancer Screening Program

800-477-9774http://fha.maryland.gov/cancer/bccp_home.cfm

Breast and Cervical Cancer Diagnosis

and Treatment Program410-767-6787800-477-9774

www.fha.maryland.gov/cancer/bccdt_home.cfm

Medicare



Program800-633-4227


866-628-4282



Cove

rage









medical needs


conditions in traditional individual market health insurance products in Maryland


Four plans o"ering comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, maternity,

skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, and preventive care, and more

bene!t options


Medicaid: Doctor visits, prescriptions, hospital care (including emergency

planning, mental health services, substance abuse services, home health care, dental care, eye care, occupational therapy, physical and speech therapy, and more

Medical Assistance for Families:Low-cost or free prescriptions, doctor visits, emergency room visits,

services, and many other services


MCHP: Prenatal and post-partum doctor visits, hospital delivery bill, immunizations, lab work and tests, dental and vision care, prescription medicines (including vitamins), transportation to medical appointments, mental health services, substance abuse treatment, after delivery, family planning services

MCHP Premium: coverage through Healthchoice,

Program



Screening mammogram,

cervical biopsy, diagnosticmammogram, colonoscopies,surgical consultation, breastultrasound, breast biopsy,

therapy (chemotherapy,radiation therapy), home

(including prosthesis andbras), physical therapy,occupational therapy, wigsand breast reconstruction










Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:



You cannot be eligible for Medicare or other public or group insurance programs



column

GUARANTEED COVERAGE


programs

Denied coverage due to a medical condition

insurance that provides

coverage for a speci!c medical condition or conditions

Families with an income at or below 300% of the FPL can qualify for discounted premiums also known as MHIP+

GUARANTEED COVERAGE

Medicaid: Pregnant Women

and children (ages 0-19):

elderly) at or below 74% of

below 300% of FPL


Maryland resident and quali!ed immigrant

Medical Assistance for Families:

121% FPL

GUARANTEED COVERAGE

MCHP:

women any age with income up to 250% FPL

MCHP Premium: Household income between

be without health insurance coverage

WIC: Live in Maryland, Pregnant and postpartum women, infants,

must be at or below 185% FPL

GUARANTEED COVERAGE

resident aged 50

Women aged 40- 49 who have symptoms of breast cancer, who have a personal history of breast cancer, or who have a mother or sister who developed breast cancer before menopause

Insurance: Uninsured or have health insurance which does not cover the screening procedures.

Income: Women with household incomes at or below 250% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and ± 40% of the COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.




varies150%

of the standard premium rate charged by commercial carriers.

$0 or minimal share of cost, no co-pays for emergency services and family planning services

MCHP: $0 or monthly premium payment depending on family income.

MCHP Premium: Monthly fee of $46 or $58 depending on family income.


$0 $0 and share of cost for

certain plans



Monthly Cost

Maryland

41 800.234.1317

Dem

ogra

phic PRIVATE HEALTH INSURANCE PRIVATE/PUBLIC PROGRAMS PUBLICLY SPONSORED PROGRAMS

Dem

ographic


Individuals recently covered by an employer health plan

Individuals and Families Above 300% of the FPL

Individuals and Groups Below

300% of the FPLWomen Children Seniors

Prog

ram


Group PlansFor help learning about plans contact:

508-634-7373

www.massahu.org

617-521-7794

www.mass.gov/doi

877-623-6765 www.mahealthconnector.org

directly from the insurance carrier or can access a select group

COBRA/Mini-COBRA

State Conversion Plans Then

HIPAA


www.dol.gov

Medical Security Program800-908-8801

Individual PlansFor help learning about plans contact:

508-634-7373www.massahu.org

617-521-7794 www.mass.gov/doi


purchase health plans either directly from the insurance carrier or can access a select group of health plans that are o"ered through the

Individual and Group PlansFor help learning about plans contact:

MassHealth Families & Children:

Unemployed Adults:MassHealth Basic

Pregnant Women: MassHealth Prenatal, Healthy StartDisabled:

www.ma.gov/masshealth

877-623-6765)www.mahealthconnector.org

The Insurance Partnership800-399-8285508-698-2070

www.insurancepartnership.org

Breast Cervical Cancer Treatment Program (BCCTP)

877-414-4447617-624-5992 TTY

www.massresources.org

Healthy Start Program

Service)

Children’s Medical Security Plan (CMSP)

888-665-9993800-909-2677

www.cmspkids.com


800-942-1007www.mass.gov


www.medicare.gov

Medicare Prescription Drug Program

800-633-4227

Program

Cove

rage

for their eligible full-time employees among several carriers and

may also facilitate the o"ering of non-employer sponsored plans

choose among any of the carriers and plans o"ered through the


COBRA or Mini-COBRA: months depending on qualifying events, bene!ts are the same as what you had with your previous employer

COBRA Subsidy: 15 months of partially subsidized

HIPAA: Bene!ts are based on the program selected

These programs allow employees to maintain their same health plan and transition to a new plan without a break in health coverage if they meet certain eligibility criteria


Bronze) are lower cost private plans that are

and directly through the di"erent insurancecarriers. The companies that are o"ering the plans

Health Plan, and Tufts Health Plan

between 18-26 to years of age and can only be


MassHealth members get similar bene!ts depending on the MassHealth plan they qualify for. There are similar plans withdi"erent names for children, adults, families, pregnant women,undocumented immigrants, the disabled and other groups

CommonWealth Care

payments that is available to members based on their income


BCCTP: Screening will be done through the Women’s Health Network. Insurance coverage will be issued through MassHealth Standard. This coverage includes cancer treatment and comprehensive medical care. You will get your bene!ts through the Primary

(cannot get coverage through

Healthy Start: complete prenatal care to pregnant women and children


CMSP: covers doctor visits with your child’s regular doctor and

covered for visits

WIC: Nutrition education and

and pediatric health-care services





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

plan with employer contributions so long as the premium contribution towards full-time non-bargaining employees (de!ned by the state

also establish a Section 125 plan for employees who are not eligible for their group plan and allow them to purchase insurance through the

more per week at a Massachusetts location (even if they livein another state). Individuals who are not considered full-time

temp agency’s employees.

requirements: 1) You must o"er a Section 125 cafeteria plan that meets

or their dependents get medical care that is paid by the state’s Free

who decline your employer sponsored health insurance and/or your employer sponsored Section 125 Plan.

GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31,

from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination

Mini-COBRA: than 20 employees

HIPAA: or if you had 18 months of continuous coverage and your company went out of business, you may convert

Medical Security Program: your former employer’s group plan, or an individual plan, you may be eligible for monthly reimbursement of your premium payments. To be eligible, you must be responsible for 100% of your monthly premium. If eligible, you will be

plan. You must continue to pay your monthly health insurance premium. The Medical Security Program will reimburse you upon receipt of a claim form with proof of payment

GUARANTEED COVERAGE

There is no medical underwriting

Bronze) may be right for you if: you are a resident of Massachusetts or are employed by a Massachusetts-based employer, you are age 18 or older, you are not

federal poverty level

between 18-26 to years of age.

GUARANTEED COVERAGE

Note: Those who are self employed, are seasonal workers and/or have income is not solely from W-2 income sources with regular pay stubs, should contact an enrollment specialist to determine what their gross income is and to determine what programs they are eligible for.

MassHealth you must be one of the following: a parent living with your children under age 19, an adult caretaker relative living with children under age 19 to whom you are related by blood, adoption, or marriage, or are a spouse or former spouse of one of those relatives, and you are the primary

cancer or cervical cancer

CommonWealth Care you must be 19 or older and have a gross income

national, quali!ed alien, or alien with special status. You are considered

premium for you health insurance in the non group insurance commercial

employer-provided health plan (where employer covers at least 20% of the cost of the premium of a family health plan or 33% of an individual plan)

The Insurance Partnership o"ers employers with 50 or fewer full time employees assistance with their premiums or their business and income eligible employees. To be eligible, employers must o"er (or plan to o"er) comprehensive health insurance to its employees and must contribute (or be willing to contribute) at least 50% of the cost of the insurance purchased

300% of the FPL, be between the ages of 19 and 64 (inclusive) and must not have been o"ered health insurance by their current employer in the past

GUARANTEED COVERAGE

BCCTP: You are under 65. You have been screened for breast or cervical cancer at a Women’s Health Network site and found in need of treatment. Your income is no greater than 250% of the FPL. Your insurance coverage does not cover the treatment you need. You meet the other eligibility requirements for MassHealth

Healthy Start: Must be pregnant, be a resident of Massachusetts, have little or no health coverage for pregnancy, be ineligible

MassHealth Limited), Income must be no greater than 200% FPL

GUARANTEED COVERAGE

CMSP: do not have other insurance.

even if their family makes too much money for other programs.

WIC: Live in Massachusetts, have

can help you determine this), are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be at or below 185% FPL

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

to $295 per employee per year.

employer’s full-time employees* are participating in the employer’s group health plan or (ii) an employer’s contribution of at least 33% toward a health plan premium for all full-time employees* who are employed more

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for


COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-150% of group health rates

Medical Security Program: You may receive 80% of the actual premium paid, or up to $1,110 per month for a family plan and up to $450 per month for an individual plan

pay a monthly premium. The premium the members pay will depend on the health plan and bene!t package they choose, and must be paid every month, even if no services are used. Members must pay a fee co-payment each time they use bene!ts. In addition, there may be a deductible an amount that the member must pay out-of-pocket for services before the health plan begins paying. This amount will vary by health plan and there will be

amounts.

MassHealth and CommonWealth Care costs vary depending on which program suites you best. The costs of each plan are based on a sliding scale.

The Insurance Partnership will pay small businesses up to $1,000 a year toward health insurance costs for each quali!ed employee. The amount depends on the tier of coverage chosen by the employee.

No monthly premium for participants with an income below 133%. Participants with an income between 133-250% of the FPL will pay a monthly premium.

CMSP: Depending on your income costs will vary (Premiums between $0-64 per

$3-4).



for certain plans

Monthly Cost

Massachusetts


Dem

ogra

phic PRIVATE HEALTH INSURANCE PRIVATE/PUBLIC PROGRAMS PUBLICLY SPONSORED PROGRAMS

Dem

ographic


Individuals recently covered by an employer health plan

Individuals and Families Above 300% of the FPL

Individuals and Groups Below

300% of the FPLWomen Children Seniors

Prog

ram


Group PlansFor help learning about plans contact:

508-634-7373

www.massahu.org

617-521-7794

www.mass.gov/doi


directly from the insurance carrier or can access a select group

COBRA/Mini-COBRA

State Conversion Plans Then

HIPAA


www.dol.gov

Medical Security Program800-908-8801

Individual PlansFor help learning about plans contact:

508-634-7373www.massahu.org

617-521-7794 www.mass.gov/doi


purchase health plans either directly from the insurance carrier or can access a select group of health plans that are o"ered through the

Individual and Group PlansFor help learning about plans contact:

MassHealth Families & Children:

Unemployed Adults:MassHealth Basic

Pregnant Women: MassHealth Prenatal, Healthy StartDisabled:

www.ma.gov/masshealth

877-623-6765)www.mahealthconnector.org

The Insurance Partnership800-399-8285508-698-2070

www.insurancepartnership.org

Breast Cervical Cancer Treatment Program (BCCTP)

877-414-4447617-624-5992 TTY

www.massresources.org

Healthy Start Program

Service)

Children’s Medical Security Plan (CMSP)

888-665-9993800-909-2677

www.cmspkids.com


800-942-1007www.mass.gov


www.medicare.gov

Medicare Prescription Drug Program

800-633-4227

Program

Cove

rage

for their eligible full-time employees among several carriers and

may also facilitate the o"ering of non-employer sponsored plans

choose among any of the carriers and plans o"ered through the


COBRA or Mini-COBRA: months depending on qualifying events, bene!ts are the same as what you had with your previous employer

COBRA Subsidy: 15 months of partially subsidized

HIPAA: Bene!ts are based on the program selected

These programs allow employees to maintain their same health plan and transition to a new plan without a break in health coverage if they meet certain eligibility criteria


Bronze) are lower cost private plans that are

and directly through the di"erent insurancecarriers. The companies that are o"ering the plans

Health Plan, and Tufts Health Plan

between 18-26 to years of age and can only be


MassHealth members get similar bene!ts depending on the MassHealth plan they qualify for. There are similar plans withdi"erent names for children, adults, families, pregnant women,undocumented immigrants, the disabled and other groups

CommonWealth Care

payments that is available to members based on their income


BCCTP: Screening will be done through the Women’s Health Network. Insurance coverage will be issued through MassHealth Standard. This coverage includes cancer treatment and comprehensive medical care. You will get your bene!ts through the Primary

(cannot get coverage through

Healthy Start: complete prenatal care to pregnant women and children


CMSP: covers doctor visits with your child’s regular doctor and

covered for visits


and pediatric health-care services





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

plan with employer contributions so long as the premium contribution towards full-time non-bargaining employees (de!ned by the state

also establish a Section 125 plan for employees who are not eligible for their group plan and allow them to purchase insurance through the

more per week at a Massachusetts location (even if they livein another state). Individuals who are not considered full-time

temp agency’s employees.

requirements: 1) You must o"er a Section 125 cafeteria plan that meets

or their dependents get medical care that is paid by the state’s Free

who decline your employer sponsored health insurance and/or your employer sponsored Section 125 Plan.

GUARANTEED COVERAGE

COBRA or Mini-COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31,

from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination

Mini-COBRA: than 20 employees

HIPAA: or if you had 18 months of continuous coverage and your company went out of business, you may convert

Medical Security Program: your former employer’s group plan, or an individual plan, you may be eligible for monthly reimbursement of your premium payments. To be eligible, you must be responsible for 100% of your monthly premium. If eligible, you will be

plan. You must continue to pay your monthly health insurance premium. The Medical Security Program will reimburse you upon receipt of a claim form with proof of payment

GUARANTEED COVERAGE

There is no medical underwriting

Bronze) may be right for you if: you are a resident of Massachusetts or are employed by a Massachusetts-based employer, you are age 18 or older, you are not

federal poverty level

between 18-26 to years of age.

GUARANTEED COVERAGE

Note: Those who are self employed, are seasonal workers and/or have income is not solely from W-2 income sources with regular pay stubs, should contact an enrollment specialist to determine what their gross income is and to determine what programs they are eligible for.

MassHealth you must be one of the following: a parent living with your children under age 19, an adult caretaker relative living with children under age 19 to whom you are related by blood, adoption, or marriage, or are a spouse or former spouse of one of those relatives, and you are the primary

cancer or cervical cancer

CommonWealth Care you must be 19 or older and have a gross income

national, quali!ed alien, or alien with special status. You are considered

premium for you health insurance in the non group insurance commercial

employer-provided health plan (where employer covers at least 20% of the cost of the premium of a family health plan or 33% of an individual plan)

The Insurance Partnership o"ers employers with 50 or fewer full time employees assistance with their premiums or their business and income eligible employees. To be eligible, employers must o"er (or plan to o"er) comprehensive health insurance to its employees and must contribute (or be willing to contribute) at least 50% of the cost of the insurance purchased

300% of the FPL, be between the ages of 19 and 64 (inclusive) and must not have been o"ered health insurance by their current employer in the past

GUARANTEED COVERAGE

BCCTP: You are under 65. You have been screened for breast or cervical cancer at a Women’s Health Network site and found in need of treatment. Your income is no greater than 250% of the FPL. Your insurance coverage does not cover the treatment you need. You meet the other eligibility requirements for MassHealth

Healthy Start: Must be pregnant, be a resident of Massachusetts, have little or no health coverage for pregnancy, be ineligible

MassHealth Limited), Income must be no greater than 200% FPL

GUARANTEED COVERAGE

CMSP: do not have other insurance.

even if their family makes too much money for other programs.

WIC: Live in Massachusetts, have

can help you determine this), are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be at or below 185% FPL

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

to $295 per employee per year.

employer’s full-time employees* are participating in the employer’s group health plan or (ii) an employer’s contribution of at least 33% toward a health plan premium for all full-time employees* who are employed more



COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-150% of group health rates

Medical Security Program: You may receive 80% of the actual premium paid, or up to $1,110 per month for a family plan and up to $450 per month for an individual plan

pay a monthly premium. The premium the members pay will depend on the health plan and bene!t package they choose, and must be paid every month, even if no services are used. Members must pay a fee co-payment each time they use bene!ts. In addition, there may be a deductible an amount that the member must pay out-of-pocket for services before the health plan begins paying. This amount will vary by health plan and there will be

amounts.

MassHealth and CommonWealth Care costs vary depending on which program suites you best. The costs of each plan are based on a sliding scale.

The Insurance Partnership will pay small businesses up to $1,000 a year toward health insurance costs for each quali!ed employee. The amount depends on the tier of coverage chosen by the employee.

No monthly premium for participants with an income below 133%. Participants with an income between 133-250% of the FPL will pay a monthly premium.

CMSP: Depending on your income costs will vary (Premiums between $0-64 per

$3-4).



for certain plans

Monthly Cost

Massachusetts

Note: Massachusetts residents age 18 and older under the Individual Mandate law are required to have health insurance that is deemed by the state to be a"ordable to them at their income

43 800.234.1317

Dem

ogra


emographic



health plan





families


familiesWomen Adults with

no ChildrenSeniors and

Disabled


(TAA recipients)

Prog

ram


800-234-1317

Group Health


www.mahu.org

COBRA and then


www.dol.gov


800-234-1317

Individual Plans


www.mahu.org

Blue Cross/ Blue Shield of

Michigan

888-642-2276www.bcbsm.org

Medicaid and Healthy Kids

800-642-3195www.michigan.gov/mdch

MIChild800-843-6447888-988-6300

www.michigan.gov/mdch

teens”)

Healthy Kids888-988-6300



Control Program




Adult Medical Program


Human Services


www.medicare.gov


Program800-633-4227

Medicare/Medicaid Assistance Program

800-803-7174


866-628-4282 Program

Cove

rage







premium



medical needs


conditions in traditional individual market health insurance products in Michigan


Plans vary depending on applicant needs


visits, family planning, health checkups, hearing and speech, home health care, hospice, hospitalization, lab and X-rays, immunizations, medical supplies, nursing home care, medicine, mental health care, personal care services, prenatal care, surgery, vision, substance abuse treatment, physical therapy


MIChild:shots, emergency care, dental care, hospital, pharmacy, hospital care, prenatal care and delivery, vision and hearing, mental health and substance abuse services

Healthy Kids:doctor visits, family planning,health checkups, hearing andspeech, home health care,hospice, hospitalization, lab

medical supplies, nursing homecare, medicine, mental healthcare, personal care services,prenatal care, surgery, vision,substance abuse treatment,

prenatal care for pregnantwomen


BCCP: and follow-up care, including cancer treatment if that should be needed




Basic medical care, pharmacy, no-inpatient



Insurance and Part B: Medical Insurance, as well as several supplemental and ‘advantage’ plans. It also o"ers a prescription drug program called Medicare Part D

Medicare/Medicaid Assistance Program is a counseling service for Seniors and Disabled





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:




for any other insurance programs

underwriting


column

GUARANTEED COVERAGE


guarantee issue coverage to residents during annual open enrollment periods

Must be Michigan resident

GUARANTEED COVERAGE

Limited assets such as cash, savings, stocks and bonds

children)

Pregnant women and infants up

150%

Non-Working Parents: 39% FPLWorking Parents: 66% FPL


GUARANTEED COVERAGE

MIChild: Income must be above 150% but below 200% of the

Families who voluntarily drop employer-based comprehensive insurance must

families drop private insurance, they may immediately enroll

Healthy Kids: Pregnant women,babies and children under age19 are eligible, Income must beat or below 150% FPL

GUARANTEED COVERAGE

BCCP: Have an income 250% FPL or lower

Be uninsured or underinsured for these tests and

Be age 40 - 64 for breast/cervical cancer screening and for diagnostic follow-up of breast/cervical abnormalities or

Be age 18 - 39 and have been identi!ed with a cervical abnormality through the Family Planning program (Title X)

Note: Women who are enrolled in a managed care program, a health maintenance organization, or Medicare Part

WIC: Live in Michigan, have a

help you determine this), are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be at or below 185% FPL

GUARANTEED COVERAGE

Uninsured, ineligible for Medicaid, meet income and assets test

35% of the FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE

Must not have access to employer plan that pays 50% of coverage cost.


Eligibility

Mon

thly

Cos


full premium



variescommunity rating)

$0 or minimal share-of-cost and no co-pays

$5 monthly payment per family for children

MIChild: $10 monthly premium and no co-pays

Healthy Kids: $0 to minimal share of cost

BCCP: $0


$0 or small share of cost $0 and share of cost for

certain plans


Monthly Cost

Michigan


Dem

ogra


emographic



health plan





families


familiesWomen Adults with

no ChildrenSeniors and

Disabled


(TAA recipients)

Prog

ram


800-234-1317

Group Health


www.mahu.org

COBRA and then


www.dol.gov


800-234-1317

Individual Plans


www.mahu.org

Blue Cross/ Blue Shield of

Michigan

888-642-2276www.bcbsm.org

Medicaid and Healthy Kids


MIChild800-843-6447888-988-6300


teens”)

Healthy Kids888-988-6300



Control Program




Adult Medical Program


Human Services


www.medicare.gov


Program800-633-4227

Medicare/Medicaid Assistance Program

800-803-7174


866-628-4282 Program

Cove

rage







premium



medical needs


conditions in traditional individual market health insurance products in Michigan


Plans vary depending on applicant needs


visits, family planning, health checkups, hearing and speech, home health care, hospice, hospitalization, lab and X-rays, immunizations, medical supplies, nursing home care, medicine, mental health care, personal care services, prenatal care, surgery, vision, substance abuse treatment, physical therapy


MIChild:shots, emergency care, dental care, hospital, pharmacy, hospital care, prenatal care and delivery, vision and hearing, mental health and substance abuse services

Healthy Kids:doctor visits, family planning,health checkups, hearing andspeech, home health care,hospice, hospitalization, lab

medical supplies, nursing homecare, medicine, mental healthcare, personal care services,prenatal care, surgery, vision,substance abuse treatment,

prenatal care for pregnantwomen


BCCP: and follow-up care, including cancer treatment if that should be needed




Basic medical care, pharmacy, no-inpatient




Medicare/Medicaid Assistance Program is a counseling service for Seniors and Disabled





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:





underwriting


column

GUARANTEED COVERAGE


guarantee issue coverage to residents during annual open enrollment periods

Must be Michigan resident

GUARANTEED COVERAGE


children)

Pregnant women and infants up

150%

Non-Working Parents: 39% FPLWorking Parents: 66% FPL


GUARANTEED COVERAGE

MIChild: Income must be above 150% but below 200% of the

Families who voluntarily drop employer-based comprehensive insurance must

families drop private insurance, they may immediately enroll

Healthy Kids: Pregnant women,babies and children under age19 are eligible, Income must beat or below 150% FPL

GUARANTEED COVERAGE

BCCP: Have an income 250% FPL or lower

Be uninsured or underinsured for these tests and

Be age 40 - 64 for breast/cervical cancer screening and for diagnostic follow-up of breast/cervical abnormalities or

Be age 18 - 39 and have been identi!ed with a cervical abnormality through the Family Planning program (Title X)

Note: Women who are enrolled in a managed care program, a health maintenance organization, or Medicare Part

WIC: Live in Michigan, have a

help you determine this), are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be at or below 185% FPL

GUARANTEED COVERAGE

Uninsured, ineligible for Medicaid, meet income and assets test

35% of the FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



variescommunity rating)

$0 or minimal share-of-cost and no co-pays

$5 monthly payment per family for children

MIChild: $10 monthly premium and no co-pays

Healthy Kids: $0 to minimal share of cost

BCCP: $0


$0 or small share of cost $0 and share of cost for

certain plans


Monthly Cost

Michigan

45 800.234.1317

Dem

ogra


emographic







conditions


familiesWomen Lower income


Disabled



Prog

ram


800-234-1317

Group Health


www.emahu.org

COBRA & Mini-COBRA


Health Insurance Portability and

www.dol.gov



Individual Plans


www.emahu.org

Minnesota Comprehensive

Health Association

952-593-9609866-894-8053

www.mchamn.com

Medicaid

651-431-2670

800-657-3739www.dhs.state.mn.us

www.bridgetobene!ts.org

Sage Screening Program

888-643-2584

www.health.state.mn.us/divs/hpcd/ccs/mbcccp.htm


800-942-4030www.health.state.mn.us/divs/

MinnesotaCare651-297-3862

800-657-3672 TTY: 800-6273529


General Assistance

651-297-3862

800-657-3672 www.bridgetobene!ts.org

Medicare



Program800-633-4227

MinnesotaHelp.info800-333-2433

TTD: 800-627-3529http://minnesotahelp.info/


866-628-4282



Cove

rage






premium






Professional service, prescription drugs and pharmacy services, mail service, prescription drug program, hospital ambulance, home health care, outpatient, rehabilitation, mental health substance abuse, durable medical equipment and prosthetics, organ and bone marrow transplant, dental infertility services, hospice, reconstructive and restorative surgery, skilled nursing, emergency and more


immunizations, ambulance, emergency room services when used for emergency care, inpatient and outpatient hospital care, lab, X-ray, family planning, pregnancy related services, nurse midwife, medical equipment and supplies, Hearing aids, physical, occupational, speech, respiratory and rehabilitative therapy, transportation, mental health services, alcohol and drug treatment, prosthetics, nursing facilities, home health services, hospice, and more


Sage Screening Program: Free screening and follow-up services to uninsured and underinsured women




MinnesotaCare: Dental services, Doctor and health clinic visits for preventive care, Doctor and health clinic visits for non-

room visits, Inpatient hospital coverage

General Assistance: Doctor and clinic visits, routine checkups, family planning, immunizations, inpatient hospital and outpatient

prescription drugs, diabetic supplies and equipment,

services, residential alcohol and drug treatment, and mental

children can also get dental and vision care




MinnesotaHelp.info is a Medicare counseling service







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


GUARANTEED COVERAGE




HIPAA:




conditions


GUARANTEED COVERAGE

months immediately preceding the completion of your application

individual health coverage

application either by a health insurance carrier of a licensed

Have reached age 65 or over and are not eligible for the health insurance bene!ts of

Have been treated with the last three years for one of

GUARANTEED COVERAGE

Limited assets such as cash,

for pregnant women and children)

Infants (ages 0-2): 280% FPL


disabilities, Parents (and adults ages 19 and 20): 100% FPL

Medically Needy Individual:

down” for eligibility

GUARANTEED COVERAGE

Sage Screening Program: Income at

underinsured

WIC: Live in Minnesota, have a

help you determine this), are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be: Family of 1: $1604 , Family of 2: $2159, Family of 3: $2714, Family of 4: $3269, $555 for each additional family member

GUARANTEED COVERAGE

MinnesotaCare:families, pregnant women, and adults without children can all

to live in Minnesota and have a

or below 200%, Parents of children under 21, Pregnant women and children under 21 income at or below 275% of the FPL. You cannot get

had health insurance during the last four months unless the insurance was Medical

without insurance, then you

General Assistance: Must be an adult between ages 21-64, have no dependent children under age 18, live in Minnesota and have income below the limits. For full medical bene!ts you must have an income at or

income is between 75% and 175% you can receive hospital coverage only

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and ± 25% of the

rate


premium



Premiums must be set between 101% - 125% of the weighted average for comparable policies

Seven individual plans options,

deductibles of $500, $1000, $2000, $5000, and $10,000, and two di"erent Medicare supplemental policies

$0 or co-pays for parents Sage Screening Program: $0


MinnesotaCare: $4 or more for children, around $22 for adults

General Assistance: $0 to minimal share of cost


certain plans



Monthly Cost

Minnesota


Dem

ogra


emographic







conditions


familiesWomen Lower income


Disabled



Prog

ram


800-234-1317

Group Health


www.emahu.org

COBRA & Mini-COBRA


Health Insurance Portability and

www.dol.gov



Individual Plans


www.emahu.org

Minnesota Comprehensive

Health Association

952-593-9609866-894-8053

www.mchamn.com

Medicaid

651-431-2670

800-657-3739www.dhs.state.mn.us


Sage Screening Program

888-643-2584

www.health.state.mn.us/divs/hpcd/ccs/mbcccp.htm


800-942-4030www.health.state.mn.us/divs/

MinnesotaCare651-297-3862

800-657-3672 TTY: 800-6273529


General Assistance

651-297-3862

800-657-3672 www.bridgetobene!ts.org

Medicare



Program800-633-4227

MinnesotaHelp.info800-333-2433

TTD: 800-627-3529http://minnesotahelp.info/


866-628-4282



Cove

rage






premium






Professional service, prescription drugs and pharmacy services, mail service, prescription drug program, hospital ambulance, home health care, outpatient, rehabilitation, mental health substance abuse, durable medical equipment and prosthetics, organ and bone marrow transplant, dental infertility services, hospice, reconstructive and restorative surgery, skilled nursing, emergency and more


immunizations, ambulance, emergency room services when used for emergency care, inpatient and outpatient hospital care, lab, X-ray, family planning, pregnancy related services, nurse midwife, medical equipment and supplies, Hearing aids, physical, occupational, speech, respiratory and rehabilitative therapy, transportation, mental health services, alcohol and drug treatment, prosthetics, nursing facilities, home health services, hospice, and more


Sage Screening Program: Free screening and follow-up services to uninsured and underinsured women




MinnesotaCare: Dental services, Doctor and health clinic visits for preventive care, Doctor and health clinic visits for non-

room visits, Inpatient hospital coverage

General Assistance: Doctor and clinic visits, routine checkups, family planning, immunizations, inpatient hospital and outpatient

prescription drugs, diabetic supplies and equipment,

services, residential alcohol and drug treatment, and mental

children can also get dental and vision care




MinnesotaHelp.info is a Medicare counseling service







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


GUARANTEED COVERAGE




HIPAA:




conditions


GUARANTEED COVERAGE

months immediately preceding the completion of your application

individual health coverage

application either by a health insurance carrier of a licensed

Have reached age 65 or over and are not eligible for the health insurance bene!ts of

Have been treated with the last three years for one of

GUARANTEED COVERAGE


for pregnant women and children)

Infants (ages 0-2): 280% FPL


disabilities, Parents (and adults ages 19 and 20): 100% FPL

Medically Needy Individual:

down” for eligibility

GUARANTEED COVERAGE

Sage Screening Program: Income at

underinsured

WIC: Live in Minnesota, have a

help you determine this), are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be: Family of 1: $1604 , Family of 2: $2159, Family of 3: $2714, Family of 4: $3269, $555 for each additional family member

GUARANTEED COVERAGE

MinnesotaCare:families, pregnant women, and adults without children can all

to live in Minnesota and have a

or below 200%, Parents of children under 21, Pregnant women and children under 21 income at or below 275% of the FPL. You cannot get

had health insurance during the last four months unless the insurance was Medical

without insurance, then you

General Assistance: Must be an adult between ages 21-64, have no dependent children under age 18, live in Minnesota and have income below the limits. For full medical bene!ts you must have an income at or

income is between 75% and 175% you can receive hospital coverage only

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


rate


premium



Premiums must be set between 101% - 125% of the weighted average for comparable policies

Seven individual plans options,

deductibles of $500, $1000, $2000, $5000, and $10,000, and two di"erent Medicare supplemental policies

$0 or co-pays for parents Sage Screening Program: $0


MinnesotaCare: $4 or more for children, around $22 for adults

General Assistance: $0 to minimal share of cost


certain plans



Monthly Cost

Minnesota

47 800.234.1317

Dem

ogra


emographic

Small businesses

(1-50 Employees)


health plan





families


familiesInfants Women Seniors and

Disabled Veterans

Prog

ram


Group Health


www.nahu.org

COBRAand then


www.dol.gov


Individual Plans


www.nahu.org

MCHIRPA

601-899 9967 888-820 9400

www.mississippihealthpool.org

Medicaid601-359-6050800-421-2408

www.medicaid.ms.gov

Mississippi CHIP

Insurance Plan877-543-7669

First Steps601-576-7427800-451-3903

www.msdh.state.ms.us/!rststeps/home.htm


800-545-6747www.msdh.state.ms.us/msdhsite/_static/41.html


601-576-7466800-721-7222

www.msdh.state.ms.us/msdhsite/_static/41,0,103.

html

Medicare



Program800-633-4227

Mississippi Seniorxms.org

888-948-3090



Cove

rage

Up to $5M lifetime

deductibles


may apply


COBRA: months depending on qualifying events, bene!ts are the same as what you had with your previous employer



coverage


on medical needs

There is a 12-month look-

conditions in traditional individual market health insurance products in Mississippi


Includes hospital services, physician care, limited mental health care, prescription drugs, and other services

Bene!ts for nervous andmental conditions, alcoholand drug services and certainother treatment and servicesare provided with substantiallimitations

Prescription coverage doesn’t begin until you have been

months

$1,000,000


o#ce visits and family planning services, hospital care, outpatient services, prescription drugs eyeglasses, home health services, long term care services, inpatient psychiatric care, non-emergency transportation services, chiropractic services, dialysis

and related treatment, durable medical equipment and medical supplies, hospice services


package that includes coverage of doctor visits, hospitalization, prescriptions, vision, hearing and dental care, and immunizations


First Steps: Provides family training and counseling, nursing care, nutritional counseling and planning, psychological services in behavior management, learning and mental health, physical therapy to help teach body movement, crawling, walking, occupational therapy to help teach self-help, playing and eating skills, speech pathologist services to help develop language skills, transportation assistance to and from appointments





Screening and/ordiagnostic mammogramsannually for women 50years of age and older,ultrasound, !ne needleaspiration of the breastand breast biopsy,colonoscopy and biopsy, ifindicated

Follow-up and referral for

mammograms



Mississippi Seniorxms.org o"ers assistance and advice to Seniors in need.




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


employee


GUARANTEED COVERAGE

COBRA: If you were involuntarily terminated between Sept 1, 2008 and May 31, 2010, you are eligible for a


HIPAA:


the date you lost your previous coverage to .You cannot be eligible




GUARANTEED COVERAGE

You have been turned down for coverage by an insurance company in the last 12 months or diagnosed with a health condition that causes insurance companies to

you were o"ered coverage by an insurance company, but the policy contained a material underwriting restriction (such

o"ered coverage costing more

cannot be eligible for or have other, similar coverage from a private or government health plan (including Medicare and Medicaid) in order to get

Legal Mississippi resident

GUARANTEED COVERAGE


95% FPL




GUARANTEED COVERAGE

family incomes up to: 200% FPL

MS resident, U.S. citizen or eligible immigrant

Proof of most recent full month's family income, (such as a paycheck stub) must accompany the application.

must provide his or her Social Security number on the application

GUARANTEED COVERAGE

First Steps: the age of 36 months) of a Mississippi resident who has a 25% or greater developmental delay in any one developmental area

WIC: Live in Mississippi, have a nutritional need, are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be: Family of 1: $1604 , Family of 2: $2159, Family of 3: $2714, Family of 4: $3269, $555 for each additional family member

GUARANTEED COVERAGE

Medicare or other insurance or method of reimbursement

Women 40-49 qualify formammograms while fundsare available

Must be 40-64 years of age

Must be 50-64 years of agefor Mammogram

18-44 years of age and have had tubal ligation, hysterectomy or post menopausal

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t employer contribution and ± 25% of the insurance company’s

COBRA: With the 65% subsidy you are responsible for 35% of the monthly

full premium



coverage variesPremiums vary based on theplan chosen as well as age and

175% of regular market rates.Deductible amount variesdepending on plan chosen

$0 to $10 co-pays $0 to 15 co-pays

Yearly costs range from $50.00 to $100.00 per child, per year up to the !rst 3 children (no

$0-950 depending on income

First Steps & WIC: $0 or minimal share of cost

$0 or minimal share of cost $0 and share of cost and co-pays depending on income level


Monthly Cost

Mississippi


Dem

ogra


emographic

Small businesses

(1-50 Employees)


health plan





families


familiesInfants Women Seniors and

Disabled Veterans

Prog

ram


Group Health


www.nahu.org

COBRAand then


www.dol.gov


Individual Plans


www.nahu.org

MCHIRPA

601-899 9967 888-820 9400

www.mississippihealthpool.org

Medicaid601-359-6050800-421-2408

www.medicaid.ms.gov

Mississippi CHIP

Insurance Plan877-543-7669

First Steps601-576-7427800-451-3903

www.msdh.state.ms.us/!rststeps/home.htm


800-545-6747www.msdh.state.ms.us/msdhsite/_static/41.html


601-576-7466800-721-7222

www.msdh.state.ms.us/msdhsite/_static/41,0,103.

html

Medicare



Program800-633-4227

Mississippi Seniorxms.org

888-948-3090



Cove

rage

Up to $5M lifetime

deductibles


may apply


COBRA: months depending on qualifying events, bene!ts are the same as what you had with your previous employer



coverage


on medical needs

There is a 12-month look-

conditions in traditional individual market health insurance products in Mississippi


Includes hospital services, physician care, limited mental health care, prescription drugs, and other services

Bene!ts for nervous andmental conditions, alcoholand drug services and certainother treatment and servicesare provided with substantiallimitations

Prescription coverage doesn’t begin until you have been

months

$1,000,000


o#ce visits and family planning services, hospital care, outpatient services, prescription drugs eyeglasses, home health services, long term care services, inpatient psychiatric care, non-emergency transportation services, chiropractic services, dialysis

and related treatment, durable medical equipment and medical supplies, hospice services


package that includes coverage of doctor visits, hospitalization, prescriptions, vision, hearing and dental care, and immunizations


First Steps: Provides family training and counseling, nursing care, nutritional counseling and planning, psychological services in behavior management, learning and mental health, physical therapy to help teach body movement, crawling, walking, occupational therapy to help teach self-help, playing and eating skills, speech pathologist services to help develop language skills, transportation assistance to and from appointments





Screening and/ordiagnostic mammogramsannually for women 50years of age and older,ultrasound, !ne needleaspiration of the breastand breast biopsy,colonoscopy and biopsy, ifindicated

Follow-up and referral for

mammograms



Mississippi Seniorxms.org o"ers assistance and advice to Seniors in need.




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


employee


GUARANTEED COVERAGE



HIPAA:


the date you lost your previous coverage to .You cannot be eligible




GUARANTEED COVERAGE

You have been turned down for coverage by an insurance company in the last 12 months or diagnosed with a health condition that causes insurance companies to

you were o"ered coverage by an insurance company, but the policy contained a material underwriting restriction (such

o"ered coverage costing more

cannot be eligible for or have other, similar coverage from a private or government health plan (including Medicare and Medicaid) in order to get


GUARANTEED COVERAGE


95% FPL




GUARANTEED COVERAGE

family incomes up to: 200% FPL

MS resident, U.S. citizen or eligible immigrant

Proof of most recent full month's family income, (such as a paycheck stub) must accompany the application.

must provide his or her Social Security number on the application

GUARANTEED COVERAGE

First Steps: the age of 36 months) of a Mississippi resident who has a 25% or greater developmental delay in any one developmental area

WIC: Live in Mississippi, have a nutritional need, are a child under 5, a new mom, or a pregnant or breastfeeding woman, Income must be: Family of 1: $1604 , Family of 2: $2159, Family of 3: $2714, Family of 4: $3269, $555 for each additional family member

GUARANTEED COVERAGE

Medicare or other insurance or method of reimbursement

Women 40-49 qualify formammograms while fundsare available

Must be 40-64 years of age

Must be 50-64 years of agefor Mammogram

18-44 years of age and have had tubal ligation, hysterectomy or post menopausal

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t employer contribution and ± 25% of the insurance company’s


full premium



coverage variesPremiums vary based on theplan chosen as well as age and

175% of regular market rates.Deductible amount variesdepending on plan chosen

$0 to $10 co-pays $0 to 15 co-pays

Yearly costs range from $50.00 to $100.00 per child, per year up to the !rst 3 children (no

$0-950 depending on income

First Steps & WIC: $0 or minimal share of cost

$0 or minimal share of cost $0 and share of cost and co-pays depending on income level


Monthly Cost

Mississippi

49 800.234.1317

Dem

ogra


Dem

ographic



health plan





families



Disabled Veterans

Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA Then convert to


www.dol.gov

or



800-234-1317

Individual Plans


www.nahu.org

Missouri Health Insurance Plan

800-843-6447800-821-2231

www.mhip.org

MO Healthnet(Medicaid)

888-275-5908

htm

Children with Special Health Care

Needs (CSHCN)573-751-6246800-451-0669

MO HealthNet for Kids

(Medicaid)888-275-5908

htm


573-751-6204 800-392-8209

www.dhss.mo.gov/wic/

Show Me Healthy Women

573-522-2845 www.dhss.mo.gov/

WISEWoman573-522-2845

www.dhss.mo.gov/

Medicare



Program800-633-4227

MO Senior Rx800-375-1406



Cove

rage






premium




services

Unlimited look-back and



Hospital, physician care, maternity, prescription drugs, some limitations on alcohol and drug abuse care

For most services, plan will pay for 80% of covered charges after you satisfy your annual deductible if you

of coinsurance charges for covered in-network services, MHIP will pay 100% of your covered charges for the rest of the calendar year




cleft lip and palate, cystic !brosis, digestive disorders, ear infections (chronic), hearing disorders, heart disorders, hemophilia, hydrocephalus, neuromuscular disorders, orthopedic disorders, paraplegia, quadriplegia, seizures, sickle cell disease, spina bi!da, spinal cord deformities,

urinary disorders


MO HealthNet for Kids:

but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more





Show Me Healthy Women: Women age 50 to 64 or older without Medicare Part B are eligible for

Women age 35-39 (with no other funding source available) are eligible for a pelvic

suspicious for cancer, and for diagnostic cervical services if their initial/follow-up cervical cancer screening was abnormal

WISEWoman: health screenings and lifestyle education that can reduce the risk of heart disease and stroke




Senior Rx is a prescription discount program




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Missouri resident

underwriting


period.



column

GUARANTEED COVERAGE


Must be Missouri resident

GUARANTEED COVERAGE


Working parents with household income up to 84% FPL

Non-working parents with household income up to 77% FPL

Pregnant women and childrenaged 0-1 up to 185% FPL

FPL

FPL

85% FPLL

GUARANTEED COVERAGE

Participants must meet bothmedical and !nancial eligibilityguidelines

Must reside in Missouri

GUARANTEED COVERAGE

MO HealthNet for Kids: Low income children up to 300% FPL and uninsured

WIC: pregnant women, non-breastfeeding postpartum women (up to 6 months after delivery or termination of the pregnancy), breastfeeding women (up to 1 year after delivery as long as they are breastfeeding the baby), infants from birth up to 1 year of age, and children up to their

at or below 185% FPL

GUARANTEED COVERAGE

Both: have legal immigration status

Women age 35-64 years of age

Must be uninsured or underinsured with income under 200% of FPL

GUARANTEED COVERAGE


(permanent kidney failure requiring dialysis or a kidney transplant).

Senior Rx: To qualify for Senior

Part D. If you are single yourincome must be at or below$21,660 and if you are a marriedyour income must be below$29,140

GUARANTEED COVERAGE



Mon

thly

Cos


full premium




Deductibles: $500, $1000, $2500,

enrollees di"erent rates based on

level they choose. MHIP rates cannot be more than twice of the amount that a healthy person would pay if he or she bought a similar plan from the !ve largest

$0 or minimal share of cost $0 or share of cost MO HealthNet for Kids: $0 or share of cost. Families will pay no more than 5% of their annual income for premiums in a year.

WIC: $0 or minimal share of cost

Both: $0 Medicare: $0 and share of cost

for certain plans

Senior Rx: $0


Monthly Cost

Missouri


Dem

ogra


Dem

ographic



health plan





families



Disabled Veterans

Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA Then convert to


www.dol.gov

or



800-234-1317

Individual Plans


www.nahu.org

Missouri Health Insurance Plan

800-843-6447800-821-2231

www.mhip.org

MO Healthnet(Medicaid)

888-275-5908

htm

Children with Special Health Care

Needs (CSHCN)573-751-6246800-451-0669

MO HealthNet for Kids

(Medicaid)888-275-5908

htm


573-751-6204 800-392-8209

www.dhss.mo.gov/wic/

Show Me Healthy Women

573-522-2845 www.dhss.mo.gov/

WISEWoman573-522-2845

www.dhss.mo.gov/

Medicare



Program800-633-4227

MO Senior Rx800-375-1406



Cove

rage






premium




services

Unlimited look-back and



Hospital, physician care, maternity, prescription drugs, some limitations on alcohol and drug abuse care

For most services, plan will pay for 80% of covered charges after you satisfy your annual deductible if you

of coinsurance charges for covered in-network services, MHIP will pay 100% of your covered charges for the rest of the calendar year




cleft lip and palate, cystic !brosis, digestive disorders, ear infections (chronic), hearing disorders, heart disorders, hemophilia, hydrocephalus, neuromuscular disorders, orthopedic disorders, paraplegia, quadriplegia, seizures, sickle cell disease, spina bi!da, spinal cord deformities,

urinary disorders


MO HealthNet for Kids:

but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more





Show Me Healthy Women: Women age 50 to 64 or older without Medicare Part B are eligible for

Women age 35-39 (with no other funding source available) are eligible for a pelvic

suspicious for cancer, and for diagnostic cervical services if their initial/follow-up cervical cancer screening was abnormal

WISEWoman: health screenings and lifestyle education that can reduce the risk of heart disease and stroke




Senior Rx is a prescription discount program




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Missouri resident

underwriting


period.



column

GUARANTEED COVERAGE


Must be Missouri resident

GUARANTEED COVERAGE


Working parents with household income up to 84% FPL

Non-working parents with household income up to 77% FPL

Pregnant women and childrenaged 0-1 up to 185% FPL

FPL

FPL

85% FPLL

GUARANTEED COVERAGE

Participants must meet bothmedical and !nancial eligibilityguidelines

Must reside in Missouri

GUARANTEED COVERAGE

MO HealthNet for Kids: Low income children up to 300% FPL and uninsured

WIC: pregnant women, non-breastfeeding postpartum women (up to 6 months after delivery or termination of the pregnancy), breastfeeding women (up to 1 year after delivery as long as they are breastfeeding the baby), infants from birth up to 1 year of age, and children up to their

at or below 185% FPL

GUARANTEED COVERAGE

Both: have legal immigration status

Women age 35-64 years of age


GUARANTEED COVERAGE



Senior Rx: To qualify for Senior

Part D. If you are single yourincome must be at or below$21,660 and if you are a marriedyour income must be below$29,140

GUARANTEED COVERAGE



Mon

thly

Cos


full premium




Deductibles: $500, $1000, $2500,

enrollees di"erent rates based on

level they choose. MHIP rates cannot be more than twice of the amount that a healthy person would pay if he or she bought a similar plan from the !ve largest

$0 or minimal share of cost $0 or share of cost MO HealthNet for Kids: $0 or share of cost. Families will pay no more than 5% of their annual income for premiums in a year.


Both: $0 Medicare: $0 and share of cost

for certain plans

Senior Rx: $0


Monthly Cost

Missouri

51 800.234.1317

Dem

ogra


emographic


Already insuredsmall businesses(2-9 employees)







Children in moderate income families Women Seniors and

Disabled


(TAA recipients)

Prog

ram


800-234-1317


www.nahu.org

Insure Montana Purchasing Pool

800-332-6148406-444-2040

www.sao.mt.gov/


800-332-6148406-444-2040

www.sao.mt.gov/

COBRAand then


www.dol.gov


Individual Plans


www.nahu.org

State Auditor’s O"ce

800-332-6148406-444-2040

http://sao.mt.gov

MCHA

800-447-7828www.mthealth.org


www.dphhs.mt.gov/programsservices/medicaid.

shtml

Healthy Montana Kids877-543-7669406-444-6971

www.chip.mt.gov


800-433-4298 406-444-4747

www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/nutrition-wic-


Prevention888-803-9343406-444-0063

www.dphhs.mt.gov/PHSD/cancer-control/

Medicare



Program800-633-4227

State Health Insurance Assistance

Program (SHIP)800-551-3191

www.dphhs.mt.gov/sltc/services/aging/ship.shtml


866-628-4282

Program

Cove

rage





Provides a refundable state

who currently pay some or all of the cost of group health

pay for insurance for the employee’s spouse or their

40% of the available funding per year is designated to the

distributed on a !rst come, !rst served basis until the money is fully allocated





for plan details)


medical needs


conditions in the Montana individual health insurance market


choose from, the primary di"erence is the annual deductible

$2,000,000

Waiting period for certain

apply


Montana program may cover are: treatment by physicians, nurse practitioners, nurse midwives, dentists, denturists,

eyeglasses


CHIP: Physician, inpatient and outpatient hospital services, routine sports or employment physicals, general anesthesia services, surgical services clinic and ambulatory health care services, prescriptions, laboratory and radiological services, inpatient, outpatient, and residential mental health services, inpatient, outpatient, and residential substance abuse treatment services


pediatric health-care services


Mammograms, clinical

detection of breast and cervical cancer



SHIP is a Medicare counseling service





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE

employee health insurance

employees that meets the eligibility criteria established

on take-up and available revenue)

than 50% of premiums paid

No employee is paid more than $75,000 per year (owner

GUARANTEED COVERAGE


Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign

HIPAA:


conditions. You have 63 days from the date you lost your previous coverage

eligible for Medicare or other public or group insurance programs

underwriting


column

GUARANTEED COVERAGE

any other government programs


Must prove denial of coverage orproof of o"er paying 150% higher

May also be automatically eligiblewith certain health conditions

days

GUARANTEED COVERAGE

Newborn-No Income Limit

Pregnant women: 150% FPL




54% FPL


GUARANTEED COVERAGE

CHIP:

covered by health insurance in the past 3 months (some employment-

eligible for Medicaid , Parents not

Income at or below 250% of the FPL

WIC: Must be a Montana resident, apregnant woman, a breastfeedingwoman, or a woman who recently had a baby. Infants from birth to 12 months, or children up to 5 years old are also covered. Income must be at or below 185% FPL

GUARANTEED COVERAGE

Must be under the age of 65, not have insurance, be a US citizen and Montana

For more information, please contact your local county o#ce

GUARANTEED COVERAGE



GUARANTEED COVERAGE


Not enrolled in certain state plans Eligibility

Mon

thly

Cos

t contribution and ±25% of the contributionCOBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.




variesPremiums and deductibles varydepending on plan

Deductibles from $1-10K, 80/20co-payments, $5-13.5K annual

$0 or small share of cost CHIP: Families with incomes above 100 percent of the FPL will pay a small co-payment when services are received, no co-payment for well-baby or well-child care, including age-appropriate immunizations, and no co-payment for dental or

any family is $215 per family/yr


$0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Montana


Dem

ogra


emographic


Already insuredsmall businesses(2-9 employees)







Children in moderate income families Women Seniors and

Disabled


(TAA recipients)

Prog

ram


800-234-1317


www.nahu.org


800-332-6148406-444-2040

www.sao.mt.gov/


800-332-6148406-444-2040

www.sao.mt.gov/

COBRAand then


www.dol.gov


Individual Plans


www.nahu.org

State Auditor’s O"ce

800-332-6148406-444-2040

http://sao.mt.gov

MCHA

800-447-7828www.mthealth.org


www.dphhs.mt.gov/programsservices/medicaid.

shtml

Healthy Montana Kids877-543-7669406-444-6971

www.chip.mt.gov


800-433-4298 406-444-4747

www.dphhs.mt.gov/PHSD/family-health/nutrition-wic/nutrition-wic-


Prevention888-803-9343406-444-0063

www.dphhs.mt.gov/PHSD/cancer-control/

Medicare



Program800-633-4227



www.dphhs.mt.gov/sltc/services/aging/ship.shtml


866-628-4282

Program

Cove

rage





Provides a refundable state

who currently pay some or all of the cost of group health

pay for insurance for the employee’s spouse or their

40% of the available funding per year is designated to the

distributed on a !rst come, !rst served basis until the money is fully allocated





for plan details)


medical needs


conditions in the Montana individual health insurance market


choose from, the primary di"erence is the annual deductible

$2,000,000

Waiting period for certain

apply


Montana program may cover are: treatment by physicians, nurse practitioners, nurse midwives, dentists, denturists,

eyeglasses


CHIP: Physician, inpatient and outpatient hospital services, routine sports or employment physicals, general anesthesia services, surgical services clinic and ambulatory health care services, prescriptions, laboratory and radiological services, inpatient, outpatient, and residential mental health services, inpatient, outpatient, and residential substance abuse treatment services


pediatric health-care services


Mammograms, clinical

detection of breast and cervical cancer








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE

employee health insurance

employees that meets the eligibility criteria established

on take-up and available revenue)

than 50% of premiums paid

No employee is paid more than $75,000 per year (owner

GUARANTEED COVERAGE


Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign

HIPAA:




underwriting


column

GUARANTEED COVERAGE

any other government programs


Must prove denial of coverage orproof of o"er paying 150% higher

May also be automatically eligiblewith certain health conditions

days

GUARANTEED COVERAGE

Newborn-No Income Limit

Pregnant women: 150% FPL




54% FPL


GUARANTEED COVERAGE

CHIP:

covered by health insurance in the past 3 months (some employment-

eligible for Medicaid , Parents not

Income at or below 250% of the FPL

WIC: Must be a Montana resident, apregnant woman, a breastfeedingwoman, or a woman who recently had a baby. Infants from birth to 12 months, or children up to 5 years old are also covered. Income must be at or below 185% FPL

GUARANTEED COVERAGE

Must be under the age of 65, not have insurance, be a US citizen and Montana

For more information, please contact your local county o#ce

GUARANTEED COVERAGE



GUARANTEED COVERAGE


Not enrolled in certain state plans Eligibility

Mon

thly

Cos

t contribution and ±25% of the contributionCOBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.




variesPremiums and deductibles varydepending on plan

Deductibles from $1-10K, 80/20co-payments, $5-13.5K annual

$0 or small share of cost CHIP: Families with incomes above 100 percent of the FPL will pay a small co-payment when services are received, no co-payment for well-baby or well-child care, including age-appropriate immunizations, and no co-payment for dental or

any family is $215 per family/yr



certain plans


Monthly Cost

Montana

53 800.234.1317

Dem

ogra


Dem

ographic



health plan




Low income families and

medically needy

Low income children Women

NativeAmerican

Indians



(TAA recipients)

Prog

ram


Group Health


www.neahu.org

COBRA & Mini-COBRAThen convert to


www.dol.gov

HIPP Health Insurance Premium Payment

402-471-3121

or



Individual Plans


www.neahu.org

NECHIP402-343-3574877-348-4304

www.nechip.com

Medicaid402-471-3121877-255-3092

TTD: 402-471-9570www.hhs.state.ne.us/med/

Kids Connection Program

402-471-8845

877-632-5437www.hhs.state.ne.us/med/


800-942-1171402-471-2781

www.dhhs.ne.gov/wic

Nebraska Every Woman Matters

Program800-532-2227 402-471-0929

TTD: 800-833-7352www.hhs.state.ne.us/hew/

owh/ewm


Medicare



Program800-633-4227


Program

Cove

rage







HIPP: Bene!ts are the same as what you had with your previous employer. HIPP is a premium assistance program


Up to $5M, assorted deductibles depending on age and residence zone


doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and

hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, dental care, vision care, and preventive care, among other services

There are eight di"erent deductible options to choose


Hospital, physician, laboratory and radiology (X-ray) , nurse midwife services, nurse practitioner services, clinic services, family planning, home health agency, personal care aide, medical transportation, ambulance, chiropractic, dental, durable medical equipment, orthotics, prosthetics, and medical supplies prescribed drugs, hearing aid services, therapies: physical, occupational, speech pathology & audiology, podiatry, psychiatric, adult day treatment, mental health and substance abuse, visual, mammograms


KCP: Hospital services, physician services, laboratory and radiology (X-ray), clinic, family planning, health checks, home health agency, medical transportation, ambulance, chiropractic dental, durable medical equipment, orthotics, prosthetics, and medical supplies, prescribed drugs, hearing aid, therapies, physical, occupational, speech pathology & audiology, podiatry mental health and substance abuse, visual





pressure check, cholesterol check, blood sugar (glucose) check, mammogram

dental, optometry, nutrition, health education, community health nursing, mental health, social services, substance abuse, and environmental health services, well-child, chronic diseases, allergy, women's health, and podiatry pharmacy, laboratory and radiology services are all provided at the centers, including in-patient and specialty care with providers in neighboring areas



B: Medical Insurance, as well as several supplemental and 'advantage' plans






Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


on license must draw wages


counting birth or adoption- may apply, (1-6 months respectively)

GUARANTEED COVERAGE




HIPAA:




Medicaid



GUARANTEED COVERAGE

Must be a legal Nebraska

prior to application


previous 6 months

You have one of the speci!ed health conditions covered by the program (full list available on program web site)

government programs

If an individual's prior coverage was through a continuation of coverage policy or contract available under state or federal

available

GUARANTEED COVERAGE

185% of FPL

Infants aged 0-1 (no parents)up to 150% of FPL

100% FPL


Non-Working Parents: 46%FPL


GUARANTEED COVERAGE

KCP: Must not be eligible for Medicaid

State resident and/or quali!ed immigrant

19 years of age or younger


WIC:

woman who recently had a

years. Determined by a health professional to be at nutritional

Nebraska, Below 185% of FPL

GUARANTEED COVERAGE

Women 40 - 64 years of age

(Health Maintenance

Do not have Medicaid

Do not have Medicare

Have a low to medium income

FPL can still receive services for a suggested $5 donation)

GUARANTEED COVERAGE

as well as others

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and± 25% of the insurance company’s




county/zone


Premiums vary based on the plan and deductible you choose and underwriting guidelines, can be around 135% of regular rates

$1-$3 and may share in some costs

KCP: $0 for most members


$0 or small share of cost $0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Nebraska


Dem

ogra


Dem

ographic



health plan





medically needy

Low income children Women

NativeAmerican

Indians



(TAA recipients)

Prog

ram


Group Health


www.neahu.org

COBRA & Mini-COBRAThen convert to


www.dol.gov

HIPP Health Insurance Premium Payment

402-471-3121

or



Individual Plans


www.neahu.org

NECHIP402-343-3574877-348-4304

www.nechip.com

Medicaid402-471-3121877-255-3092

TTD: 402-471-9570www.hhs.state.ne.us/med/

Kids Connection Program

402-471-8845

877-632-5437www.hhs.state.ne.us/med/


800-942-1171402-471-2781

www.dhhs.ne.gov/wic

Nebraska Every Woman Matters

Program800-532-2227 402-471-0929

TTD: 800-833-7352www.hhs.state.ne.us/hew/

owh/ewm


Medicare



Program800-633-4227


Program

Cove

rage







HIPP: Bene!ts are the same as what you had with your previous employer. HIPP is a premium assistance program




doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and

hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, dental care, vision care, and preventive care, among other services

There are eight di"erent deductible options to choose


Hospital, physician, laboratory and radiology (X-ray) , nurse midwife services, nurse practitioner services, clinic services, family planning, home health agency, personal care aide, medical transportation, ambulance, chiropractic, dental, durable medical equipment, orthotics, prosthetics, and medical supplies prescribed drugs, hearing aid services, therapies: physical, occupational, speech pathology & audiology, podiatry, psychiatric, adult day treatment, mental health and substance abuse, visual, mammograms


KCP: Hospital services, physician services, laboratory and radiology (X-ray), clinic, family planning, health checks, home health agency, medical transportation, ambulance, chiropractic dental, durable medical equipment, orthotics, prosthetics, and medical supplies, prescribed drugs, hearing aid, therapies, physical, occupational, speech pathology & audiology, podiatry mental health and substance abuse, visual





pressure check, cholesterol check, blood sugar (glucose) check, mammogram

dental, optometry, nutrition, health education, community health nursing, mental health, social services, substance abuse, and environmental health services, well-child, chronic diseases, allergy, women's health, and podiatry pharmacy, laboratory and radiology services are all provided at the centers, including in-patient and specialty care with providers in neighboring areas



B: Medical Insurance, as well as several supplemental and 'advantage' plans






Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


on license must draw wages


counting birth or adoption- may apply, (1-6 months respectively)

GUARANTEED COVERAGE




HIPAA:




Medicaid



GUARANTEED COVERAGE

Must be a legal Nebraska

prior to application


previous 6 months

You have one of the speci!ed health conditions covered by the program (full list available on program web site)

government programs

If an individual's prior coverage was through a continuation of coverage policy or contract available under state or federal

available

GUARANTEED COVERAGE

185% of FPL

Infants aged 0-1 (no parents)up to 150% of FPL

100% FPL


Non-Working Parents: 46%FPL


GUARANTEED COVERAGE

KCP: Must not be eligible for Medicaid

State resident and/or quali!ed immigrant

19 years of age or younger


WIC:

woman who recently had a

years. Determined by a health professional to be at nutritional

Nebraska, Below 185% of FPL

GUARANTEED COVERAGE


(Health Maintenance

Do not have Medicaid

Do not have Medicare

Have a low to medium income

FPL can still receive services for a suggested $5 donation)

GUARANTEED COVERAGE

as well as others

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and± 25% of the insurance company’s




county/zone


Premiums vary based on the plan and deductible you choose and underwriting guidelines, can be around 135% of regular rates

$1-$3 and may share in some costs

KCP: $0 for most members


$0 or small share of cost $0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Nebraska

55 800.234.1317

Dem

ogra

phic


ographic






familiesChildren

Children with developmental

delaysWomen Seniors and

Disabled



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA/Mini-COBRA

Then convert to


www.dol.gov

State Conversion Planswww.doi.state.nv.us


800-234-1317

Individual Plans


www.nahu.org

NV Medicaid775-684-3600 800-992-0900

http://dwss.nv.gov/

To !nd address and phone number of welfare o#ce near

you:

php?option=com_content&task=view&id=122&Itemid=319

Nevada Check Up(877-543-7669)800-360-6044 775-684-3777

www.nevadacheckup.state.nv.us


800-863-8942

Early Intervention Services

800-522-0066

Women’s Health Connection

888-463-8942775-684-4285

Maternal Child Health Line

800-429-2669


www.medicare.gov


Program800-633-4227

Senior Rx866-303-6323775-687-8711

http://www.dhhs.nv.gov/



877-222-8387www.va.gov

Program

Cove

rage


on enrollees who do not have prior creditable coverage




premium




how far back they can look at


Diagnosis (services to !nd out what is wrong), physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services


NV Check Up: Well baby/well child visits, prescription drugs, mental health bene!ts, immunizations, dental and vision services





family training, counseling and home visits, health services, medical services for diagnostic or evaluation purposes, nutrition counseling, occupational therapy, physical therapy, psychological services, service coordination, social work services, special instruction, speech and language services, transportation services, vision and more


WHC: Some diagnostic services such as ultrasound, breast biopsy, surgical consultation, colonoscopy


MHL: Provides prenatal care and other maternity services



Senior RX: for medication. There are plans for seniors with Medicare Part D and for seniors without Medicare Part D






primary care, outpatient and inpatient services.


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:



underwriting

o"ered two standard policies

GUARANTEED COVERAGE

Non-working parents: 26% FPL

Working parent: 91% FPL

Pregnant woman: 133% FPL

GUARANTEED COVERAGE

NV Check Up: Must not be eligible for Medicaid.If not covered by employer health plan (with employer paying 50%

Household income between

determined for one year unless child moves out of state, is enrolled in Medicaid, has other coverage, or becomes !nancially ineligible

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income mustbe: Family of 1: $1,670 , Familyof 2: $2,247, Family of 3: $2,823,Family of 4: $3,400, $555 foreach additional family member

GUARANTEED COVERAGE

Must live in state

of the covered diagnoseddevelopmental disorders orshow signi!cant delays indevelopment such as talkingor walking

eligibility criteria

GUARANTEED COVERAGE

WHC: annual mammogram)



MHL:

GUARANTEED COVERAGE



Senior RX: Seniors with an income at or below $25,477 if you are single and at or below $33,963 if you are a married couple.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


premium


column

county/zone


$0 may share in some costs NV Check Up: $0 for most. Depending on your family income you could pay a quarterly premium of $25-$80. You are not required to pay co-payments, deductibles, or other charges for covered services.


$0 or minimal share-of-cost $0 and share of cost sliding scale

Medicare: $0 and share of cost

for certain plans

Senior RX: $0 or minimal share-of-cost



Monthly Cost

Nevada


Dem

ogra

phic


ographic






familiesChildren

Children with developmental

delaysWomen Seniors and

Disabled



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA/Mini-COBRA

Then convert to


www.dol.gov

State Conversion Planswww.doi.state.nv.us


800-234-1317

Individual Plans


www.nahu.org

NV Medicaid775-684-3600 800-992-0900

http://dwss.nv.gov/

To !nd address and phone number of welfare o#ce near

you:

php?option=com_content&task=view&id=122&Itemid=319

Nevada Check Up(877-543-7669)800-360-6044 775-684-3777

www.nevadacheckup.state.nv.us


800-863-8942

Early Intervention Services

800-522-0066

Women’s Health Connection

888-463-8942775-684-4285

Maternal Child Health Line

800-429-2669


www.medicare.gov


Program800-633-4227

Senior Rx866-303-6323775-687-8711

http://www.dhhs.nv.gov/



877-222-8387www.va.gov

Program

Cove

rage


on enrollees who do not have prior creditable coverage




premium




how far back they can look at




NV Check Up: Well baby/well child visits, prescription drugs, mental health bene!ts, immunizations, dental and vision services





family training, counseling and home visits, health services, medical services for diagnostic or evaluation purposes, nutrition counseling, occupational therapy, physical therapy, psychological services, service coordination, social work services, special instruction, speech and language services, transportation services, vision and more


WHC: Some diagnostic services such as ultrasound, breast biopsy, surgical consultation, colonoscopy


MHL: Provides prenatal care and other maternity services



Senior RX: for medication. There are plans for seniors with Medicare Part D and for seniors without Medicare Part D








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:



underwriting

o"ered two standard policies

GUARANTEED COVERAGE




GUARANTEED COVERAGE

NV Check Up: Must not be eligible for Medicaid.If not covered by employer health plan (with employer paying 50%

Household income between

determined for one year unless child moves out of state, is enrolled in Medicaid, has other coverage, or becomes !nancially ineligible

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income mustbe: Family of 1: $1,670 , Familyof 2: $2,247, Family of 3: $2,823,Family of 4: $3,400, $555 foreach additional family member

GUARANTEED COVERAGE

Must live in state

of the covered diagnoseddevelopmental disorders orshow signi!cant delays indevelopment such as talkingor walking

eligibility criteria

GUARANTEED COVERAGE

WHC: annual mammogram)



MHL:

GUARANTEED COVERAGE



Senior RX: Seniors with an income at or below $25,477 if you are single and at or below $33,963 if you are a married couple.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


premium


column

county/zone


$0 may share in some costs NV Check Up: $0 for most. Depending on your family income you could pay a quarterly premium of $25-$80. You are not required to pay co-payments, deductibles, or other charges for covered services.


$0 or minimal share-of-cost $0 and share of cost sliding scale

Medicare: $0 and share of cost

for certain plans

Senior RX: $0 or minimal share-of-cost



Monthly Cost

Nevada

57 800.234.1317

Dem

ogra


emographic



health plan




Low income individuals

and families



Disabled



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA/Mini-COBRA

Then convert to


www.dol.gov



800-234-1317

Individual Plans


www.nahu.org

New Hampshire Health Plan

877-888-NHHP877-888-6447

www.nhhealthplan.org

Catastrophic Illness Plan

603-271-4495

www.dhhs.state.nh.us/dhhs/beas/cip.htm


www.dhhs.state.nh.us/ dhhs/medicaidprogram/

default.htm

Healthy Kids877-464-2447603-228-2925

www.nhhealthykids.comor

www.dhhs.nh.gov/dhhs/medassistelig/eligibility/d4.htm


800-942-4321603-271-4546

www.dhhs.state.nh.us/dhhs/wic/default.htm

Let No Woman Be Overlooked Program

603-271-4931www.dhhs.nh.gov/dhhs/cdpc/

bccp.htm


www.medicare.gov


Program800-633-4227

NH Senior Prescriptions

Discounts888-580-8902



877-222-8387www.va.gov

Program

Cove

rage






premium





NHHP: options each with a di"erent deductible. Hospitalization, physician care, diagnostic tests,

and some mental health care services

CIP: Meant to provide !nancial assistance to persons with cancer, hemophilia, end stage renal disease, cystic !brosis,

per individual per year.




HK: Hospital and physician care, prescription drugs, mental health care, and some other services





Women age 18 and younger receive free Pap tests

Women age 40 and over receive free mammograms every 1-2 years











Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee

Twice annually, self-employed persons can be a small group health plan with guarantee issue


GUARANTEED COVERAGE




HIPAA:



underwriting


column

GUARANTEED COVERAGE

NHHP: Declined for health coverage because of health

NHHP but at a higher premium. You have a pre qualifying medical condition (see list on

terminated for reasons other than non-payment of premium

Hampshire resident

CIP:

or guardian having primary responsibility for the applicant

21 or over, Must have one of thecovered health conditions

GUARANTEED COVERAGE

Infant: 300% FPL




Medically needy individual: 76% FPL

Medically needy couple: 70% FPL

GUARANTEED COVERAGE

HK: U.S. citizen, a refugee, an asylee, or a permanent resident who has been in the U.S. for at least

who are at or below 185% FPLand infants at 300% FPL qualify

185-400% FPL qualify for Silveror Buy-In Programs

WIC: Be a pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must beat or below 185% FPL

GUARANTEED COVERAGE

Have income less than 250%


Women under age 40 are eligible for a clinical breast

smear, and a mammogram when a breast lump is found

Women ages 40 to 64 are eligible for a clinical breast

and mammogram Women age 65+ are eligible

mammogram when not eligible for the Medicare program or not enrolled in Medicare Part B

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and the Modi!ed COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium



county/zone.


NHHP: Premiums vary based on the plan and deductible you

similar plans o"ered to a healthy individual through private insurance options)

CIP: $0 to minimal share of cost

$0 may share in some costs HK: $0 for Gold Program. Monthly premium for Silver Program is based on family size and household income.



certain plans



Monthly Cost

New Hampshire


Dem

ogra


emographic



health plan




Low income individuals

and families



Disabled



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRA/Mini-COBRA

Then convert to


www.dol.gov



800-234-1317

Individual Plans


www.nahu.org

New Hampshire Health Plan

877-888-NHHP877-888-6447

www.nhhealthplan.org

Catastrophic Illness Plan

603-271-4495

www.dhhs.state.nh.us/dhhs/beas/cip.htm


www.dhhs.state.nh.us/ dhhs/medicaidprogram/

default.htm

Healthy Kids877-464-2447603-228-2925

www.nhhealthykids.comor

www.dhhs.nh.gov/dhhs/medassistelig/eligibility/d4.htm


800-942-4321603-271-4546

www.dhhs.state.nh.us/dhhs/wic/default.htm

Let No Woman Be Overlooked Program

603-271-4931www.dhhs.nh.gov/dhhs/cdpc/

bccp.htm


www.medicare.gov


Program800-633-4227

NH Senior Prescriptions

Discounts888-580-8902



877-222-8387www.va.gov

Program

Cove

rage






premium





NHHP: options each with a di"erent deductible. Hospitalization, physician care, diagnostic tests,

and some mental health care services

CIP: Meant to provide !nancial assistance to persons with cancer, hemophilia, end stage renal disease, cystic !brosis,

per individual per year.




HK: Hospital and physician care, prescription drugs, mental health care, and some other services





Women age 18 and younger receive free Pap tests

Women age 40 and over receive free mammograms every 1-2 years











Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee

Twice annually, self-employed persons can be a small group health plan with guarantee issue


GUARANTEED COVERAGE




HIPAA:



underwriting


column

GUARANTEED COVERAGE

NHHP: Declined for health coverage because of health

NHHP but at a higher premium. You have a pre qualifying medical condition (see list on

terminated for reasons other than non-payment of premium

Hampshire resident

CIP:

or guardian having primary responsibility for the applicant

21 or over, Must have one of thecovered health conditions

GUARANTEED COVERAGE

Infant: 300% FPL




Medically needy individual: 76% FPL

Medically needy couple: 70% FPL

GUARANTEED COVERAGE

HK: U.S. citizen, a refugee, an asylee, or a permanent resident who has been in the U.S. for at least

who are at or below 185% FPLand infants at 300% FPL qualify

185-400% FPL qualify for Silveror Buy-In Programs

WIC: Be a pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must beat or below 185% FPL

GUARANTEED COVERAGE

Have income less than 250%


Women under age 40 are eligible for a clinical breast

smear, and a mammogram when a breast lump is found

Women ages 40 to 64 are eligible for a clinical breast

and mammogram Women age 65+ are eligible

mammogram when not eligible for the Medicare program or not enrolled in Medicare Part B

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and the Modi!ed COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

full premium



county/zone.


NHHP: Premiums vary based on the plan and deductible you

similar plans o"ered to a healthy individual through private insurance options)

CIP: $0 to minimal share of cost

$0 may share in some costs HK: $0 for Gold Program. Monthly premium for Silver Program is based on family size and household income.



certain plans



Monthly Cost

New Hampshire

59 800.234.1317

Dem

ogra


emographic







conditions


families

Moderate income families Women Seniors and

Disabled



Prog

ram


800-234-1317

Group Health

of Health Underwriters

COBRA & Mini-COBRAand then


www.dol.gov


800-234-1317

Individual Plans


Individual Health Coverage

Program609-633-1882

Medicaid800-356-1561609-588-2600

humanservices/dmahs/home/

NJ Family Care Program800-701-0710


866-446-5942609-292-9560

Cancer Education and Early Detection

609-292-8540800-328-3838

Medicare



Program800-633-4227

Senior Gold Program 800-792-9745

seniorbene!ts/paadapp.htm




Cove

rage


enrollees that do not have prior creditable coverage (this may only apply to certain groups)






plan details)


medical needs

issue coverage to all individuals


conditions


o#ce visits, hospital care, prenatal and maternity care, immunizations, well-child care, screenings (including mammographies, pap smears and prostate

laboratory services, certain mental health and substance abuse services, prescription drugs

a 12 month waiting periodfor coverage of pre-


Inpatient and outpatient hospital treatment, laboratory tests and X-rays, early and periodic screening, diagnostic and treatment services, home health care, physician services, nurse-midwife services, assistance with family planning and any necessary supplies, nursing facilities for people over 21


NJ Family Care: Physician services, preventive health care, emergency medical care, inpatient hospital services, outpatient hospital services, laboratory services, prescription drugs, eyeglasses, dental services in most cases, emergency transportation, mental health services and more





Screening mammograms,

instructions on breast

Diagnostic tests such as needle biopsies, breast ultrasounds and colonoscopies.

and follow-up are provided to

is placed on rescreening women who are currently being served by the program



Senior Gold: is a state funded prescription discount program







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)


Most carriers require the most recent copy of NJ’s quarterly

GUARANTEED COVERAGE


Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign up for


HIPAA:



cannot be eligible for Medicare or other public or group insurance programs

GUARANTEED COVERAGE

New Jersey resident

Medical underwriting is not allowed


column

GUARANTEED COVERAGE

least 6 months

Not eligible for coverage under a group health plan, governmental plan or church plan

Not eligible for coverage under Medicare

GUARANTEED COVERAGE

Infants (ages 0-1): 200% FPL (mother is enrolled in Medicaid at the time of birth. If not, infants with family incomes of 185% FPL)


with incomes between 186 and 200% may also be available)

Quali!ed Parents: 100% FPL


100% FPL

GUARANTEED COVERAGE

NJ Family Care: Uninsured children age 18 or younger with family incomes of up to 350% FPL

Quali!ed parents at or below 200% FPL

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family of 1: $1604 , Family of 2: $2159, Family of 3: $2714, Family of 4: $3269, $555 for each additional family member

GUARANTEED COVERAGE

Income below 250% of FPL

Uninsured or under-insured

GUARANTEED COVERAGE



Senior Gold: at least 65 years

and receiving Social Security Disability Title II ben!ts, income restrictions

GUARANTEED COVERAGE



Jersey

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and the Modi!ed COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for

premium


column

varies selected carrier and plan (premiums, deductibles and co-pays)

$0 or small share of cost NJ Family Care: $0-128 premiums and $0-35 co-pays depending on income


$0 or minimal share of cost $0 and share of cost for certain services: deductibles for certain plans

Senior Gold: $0 to minimal share of cost



Monthly Cost

New Jersey


Dem

ogra


emographic







conditions


families


Disabled



Prog

ram


800-234-1317

Group Health




www.dol.gov


800-234-1317

Individual Plans


Individual Health Coverage

Program609-633-1882

Medicaid800-356-1561609-588-2600

humanservices/dmahs/home/

NJ Family Care Program800-701-0710


866-446-5942609-292-9560

Cancer Education and Early Detection

609-292-8540800-328-3838

Medicare



Program800-633-4227

Senior Gold Program 800-792-9745

seniorbene!ts/paadapp.htm




Cove

rage








plan details)


medical needs



conditions


o#ce visits, hospital care, prenatal and maternity care, immunizations, well-child care, screenings (including mammographies, pap smears and prostate

laboratory services, certain mental health and substance abuse services, prescription drugs

a 12 month waiting periodfor coverage of pre-


Inpatient and outpatient hospital treatment, laboratory tests and X-rays, early and periodic screening, diagnostic and treatment services, home health care, physician services, nurse-midwife services, assistance with family planning and any necessary supplies, nursing facilities for people over 21


NJ Family Care: Physician services, preventive health care, emergency medical care, inpatient hospital services, outpatient hospital services, laboratory services, prescription drugs, eyeglasses, dental services in most cases, emergency transportation, mental health services and more





Screening mammograms,

instructions on breast

Diagnostic tests such as needle biopsies, breast ultrasounds and colonoscopies.

and follow-up are provided to

is placed on rescreening women who are currently being served by the program



Senior Gold: is a state funded prescription discount program







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)


Most carriers require the most recent copy of NJ’s quarterly

GUARANTEED COVERAGE


Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign up for


HIPAA:



cannot be eligible for Medicare or other public or group insurance programs

GUARANTEED COVERAGE

New Jersey resident



column

GUARANTEED COVERAGE

least 6 months

Not eligible for coverage under a group health plan, governmental plan or church plan

Not eligible for coverage under Medicare

GUARANTEED COVERAGE

Infants (ages 0-1): 200% FPL (mother is enrolled in Medicaid at the time of birth. If not, infants with family incomes of 185% FPL)


with incomes between 186 and 200% may also be available)



100% FPL

GUARANTEED COVERAGE

NJ Family Care: Uninsured children age 18 or younger with family incomes of up to 350% FPL

Quali!ed parents at or below 200% FPL

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family of 1: $1604 , Family of 2: $2159, Family of 3: $2714, Family of 4: $3269, $555 for each additional family member

GUARANTEED COVERAGE

Income below 250% of FPL

Uninsured or under-insured

GUARANTEED COVERAGE



Senior Gold: at least 65 years

and receiving Social Security Disability Title II ben!ts, income restrictions

GUARANTEED COVERAGE



Jersey

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and the Modi!ed COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for

premium


column

varies selected carrier and plan (premiums, deductibles and co-pays)

$0 or small share of cost NJ Family Care: $0-128 premiums and $0-35 co-pays depending on income



Senior Gold: $0 to minimal share of cost



Monthly Cost

New Jersey

61 800.234.1317

Dem

ogra

phic PRIVATE HEALTH INSURANCE PRIVATE/PUBLIC

PROGRAMPUBLICLY SPONSORED PROGRAMS D

emographic



health plan


Individuals Below 200% FPL





familiesPregnant Women Women Native American

Indians

Prog

ram


Group Healthof Health Underwriters

www.nmsahu.org

Small Employer Insurance Program

(SEIP)866-901-4538

http://www.generalservices.state.nm.us/rmd/seip.html

COBRA & New Mexico State Continuation

Conversion Coverage


www.dol.gov


Individual Plans

Underwriterswww.nmsahu.org

State Coverage Insurance (SCI)

888-997-2583

(Waitlist is currently open The program and enrollment

will be closed until further

legislature.)

INSURE New Mexico!Solutions888-997-2583

www.

nm.us/

NMMIPInsurance Pool888-997-2583505-424-7105800-432-0750

www.nmmip.com

New Mexico Health Insurance Alliance

800-204-4700888-997-2583

www.nmhia.com

Medicaid888-997-2583505-827-3100

www.state.nm.us/hsd/mad


New Mexikids888-997-2583

or

Premium Assistance for Kids (PAK)

888-997-2583

net/pakhome.htm

Premium Assistance for Maternity (PAM)

888-997-2583




866-867-3124www.health.state.nm.us/phd/

Breast & Cervical Cancer Early

Detection Program877-852-2585

www.cancernm.org/bcc


Program

Cove

rage




SEIP:$100,000 per enrollee





similar to the NM Health Insurance




Bene!ts are limited to $100,000 payable per member

and behavioral health and substance abuse


NMMIP: Hospital and physician care, prescription drugs, and other services, limited home health visits and organ transplant coverage are available, there is no

member for organ transplant), and maternity coverage is available

The Alliance:indemnity plans




New Mexikids & PAK: Doctor visits, hospital care, prescriptions, and vision, hearing, and dental care.

PAK: Medical underwriting applies

are not covered. Provides assistance with payment of the premium for commercial, comprehensive child health insurance, which usually includes preventive,primary and specialty care, inpatient and outpatienthospitalization, pharmacy, labs

and speech therapy.


PAM: delivery, and pregnancy-related health services.

Medicaid: vision, and prescription coverage





(every two years for women 40-49, yearly for women 50 and older, or when medically indicated) , pap tests, as well as some additional breast and cervical tests if needed, such as ultrasound, biopsies, and other services

If diagnosed with a cancerous or precancerous condition through

eligible for full Medicaid services which include the cost of cancer treatment


are the 19 Pueblos, the Jicarilla

health facilities are strategically located near population centers and include 5 hospitals, 11 health centers, and 12 !eld clinics. The

the Indian people a wide array of inpatient and outpatient services.


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


an employee


SEIP:groups and has special rules

GUARANTEED COVERAGE


Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination

HIPAA:



Medicare or other public insurance programs


If you are denied coverage for a medical condition, you may be eligible for NMMIP, see the "Individuals with pre-

medical conditions" column

GUARANTEED COVERAGE

Uninsured adults between the ages of 19-64

Not eligible for certain government health insurance bene!ts (i.e. Medicaid,

Do not have other private or public health insurance

No asset test for eligibility

GUARANTEED COVERAGE

NMMIP: Must be a resident of New

You are eligible if your previous coverage was terminated for reasons other than non-paymentor fraud

Must prove denial of coverage or o"er of higher premium than NMMIP

You are also eligible if you have a qualifying medical condition

allowable coverage limit of yourcurrent health insurance plan

The Alliance:eligible

Do not have any health plan available, but have had 18 months of creditable coverage

In addition, if you have a policy

transfer into NMMIP

GUARANTEED COVERAGE

Pregnant: up to 185% FPL


Working Parents: up to 69% FPL

Non-Working Parents: up to30% FPL


Parents: up to 31% FPL

Live in state

GUARANTEED COVERAGE

New MexiKids:between 185%-235% FPL Must be ineligible for no-cost Medicaid or employer-based coverage

PAK:age 18 if part of a sibling group that includes a child below age 12. Income must be too high to

GUARANTEED COVERAGE

PAM: Income must be too high to qualify for Medicaid. Mustbe pregnant, a resident of New

Medicaid: Pregnant women can have an income up to 185% of the FPL.

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be at or below 185% FPL

GUARANTEED COVERAGE

Women age 30 and over

Live at or below 250% of the federal poverty threshold

Have no health insurance or have health insurance, but deductibles and/or co-pays are too high

GUARANTEED COVERAGE

Tribal members from throughout the United States who live, work, or go to school in the urban centers of the area

Eligibility

Mon

thly

Cos

t


SEIP: Premium determined buy age, gender, and geographic location.

at least 50% of the monthly premium


full premium



coverage vary according: age, gender, smoking and geographic location

$75) of the monthly premium, the employee pays a portion ($0 to $35) of the monthly premium, and if you make less than 100% FPL the state contributes the premium payment.

Individuals without an employer group pay both the employer and employee premium share which is either $0 or $95 or $110 depending on their income

NMMIP: Premiums vary according

available for individuals up to 400% FPL

higher than the average a healthy person would pay for a similar plan sold by a private NM insurer

The Alliance:for individuals are usually about 9% higher than premiums charged for similar coverage

$0 or minimal share of cost New MexiKids: may require a co-payment at the time each

range from $2-$25 depending on

PAK: The state generally pays 50% of the premium while the family pays 50% per child. Full premiums are

monthly per child. Deductibles and co-payments apply.

PAM: $150 or $300. No co-payments or deductibles.

Medicaid & WIC: $0 or minimal share of cost

$0 or share of cost $0 or share of cost

Monthly Cost

New Mexico


Dem

ogra

phic PRIVATE HEALTH INSURANCE PRIVATE/PUBLIC

PROGRAMPUBLICLY SPONSORED PROGRAMS D

emographic



health plan


Individuals Below 200% FPL





familiesPregnant Women Women Native American

Indians

Prog

ram


Group Healthof Health Underwriters

www.nmsahu.org

Small Employer Insurance Program

(SEIP)866-901-4538

http://www.generalservices.state.nm.us/rmd/seip.html

COBRA & New Mexico State Continuation

Conversion Coverage


www.dol.gov


Individual Plans

Underwriterswww.nmsahu.org

State Coverage Insurance (SCI)

888-997-2583

(Waitlist is currently open The program and enrollment

will be closed until further

legislature.)

INSURE New Mexico!Solutions888-997-2583

www.

nm.us/

NMMIPInsurance Pool888-997-2583505-424-7105800-432-0750

www.nmmip.com

New Mexico Health Insurance Alliance

800-204-4700888-997-2583

www.nmhia.com

Medicaid888-997-2583505-827-3100



New Mexikids888-997-2583

or

Premium Assistance for Kids (PAK)

888-997-2583

net/pakhome.htm

Premium Assistance for Maternity (PAM)

888-997-2583




866-867-3124www.health.state.nm.us/phd/

Breast & Cervical Cancer Early

Detection Program877-852-2585

www.cancernm.org/bcc


Program

Cove

rage




SEIP:$100,000 per enrollee





similar to the NM Health Insurance




Bene!ts are limited to $100,000 payable per member

and behavioral health and substance abuse


NMMIP: Hospital and physician care, prescription drugs, and other services, limited home health visits and organ transplant coverage are available, there is no

member for organ transplant), and maternity coverage is available

The Alliance:indemnity plans




New Mexikids & PAK: Doctor visits, hospital care, prescriptions, and vision, hearing, and dental care.

PAK: Medical underwriting applies

are not covered. Provides assistance with payment of the premium for commercial, comprehensive child health insurance, which usually includes preventive,primary and specialty care, inpatient and outpatienthospitalization, pharmacy, labs

and speech therapy.


PAM: delivery, and pregnancy-related health services.

Medicaid: vision, and prescription coverage





(every two years for women 40-49, yearly for women 50 and older, or when medically indicated) , pap tests, as well as some additional breast and cervical tests if needed, such as ultrasound, biopsies, and other services

If diagnosed with a cancerous or precancerous condition through

eligible for full Medicaid services which include the cost of cancer treatment


are the 19 Pueblos, the Jicarilla

health facilities are strategically located near population centers and include 5 hospitals, 11 health centers, and 12 !eld clinics. The

the Indian people a wide array of inpatient and outpatient services.


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees


an employee


SEIP:groups and has special rules

GUARANTEED COVERAGE


Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination

HIPAA:



Medicare or other public insurance programs


If you are denied coverage for a medical condition, you may be eligible for NMMIP, see the "Individuals with pre-

medical conditions" column

GUARANTEED COVERAGE

Uninsured adults between the ages of 19-64

Not eligible for certain government health insurance bene!ts (i.e. Medicaid,

Do not have other private or public health insurance

No asset test for eligibility

GUARANTEED COVERAGE

NMMIP: Must be a resident of New

You are eligible if your previous coverage was terminated for reasons other than non-paymentor fraud

Must prove denial of coverage or o"er of higher premium than NMMIP

You are also eligible if you have a qualifying medical condition

allowable coverage limit of yourcurrent health insurance plan

The Alliance:eligible

Do not have any health plan available, but have had 18 months of creditable coverage

In addition, if you have a policy

transfer into NMMIP

GUARANTEED COVERAGE

Pregnant: up to 185% FPL



Non-Working Parents: up to30% FPL


Parents: up to 31% FPL

Live in state

GUARANTEED COVERAGE

New MexiKids:between 185%-235% FPL Must be ineligible for no-cost Medicaid or employer-based coverage

PAK:age 18 if part of a sibling group that includes a child below age 12. Income must be too high to

GUARANTEED COVERAGE

PAM: Income must be too high to qualify for Medicaid. Mustbe pregnant, a resident of New

Medicaid: Pregnant women can have an income up to 185% of the FPL.

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be at or below 185% FPL

GUARANTEED COVERAGE

Women age 30 and over

Live at or below 250% of the federal poverty threshold

Have no health insurance or have health insurance, but deductibles and/or co-pays are too high

GUARANTEED COVERAGE

Tribal members from throughout the United States who live, work, or go to school in the urban centers of the area

Eligibility

Mon

thly

Cos

t


SEIP: Premium determined buy age, gender, and geographic location.

at least 50% of the monthly premium


full premium



coverage vary according: age, gender, smoking and geographic location

$75) of the monthly premium, the employee pays a portion ($0 to $35) of the monthly premium, and if you make less than 100% FPL the state contributes the premium payment.

Individuals without an employer group pay both the employer and employee premium share which is either $0 or $95 or $110 depending on their income

NMMIP: Premiums vary according

available for individuals up to 400% FPL

higher than the average a healthy person would pay for a similar plan sold by a private NM insurer

The Alliance:for individuals are usually about 9% higher than premiums charged for similar coverage

$0 or minimal share of cost New MexiKids: may require a co-payment at the time each

range from $2-$25 depending on

PAK: The state generally pays 50% of the premium while the family pays 50% per child. Full premiums are

monthly per child. Deductibles and co-payments apply.

PAM: $150 or $300. No co-payments or deductibles.

Medicaid & WIC: $0 or minimal share of cost

$0 or share of cost $0 or share of cost

Monthly Cost

New Mexico

63 800.234.1317

Dem

ogra


emographic




Small businesses & working individuals



families

Low and moderate income children

and familiesAdults Seniors and

Disabled



Prog

ram


800-234-1317

Group PlansNew York State Insurance

Department800-342-3736

www.ins.state.ny.us/chealth.htm

COBRA/Mini-COBRA

or

HIPAAHealth Insurance Portability and

www.dol.gov

Healthy NY(866-432-5849)

www.healthyny.com


Individual PlansNew York State Insurance



Medicaid800-541-2831 877-472-8411718-557-1399

www.health.state.ny.us

Child Health Plus800-698-4KIDS 800-698-4543

www.health.state.ny.us/nysdoh/chplus/

Family Health Plus877-9FHPLUS

(877-934-7587)www.health.state.ny.us/

nysdoh/fhplus/

Breast, Cervical,Colorectal and

Prostate CancerProgram800-422-6237

www.health.state.ny.us/nysdoh/bcctp/bcctp.htm


www.medicare.gov


Program800-633-4227

New York Elderly Pharmaceutical

Insurance Coverage (EPIC) Program

800-332-3742




Cove

rage





COBRA or Mini-COBRA: available for up to 18 months depending on qualifying events, bene!ts are the same as what you had with your previous employer




Inpatient and outpatient

choose a bene!t package with or without a limited prescription bene!t

High Deductible Plan nowavailable


medical needs

issue coverage to all individuals, including two comprehensive standardized plans


conditions

No medical underwriting


Smoking cessation agents treatment and preventive health and dental care, hospital inpatient and outpatient services, laboratory and X-ray, nursing home, home health agencies and personal care, treatment in psychiatric hospitals, mental health facilities, family planning, early periodic screening, diagnosis, and treatment for children, medical equipment, and appliances, transportation to medical appointments, emergency ambulance, pre-natal care and other health services


immunizations, diagnosis and

surgery, emergency care, prescription and non-prescription drugs if ordered, inpatient hospital medical or surgical care, short-term therapeutic outpatient services (chemotherapy, hemodialysis), limited inpatient and outpatient treatment for alcoholism and substance abuse, and mental health, dental, vision, speech and hearing, durable medical equipment, emergency ambulance transportation to a hospital, hospice


Screening, treatment and comprehensive health care through Medicaid


Medicare:


EPIC:prescription discount program







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)

GUARANTEED COVERAGE


from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign


HIPAA:




GUARANTEED COVERAGE

Must reside in New York and you or your spouse must either be currently employed or must have been employed within the past 12 months.

Do not have access to employer health insurance or Medicare

Uninsured for the 12-month period preceding application or have lost that coverage due to a qualifying event

30% of the employees must earn wages of $40,000 or less

Individuals and Sole Proprietors must have an income at or below 250%

GUARANTEED COVERAGE

New York resident


GUARANTEED COVERAGE

Pregnant women and infants (ages 0-1): 200% FPL


FPL, Individual: 87% FPL,

Individuals may also own a home, a car, and personal property and still be eligible. The income and resources of legally responsible relatives in the household will be counted, limits on cash resources

GUARANTEED COVERAGE

Both: State and are United States citizens or fall under one of many immigration categories

CHP: Uninsured children age 18 or younger with family incomes of up to 400% FPL. Families with incomes above 400% FPL can pay the full premium

FHP: adults between the ages of 19 and 64 who do not have health insurance - either on their own or through their employers - but have income or resources too high to qualify

of the FPL, Parents/Guardians

Under 21-150% of the FPL

GUARANTEED COVERAGE

For Breast/Cervical: Be 18 years

of treatment for breast and/or cervical cancer or a precancerouscondition

For Colorectal/Prostate: Bescreened and/or diagnosed

for colorectal and/or prostatecancer or pre-cancerouscondition

Both: Have income that is at orbelow 250% Federal Poverty

Be ineligible for Medicaid

and Be a U.S. citizen or an alienwith satisfactory immigrationstatus

GUARANTEED COVERAGE



EPIC: Seniors with other prescription coverage through Medicare or most other plans

costs not covered by that other coverage

GUARANTEED COVERAGE



New York Program

GUARANTEED COVERAGE



Mon

thly

Cos

t

contribution and the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

you are responsible for full premium


column

$0 for some services and $500 for hospital stays, monthly premiums vary but the amounts of the co payments and deductible are the same for each health plan

The 2010 deductible amounts are $1,200 for individual coverage and $2,400 for family coverage for the High Deductible Plan

varies$0 or small share of cost CHP: $0-60 premiums and no

co-pays

FHP: $0


certain plans



Monthly Cost

New York


Dem

ogra


emographic




Small businesses & working individuals



families

Low and moderate income children

and familiesAdults Seniors and

Disabled



Prog

ram


800-234-1317

Group PlansNew York State Insurance



COBRA/Mini-COBRA

or

HIPAAHealth Insurance Portability and

www.dol.gov

Healthy NY(866-432-5849)

www.healthyny.com


Individual PlansNew York State Insurance



Medicaid800-541-2831 877-472-8411718-557-1399

www.health.state.ny.us

Child Health Plus800-698-4KIDS 800-698-4543

www.health.state.ny.us/nysdoh/chplus/

Family Health Plus877-9FHPLUS

(877-934-7587)www.health.state.ny.us/

nysdoh/fhplus/

Breast, Cervical,Colorectal and

Prostate CancerProgram800-422-6237

www.health.state.ny.us/nysdoh/bcctp/bcctp.htm


www.medicare.gov


Program800-633-4227

New York Elderly Pharmaceutical

Insurance Coverage (EPIC) Program

800-332-3742




Cove

rage





COBRA or Mini-COBRA: available for up to 18 months depending on qualifying events, bene!ts are the same as what you had with your previous employer




Inpatient and outpatient

choose a bene!t package with or without a limited prescription bene!t

High Deductible Plan nowavailable


medical needs

issue coverage to all individuals, including two comprehensive standardized plans


conditions

No medical underwriting


Smoking cessation agents treatment and preventive health and dental care, hospital inpatient and outpatient services, laboratory and X-ray, nursing home, home health agencies and personal care, treatment in psychiatric hospitals, mental health facilities, family planning, early periodic screening, diagnosis, and treatment for children, medical equipment, and appliances, transportation to medical appointments, emergency ambulance, pre-natal care and other health services


immunizations, diagnosis and

surgery, emergency care, prescription and non-prescription drugs if ordered, inpatient hospital medical or surgical care, short-term therapeutic outpatient services (chemotherapy, hemodialysis), limited inpatient and outpatient treatment for alcoholism and substance abuse, and mental health, dental, vision, speech and hearing, durable medical equipment, emergency ambulance transportation to a hospital, hospice


Screening, treatment and comprehensive health care through Medicaid


Medicare:


EPIC:prescription discount program







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)

GUARANTEED COVERAGE


from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to sign


HIPAA:




GUARANTEED COVERAGE

Must reside in New York and you or your spouse must either be currently employed or must have been employed within the past 12 months.

Do not have access to employer health insurance or Medicare

Uninsured for the 12-month period preceding application or have lost that coverage due to a qualifying event

30% of the employees must earn wages of $40,000 or less

Individuals and Sole Proprietors must have an income at or below 250%

GUARANTEED COVERAGE

New York resident


GUARANTEED COVERAGE

Pregnant women and infants (ages 0-1): 200% FPL


FPL, Individual: 87% FPL,

Individuals may also own a home, a car, and personal property and still be eligible. The income and resources of legally responsible relatives in the household will be counted, limits on cash resources

GUARANTEED COVERAGE

Both: State and are United States citizens or fall under one of many immigration categories

CHP: Uninsured children age 18 or younger with family incomes of up to 400% FPL. Families with incomes above 400% FPL can pay the full premium

FHP: adults between the ages of 19 and 64 who do not have health insurance - either on their own or through their employers - but have income or resources too high to qualify

of the FPL, Parents/Guardians

Under 21-150% of the FPL

GUARANTEED COVERAGE

For Breast/Cervical: Be 18 years

of treatment for breast and/or cervical cancer or a precancerouscondition

For Colorectal/Prostate: Bescreened and/or diagnosed

for colorectal and/or prostatecancer or pre-cancerouscondition

Both: Have income that is at orbelow 250% Federal Poverty

Be ineligible for Medicaid

and Be a U.S. citizen or an alienwith satisfactory immigrationstatus

GUARANTEED COVERAGE



EPIC: Seniors with other prescription coverage through Medicare or most other plans

costs not covered by that other coverage

GUARANTEED COVERAGE



New York Program

GUARANTEED COVERAGE



Mon

thly

Cos

t

contribution and the COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst

you are responsible for full premium


column

$0 for some services and $500 for hospital stays, monthly premiums vary but the amounts of the co payments and deductible are the same for each health plan

The 2010 deductible amounts are $1,200 for individual coverage and $2,400 for family coverage for the High Deductible Plan

varies$0 or small share of cost CHP: $0-60 premiums and no

co-pays

FHP: $0


certain plans



Monthly Cost

New York

65 800.234.1317

Dem

ogra


Dem

ographic



health plan






families

Pregnant women and infants




Prog

ram


800-234-1317

Group Plans


www.ncahu.org



www.dol.gov

or

Conversion Plans


800-234-1317

Individual Plans


www.ncahu.org

Inclusive Health

866-665-2117 www.inclusivehealth.org

Medicaid800-662-7030919-855-4400

TTY: 919-733-4851www.dhhs.state.nc.us/dma/

medicaid/

North Carolina’s Health Choice

800-662-7030919-855-4440

www.ncdhhs.gov/dma/cpcont.htm


919-707-5800www.nutritionnc.com/wic

Medicaid forPregnant Women

919-707-5700 TTD: 877-452-2514

www.dhhs.state.nc.us/dma/medicaid

Baby Love919-855-4260

www.ncdhhs.gov/dma/services/babylove.htm

NC Family Health Resource Line

800-367-2229TTY: 1-800-976-1922


www.medicare.gov


Program800-633-4227

Senior Insurance Counseling (SHIIP)

919-807-6900800-443-9354



877-222-8387www.va.gov

Program

Cove

rage







premium



medical needs


traditional individual market health insurance products


that cover a broad range of services, including preventive care, urgent care, outpatient services, a prescription drug bene!t and other common health care services

May have a 6 to 12 month

conditions

$1,000,000


Inpatient hospital services outpatient hospital services,

nursing facility services for persons aged 21 or older. Family planning services and

for persons eligible for skilled

and family nurse practitioner

services and possibly more


NCHC:

occupational therapy and therapy for individuals with speech,

hospice care and possibly more





Medicaid for Pregnant Women:

and 60 days postpartumcare, services to treat medicalconditions which maycomplicate pregnancy (someservices require prior approval),childbirth and parenting classes,family planning services

Baby Care: Maternity carecoordination, childbirtheducation classes, counselingand emotional support, medicalhome visits, and referral to otherprograms

NC Family Health Resource Line: Provides information, referral and advocacy services for pregnancy and child care issues



Insurance and Part B: Medical Insurance, as wells several supplemental and advantage plans. It also o"ers a prescription drug program called Medicare Part D

SHIIP answers questions and counsels Medicare bene!ciaries and caregivers about Medicare, Medicare supplements,

prescription drug plans, long-term care insurance and other health insurance concerns





and primary care, outpatient and inpatient services


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)



GUARANTEED COVERAGE




HIPAA:





underwriting

If you are denied coverage for a medical condition, you may be eligible for guarantee issue through Inclusive Health, see

GUARANTEED COVERAGE

Not eligible Medicaid or

the US and currently reside in

continuous resident of North

Do not have access to group coverage as an employee or as

an insurer for similar coverage due to medical reasons, o"ered coverage by an insurer but with a conditional rider limiting coverage, o"ered coverage at higher premium rate, have been diagnosed with a medical condition that is outlined by Inclusive Health allowing automatic enrollment into Inclusive

eligible individual, eligible for

GUARANTEED COVERAGE


ages 6-19: 100% FPL (also aged, blind and disabled)


Working parents with incomesup to 51% FPL

Non-working parents up to37% FPL

Medically Needy Individuals upto 34% FPL

33% FPL

GUARANTEED COVERAGE

NCHC: Family Income up to 200%

Medicaid or have any other

WIC: a pregnant or recently pregnant woman, infant or child up to age 5, Be determined to have a nutritional risk, Income must be at or below 185% FPL

GUARANTEED COVERAGE


Monthly family income cannot

If a pregnant woman is covered by Medicaid on the date she delivers, her newborn child may be eligible for Medicaid up to age 1 without a separate application

Baby Love: Pregnant and postpartum women are eligible to receive services

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium



variesPremiums vary based on age, gender, whether you are a smoker or not, and your choice of plan option.

Deductible varies depending onplan chosen.

$0 or minimal share of cost NCHC: $0-100$1-20 co-pays depending on





Monthly Cost

North Carolina


Dem

ogra


Dem

ographic



health plan






families

Pregnant women and infants




Prog

ram


800-234-1317

Group Plans


www.ncahu.org



www.dol.gov

or

Conversion Plans


800-234-1317

Individual Plans


www.ncahu.org

Inclusive Health

866-665-2117 www.inclusivehealth.org

Medicaid800-662-7030919-855-4400

TTY: 919-733-4851www.dhhs.state.nc.us/dma/

medicaid/

North Carolina’s Health Choice

800-662-7030919-855-4440

www.ncdhhs.gov/dma/cpcont.htm


919-707-5800www.nutritionnc.com/wic

Medicaid forPregnant Women

919-707-5700 TTD: 877-452-2514

www.dhhs.state.nc.us/dma/medicaid

Baby Love919-855-4260

www.ncdhhs.gov/dma/services/babylove.htm

NC Family Health Resource Line

800-367-2229TTY: 1-800-976-1922


www.medicare.gov


Program800-633-4227

Senior Insurance Counseling (SHIIP)

919-807-6900800-443-9354



877-222-8387www.va.gov

Program

Cove

rage







premium



medical needs




that cover a broad range of services, including preventive care, urgent care, outpatient services, a prescription drug bene!t and other common health care services

May have a 6 to 12 month

conditions

$1,000,000


Inpatient hospital services outpatient hospital services,

nursing facility services for persons aged 21 or older. Family planning services and

for persons eligible for skilled

and family nurse practitioner

services and possibly more


NCHC:

occupational therapy and therapy for individuals with speech,

hospice care and possibly more






and 60 days postpartumcare, services to treat medicalconditions which maycomplicate pregnancy (someservices require prior approval),childbirth and parenting classes,family planning services

Baby Care: Maternity carecoordination, childbirtheducation classes, counselingand emotional support, medicalhome visits, and referral to otherprograms

NC Family Health Resource Line: Provides information, referral and advocacy services for pregnancy and child care issues



Insurance and Part B: Medical Insurance, as wells several supplemental and advantage plans. It also o"ers a prescription drug program called Medicare Part D

SHIIP answers questions and counsels Medicare bene!ciaries and caregivers about Medicare, Medicare supplements,

prescription drug plans, long-term care insurance and other health insurance concerns





and primary care, outpatient and inpatient services


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)



GUARANTEED COVERAGE




HIPAA:





underwriting

If you are denied coverage for a medical condition, you may be eligible for guarantee issue through Inclusive Health, see

GUARANTEED COVERAGE

Not eligible Medicaid or

the US and currently reside in

continuous resident of North

Do not have access to group coverage as an employee or as

an insurer for similar coverage due to medical reasons, o"ered coverage by an insurer but with a conditional rider limiting coverage, o"ered coverage at higher premium rate, have been diagnosed with a medical condition that is outlined by Inclusive Health allowing automatic enrollment into Inclusive

eligible individual, eligible for

GUARANTEED COVERAGE


ages 6-19: 100% FPL (also aged, blind and disabled)


Working parents with incomesup to 51% FPL

Non-working parents up to37% FPL

Medically Needy Individuals upto 34% FPL

33% FPL

GUARANTEED COVERAGE

NCHC: Family Income up to 200%

Medicaid or have any other

WIC: a pregnant or recently pregnant woman, infant or child up to age 5, Be determined to have a nutritional risk, Income must be at or below 185% FPL

GUARANTEED COVERAGE


Monthly family income cannot

If a pregnant woman is covered by Medicaid on the date she delivers, her newborn child may be eligible for Medicaid up to age 1 without a separate application

Baby Love: Pregnant and postpartum women are eligible to receive services

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium



variesPremiums vary based on age, gender, whether you are a smoker or not, and your choice of plan option.

Deductible varies depending onplan chosen.

$0 or minimal share of cost NCHC: $0-100$1-20 co-pays depending on





Monthly Cost

North Carolina

67 800.234.1317

Dem

ogra


emographic



health plan





Children in low income families


familiesWomen Native American

Indians


(TAA recipients)

Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRA/Mini-COBRA

or


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

CHAND

800-737-0016701-277-2271

www.chand.org

Medicaid800-755-2604701-328-2321

701-328-8950 (TTY)www.nd.gov/dhs/services/

medicalserv/medicaid/

Healthy Steps

877-543-7669www.nd.gov/dhs/services/

medicalserv/chip


800-472-2286www.health.state.nd.us/wic

Caring for Children Program

800-342-4718701-277-2227

www.ndcaring.org

Women’s Way

800-449-6636www.womensway.net


605-226-7582www.ihs.gov/FacilitiesServices/


866-628-4282

Program

Cove

rage







premium





Two comprehensive coverage options with $500 or $1000 deductibles including: doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs

hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, dental care, vision care, and preventive care, and other services

lifetime limit of $1,000,000


Hospital, nursing facility, clinics, rural health clinics, hospice, physicians, prescription drugs, chiropractor, health

durable medical equipment, and supplies, dental, family planning, sterilization, podiatry, mental health, ambulance, transportation, vision, therapies, waivered services - home and community based

out-of-state services


HS:

outpatient hospital and clinic

routine preventive services (i.e. well-baby check-ups

services. Some plans o"er preventive services and some dental and vision services





Primary and preventive health, physician o#ce visits and routine physicals, emergency accident care, well child care and immunizations, limited inpatient and surgical services, mental health and chemical dependency, preventive dental service



Indians on reservations located in North Dakota, South Dakota, Nebraska, and Iowa





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:



underwriting


column

GUARANTEED COVERAGE

You have physically resided in ND for at least 183 days

You have written evidence from at least one carrier that

o"ered coverage which substantially restricts bene!ts

evidence from a medical

a qualifying condition

Must be ineligible for health bene!ts under ND's medical

or certain other government programs

also available

GUARANTEED COVERAGE

ages 0-5: 133% FPL

Parents: 38% FPL

Medically Needy: 83% FPL

People with high medical

from income they may be eligible

GUARANTEED COVERAGE

HS: Uninsured children age 18 and younger who live in families with qualifying incomes. Single 18-year-olds with eligible incomes may also

160% of the FPL

WIC: a pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL

GUARANTEED COVERAGE

Be younger than age 19

Be a resident of the state of North Dakota

Be a U.S. citizen or legal permanent resident

Be without comprehensive medical coverage through Medicaid, Healthy Steps or a private insurance carrier

Income must be between 161% and 200% FPL

GUARANTEED COVERAGE

Must be a woman age 40 through 64

No health insurance, or unable to pay insurance deductibles and/or co-payments, or Pap smears and/or mammograms not covered by insurance plan

the United States for at least 30 days to be eligible for Women's Way

No documentation is required to verify residency

GUARANTEED COVERAGE

Four federally recognized tribal

the Turtle Mountain Band of

Tribes - Mandan, Hidatsa, and

home to the Trenton Indian

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium



varies will pay 80% of allowed charges.$3,000 annual limit on out-of pocket spending on deductibles

services

Price depends on age and location

135% of the premiums charged in North Dakota for similar coverage.

$0 or minimal share of cost HS: service from $0-50


$0 or minimal share of cost $0 or minimal share of cost $0 or minimal share of cost 20% of the insurance premium M

onthly Cost

North Dakota


Dem

ogra


emographic



health plan





Children in low income families


familiesWomen Native American

Indians


(TAA recipients)

Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRA/Mini-COBRA

or


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

CHAND

800-737-0016701-277-2271

www.chand.org

Medicaid800-755-2604701-328-2321

701-328-8950 (TTY)www.nd.gov/dhs/services/

medicalserv/medicaid/

Healthy Steps

877-543-7669www.nd.gov/dhs/services/

medicalserv/chip


800-472-2286www.health.state.nd.us/wic

Caring for Children Program

800-342-4718701-277-2227

www.ndcaring.org

Women’s Way

800-449-6636www.womensway.net




866-628-4282

Program

Cove

rage







premium





Two comprehensive coverage options with $500 or $1000 deductibles including: doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs

hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, dental care, vision care, and preventive care, and other services

lifetime limit of $1,000,000


Hospital, nursing facility, clinics, rural health clinics, hospice, physicians, prescription drugs, chiropractor, health

durable medical equipment, and supplies, dental, family planning, sterilization, podiatry, mental health, ambulance, transportation, vision, therapies, waivered services - home and community based

out-of-state services


HS:

outpatient hospital and clinic

routine preventive services (i.e. well-baby check-ups

services. Some plans o"er preventive services and some dental and vision services





Primary and preventive health, physician o#ce visits and routine physicals, emergency accident care, well child care and immunizations, limited inpatient and surgical services, mental health and chemical dependency, preventive dental service



Indians on reservations located in North Dakota, South Dakota, Nebraska, and Iowa





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:



underwriting


column

GUARANTEED COVERAGE

You have physically resided in ND for at least 183 days

You have written evidence from at least one carrier that

o"ered coverage which substantially restricts bene!ts

evidence from a medical

a qualifying condition

Must be ineligible for health bene!ts under ND's medical

or certain other government programs

also available

GUARANTEED COVERAGE

ages 0-5: 133% FPL

Parents: 38% FPL


People with high medical

from income they may be eligible

GUARANTEED COVERAGE

HS: Uninsured children age 18 and younger who live in families with qualifying incomes. Single 18-year-olds with eligible incomes may also

160% of the FPL

WIC: a pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL

GUARANTEED COVERAGE

Be younger than age 19

Be a resident of the state of North Dakota

Be a U.S. citizen or legal permanent resident

Be without comprehensive medical coverage through Medicaid, Healthy Steps or a private insurance carrier

Income must be between 161% and 200% FPL

GUARANTEED COVERAGE

Must be a woman age 40 through 64

No health insurance, or unable to pay insurance deductibles and/or co-payments, or Pap smears and/or mammograms not covered by insurance plan

the United States for at least 30 days to be eligible for Women's Way

No documentation is required to verify residency

GUARANTEED COVERAGE

Four federally recognized tribal

the Turtle Mountain Band of

Tribes - Mandan, Hidatsa, and

home to the Trenton Indian

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium



varies will pay 80% of allowed charges.$3,000 annual limit on out-of pocket spending on deductibles

services

Price depends on age and location

135% of the premiums charged in North Dakota for similar coverage.

$0 or minimal share of cost HS: service from $0-50


$0 or minimal share of cost $0 or minimal share of cost $0 or minimal share of cost 20% of the insurance premium M

onthly Cost

North Dakota

69 800.234.1317

Dem

ogra

phic


ographic



health plan



familiesChildren Women Individuals with

genetic disordersSeniors and

Disabled



Prog

ram


800-234-1317

Group Health


www.ohioahu.org/

COBRA/Mini-COBRA

Then convert to


www.dol.gov

or



800-234-1317

Individual Plans


www.ohioahu.org/

Healthy FamiliesMedicaid800-324-8680

800-292-3572 TDD

Healthy StartMedicaid800-324-8680

800-292-3572 TDD


614-644-8006

800-755-4769www.odh.ohio.gov/

odhPrograms/ns/wicn/wic1.

Breast and Cervical Cancer Protection

Program614-728-2177

www.odh.ohio.gov/odhPrograms/hprr/bc_canc/

Ohio Genetics Program614-728-4677

www.odh.ohio.gov/odhprograms/cmh/genserv/


www.medicare.gov


Program800-633-4227


866-628-4282



Cove

rage






premium



items

conditions





HS: including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more





Services provided includemammograms, pap tests,o#ce visits, clinical breast

utlrasounds, biopsies and otherdiagnostic procedures



insurance, but is a system of clinics for individuals with genetic illnesses

Genetic services include, but are not limited to genetic counseling, education, diagnosis and treatment for all genetic conditions and congenital abnormalities.

Genetic services are covered by most insurance companies & Medicaid

Those who do not have medical coverage are billed based on their income level: No one is turned away from the genetics clinics for not having insurance










Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE




HIPAA:



underwriting


period.


GUARANTEED COVERAGE

immigrant


age of 19 Income at or below 90% FPL

Uninsured children under age 19 and Pregnant women may have an income at or below 200% FPL

Disabled and elderly up to 64% FPL

GUARANTEED COVERAGE

HS: Uninsured children under age 19 and Pregnant women may have an income at or below 200% FPL

WIC: pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL

GUARANTEED COVERAGE

legal immigration status For mammograms must be between 50 and 64 years of age



information regarding genetic disorders

Individuals/families might bene!t from genetic services if they have questions about: the cause of a medical condition or

chance of the same condition showing up in their children

prepare for and have a healthy

based on an understanding

recent genetic discoveries and current research about

medical specialists, community resources and parent support groups in their area or nationally.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium

COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-150% of group health rates, individual coverage may be less


$0 or minimal share of cost HS & WIC: $0 or minimal share of cost

$0 There are di"erent costs for the various services at genetics clinics. Most insurance companies and third party payers cover the costs of most services. Those who do not have medical coverage are billed based on their income level.


certain plans



Monthly Cost

Ohio


Dem

ogra

phic


ographic



health plan



familiesChildren Women Individuals with

genetic disordersSeniors and

Disabled



Prog

ram


800-234-1317

Group Health


www.ohioahu.org/

COBRA/Mini-COBRA

Then convert to


www.dol.gov

or



800-234-1317

Individual Plans


www.ohioahu.org/

Healthy FamiliesMedicaid800-324-8680

800-292-3572 TDD

Healthy StartMedicaid800-324-8680

800-292-3572 TDD


614-644-8006

800-755-4769www.odh.ohio.gov/

odhPrograms/ns/wicn/wic1.

Breast and Cervical Cancer Protection

Program614-728-2177

www.odh.ohio.gov/odhPrograms/hprr/bc_canc/

Ohio Genetics Program614-728-4677

www.odh.ohio.gov/odhprograms/cmh/genserv/


www.medicare.gov


Program800-633-4227


866-628-4282



Cove

rage






premium



items

conditions





HS: including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more





Services provided includemammograms, pap tests,o#ce visits, clinical breast

utlrasounds, biopsies and otherdiagnostic procedures



insurance, but is a system of clinics for individuals with genetic illnesses

Genetic services include, but are not limited to genetic counseling, education, diagnosis and treatment for all genetic conditions and congenital abnormalities.

Genetic services are covered by most insurance companies & Medicaid

Those who do not have medical coverage are billed based on their income level: No one is turned away from the genetics clinics for not having insurance










Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE




HIPAA:



underwriting


period.


GUARANTEED COVERAGE

immigrant


age of 19 Income at or below 90% FPL

Uninsured children under age 19 and Pregnant women may have an income at or below 200% FPL

Disabled and elderly up to 64% FPL

GUARANTEED COVERAGE

HS: Uninsured children under age 19 and Pregnant women may have an income at or below 200% FPL


GUARANTEED COVERAGE

legal immigration status For mammograms must be between 50 and 64 years of age



information regarding genetic disorders

Individuals/families might bene!t from genetic services if they have questions about: the cause of a medical condition or

chance of the same condition showing up in their children

prepare for and have a healthy

based on an understanding

recent genetic discoveries and current research about

medical specialists, community resources and parent support groups in their area or nationally.

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos


full premium

COBRA, Mini-COBRA, HIPAA: Premiums range from 102%-150% of group health rates, individual coverage may be less


$0 or minimal share of cost HS & WIC: $0 or minimal share of cost

$0 There are di"erent costs for the various services at genetics clinics. Most insurance companies and third party payers cover the costs of most services. Those who do not have medical coverage are billed based on their income level.


certain plans



Monthly Cost

Ohio

71 800.234.1317

Dem

ogra


emographic



health plan





familiesChildren Native American

IndiansSeniors and

Disabled



Prog

ram


800-234-1317

Group PlansHealth Underwriters

703-276-0220www.osahu.org

Insure Oklahoma888-365-3742

www.insureoklahoma.org

COBRA/Mini-COBRA

and then


www.dol.gov


800-234-1317





Oklahoma Health Insurance

High Risk Pool 877-793-6477

www.okhrp.org

MedicaidSoonerCare

800-987-7767www.okdhs.org/

programsandservices/health/med

orwww.ohca.state.ok.us/

Family Planning405-271-4476

www.okdhs.org/programsandservices/health/

famplan

Child and Adolescent Health

Clinical Services405-271-4471


405-271-4676

888-655-2942

html



cfm


www.medicare.gov


Program800-633-4227


Counseling Program (SHIP)

800-763-2828405-521-6628

www.oid.state.ok.us



877-222-8387www.va.gov

Program

Cove

rage

conditions.







premium



medical needs

issue coverage to all individuals with at least 12 months of prior coverage

months of prior coverage, there is a 36-month look-back and

Bene!ts will vary dependingon plan chosen


$1,000,000

doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs

home health visits, transplants, rehabilitation, durable medical equipment, and mental health and substance abuse, among other services


Family planning, home health inpatient, laboratory and

facility outpatient, physician, ambulatory surgical center, hearing, chiropractic, dental durable medical equipment, prescription drugs, prosthetics mental health, rehabilitative services, transportation services, dental and vision for some people …and more


CAHCS: Well child care and treatment for minor acute illnesses





7 Indian hospitals and 40 outpatient health centers

26 are totally managed by tribes under compact/contract, 12 are operated directly by the IHS, and 2 are operated under contract with Indian organizations











Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE




HIPAA:





underwriting


Insure Oklahoma: US citizenor legalized alien, resident

Not currently on Medicareor any Medicaid program,employer must be located

fewer employees, income level

GUARANTEED COVERAGE

least one year and turned down by at least two insurance carriers

government programs (must

option for those who are

GUARANTEED COVERAGE

SoonerCare: Pregnant women and children ages 0-19: 185% FPL


Non-Working Parent: 32% FPL

100% FPL


Medically Needy couple: 34% FPLMedically Needy individual: 36% FPL

for some people

Family Planning: Income 100% or below Federal Poverty Level (FPL).

GUARANTEED COVERAGE

CAHCS: at or below 185% of Federal Poverty Level (FPL) who are uninsured or underinsured for health care services

WIC:pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL

GUARANTEED COVERAGE GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies

Insure Oklahoma: Premiums vary according to income level,

$5-50depending on service

50% higher than standard rates

Both: $0 or share of cost CAHCS & WIC: $0 or minimal share of cost

$0 or minimal share of cost Medicare: $0 and share of cost

for certain plans



Monthly Cost

Oklahoma


Dem

ogra


emographic



health plan





familiesChildren Native American

IndiansSeniors and

Disabled



Prog

ram


800-234-1317





COBRA/Mini-COBRA

and then


www.dol.gov


800-234-1317





Oklahoma Health Insurance

High Risk Pool 877-793-6477

www.okhrp.org

MedicaidSoonerCare

800-987-7767www.okdhs.org/

programsandservices/health/med

orwww.ohca.state.ok.us/


www.okdhs.org/programsandservices/health/

famplan

Child and Adolescent Health

Clinical Services405-271-4471


405-271-4676

888-655-2942

html



cfm


www.medicare.gov


Program800-633-4227


Counseling Program (SHIP)

800-763-2828405-521-6628

www.oid.state.ok.us



877-222-8387www.va.gov

Program

Cove

rage

conditions.







premium



medical needs



Bene!ts will vary dependingon plan chosen


$1,000,000


home health visits, transplants, rehabilitation, durable medical equipment, and mental health and substance abuse, among other services



facility outpatient, physician, ambulatory surgical center, hearing, chiropractic, dental durable medical equipment, prescription drugs, prosthetics mental health, rehabilitative services, transportation services, dental and vision for some people …and more


CAHCS: Well child care and treatment for minor acute illnesses





7 Indian hospitals and 40 outpatient health centers

26 are totally managed by tribes under compact/contract, 12 are operated directly by the IHS, and 2 are operated under contract with Indian organizations











Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE




HIPAA:





underwriting


Insure Oklahoma: US citizenor legalized alien, resident

Not currently on Medicareor any Medicaid program,employer must be located

fewer employees, income level

GUARANTEED COVERAGE

least one year and turned down by at least two insurance carriers


option for those who are

GUARANTEED COVERAGE

SoonerCare: Pregnant women and children ages 0-19: 185% FPL


Non-Working Parent: 32% FPL

100% FPL


Medically Needy couple: 34% FPLMedically Needy individual: 36% FPL

for some people

Family Planning: Income 100% or below Federal Poverty Level (FPL).

GUARANTEED COVERAGE

CAHCS: at or below 185% of Federal Poverty Level (FPL) who are uninsured or underinsured for health care services

WIC:pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL




GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies

Insure Oklahoma: Premiums vary according to income level,

$5-50depending on service

50% higher than standard rates

Both: $0 or share of cost CAHCS & WIC: $0 or minimal share of cost

$0 or minimal share of cost Medicare: $0 and share of cost

for certain plans



Monthly Cost

Oklahoma

73 800.234.1317

Dem

ogra

phic


ographic


Individuals recently

covered by an employer plan





families


familiesFamilies Women Native American

Indians


(TAA recipients)

Prog

ram


800-234-1317www.coverageforall.org

Group Plans


877-412-6248www.orahu.org

COBRA


www.dol.gov




Individual Plans



OMIP

Insurance Pool)503-225-6620800-848-7280

TTY: 800-375-2863

plan administrator)www.omip.state.or.us

Oregon Health Plan503-945-5772 800-527-5772

TTY: 800-375-2863www.oregon.gov/DHS/

healthplan

Oregon Health Plan Plus

www.oregon.gov/DHS/healthplan/

Healthy Kids503-378-2666877-314-5678

www.oregonhealthykids.gov

Family Health Insurance Assistance

Program(Subsidy program)

503-373-1692888-564-9669

www.fhiap.oregon.gov

The program is currently not accepting new applications. If you would like to receive

an application when the program reopens you may sign

Oregon Breast andCervical Cancer

Program971-673-0984877-255-7070

www.oregon.gov/DHS/ph/bcc


800-723-3638http://oregon.gov/DHS/ph/wic/

about_us.shtml




(Subsidy program)

866-628-4282 Program

Cove

rage


and adopted children are automatically covered under parents’ fully insured health plan for the !rst 31 days, if the plan provides dependent coverage




premium





million per covered person.

In some cases bene!ts will notbe provided during the !rst

Provides diagnosis, physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services


Both: medical, dental and vision careregular checkups and preventive care, prescription medicines, medical equipment,mental health and chemical dependency services

full year or more as long as the child remains eligible


health insurance plan you choose

If employer-sponsored plan is available then you must use

that plan

BCCP: Some diagnostic services such as ultrasound, breast biopsy, surgical consultation, colonoscopy





covered for eligible Native

areas of emphasis are: Infant

Use, Intervention, Domestic Violence, Diabetes, Women's

Screening.




one of the four health plans


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

Two employees must work 17.5 hrs/week for coverage

employee


conditions apply for individuals with no more than a 63 day break in coverage

GUARANTEED COVERAGE



HIPAA:



underwriting


column

GUARANTEED COVERAGE


or government programs

Have one of the listed medicalconditions

period may apply for prior coverage

GUARANTEED COVERAGE

100% FPL

Pregnant woman: 185%

Medically Needy Individual:58% FPL

FPL

documented immigrant

GUARANTEED COVERAGE

Both:

granted for certain groups)

OHP Plus: Must be uninsured for 6 months

Household income at or below 200% FPL

Healthy Kids: been without health insurance for two months (though there

special circumstances, like a

serious medical need)

For free or low-cost coverage, household income cannot

it is still possible to receive coverage, but share of cost may be higher

GUARANTEED COVERAGE

immigrant

Uninsured for at least 6 months

Savings less than $10k (including rental property)

Not eligible for Medicare

Must be uninsured for the previous two months, unless

program and have income up to

GUARANTEED COVERAGE

BCCP:



for Medicare Part B


GUARANTEED COVERAGE

Health services from the Indian Health Service is that the individual is an enrolled member of a Federally recognized Tribe.

owns restricted property

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium



county

If you are self-employed and buy your own insurance you can deduct 100% of the cost of the premium from your federal

The plans o"er a range ofdeductibles including $500,$750, $1,000 and $1,500

Similar to private rates if

25% higher for the high risk pool rate

$0 to a share of the monthly premium for Standard or Plus plans

OHP Plus: No premium or co-pays

Healthy Kids: Premiums vary depending on income level

Depending on family size and

are responsible for co-pays, deductibles and coninsurance.

Both: $0 and share-of-cost sliding scale

$0 or minimal share of cost 20% of the insurance premium M

onthly Cost

Oregon


Dem

ogra

phic


ographic


Individuals recently

covered by an employer plan





families


familiesFamilies Women Native American

Indians


(TAA recipients)

Prog

ram



Group Plans



COBRA


www.dol.gov




Individual Plans



OMIP

Insurance Pool)503-225-6620800-848-7280

TTY: 800-375-2863

plan administrator)www.omip.state.or.us

Oregon Health Plan503-945-5772 800-527-5772

TTY: 800-375-2863www.oregon.gov/DHS/

healthplan

Oregon Health Plan Plus

www.oregon.gov/DHS/healthplan/

Healthy Kids503-378-2666877-314-5678

www.oregonhealthykids.gov

Family Health Insurance Assistance

Program(Subsidy program)

503-373-1692888-564-9669

www.fhiap.oregon.gov

The program is currently not accepting new applications. If you would like to receive

an application when the program reopens you may sign

Oregon Breast andCervical Cancer

Program971-673-0984877-255-7070

www.oregon.gov/DHS/ph/bcc


800-723-3638http://oregon.gov/DHS/ph/wic/

about_us.shtml




(Subsidy program)

866-628-4282 Program

Cove

rage


and adopted children are automatically covered under parents’ fully insured health plan for the !rst 31 days, if the plan provides dependent coverage




premium





million per covered person.

In some cases bene!ts will notbe provided during the !rst

Provides diagnosis, physician services, check-ups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, mental health services


Both: medical, dental and vision careregular checkups and preventive care, prescription medicines, medical equipment,mental health and chemical dependency services

full year or more as long as the child remains eligible


health insurance plan you choose

If employer-sponsored plan is available then you must use

that plan

BCCP: Some diagnostic services such as ultrasound, breast biopsy, surgical consultation, colonoscopy





covered for eligible Native

areas of emphasis are: Infant

Use, Intervention, Domestic Violence, Diabetes, Women's

Screening.




one of the four health plans


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

Two employees must work 17.5 hrs/week for coverage

employee


conditions apply for individuals with no more than a 63 day break in coverage

GUARANTEED COVERAGE



HIPAA:



underwriting


column

GUARANTEED COVERAGE


or government programs

Have one of the listed medicalconditions

period may apply for prior coverage

GUARANTEED COVERAGE

100% FPL

Pregnant woman: 185%

Medically Needy Individual:58% FPL

FPL

documented immigrant

GUARANTEED COVERAGE

Both:

granted for certain groups)

OHP Plus: Must be uninsured for 6 months

Household income at or below 200% FPL

Healthy Kids: been without health insurance for two months (though there

special circumstances, like a

serious medical need)

For free or low-cost coverage, household income cannot

it is still possible to receive coverage, but share of cost may be higher

GUARANTEED COVERAGE

immigrant

Uninsured for at least 6 months

Savings less than $10k (including rental property)


Must be uninsured for the previous two months, unless

program and have income up to

GUARANTEED COVERAGE

BCCP:



for Medicare Part B


GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium



county

If you are self-employed and buy your own insurance you can deduct 100% of the cost of the premium from your federal

The plans o"er a range ofdeductibles including $500,$750, $1,000 and $1,500

Similar to private rates if

25% higher for the high risk pool rate

$0 to a share of the monthly premium for Standard or Plus plans

OHP Plus: No premium or co-pays

Healthy Kids: Premiums vary depending on income level

Depending on family size and

are responsible for co-pays, deductibles and coninsurance.

Both: $0 and share-of-cost sliding scale

$0 or minimal share of cost 20% of the insurance premium M

onthly Cost

Oregon

75 800.234.1317

Dem

ogra


Dem

ographic



health plan





familiesChildren Women Adults



Prog

ram


800-234-1317


717-232-0022www.pahu.org

COBRAand then

HIPP Health Insurance

Premium Payment800-644-7730

or

HIPAAHealth Insurance Portability

www.dol.gov


800-234-1317



Blue CrossBlue Shield

800-275-2583


www.dpw.state.pa.us

For more information call your local county o#ce:

CHIP

Insurance Plan)800-986-5437

www.chipcoverspakids.com

Healthy Baby Help Line

800-986-2229

Healthy Woman Program800-215-7494

www.pahealthywoman.com

adultBasic800-462-2742

low_income/adultbasic.htmlor

www.portal.state.pa.us/portal/server.pt/community/

health_insurance/9189/adultbasic/592645




Cove

rage







premium




design options available for selection

Limits on pre-existing healthconditions may apply

plans operating in the state voluntarily serve as the carriers-of-last-resort for people seeking coverage in the individual market through a year-round open enrollment for speci!ed products

Guaranteed issue coverage is available for !ve counties -

Montgomery, and Buck

conditions for 1 year


immunizations, vision testing and eyeglasses, emergency room care, lab testing and X-rays, hearing testing and hearing aids, mental and substance abuse treatment


CHIP:

partial hospitalization for

health care

Healthy Baby: Provides health insurance assistance information and referral service for pregnant women


mammogram, pelvic

follow-up diagnostic care for an abnormal result


Hospitalization (unlimited days), physician services (primary care and specialists), emergency services, diagnostic tests (e.g. X-rays, mammograms and laboratory tests), maternity care, rehabilitation and skilled

hospitalization)








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE



HIPP: You may be eligible for HIPP if you have a high-cost health condition, and are on Medicaid

HIPAA:





underwriting

If you are denied coverage for a medical condition, you may be eligible for guarantee issue

GUARANTEED COVERAGE

Been refused health insurance by other carriers

GUARANTEED COVERAGE


blind and disabled)

Parents with incomes up to 200% FPL can also apply for

currently has a waiting list for coverage)



46% FPL

GUARANTEED COVERAGE

CHIP: Must not be eligible for

health insurance,

Must be a Pennsylvania resident and citizen

under the age of 19 despite their families income level

Families with income below 200% FPL will receive free coverage, 200-300% FPL will receive discounted coverage, and 300% FPL or more will have to pay full cost

GUARANTEED COVERAGE

Women 40 to 64 years old (or under 40 if they are symptomatic of breast cancer, require follow-up for an abnormal Pap test, or have not been screened in the past !ve years for cervical cancer)

Must have no insurance orlimited insurance that does not cover breast and cervicalcancer screening services

Must have income below 250% FPL

GUARANTEED COVERAGE


You do not have any other healthcare coverage (including

been without health insurance for 90 days prior to enrollment,

lost health insurance coverage because you are no longer employed

Your family income is below certain income limits

You are a resident of Pennsylvania for at least 90 days

U.S. citizenship or permanent legal alien status

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution (also see HIPP) with rate variations allowed up to 300% of the base rate


full premium




variesPrices based on age and several coverage options, applicant needs etc.

$0 CHIP: your child quali!es for free, low cost, or full cost health

range between $0-195 with co-payments of $0-50.

$0 $36 per month premium payment if enrolled in the program or $600 per month premium payment if purchasing coverage while

between $10-50



onthly Cost

Pennsylvania


Dem

ogra


Dem

ographic



health plan





familiesChildren Women Adults



Prog

ram


800-234-1317



COBRAand then

HIPP Health Insurance

Premium Payment800-644-7730

or

HIPAAHealth Insurance Portability

www.dol.gov


800-234-1317



Blue CrossBlue Shield

800-275-2583


www.dpw.state.pa.us

For more information call your local county o#ce:

CHIP

Insurance Plan)800-986-5437

www.chipcoverspakids.com

Healthy Baby Help Line

800-986-2229

Healthy Woman Program800-215-7494

www.pahealthywoman.com

adultBasic800-462-2742

low_income/adultbasic.htmlor

www.portal.state.pa.us/portal/server.pt/community/

health_insurance/9189/adultbasic/592645




Cove

rage







premium




design options available for selection

Limits on pre-existing healthconditions may apply

plans operating in the state voluntarily serve as the carriers-of-last-resort for people seeking coverage in the individual market through a year-round open enrollment for speci!ed products

Guaranteed issue coverage is available for !ve counties -

Montgomery, and Buck

conditions for 1 year


immunizations, vision testing and eyeglasses, emergency room care, lab testing and X-rays, hearing testing and hearing aids, mental and substance abuse treatment


CHIP:

partial hospitalization for

health care

Healthy Baby: Provides health insurance assistance information and referral service for pregnant women


mammogram, pelvic

follow-up diagnostic care for an abnormal result


Hospitalization (unlimited days), physician services (primary care and specialists), emergency services, diagnostic tests (e.g. X-rays, mammograms and laboratory tests), maternity care, rehabilitation and skilled

hospitalization)








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE



HIPP: You may be eligible for HIPP if you have a high-cost health condition, and are on Medicaid

HIPAA:





underwriting

If you are denied coverage for a medical condition, you may be eligible for guarantee issue

GUARANTEED COVERAGE

Been refused health insurance by other carriers

GUARANTEED COVERAGE


blind and disabled)

Parents with incomes up to 200% FPL can also apply for

currently has a waiting list for coverage)



46% FPL

GUARANTEED COVERAGE

CHIP: Must not be eligible for

health insurance,

Must be a Pennsylvania resident and citizen

under the age of 19 despite their families income level

Families with income below 200% FPL will receive free coverage, 200-300% FPL will receive discounted coverage, and 300% FPL or more will have to pay full cost

GUARANTEED COVERAGE

Women 40 to 64 years old (or under 40 if they are symptomatic of breast cancer, require follow-up for an abnormal Pap test, or have not been screened in the past !ve years for cervical cancer)

Must have no insurance orlimited insurance that does not cover breast and cervicalcancer screening services

Must have income below 250% FPL

GUARANTEED COVERAGE


You do not have any other healthcare coverage (including

been without health insurance for 90 days prior to enrollment,

lost health insurance coverage because you are no longer employed

Your family income is below certain income limits

You are a resident of Pennsylvania for at least 90 days

U.S. citizenship or permanent legal alien status

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution (also see HIPP) with rate variations allowed up to 300% of the base rate


full premium




variesPrices based on age and several coverage options, applicant needs etc.

$0 CHIP: your child quali!es for free, low cost, or full cost health

range between $0-195 with co-payments of $0-50.

$0 $36 per month premium payment if enrolled in the program or $600 per month premium payment if purchasing coverage while

between $10-50



onthly Cost

Pennsylvania

77 800.234.1317

Dem

ogra


emographic

Small businesses(1-50 Employees)


health plan





families

Moderate income families Adults Seniors and

Disabled

Trade Dislocated

Workers(TAA recipients)

Veterans

Prog

ram


800-234-1317



COBRA/Mini-COBRAand then


www.dol.gov


800-234-1317



Blue Cross Blue Shield of Rhode Island

800-639-2227401-459-5000

401-831-2202 TTD www.bcbsri.com

RI Medical Assistance Program

(Medicaid)401-462-5300

401-462-3363 TTYwww.dhs.state.ri.us

RIteShare/RiteCare401-462-5300



800-942-7434401-222-5960

www.health.ri.gov/family/wic/

Women’s Cancer Screening401-222-4324401-222-1161

www.health.ri.gov/disease/cancer/women-screening.php

General Public Assistance


www.medicare.gov


Program800-633-4227

Senior’s Health Insurance Program

401-462-0524 www.dea.state.ri.us




Cove

rage

Group insurance carriers may not look-back at, issue

issuing small group coverage





premium



medical needs




Plan options vary based on applicant needs



facility outpatient, physician, ambulatory surgical center, hearing, chiropractic, dental, durable medical equipment,

prosthetics, psychology services, rehabilitative services for persons with mental illness, rehabilitative services for persons with physical disabilities, targeted case management, transportation services, ventilator equipment, visual services ...and more


RIteShare: coverage through di"erent

assistance program that helps families get health insurance coverage through their employer

pays for all or part of the employee’s share of the health

also pays for co-payments in the employer’s health insurance plan





WCS:

and mammograms (breast

covers diagnostic tests and possibly full treatment through Medicaid

GPA: doctors’ o#ce visits/ health centers visits and most generic prescription medications











Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE




HIPAA:



be eligible for any other public or private insurance programs

underwriting

If you are denied for a medical condition, you may be eligible

GUARANTEED COVERAGE


Limited annual open enrollment period

GUARANTEED COVERAGE

Pregnant women and children ages 0-19: 250% FPL

Working Parents: 192% FPLNon-working Parents: 185% FPL

100% FPL

Medically Needy individual:

couple: 87% FPL


for some people

GUARANTEED COVERAGE

RIteShare: adolescents at or below 250%of Federal Poverty Level (FPL) who are uninsured or underinsured for health care services


GUARANTEED COVERAGE

WCS: Must be a resident of

insurance coverage for the services provided by the program, have a family income less than 250% of the FPL and be between 50-64 years old. Women younger than 40 may receive services if they are found to have a palpable lump or a clinical !nding of something suspicious for cancer. Women over 65 who are enrolled in Medicare but do not have Medicare part B may also be eligible for the program, as are undocumented women over 65

GPA: resident between the ages of 19

or medical condition, which is

and prevents you from working, have a monthly income of $327 or less, have resources of less than $400 and an automobile with a value of less than $4,650. You must also not be eligible for any other federal assistance programs

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies50% higher than standard rates

$0 RIteShare: $0-92 per month depending on income


Both: $0 or minimal share of cost


certain plans



Monthly Cost

Rhode Island


Dem

ogra


emographic

Small businesses(1-50 Employees)


health plan





families

Moderate income families Adults Seniors and

Disabled

Trade Dislocated

Workers(TAA recipients)

Veterans

Prog

ram


800-234-1317





www.dol.gov


800-234-1317



Blue Cross Blue Shield of Rhode Island

800-639-2227401-459-5000

401-831-2202 TTD www.bcbsri.com

RI Medical Assistance Program

(Medicaid)401-462-5300


RIteShare/RiteCare401-462-5300



800-942-7434401-222-5960

www.health.ri.gov/family/wic/

Women’s Cancer Screening401-222-4324401-222-1161

www.health.ri.gov/disease/cancer/women-screening.php

General Public Assistance


www.medicare.gov


Program800-633-4227

Senior’s Health Insurance Program

401-462-0524 www.dea.state.ri.us




Cove

rage

Group insurance carriers may not look-back at, issue

issuing small group coverage





premium



medical needs




Plan options vary based on applicant needs



facility outpatient, physician, ambulatory surgical center, hearing, chiropractic, dental, durable medical equipment,

prosthetics, psychology services, rehabilitative services for persons with mental illness, rehabilitative services for persons with physical disabilities, targeted case management, transportation services, ventilator equipment, visual services ...and more


RIteShare: coverage through di"erent

assistance program that helps families get health insurance coverage through their employer

pays for all or part of the employee’s share of the health

also pays for co-payments in the employer’s health insurance plan





WCS:

and mammograms (breast

covers diagnostic tests and possibly full treatment through Medicaid

GPA: doctors’ o#ce visits/ health centers visits and most generic prescription medications











Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE




HIPAA:



be eligible for any other public or private insurance programs

underwriting

If you are denied for a medical condition, you may be eligible

GUARANTEED COVERAGE


Limited annual open enrollment period

GUARANTEED COVERAGE

Pregnant women and children ages 0-19: 250% FPL

Working Parents: 192% FPLNon-working Parents: 185% FPL

100% FPL

Medically Needy individual:

couple: 87% FPL


for some people

GUARANTEED COVERAGE

RIteShare: adolescents at or below 250%of Federal Poverty Level (FPL) who are uninsured or underinsured for health care services


GUARANTEED COVERAGE

WCS: Must be a resident of

insurance coverage for the services provided by the program, have a family income less than 250% of the FPL and be between 50-64 years old. Women younger than 40 may receive services if they are found to have a palpable lump or a clinical !nding of something suspicious for cancer. Women over 65 who are enrolled in Medicare but do not have Medicare part B may also be eligible for the program, as are undocumented women over 65

GPA: resident between the ages of 19

or medical condition, which is

and prevents you from working, have a monthly income of $327 or less, have resources of less than $400 and an automobile with a value of less than $4,650. You must also not be eligible for any other federal assistance programs

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies50% higher than standard rates

$0 RIteShare: $0-92 per month depending on income




certain plans



Monthly Cost

Rhode Island

79 800.234.1317

Dem

ogra


emographic



health plan





families



Disabled



Prog

ram


800-234-1317

Group Plans


www.scahu.org



www.dol.gov

or

Conversion Plans


800-234-1317

Individual Plans


www.scahu.org

SCHIP

Insurance Pool

www.doi.sc.gov/consumer/schip.htm

Medicaid888-549-0820803-898-2500

www.dhhs.state.sc.us

SC Healthy Connections Kids

877-552-4642 www.scchoices.com/

South Carolina Children’s

Rehabilitative Services

800-868-0404www.scdhec.gov/health/mch/

BabyNet803-734-0479800-868-0404

www.scdhec.gov/health/mch/cshcn/programs/babynet/

Best Chance Network

800-868-0404803-545-4102 803-545-4145

www.dhec.sc.gov/health/chcdp/cancer/bcn.htm

South Carolina Maternity/Prenatal

Care Services803-898-3432


www.medicare.gov


Program800-633-4227


Program (SHIP)www.aging.sc.gov/seniors/


866-628-4282



Cove

rage

carriers can impose a 6-month look-back/12-month






premium



medical needs





hospice, home health visits, transplants, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy among other services


Both: Hospitalization, well child/adult appointments, lab and X-rays, doctor visits, vision, dental prescription drugs, family planning, medical equipment, hospice, ambulance, transportation, nursing facility,

Inpatient psychiatric care, home health, physical therapy, speech therapy, mental health, family support services, targeted case management, behavioral health,

services and more


CRS: pharmacy, durable medical equipment, physician services, genetics, social work, nutrition, transition, and parent-to-parent support

BabyNet: Provides services to infants and toddlers with developmental delays or diagnosed disabilities


BCN: Program covers mammograms, clinical breast

diagnostic procedures, case management, community education on breast/cervical cancer and early detection

Maternity/Prenatal Care Services: Services are o"ered to women during their prenatal periods and emphasize primary and preventive care including health promotion and education











Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:





underwriting


column

GUARANTEED COVERAGE

Been refused health insurance by any insurer for health

pool rate

GUARANTEED COVERAGE

Medicaid: Pregnant women

Non-Working Parents: 49%

Family Planning Services: 185%

limits for some people

SCHCK: 19 must have a family income at or below 200% of the FPL

GUARANTEED COVERAGE

CRS: program, a child must be a legal resident of the United States,

21 years old, be diagnosed with a covered medical condition, and must meet certain income guidelines

BabyNet: Infants and toddlers from birth to three years may be eligible for BabyNet services if they are developing more slowly

GUARANTEED COVERAGE

BCN: Must lack insurance or have insurance that only covers hospital care, Must be between the ages of 40 and 64, and have income at or below 200% FPL

Maternity/Prenatal Care Services: Program available to pregnant women with incomes at or below 185% FPL. Pregnancy includes the 60-day postpartum period. The 60 days begin on the date of delivery or termination of the pregnancy

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies with a $500 deductible and various coinsurance requirements





certain plans



Monthly Cost

South Carolina


Dem

ogra


emographic



health plan





families



Disabled



Prog

ram


800-234-1317

Group Plans


www.scahu.org



www.dol.gov

or

Conversion Plans


800-234-1317

Individual Plans


www.scahu.org

SCHIP

Insurance Pool

www.doi.sc.gov/consumer/schip.htm

Medicaid888-549-0820803-898-2500

www.dhhs.state.sc.us

SC Healthy Connections Kids

877-552-4642 www.scchoices.com/

South Carolina Children’s

Rehabilitative Services

800-868-0404www.scdhec.gov/health/mch/

BabyNet803-734-0479800-868-0404

www.scdhec.gov/health/mch/cshcn/programs/babynet/

Best Chance Network

800-868-0404803-545-4102 803-545-4145

www.dhec.sc.gov/health/chcdp/cancer/bcn.htm

South Carolina Maternity/Prenatal

Care Services803-898-3432


www.medicare.gov


Program800-633-4227


Program (SHIP)www.aging.sc.gov/seniors/


866-628-4282



Cove

rage

carriers can impose a 6-month look-back/12-month






premium



medical needs





hospice, home health visits, transplants, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy among other services


Both: Hospitalization, well child/adult appointments, lab and X-rays, doctor visits, vision, dental prescription drugs, family planning, medical equipment, hospice, ambulance, transportation, nursing facility,

Inpatient psychiatric care, home health, physical therapy, speech therapy, mental health, family support services, targeted case management, behavioral health,

services and more


CRS: pharmacy, durable medical equipment, physician services, genetics, social work, nutrition, transition, and parent-to-parent support

BabyNet: Provides services to infants and toddlers with developmental delays or diagnosed disabilities


BCN: Program covers mammograms, clinical breast

diagnostic procedures, case management, community education on breast/cervical cancer and early detection

Maternity/Prenatal Care Services: Services are o"ered to women during their prenatal periods and emphasize primary and preventive care including health promotion and education











Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:





underwriting


column

GUARANTEED COVERAGE

Been refused health insurance by any insurer for health

pool rate

GUARANTEED COVERAGE

Medicaid: Pregnant women

Non-Working Parents: 49%

Family Planning Services: 185%

limits for some people

SCHCK: 19 must have a family income at or below 200% of the FPL

GUARANTEED COVERAGE

CRS: program, a child must be a legal resident of the United States,

21 years old, be diagnosed with a covered medical condition, and must meet certain income guidelines

BabyNet: Infants and toddlers from birth to three years may be eligible for BabyNet services if they are developing more slowly

GUARANTEED COVERAGE

BCN: Must lack insurance or have insurance that only covers hospital care, Must be between the ages of 40 and 64, and have income at or below 200% FPL

Maternity/Prenatal Care Services: Program available to pregnant women with incomes at or below 185% FPL. Pregnancy includes the 60-day postpartum period. The 60 days begin on the date of delivery or termination of the pregnancy

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies with a $500 deductible and various coinsurance requirements





certain plans



Monthly Cost

South Carolina

81 800.234.1317

Dem

ogra


emographic



health plan




Low income families Children Women Refugees newly

arriving in U.S.Native American

IndiansSeniors and

Disabled

Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRA/Mini-COBRA

then


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

South Dakota Risk Pool605-773-3148

www.state.sd.us/bop/ riskpool.htm

South Dakota Medical Assistance

800-305-3064www.state.sd.us/social

CHIP


http://dss.sd.gov/medicalservices/chip/


800-738-2301

All Women Count800-738-2301

http://doh.sd.gov/



of social services




www.medicare.gov


Program800-633-4227

Senior Health Information &

Insurance Education (SHIINE)

800-536-8197www.shiine.net

Program

Cove

rage







premium





including daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care including pharmaceuticals


Full medical assistance coverage

appointments, hospital stays, dental and vision services, prescription drugs, rehab/therapy, chiropractic, etc.

Medical coverage may begin three months prior to the application date


CHIP: covers doctor appointments, hospital stays, dental and vision services, prescription drugs, mental health care and other medical services





mammograms, and some additional diagnostic services Pre-Existing Health Conditions Covered


from a person's entry to the United States


Provide inpatient and outpatient care and conduct preventive and curative clinics.




SHIINE is a Medicare counseling service


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:





underwriting


GUARANTEED COVERAGE

Be a resident of South Dakota

Uninsured children under age 19 who have been denied or o"ered coverage by two insurance companies and have been without health insurance for the last 6 months may be

under this eligibility criteria will

condition waiting period

Individuals who have received notice from their insurance carrier that they are near or have reached their lifetime

eligible for the program

Must apply within 63 days of losing your prior coverage and must have had at least 12 months of continuous creditable coverage

state continuation coverage

other form of health insurance and not had your most recent coverage terminated due to nonpayment of premiums or fraud

GUARANTEED COVERAGE

Families with or without private health insurance

Family must consist of a parent or other adult caretaker relative (grandparent, brother, sister, stepparent, etc. ) and a dependent child

is 18 years old and still a full time student in high school, the child is considered a dependent child if he or she is

before reaching age 19

Prengnant Women - 133% FPLParents - 64% FPL

GUARANTEED COVERAGE

CHIP: FPL who already have private health insurance may also

deductibles, co-payments and other medical services not covered by their private policy. If a child’s income puts the family over the income limit the family’s other children may

with his or her teen parents may be eligible without looking at grandparents’ income

WIC: Be a pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL

GUARANTEED COVERAGE

Women whose income is below 200% FPL are eligible for Pap tests if they are 30-64 and for mammograms if they are 40-64

GUARANTEED COVERAGE

Must be a refugee

Income limit is 62% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies region and program$0 or minimal share of cost CHIP & WIC: $0 or minimal share

of cost$0 or minimal share of cost $0 or minimal share of cost $0 or minimal share of cost $0 and share of cost for

certain plans

Monthly Cost

South Dakota


Dem

ogra


emographic



health plan




Low income families Children Women Refugees newly

arriving in U.S.Native American

IndiansSeniors and

Disabled

Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRA/Mini-COBRA

then


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

South Dakota Risk Pool605-773-3148

www.state.sd.us/bop/ riskpool.htm



CHIP


http://dss.sd.gov/medicalservices/chip/


800-738-2301

All Women Count800-738-2301

http://doh.sd.gov/



of social services




www.medicare.gov


Program800-633-4227

Senior Health Information &

Insurance Education (SHIINE)

800-536-8197www.shiine.net

Program

Cove

rage







premium





including daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care including pharmaceuticals


Full medical assistance coverage


Medical coverage may begin three months prior to the application date


CHIP: covers doctor appointments, hospital stays, dental and vision services, prescription drugs, mental health care and other medical services





mammograms, and some additional diagnostic services Pre-Existing Health Conditions Covered


from a person's entry to the United States


Provide inpatient and outpatient care and conduct preventive and curative clinics.




SHIINE is a Medicare counseling service


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE




HIPAA:





underwriting


GUARANTEED COVERAGE

Be a resident of South Dakota

Uninsured children under age 19 who have been denied or o"ered coverage by two insurance companies and have been without health insurance for the last 6 months may be

under this eligibility criteria will

condition waiting period

Individuals who have received notice from their insurance carrier that they are near or have reached their lifetime

eligible for the program

Must apply within 63 days of losing your prior coverage and must have had at least 12 months of continuous creditable coverage

state continuation coverage

other form of health insurance and not had your most recent coverage terminated due to nonpayment of premiums or fraud

GUARANTEED COVERAGE

Families with or without private health insurance

Family must consist of a parent or other adult caretaker relative (grandparent, brother, sister, stepparent, etc. ) and a dependent child

is 18 years old and still a full time student in high school, the child is considered a dependent child if he or she is

before reaching age 19

Prengnant Women - 133% FPLParents - 64% FPL

GUARANTEED COVERAGE

CHIP: FPL who already have private health insurance may also

deductibles, co-payments and other medical services not covered by their private policy. If a child’s income puts the family over the income limit the family’s other children may

with his or her teen parents may be eligible without looking at grandparents’ income

WIC: Be a pregnant or recently pregnant woman, infant or child up to age 5 , Be determined to have a nutritional risk, Income must be: Family Income at or below 185% FPL

GUARANTEED COVERAGE

Women whose income is below 200% FPL are eligible for Pap tests if they are 30-64 and for mammograms if they are 40-64

GUARANTEED COVERAGE

Must be a refugee

Income limit is 62% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies region and program$0 or minimal share of cost CHIP & WIC: $0 or minimal share

of cost$0 or minimal share of cost $0 or minimal share of cost $0 or minimal share of cost $0 and share of cost for

certain plans

Monthly Cost

South Dakota

83 800.234.1317

Dem

ogra


emographic







conditions

Low income individuals and families Children Women Native American

IndiansSeniors and

Disabled


(TAA recipients)

Prog

ram



703-276-0220www.tnahu.org



www.dol.gov




AccessTN866-268-3786

www.covertn.gov/web/access_tn.html


www.state.tn.us/tenncare

Families First888-863-6178

www.state.tn.us/tenncare/

CoverTN888-887-3224

www.covertn.gov

as a result of reaching budget capacity.

businesses, as well as those who have been approved for coverage e"ective in January 2010, will be una"ected by the suspension)

TENNderCare866-311-4287

http://state.tn.us/tenncare/

CoverKids888-325-8386

www.coverkids.com

Breast and Cervical Cancer Screening

Program

877-969-6636




www.medicare.gov


Program800-633-4227

Medicare Supplement

Insurance Policy888-486-9355


Program

Cove

rage

6-month look-back/12-

on enrollees that do not have prior creditable coverage (this may only apply to certain groups)





premium



on medical needs


There is a 6-month look-back and a 12-month


Three plans to choose from o"ering comprehensive health coverage similar to the bene!ts o"ered to state employees. Participants will be able to select the plan that is best

the bene!t plan for more information on covered services.


Medicaid: Inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing services, laboratory

practitioner services, nurse/midwife services

FF: Provides coverage to low income families

meet FF requirements, and Pregnant Women

CoverTN: Limited-bene!t health plan designed to cover the medical services needed by most people. Services include coverage for doctor visits, emergency treatment, inpatient and outpatient care, as well as pharmacy coverage.


TENNderCare: of check ups and health care services for children who have

These services make sure babies, children, teens and young adults receive the health care they need

CoverKids:

Services, Hospital emergency care, Urgent care services,

drug coverage, vision services


mammograms, and Pap tests


clinics.




and Insurance regulates providers of supplemental policies to help cover Medicare co-pays and deductibles





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


GUARANTEED COVERAGE




HIPAA:


have 63 days from the date you lost your previous coverage to

eligible for any other insurance programs

Must be a TN resident

Individuals must pass medical underwriting so it is possible they can be turned

conditions


GUARANTEED COVERAGE

Must be a Tennessee resident, U.S. citizen or quali!ed legal alien.

Uninsurable by medical or insurance determination

No access to employer-sponsored health insurance (other than

application

Denial by two una#liated insurance carriers for individual coverage due to a health-related condition

Without health coverage

to insurance at time of

continuation coverage

GUARANTEED COVERAGE

Medicaid: Pregnant women & infants: 185%

children with family incomes of 100% FPL are

FF:

CoverTN:

(employees at non-participating employers or

coverage)

GUARANTEED COVERAGE

TENNderCare:

CoverKids:

citizen or quali!ed legal alien, Uninsured for at least three months prior to application,

access to state employee health insurance, Income up to 250% of FPL, Maternity coverage available for pregnant women who meet eligibility criteria.

into the program.

GUARANTEED COVERAGE

Must be uninsured or underinsured with income at or below 250% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and ± 35% of the insurance company’s

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium




coverage varies tobacco use, etc. Premiums could be $284-1225, !nancial assistance for certain income levels could reduce price 30%-70%

Medicaid & FF: $0 or small share of cost

CoverTN: Premiums are based on an individual’s age, weight and tobacco use. Must agree to pay one-third or two thirds share of premium depending on quali!cations.

TENNderCare & CoverKids: $0 or signi!cant share of premium cost and co-pays

$0 $0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Tennessee


Dem

ogra


emographic







conditions

Low income individuals and families Children Women Native American

IndiansSeniors and

Disabled


(TAA recipients)

Prog

ram






www.dol.gov




AccessTN866-268-3786

www.covertn.gov/web/access_tn.html


www.state.tn.us/tenncare

Families First888-863-6178

www.state.tn.us/tenncare/

CoverTN888-887-3224

www.covertn.gov

as a result of reaching budget capacity.

businesses, as well as those who have been approved for coverage e"ective in January 2010, will be una"ected by the suspension)

TENNderCare866-311-4287

http://state.tn.us/tenncare/

CoverKids888-325-8386

www.coverkids.com


Program

877-969-6636




www.medicare.gov


Program800-633-4227

Medicare Supplement

Insurance Policy888-486-9355


Program

Cove

rage

6-month look-back/12-

on enrollees that do not have prior creditable coverage (this may only apply to certain groups)





premium



on medical needs


There is a 6-month look-back and a 12-month


Three plans to choose from o"ering comprehensive health coverage similar to the bene!ts o"ered to state employees. Participants will be able to select the plan that is best

the bene!t plan for more information on covered services.


Medicaid: Inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing services, laboratory

practitioner services, nurse/midwife services

FF: Provides coverage to low income families

meet FF requirements, and Pregnant Women

CoverTN: Limited-bene!t health plan designed to cover the medical services needed by most people. Services include coverage for doctor visits, emergency treatment, inpatient and outpatient care, as well as pharmacy coverage.


TENNderCare: of check ups and health care services for children who have

These services make sure babies, children, teens and young adults receive the health care they need

CoverKids:

Services, Hospital emergency care, Urgent care services,

drug coverage, vision services


mammograms, and Pap tests


clinics.




and Insurance regulates providers of supplemental policies to help cover Medicare co-pays and deductibles





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


GUARANTEED COVERAGE




HIPAA:


have 63 days from the date you lost your previous coverage to

eligible for any other insurance programs

Must be a TN resident

Individuals must pass medical underwriting so it is possible they can be turned

conditions


GUARANTEED COVERAGE

Must be a Tennessee resident, U.S. citizen or quali!ed legal alien.

Uninsurable by medical or insurance determination

No access to employer-sponsored health insurance (other than

application

Denial by two una#liated insurance carriers for individual coverage due to a health-related condition

Without health coverage

to insurance at time of

continuation coverage

GUARANTEED COVERAGE

Medicaid: Pregnant women & infants: 185%

children with family incomes of 100% FPL are

FF:

CoverTN:

(employees at non-participating employers or

coverage)

GUARANTEED COVERAGE

TENNderCare:

CoverKids:

citizen or quali!ed legal alien, Uninsured for at least three months prior to application,

access to state employee health insurance, Income up to 250% of FPL, Maternity coverage available for pregnant women who meet eligibility criteria.

into the program.

GUARANTEED COVERAGE

Must be uninsured or underinsured with income at or below 250% FPL

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contribution and ± 35% of the insurance company’s

COBRA or Mini-COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium




coverage varies tobacco use, etc. Premiums could be $284-1225, !nancial assistance for certain income levels could reduce price 30%-70%

Medicaid & FF: $0 or small share of cost

CoverTN: Premiums are based on an individual’s age, weight and tobacco use. Must agree to pay one-third or two thirds share of premium depending on quali!cations.

TENNderCare & CoverKids: $0 or signi!cant share of premium cost and co-pays

$0 $0 or minimal share of cost $0 and share of cost for

certain plans


Monthly Cost

Tennessee

85 800.234.1317

Dem

ogra


emographic







Children with expensive medical

conditions


families

Low income families and adults Women Native American

IndiansSeniors and

Disabled

Prog

ram


800-234-1317

Group PlansUnderwriters703-276-0220www.tahu.org

Texas Employee Group Insurance

Program (GBP)877-275-4377

COBRAthen convert to


www.dol.gov

and also

Conversion Policies


Individual PlansUnderwriters703-276-0220www.tahu.org

Texas Health Insurance Risk Pool


TDD 800-735-2989

TX Children with Special Needs

800-252-8023

CHIPProgram and Medicaid)

800-647-6558

www.chipmedicaid.org

State Kid Insurance Program (SKIP)

877-543-7669

Medicaid800-252-8263 877-541-7905


Treatment Program512-458-7796

bcccs/default.shtm


Albuquerque Area o"ce505-248-4500

www.ihs.gov/FacilitiesServices/

Nashville O"ces615-467-1500


Oklahoma City Areawww.ihs.gov/FacilitiesServices/

cfm


www.medicare.gov


Program800-633-4227

Employee Retirement System

(ERS) Of Texas877-275-4377

Program

Cove

rage

to plan

By law all insurers must o"er at least one plan that includes coverage for state mandated bene!ts such as preventive care, mammograms etc.








Hospitalization, physician care, maternity, prescriptions, drugs, treatment for serious mental health illnesses and other services

5 plans to choose from

Quali!ed Plan.

There is a 12 month waiting period for people with pre-

where the policy will not

condition. If you were covered by creditable coverage in place during the 12 months before your e"ective date your wait time will be reduced.


Surgery, Primary & Preventative

and Hearing Services, Vision

Services, Mental Health

Supplies, Home Health Nursing,

Lodging and Transportationwhen needed to obtain medicalcare, Medicines, Physician

Special Nutritional Products &Services and Insurance Premium


Both: Doctor and nurse care immunizations, preventive care, health clinics, laboratory tests, prescriptions, medical equipment, transportation, hospitalization, mental health services, well child visits, dental, vision and more

CHIP: the !rst time after being covered by private health insurance will have a 90-day waiting period before bene!ts can be used


vision, and prescription coverage


tests at little or no cost toeligible women


clinics.


Medicare:

Insurance and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also o"ers a prescription drug coverage plan, known as Medicare Part D


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(or self-employed)

Insurance companies may require minimum participation

GUARANTEED COVERAGE


from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date

coverage

HIPAA:





GUARANTEED COVERAGE

Individuals with applicable

qualify

your premiums and continue to

conditions:

Ineligible for public or employer-based coverage

If one family member quali!es then all are quali!ed

You must have had 18 months of continuous coverage with the last day in a group health plan

GUARANTEED COVERAGE

years of age who has a chronic physical, developmental, or emotional condition that will

least 12 months

Person of any age with cystic !brosis

Must have applied for Medicaid

bene!ts

GUARANTEED COVERAGE

Both:

Must be ineligible for Medicaid

CHIP:

immigrants, and pregnant women can also qualify for

employer-based coverage

No health insurance for the

application

SKIP:

GBP

GUARANTEED COVERAGE

immigrants

with low income and Medicare may also qualify for Medicaid assistance

GUARANTEED COVERAGE

Diagnosed with breast orcervical cancer

Women under age 65

screening

cancer screening if no Pap in previous years

resident


GUARANTEED COVERAGE



GUARANTEED COVERAGE


(permanent kidney failure requiring dialysis or a kidney transplant). Eligibility

Mon

thly

Cos

t

contribution and ± 25% of the COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15

are responsible for full premium

COBRA & HIPAA: Premiums range from 102%-150% of group health

coverage variesPremiums vary based on health plan chosen, age, gender and geographic zone

amount a healthy person in a similar plan pays

$0 CHIP: $0 $50 covers all children in

range between $3 to $10.SKIP: $15 to $25 per month

$0 or minimal share of cost $0 or minimal share of cost $0 or minimal share of cost $0 and share of cost for

certain plans

Monthly Cost

Texas


Dem

ogra


emographic







Children with expensive medical

conditions


families

Low income families and adults Women Native American

IndiansSeniors and

Disabled

Prog

ram


800-234-1317

Group PlansUnderwriters703-276-0220www.tahu.org

Texas Employee Group Insurance

Program (GBP)877-275-4377

COBRAthen convert to


www.dol.gov

and also

Conversion Policies


Individual PlansUnderwriters703-276-0220www.tahu.org

Texas Health Insurance Risk Pool


TDD 800-735-2989

TX Children with Special Needs

800-252-8023

CHIPProgram and Medicaid)

800-647-6558

www.chipmedicaid.org

State Kid Insurance Program (SKIP)

877-543-7669

Medicaid800-252-8263 877-541-7905


Treatment Program512-458-7796

bcccs/default.shtm


Albuquerque Area o"ce505-248-4500


Nashville O"ces615-467-1500


Oklahoma City Areawww.ihs.gov/FacilitiesServices/

cfm


www.medicare.gov


Program800-633-4227

Employee Retirement System

(ERS) Of Texas877-275-4377

Program

Cove

rage

to plan

By law all insurers must o"er at least one plan that includes coverage for state mandated bene!ts such as preventive care, mammograms etc.








Hospitalization, physician care, maternity, prescriptions, drugs, treatment for serious mental health illnesses and other services

5 plans to choose from

Quali!ed Plan.

There is a 12 month waiting period for people with pre-

where the policy will not

condition. If you were covered by creditable coverage in place during the 12 months before your e"ective date your wait time will be reduced.


Surgery, Primary & Preventative

and Hearing Services, Vision

Services, Mental Health

Supplies, Home Health Nursing,

Lodging and Transportationwhen needed to obtain medicalcare, Medicines, Physician

Special Nutritional Products &Services and Insurance Premium


Both: Doctor and nurse care immunizations, preventive care, health clinics, laboratory tests, prescriptions, medical equipment, transportation, hospitalization, mental health services, well child visits, dental, vision and more

CHIP: the !rst time after being covered by private health insurance will have a 90-day waiting period before bene!ts can be used


vision, and prescription coverage


tests at little or no cost toeligible women


clinics.


Medicare:

Insurance and Part B: Medical Insurance, as well as several supplemental and advantage plans. It also o"ers a prescription drug coverage plan, known as Medicare Part D


Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(or self-employed)

Insurance companies may require minimum participation

GUARANTEED COVERAGE


from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date

coverage

HIPAA:





GUARANTEED COVERAGE

Individuals with applicable

qualify

your premiums and continue to

conditions:

Ineligible for public or employer-based coverage

If one family member quali!es then all are quali!ed

You must have had 18 months of continuous coverage with the last day in a group health plan

GUARANTEED COVERAGE

years of age who has a chronic physical, developmental, or emotional condition that will

least 12 months

Person of any age with cystic !brosis

Must have applied for Medicaid

bene!ts

GUARANTEED COVERAGE

Both:

Must be ineligible for Medicaid

CHIP:

immigrants, and pregnant women can also qualify for

employer-based coverage

No health insurance for the

application

SKIP:

GBP

GUARANTEED COVERAGE

immigrants

with low income and Medicare may also qualify for Medicaid assistance

GUARANTEED COVERAGE

Diagnosed with breast orcervical cancer

Women under age 65

screening

cancer screening if no Pap in previous years

resident


GUARANTEED COVERAGE



GUARANTEED COVERAGE


(permanent kidney failure requiring dialysis or a kidney transplant). Eligibility

Mon

thly

Cos

t

contribution and ± 25% of the COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15

are responsible for full premium

COBRA & HIPAA: Premiums range from 102%-150% of group health

coverage variesPremiums vary based on health plan chosen, age, gender and geographic zone

amount a healthy person in a similar plan pays

$0 CHIP: $0 $50 covers all children in

range between $3 to $10.SKIP: $15 to $25 per month

$0 or minimal share of cost $0 or minimal share of cost $0 or minimal share of cost $0 and share of cost for

certain plans

Monthly Cost

Texas

87 800.234.1317

Dem

ogra


emographic



health plan





medically needy

Low income children Women Native American

Indian



Prog

ram


800-234-1317

Group Plans


www.uahu.org

Utah’s Premium Partnership for

Health Insurance (UPP)

888-222-2542http://health.utah.gov/upp


Then convert


www.dol.gov



800-234-1317

Individual Plans


www.uahu.org

HIPUtah

Health Insurance Pool)

800-705-9173801-442-6660

Member Services800-538-5038801-442-5038

www.selecthealth.orgwww.insurance.utah.gov/

Medicaid800-662-9651801-538-6155

http://health.utah.gov/medicaid

Utah CHIP

Insurance Program)

877-543-7669866-772-1261866-435-7414801-538-9004

www.utahchip.org


www.health.utah.gov/wic/

Utah Cancer Control800-717-1811801-538-6157

www.cancerutah.org



866-628-4282



Cove

rage

There is a 6-month look-back/12-month


UPP is a program for adults and children who do not currently have health insurance or

help pay for monthly insurance premiums for individuals enrolled in their employer’s




premium





prescription drugs, outpatient and in-hospital care, maternity,

skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, and preventive care, among other services


Inpatient hospital, outpatient hospital services, prenatal care, vaccines for children, physician, nursing facility services, family planning, rural health clinic services, home health care for persons eligible for skilled nursing

services, pediatric and family nurse practitioner services, nurse-midwife services and more


Utah CHIP: immunizations, health care provider visits, prescriptions,

health services, dental services for prevention and treatment of tooth decay





referral for a free mammogram, education on breast self

provides pediatrics, internal medicine and family medicine ambulatory care, services provided include laboratory, pharmacy, dental, public health nursing, mental health, health

leading reasons for outpatient visits include respiratory illness, preventive health activities,

prenatal care




coverage through the State of Utah's Department of Workforce Services




Elig

ibili

ty

GUARANTEED COVERAGE

Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for

employee




UPP: Must be between the ages

health insurance through an

your cost of health insurance be

GUARANTEED COVERAGE




HIPAA:




Medicare or any other public or private insurance programs

underwriting


column

GUARANTEED COVERAGE

Previous coverage terminated for reasons other than non-payment of premium or

within previous 6 months

government programs

Must have resided in Utah for 12 consecutive months immediately preceding the date of application for HIPUtah (the 12 month requirement can be waived if moving from another state’s high risk pool)

GUARANTEED COVERAGE

Parents: 70% FPL

women: 133% FPL

(also aged, blind and disabled)


Medically Needy

Working legally disabled 250%

Parent or caretaker relative of achild 54% to 60%

Some services are based on age of member

GUARANTEED COVERAGE

Utah CHIP: or legal resident, Under age 19, Not currently covered by health insurance, Income must be at or below 200% FPL


GUARANTEED COVERAGE


(Health Maintenance

Do not have Medicaid or Medicare

Uninsured or unable to a"ord insurance premium

Income at or below 250% of FPL




GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


UPP: Up to $150 per adult and up to $120 per child in the family, every month


full premium



county/zone


Premiums vary based on the plan, can be 150% of average rate

Three available deductible options of $500 medical/$150 pharmacy, $1000 medical/$250 pharmacy and $2500 medical/$500 pharmacy

High deductible plan is also available with a $5,000 deductible

$0 copays

Utah CHIP: $0-75 per quarter depending on income


$0 $0 or minimal share of cost 20% of the insurance premium


Monthly Cost

Utah


Dem

ogra


emographic



health plan





medically needy

Low income children Women Native American

Indian



Prog

ram


800-234-1317

Group Plans


www.uahu.org

Utah’s Premium Partnership for

Health Insurance (UPP)

888-222-2542http://health.utah.gov/upp


Then convert


www.dol.gov



800-234-1317

Individual Plans


www.uahu.org

HIPUtah

Health Insurance Pool)

800-705-9173801-442-6660

Member Services800-538-5038801-442-5038

www.selecthealth.orgwww.insurance.utah.gov/

Medicaid800-662-9651801-538-6155

http://health.utah.gov/medicaid

Utah CHIP

Insurance Program)

877-543-7669866-772-1261866-435-7414801-538-9004

www.utahchip.org


www.health.utah.gov/wic/

Utah Cancer Control800-717-1811801-538-6157

www.cancerutah.org



866-628-4282



Cove

rage



UPP is a program for adults and children who do not currently have health insurance or

help pay for monthly insurance premiums for individuals enrolled in their employer’s




premium





prescription drugs, outpatient and in-hospital care, maternity,

skilled nursing care, hospice, home health visits, transplants, rehabilitation, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy, and preventive care, among other services


Inpatient hospital, outpatient hospital services, prenatal care, vaccines for children, physician, nursing facility services, family planning, rural health clinic services, home health care for persons eligible for skilled nursing

services, pediatric and family nurse practitioner services, nurse-midwife services and more


Utah CHIP: immunizations, health care provider visits, prescriptions,

health services, dental services for prevention and treatment of tooth decay





referral for a free mammogram, education on breast self

provides pediatrics, internal medicine and family medicine ambulatory care, services provided include laboratory, pharmacy, dental, public health nursing, mental health, health

leading reasons for outpatient visits include respiratory illness, preventive health activities,

prenatal care




coverage through the State of Utah's Department of Workforce Services




Elig

ibili

ty

GUARANTEED COVERAGE

Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for

employee




UPP: Must be between the ages

health insurance through an

your cost of health insurance be

GUARANTEED COVERAGE




HIPAA:




Medicare or any other public or private insurance programs

underwriting


column

GUARANTEED COVERAGE

Previous coverage terminated for reasons other than non-payment of premium or

within previous 6 months

government programs

Must have resided in Utah for 12 consecutive months immediately preceding the date of application for HIPUtah (the 12 month requirement can be waived if moving from another state’s high risk pool)

GUARANTEED COVERAGE

Parents: 70% FPL

women: 133% FPL

(also aged, blind and disabled)


Medically Needy

Working legally disabled 250%

Parent or caretaker relative of achild 54% to 60%

Some services are based on age of member

GUARANTEED COVERAGE

Utah CHIP: or legal resident, Under age 19, Not currently covered by health insurance, Income must be at or below 200% FPL


GUARANTEED COVERAGE


(Health Maintenance

Do not have Medicaid or Medicare

Uninsured or unable to a"ord insurance premium

Income at or below 250% of FPL




GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


UPP: Up to $150 per adult and up to $120 per child in the family, every month


full premium



county/zone


Premiums vary based on the plan, can be 150% of average rate

Three available deductible options of $500 medical/$150 pharmacy, $1000 medical/$250 pharmacy and $2500 medical/$500 pharmacy

High deductible plan is also available with a $5,000 deductible

$0 copays

Utah CHIP: $0-75 per quarter depending on income


$0 $0 or minimal share of cost 20% of the insurance premium


Monthly Cost

Utah

89 800.234.1317

Dem

ogra


emographic

Small business

(1-50 Employees)





Medically Needy

Low Income Children &

Pregnant WomenWomen Adults Seniors and

Disabled



Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRAThen convert to


www.dol.gov



Individual Plans

Health Underwriters(To !nd and agent)



www.ovha.vermont.govor

www.greenmountaincare.org

Dr. Dynasaur





800-649-4357802-863-7333

http://healthvermont.gov/

Ladies First800-508-2222 802-863-7200

TDD 800-319-3141http://healthvermont.gov/

VHAP

800-250-8427888-834-7898 TTY

www.dsw.state.vt.usor



www.medicare.gov


Program800-633-4227



www.medicarehelpvt.net


866-628-4282



Cove

rage









There is a 9-12 month look-back period limit

conditions


Doctor visits, prescriptions, hospital care (including

family planning, mental health services, substance abuse services, home health care, dental care, eye care, occupational therapy, physical and speech therapy, and more


Dr. Dynasaur: Doctor visits, check-ups, dental care, immunizations, vision, hospital care, prescriptions, physical therapy, speech therapy, mental health care. Pregnant women receive doctor visits, hospital care, lab work & tests, prescriptions, prenatal vitamins and other services





Pap tests, instruction in breast

disease risk factor (cholesterol, high blood pressure, diabetes) screening

ultrasounds, biopsies, and colonoscopies

Full coverage for some women


Doctor visits, prescriptions, visits to specialists, emergency room care, inpatient hospital care - emergency and urgent admissions only, outpatient

planning, mental health services, substances abuse services, home health care








coverage through the Blue

and MVP Health Plans




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee




GUARANTEED COVERAGE


Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to

to businesses with more than 20 employees

HIPAA:



eligible for Medicare or any other public or private insurance programs

GUARANTEED COVERAGE


GUARANTEED COVERAGE


Non-working Parents: 185% FPLWorking Parents: 192% FPL

Medically Needy Individual: 102% FPL (or 111% of the Federal Poverty Level for

only)

only)

GUARANTEED COVERAGE

Dr. Dynasaur: Provides coverage for children under 18 and pregnant women. Household income must be at or below 200% FPL for pregnant women, and up to 300% FPL

prior health coverage in the last month to be eligible, unless the coverage was dropped because of unemployment, death or divorce, or loss of dependent eligibility

WIC: Nutritionally or medically at risk pregnant, postpartum or breastfeeding women, and children younger than 5 years old. Must be at or below 185% FPL

GUARANTEED COVERAGE

Part B


If you have breast symptoms or an abnormal Pap test, you are eligible for a limited membership. This includes breast and cervical screening and diagnostic tests, but not screenings for heart disease risk factors.

In addition, all women who have been screened through Ladies First and need treatment for breast and cervical cancer may be eligible for full Medicaid bene!ts during treatment, including coverage for pre-malignant conditions

GUARANTEED COVERAGE

Must have income between 50- 185% FPL

program for adults age 18 and older

Must have been uninsured for 12 months or more – with

recently lost their insurance because of a life change such as

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and the Modi!ed COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.




county/zone


$0 copays

Dr. Dynasaur: $0 or $60 premium for children with family incomes between 200% and 300% FPL


$0 $7-$49 Medicare: $0 and share of cost

for certain plans



Monthly Cost

Vermont


Dem

ogra


emographic

Small business

(1-50 Employees)





Medically Needy

Low Income Children &

Pregnant WomenWomen Adults Seniors and

Disabled



Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRAThen convert to


www.dol.gov



Individual Plans

Health Underwriters(To !nd and agent)





Dr. Dynasaur





800-649-4357802-863-7333

http://healthvermont.gov/

Ladies First800-508-2222 802-863-7200

TDD 800-319-3141http://healthvermont.gov/

VHAP

800-250-8427888-834-7898 TTY

www.dsw.state.vt.usor



www.medicare.gov


Program800-633-4227



www.medicarehelpvt.net


866-628-4282



Cove

rage









There is a 9-12 month look-back period limit

conditions


Doctor visits, prescriptions, hospital care (including

family planning, mental health services, substance abuse services, home health care, dental care, eye care, occupational therapy, physical and speech therapy, and more


Dr. Dynasaur: Doctor visits, check-ups, dental care, immunizations, vision, hospital care, prescriptions, physical therapy, speech therapy, mental health care. Pregnant women receive doctor visits, hospital care, lab work & tests, prescriptions, prenatal vitamins and other services





Pap tests, instruction in breast

disease risk factor (cholesterol, high blood pressure, diabetes) screening

ultrasounds, biopsies, and colonoscopies

Full coverage for some women


Doctor visits, prescriptions, visits to specialists, emergency room care, inpatient hospital care - emergency and urgent admissions only, outpatient

planning, mental health services, substances abuse services, home health care








coverage through the Blue

and MVP Health Plans




Coverage

Elig

ibili

ty

GUARANTEED COVERAGE


employee




GUARANTEED COVERAGE


Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples. You have 60 days from date of termination to

to businesses with more than 20 employees

HIPAA:



eligible for Medicare or any other public or private insurance programs

GUARANTEED COVERAGE


GUARANTEED COVERAGE


Non-working Parents: 185% FPLWorking Parents: 192% FPL

Medically Needy Individual: 102% FPL (or 111% of the Federal Poverty Level for

only)

only)

GUARANTEED COVERAGE

Dr. Dynasaur: Provides coverage for children under 18 and pregnant women. Household income must be at or below 200% FPL for pregnant women, and up to 300% FPL

prior health coverage in the last month to be eligible, unless the coverage was dropped because of unemployment, death or divorce, or loss of dependent eligibility

WIC: Nutritionally or medically at risk pregnant, postpartum or breastfeeding women, and children younger than 5 years old. Must be at or below 185% FPL

GUARANTEED COVERAGE

Part B


If you have breast symptoms or an abnormal Pap test, you are eligible for a limited membership. This includes breast and cervical screening and diagnostic tests, but not screenings for heart disease risk factors.

In addition, all women who have been screened through Ladies First and need treatment for breast and cervical cancer may be eligible for full Medicaid bene!ts during treatment, including coverage for pre-malignant conditions

GUARANTEED COVERAGE

Must have income between 50- 185% FPL

program for adults age 18 and older

Must have been uninsured for 12 months or more – with

recently lost their insurance because of a life change such as

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

contribution and the Modi!ed COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the !rst 15 months.




county/zone


$0 copays

Dr. Dynasaur: $0 or $60 premium for children with family incomes between 200% and 300% FPL


$0 $7-$49 Medicare: $0 and share of cost

for certain plans



Monthly Cost

Vermont

91 800.234.1317

Dem

ogra


emographic



health plan





families

Children In Moderate Income

FamiliesWomen

Individuals with life-threatening illness or injury



Prog

ram


800-234-1317

Group HealthVirginia

Underwriters 703-276-0220

www.vahu.org

COBRA

or


www.dol.gov

or

Continuation and Conversion Policies


800-234-1317

Individual PlansVirginia


www.vahu.org

Anthem800-304-0372

www.anthem.com

CareFirst866-520-6099

www.care!rst.com


www.dmas.virginia.gov

Family Access to Medical Insurance

Security

866-873-2647888-221-1590 (TDD)

www.famis.org


888-942-3663www.vahealth.org/wic

Breast and Cervical Cancer Early

Detection Program 866-395-4968804-864-7761

www.vahealth.org/breastcancer

Uninsured Medical Catastrophe Fund

800-432-5924 www.dmas.virginia.gov


866-628-4282



Cove

rage






premium




Plans will vary but insurers are required to o"er certain bene!ts such as postpartum care and mammograms


Plans will vary but these two insurers o"er plans to individuals denied coverage due to medical conditions

o"er certain bene!ts such as postpartum care and mammograms




FAMIS: Doctor visits, check-ups, immunizations, preventive care, dental, mental, hospitalization





If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Medicaid, including dental, prescriptions etc.


Inpatient and outpatient hospital services and surgical centers, ambulatory care,

ambulatory care, medical care furnished by licensed practitioners, prescribed drugs and rehabilitative services to recover from medical

tissue transplant procedures covered are: kidney, liver, heart, lung and bone marrow








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Virginia resident


If you are denied coverage for a medical condition, you may be eligible for coverage through

column

GUARANTEED COVERAGE

Must not be eligible for any other insurance, including individual, group or public

Plan availability will depend on county residence

Virginia resident

GUARANTEED COVERAGE

Pregnant women, infants and children up to 133% FPL

Medically needy couples up to 47% FPL

Medically needy individuals 42% FPL


80% FPL


High cost of medical conditions subtracted from income may make eligible

GUARANTEED COVERAGE

FAMIS: Low income children under age 19, Uninsured and ineligible for Medicaid, Virginia resident, Income below 200% of FPL


GUARANTEED COVERAGE

Must be Virginia resident Women between 40-64 yearsof age. Women ages 18-39 canalso qualify for tests but mayneed to pay for them


GUARANTEED COVERAGE

Gross family income at or below 300% of the FPL

Have a life threatening illness

needed treatment and not eligible for coverage for the needed treatment through private health insurance or federal, state, or local government medical assistance programs

Identify a provider who is willing to accept the global fee established for the medical treatment plan

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and for standardized plans, ± 25% of

rate


full premium




$0 or minimal share of cost FAMIS: $2-5 co-pays, $0 for well-child and well-baby check-ups


$0 or nominal co-payment $0 or minimal share of cost 20% of the insurance premium


Monthly Cost

Virginia


Dem

ogra


emographic



health plan





families

Children In Moderate Income

FamiliesWomen

Individuals with life-threatening illness or injury



Prog

ram


800-234-1317

Group HealthVirginia

Underwriters 703-276-0220

www.vahu.org

COBRA

or


www.dol.gov

or

Continuation and Conversion Policies


800-234-1317

Individual PlansVirginia


www.vahu.org

Anthem800-304-0372

www.anthem.com

CareFirst866-520-6099

www.care!rst.com


www.dmas.virginia.gov

Family Access to Medical Insurance

Security

866-873-2647888-221-1590 (TDD)

www.famis.org


888-942-3663www.vahealth.org/wic

Breast and Cervical Cancer Early

Detection Program 866-395-4968804-864-7761

www.vahealth.org/breastcancer

Uninsured Medical Catastrophe Fund

800-432-5924 www.dmas.virginia.gov


866-628-4282



Cove

rage






premium




Plans will vary but insurers are required to o"er certain bene!ts such as postpartum care and mammograms


Plans will vary but these two insurers o"er plans to individuals denied coverage due to medical conditions

o"er certain bene!ts such as postpartum care and mammograms




FAMIS: Doctor visits, check-ups, immunizations, preventive care, dental, mental, hospitalization





If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Medicaid, including dental, prescriptions etc.


Inpatient and outpatient hospital services and surgical centers, ambulatory care,

ambulatory care, medical care furnished by licensed practitioners, prescribed drugs and rehabilitative services to recover from medical

tissue transplant procedures covered are: kidney, liver, heart, lung and bone marrow








Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPAA:



Must be a Virginia resident


If you are denied coverage for a medical condition, you may be eligible for coverage through

column

GUARANTEED COVERAGE

Must not be eligible for any other insurance, including individual, group or public

Plan availability will depend on county residence

Virginia resident

GUARANTEED COVERAGE

Pregnant women, infants and children up to 133% FPL


Medically needy individuals 42% FPL


80% FPL


High cost of medical conditions subtracted from income may make eligible

GUARANTEED COVERAGE

FAMIS: Low income children under age 19, Uninsured and ineligible for Medicaid, Virginia resident, Income below 200% of FPL


GUARANTEED COVERAGE

Must be Virginia resident Women between 40-64 yearsof age. Women ages 18-39 canalso qualify for tests but mayneed to pay for them


GUARANTEED COVERAGE

Gross family income at or below 300% of the FPL

Have a life threatening illness

needed treatment and not eligible for coverage for the needed treatment through private health insurance or federal, state, or local government medical assistance programs

Identify a provider who is willing to accept the global fee established for the medical treatment plan

GUARANTEED COVERAGE



GUARANTEED COVERAGE



Mon

thly

Cos

t contribution and for standardized plans, ± 25% of

rate


full premium




$0 or minimal share of cost FAMIS: $2-5 co-pays, $0 for well-child and well-baby check-ups


$0 or nominal co-payment $0 or minimal share of cost 20% of the insurance premium


Monthly Cost

Virginia

93 800.234.1317

Dem

ogra

phic


ographic



health plan




Low Income Individuals &

Families

Individuals andFamilies Children Women Native American

IndiansSeniors and

Disabled

Prog

ram


800-234-1317

Group Health Planswww.dol.gov/ebsa


www.wahu-online.org

COBRAor


www.dol.gov

or



800-234-1317



www.wahu-online.org

WSHIP Washington State

Health Insurance Pool800-877-5187

www.wship.org

Healthy Options(Medicaid Managed

800-562-3022TTD: 800-848-5429

http://maa.dshs.wa.gov/

MedicaidDepartment of Social and Health Services

800-737-0617800-562-3022

www1.dshs.wa.gov

Washington Basic Health Plan(Subsidy program)

800-826-2444800-660-9840

www.basichealth.hca.wa.gov

(Basic Health is no longerprocessing applications andhas o#cially implemented a

waiting list)

WashingtonPrescription Drug

Discount Card877-208-1131

Apple Health forKids (CHIP)

877-543-7669800-562-3022

http://hrsa.dshs.wa.gov/


800-841-1410www.doh.wa.gov/cfh/wic/

default.htm

Washington Breast and Cervical

Cancer Program888-438-2247

www.doh.wa.gov/wbchp

Indian Health Service

503-326-2020(Portland-based)

www.ihs.gov

Seattle Indian Health Board

206-324-9360www.sihb.org


www.medicare.gov


Program800-633-4227

Program

Cove

rage


Under Washington law, newborns and adopted children are automatically covered under parents’ fully insured health plan for three weeks (60 days to notify carrier to add) if the plan provides dependent coverage.




premium



Up to $2M, assorted deductibles depending on age and county of residence


million per covered person

Non-Medicare plans

if applicant signs up through a portability policy


HO:di"erent plans

Medicaid: Physician services, checkups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, mental health, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, eye glasses, hearing aids


BHP:

Health Plan of Washington

Not all plans are o"ered in all counties

including preventive care, o#ce visits, pharmacy, emergency care, and maternity care

WPDD: Provides prescription drug discounts to all Washington state residents


Apple Health: Some children may qualify to have unpaid medical bills for the last three months covered

Full medical, dental and vision coverage







IHS: Programs vary depending on health center: primary & well child care, prenatal and post delivery care, family planning (birth control), minor surgical and orthopedic care, Pharmacy, dental and orthodontics, optometry, nursing, mental health, laboratory & radiology

SIHB: multi-service non-pro!t community health center dedicated to improving the health and well-being of urban Indians living in the greater





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees

Two employees must work 30 hrs/week for coverage

employee with proprietor


If uninsured for previous 64-90 days, a waiting period

conditions- not counting birth

up to 9 mos. 20-50 employees,

GUARANTEED COVERAGE



HIPAA:



underwriting


column

GUARANTEED COVERAGE

Must be a Washington resident

coverage by an insurance carrier

coverage

Individuals who are eligible for Medicare may qualify for the WSHIP Medicare plan

GUARANTEED COVERAGE

HO:

under age 19

Medicaid: FPL

Working parents: up to 77% FPL

Non-working parents: up to38% FPL


Parent: 50% FPL with resource test

Washington resident and quali!ed immigrant

GUARANTEED COVERAGE

BHP: 9 month waiting period of

prescriptions

Washington resident


WPDD: Must live in Washington state. There are no income or age requirements to qualify for this prescription card.

GUARANTEED COVERAGE

Apple Health: and under who are Washington residents

Family income up to 300% (some children with higher incomes may still qualify)


GUARANTEED COVERAGE



GUARANTEED COVERAGE

Member of a federally recognized tribe

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

and + 375% of the Modi!ed COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium



county/zone.


income)

Plan usually pays 80% of most

deductibles $500-$1,500, subsidies for age 50+


BHP: Premiums vary depending on plan chosen

WPDD: $0

Apple Health: $0-30 a monthdepending on income. Nofamily pays more than $60


$0 and share of cost sliding scale

$0 or sliding scale depending on income


certain plans

Monthly Cost

Washington


Dem

ogra

phic


ographic



health plan




Low Income Individuals &

Families

Individuals andFamilies Children Women Native American

IndiansSeniors and

Disabled

Prog

ram


800-234-1317

Group Health Planswww.dol.gov/ebsa


www.wahu-online.org

COBRAor


www.dol.gov

or



800-234-1317



www.wahu-online.org

WSHIP Washington State

Health Insurance Pool800-877-5187

www.wship.org

Healthy Options(Medicaid Managed

800-562-3022TTD: 800-848-5429

http://maa.dshs.wa.gov/

MedicaidDepartment of Social and Health Services

800-737-0617800-562-3022

www1.dshs.wa.gov

Washington Basic Health Plan(Subsidy program)

800-826-2444800-660-9840

www.basichealth.hca.wa.gov

(Basic Health is no longerprocessing applications andhas o#cially implemented a

waiting list)

WashingtonPrescription Drug

Discount Card877-208-1131

Apple Health forKids (CHIP)

877-543-7669800-562-3022

http://hrsa.dshs.wa.gov/


800-841-1410www.doh.wa.gov/cfh/wic/

default.htm

Washington Breast and Cervical

Cancer Program888-438-2247

www.doh.wa.gov/wbchp

Indian Health Service

503-326-2020(Portland-based)

www.ihs.gov

Seattle Indian Health Board

206-324-9360www.sihb.org


www.medicare.gov


Program800-633-4227

Program

Cove

rage


Under Washington law, newborns and adopted children are automatically covered under parents’ fully insured health plan for three weeks (60 days to notify carrier to add) if the plan provides dependent coverage.




premium



Up to $2M, assorted deductibles depending on age and county of residence


million per covered person

Non-Medicare plans

if applicant signs up through a portability policy


HO:di"erent plans

Medicaid: Physician services, checkups (medical and dental), family planning, maternity, prenatal, and newborn care, prescriptions, mental health, hospital services, comfort care, hospice, dental services, drug and alcohol treatment, eye glasses, hearing aids


BHP:

Health Plan of Washington

Not all plans are o"ered in all counties

including preventive care, o#ce visits, pharmacy, emergency care, and maternity care

WPDD: Provides prescription drug discounts to all Washington state residents


Apple Health: Some children may qualify to have unpaid medical bills for the last three months covered

Full medical, dental and vision coverage







IHS: Programs vary depending on health center: primary & well child care, prenatal and post delivery care, family planning (birth control), minor surgical and orthopedic care, Pharmacy, dental and orthodontics, optometry, nursing, mental health, laboratory & radiology

SIHB: multi-service non-pro!t community health center dedicated to improving the health and well-being of urban Indians living in the greater





Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employees

Two employees must work 30 hrs/week for coverage

employee with proprietor


If uninsured for previous 64-90 days, a waiting period

conditions- not counting birth

up to 9 mos. 20-50 employees,

GUARANTEED COVERAGE



HIPAA:



underwriting


column

GUARANTEED COVERAGE

Must be a Washington resident

coverage by an insurance carrier

coverage

Individuals who are eligible for Medicare may qualify for the WSHIP Medicare plan

GUARANTEED COVERAGE

HO:

under age 19

Medicaid: FPL

Working parents: up to 77% FPL

Non-working parents: up to38% FPL


Parent: 50% FPL with resource test

Washington resident and quali!ed immigrant

GUARANTEED COVERAGE

BHP: 9 month waiting period of

prescriptions

Washington resident


WPDD: Must live in Washington state. There are no income or age requirements to qualify for this prescription card.

GUARANTEED COVERAGE

Apple Health: and under who are Washington residents

Family income up to 300% (some children with higher incomes may still qualify)


GUARANTEED COVERAGE



GUARANTEED COVERAGE


GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t

and + 375% of the Modi!ed COBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium



county/zone.


income)

Plan usually pays 80% of most

deductibles $500-$1,500, subsidies for age 50+


BHP: Premiums vary depending on plan chosen

WPDD: $0

Apple Health: $0-30 a monthdepending on income. Nofamily pays more than $60


$0 and share of cost sliding scale

$0 or sliding scale depending on income


certain plans

Monthly Cost

Washington

95 800.234.1317

Dem

ogra


emographic



health plan




Low Income families &

medically needy


Disabled



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRAThen


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

Care!rst Blue Cross Blue Shield

800-321-3497www.care!rst.com

Medicaid202-727-5355202-442-5988

http://doh.dc.gov/doh

D.C. Healthy Families202-639-4030

TTY: 202-639-4041http://doh.dc.gov/doh

Project Wish

202-442-5900202-442-9128 (Spanish)http://doh.dc.gov/doh


www.medicare.gov


Program800-633-4227


866-628-4282


877-222-8387www.va.gov

Program

Cove

rage






premium



basis to all consumers


depending on needs of applicant

cover certain bene!ts – such as mammograms, prostate cancer screening, and diabetes treatment

Two month waiting period


Doctor visits, immunizations (shots), school physicals, emergency care, hospital stays, prescriptions, prenatal labor and delivery, vision care and glasses, dental, family planning, transportation to doctor appointments, home health care, durable medical equipment, health education services, mental health services, drug and alcohol treatment and more


Unison Health Plan



diagnostic services










Elig

ibili

ty

GUARANTEED COVERAGE

Most carriers require proof of the business or business owner, viability etc.

GUARANTEED COVERAGE



businesses with more than 20 employees

HIPAA:



GUARANTEED COVERAGE


GUARANTEED COVERAGE

for which you ever got care or for which the insurer thought

this is called the prudent person rule

to credit your prior health

GUARANTEED COVERAGE

Pregnant Women may have an income up to 300% of the FPL

100% FPL


41% FPL


GUARANTEED COVERAGE

For children, adolescents under age 19 who live alone, pregnant women, and parents/guardians

Must be a resident of

Up to 200% FPL for entirefamily, up to 300% for childrenonly

GUARANTEED COVERAGE


eligible for a free annual mammogram

Free transportation and interpreter services

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contributionCOBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium



county/zonePremiums can vary due to age, gender, health status, family size, and other factors.

$0 or share of cost $0 or share of cost $0 $0 and share of cost for

certain plans



Monthly Cost

Washington D.C.


Dem

ogra


emographic



health plan




Low Income families &

medically needy


Disabled



Prog

ram


800-234-1317

Group Health


www.nahu.org

COBRAThen


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

Care!rst Blue Cross Blue Shield

800-321-3497www.care!rst.com

Medicaid202-727-5355202-442-5988

http://doh.dc.gov/doh

D.C. Healthy Families202-639-4030

TTY: 202-639-4041http://doh.dc.gov/doh

Project Wish

202-442-5900202-442-9128 (Spanish)http://doh.dc.gov/doh


www.medicare.gov


Program800-633-4227


866-628-4282


877-222-8387www.va.gov

Program

Cove

rage






premium



basis to all consumers


depending on needs of applicant

cover certain bene!ts – such as mammograms, prostate cancer screening, and diabetes treatment

Two month waiting period




Unison Health Plan



diagnostic services










Elig

ibili

ty

GUARANTEED COVERAGE

Most carriers require proof of the business or business owner, viability etc.

GUARANTEED COVERAGE



businesses with more than 20 employees

HIPAA:



GUARANTEED COVERAGE


GUARANTEED COVERAGE

for which you ever got care or for which the insurer thought

this is called the prudent person rule

to credit your prior health

GUARANTEED COVERAGE

Pregnant Women may have an income up to 300% of the FPL

100% FPL


41% FPL


GUARANTEED COVERAGE

For children, adolescents under age 19 who live alone, pregnant women, and parents/guardians


Up to 200% FPL for entirefamily, up to 300% for childrenonly

GUARANTEED COVERAGE


eligible for a free annual mammogram

Free transportation and interpreter services

GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t contributionCOBRA: With the 65% subsidy you are responsible for 35% of the monthly premium for the

full premium



county/zonePremiums can vary due to age, gender, health status, family size, and other factors.

$0 or share of cost $0 or share of cost $0 $0 and share of cost for

certain plans



Monthly Cost

Washington D.C.

97 800.234.1317

Dem

ogra


emographic



health plan




Low income families



Disabled



Prog

ram


800-234-1317

Group Plans


www.nahu.org



www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

Access WV(WV Health Insurance Plan)

866-445-8491 304-558-8264

www.accesswv.org

Medicaid304-348-3365 888-483-0797

www.wvdhhr.org/bcf/family_assistance/medicaid.asp

WVCHIP

Insurance Plan)

877-982-2447 304-558-2732

www.wvchip.org


304-558-0030http://ons.wvdhhr.org/


800-642-8522304-558-5388

www.wvdhhr.org/bccsp


www.medicare.gov


Program800-633-4227

WVSHIP304-558-3317877-987-4463

www.wvship.org




Cove

rage







premium



medical needs


period limit


Four plan options including doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health and substance abuse services

$200K and lifetime $1M

Must meet a 6-month waiting

conditions. This means that

bene!ts for services related to these conditions, including prescriptions, for 6 months after coverage is e"ective


Physician's services, hospital inpatient care, outpatient hospital services, emergency room services, X-ray and laboratory services prescribed by an authorized practitioner, routine dental care for children and with approval some medically necessary special care such as braces, adult dental limited to removal of cysts or tumors, biopsies, treatment

and some emergency services, prescribed drugs, ambulance, arti!cial limbs, braces etc., vision, nursing facilities, family planning services, outpatient mental health services


WVCHIP: Doctor visits, check-ups, hospital visits, immunizations,

dental care, vision, emergency care, 24 hour nurse-line, mental health, diabetic supplies, urgent care or after hour clinic visits, case management for special needs and other services





Mammograms for women age 50 and older

women age 25 and older

Surgical breast consults, diagnostic mammograms, !ne needle aspirations, breast biopsies, breast ultrasounds, and colposcopies with or without biopsies available if deemed necessary




WVSHIP is a Medicare counseling service







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE




HIPAA:





underwriting


column

GUARANTEED COVERAGE




GUARANTEED COVERAGE

Pregnant Women and infants (ages 0-1): 150% FPL





WVCHIP: Must be a West Virginia resident currently living in the state, Must be 18 or younger,

now and cannot have had

past twelve months for the

cannot be eligible for the West

have a family income at or below 250% FPL


GUARANTEED COVERAGE

No health insurance, or your health insurance does not cover the services

service, 25-64


GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies$400-2,000 deductible for one person depending on the plan

Premium prices vary based on family or single, region, age and plan selected

$0 WVCHIP: $0-35 co-pays for drugs and services with a

depending on family size and income



certain plans



Monthly Cost

West Virginia


Dem

ogra


emographic



health plan




Low income families



Disabled



Prog

ram


800-234-1317

Group Plans


www.nahu.org



www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

Access WV(WV Health Insurance Plan)

866-445-8491 304-558-8264

www.accesswv.org

Medicaid304-348-3365 888-483-0797

www.wvdhhr.org/bcf/family_assistance/medicaid.asp

WVCHIP

Insurance Plan)

877-982-2447 304-558-2732

www.wvchip.org


304-558-0030http://ons.wvdhhr.org/


800-642-8522304-558-5388

www.wvdhhr.org/bccsp


www.medicare.gov


Program800-633-4227

WVSHIP304-558-3317877-987-4463

www.wvship.org




Cove

rage







premium



medical needs


period limit


Four plan options including doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health and substance abuse services

$200K and lifetime $1M

Must meet a 6-month waiting

conditions. This means that

bene!ts for services related to these conditions, including prescriptions, for 6 months after coverage is e"ective


Physician's services, hospital inpatient care, outpatient hospital services, emergency room services, X-ray and laboratory services prescribed by an authorized practitioner, routine dental care for children and with approval some medically necessary special care such as braces, adult dental limited to removal of cysts or tumors, biopsies, treatment

and some emergency services, prescribed drugs, ambulance, arti!cial limbs, braces etc., vision, nursing facilities, family planning services, outpatient mental health services


WVCHIP: Doctor visits, check-ups, hospital visits, immunizations,

dental care, vision, emergency care, 24 hour nurse-line, mental health, diabetic supplies, urgent care or after hour clinic visits, case management for special needs and other services





Mammograms for women age 50 and older

women age 25 and older

Surgical breast consults, diagnostic mammograms, !ne needle aspirations, breast biopsies, breast ultrasounds, and colposcopies with or without biopsies available if deemed necessary




WVSHIP is a Medicare counseling service







Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

(including owner)




GUARANTEED COVERAGE




HIPAA:





underwriting


column

GUARANTEED COVERAGE




GUARANTEED COVERAGE

Pregnant Women and infants (ages 0-1): 150% FPL





WVCHIP: Must be a West Virginia resident currently living in the state, Must be 18 or younger,

now and cannot have had

past twelve months for the

cannot be eligible for the West

have a family income at or below 250% FPL


GUARANTEED COVERAGE

No health insurance, or your health insurance does not cover the services

service, 25-64


GUARANTEED COVERAGE



GUARANTEED COVERAGE



GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos


full premium



varies$400-2,000 deductible for one person depending on the plan

Premium prices vary based on family or single, region, age and plan selected

$0 WVCHIP: $0-35 co-pays for drugs and services with a

depending on family size and income



certain plans



Monthly Cost

West Virginia

99 800.234.1317

Dem

ogra


Dem

ographic

Small businesses

(2-50 Employees)


health plan






Individuals with chronic health

conditionsAdults


(TAA recipients)

Prog

ram


800-234-1317

Group Health

800-236-8517608-266-3585

http://oci.wi.gov

COBRA orHIPP

Then convert to


www.dol.gov



800-234-1317

Individual Plans

800-236-8517608-266-3585

http://oci.wi.gov

HIRSP(Wisconsin Health Insurance

800-828-4777608-221-4551

www.hirsp.org


www.dhfs.state.wi.us/Medicaid

Badger Care Plus800-362-3002

www.badgercareplus.org


800-722-2295http://dhs.wisconsin.gov/wic/

Wisconsin Well Women Program

608-266-8311800-218-8408

www.dhfs.wisconsin.gov/womenshealth/wwwp

Wisconsin Chronic Disease Program

866-908-1363http://dhfs.wisconsin.gov/wcdp

BadgerCare Core800-291-2002

http://dhs.wisconsin.gov/

enrollment process for

been suspended because the total number of applications received is greater than the

waitlist has been created and those on the waitlist will be

able to enroll as space becomes available)


866-628-4282

Program

Cove

rage






premium




items,

conditions



Plan 1 is for people not eligible for Medicare and o"ers two deductible choices, and Plan 2 is only for people eligible for Medicare

Hospital and physician care, prescription drugs and insulin, maternity care and other services




BCP: including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more (o"ers same as Medicaid)





If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Well Woman Medicaid


o"ers assistance to Wisconsin residents with chronic renal disease, hemophilia and adult cystic !brosis

pays health care providers for disease related services and supplies provided to certi!ed

Program participants after all other sources of payment have

Doctor visits, Hospital services,

Some prescription drugs,

therapy, Speech therapy,

medical equipment, Disposable medical supplies, Dialysis/kidney-related services






Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPP: Pays employer premiums for families that have high cost medical conditions and are

HIPAA:



underwriting


period



column

GUARANTEED COVERAGE

Must be under age 65

Must be Wisconsin resident

Must demonstrate uninsurability

o"ered group health insurance

comprehensive Wisconsin

Plus


GUARANTEED COVERAGE


Parents, children 1-19, pregnant women and infants at 185% FPL

Medically needy individuals up to 83% FPL


Wisconsin resident or documented immigrant

assistance or SSI

GUARANTEED COVERAGE

BCP: old without access to health

a monthly income up to 300% of

up to 200% of the FPL


GUARANTEED COVERAGE

Must be Wisconsin resident and have satisfactory immigration status 45 to 64 years of age with no insurance


GUARANTEED COVERAGE

participants are responsible for certain co-payments and annual deductible determined by the program. Participants

300% of the federal poverty level must pay a certain percent

before becoming eligible to

state seeks repayment of

GUARANTEED COVERAGE

have children or dependent children, under age 19 living

Have family income at or below

health insurance or employer coverage 12 months before

not currently have access to

Plus, Medicaid or Medicare.

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium





Premiums vary based on plan.Plan 1: deductible of $1000 and 20% co-pay with out-of-pocket

deductible of $2500 with $3500

co-paysPlan 2: $500 annual deductible

$0 or minimal share of cost Both: $0 to minimal share of cost

$0 $0 or minimal share of cost $0 or minimal share of cost 20% of the insurance premium M

onthly Cost

Wisconsin


Dem

ogra


Dem

ographicSmall

businesses (2-50 Employees)


health plan






Individuals with chronic health

conditionsAdults


(TAA recipients)

Prog

ram


800-234-1317

Group Health

800-236-8517608-266-3585

http://oci.wi.gov

COBRA orHIPP

Then convert to


www.dol.gov



800-234-1317

Individual Plans

800-236-8517608-266-3585

http://oci.wi.gov

HIRSP(Wisconsin Health Insurance

800-828-4777608-221-4551

www.hirsp.org


www.dhfs.state.wi.us/Medicaid

Badger Care Plus800-362-3002

www.badgercareplus.org


800-722-2295http://dhs.wisconsin.gov/wic/

Wisconsin Well Women Program

608-266-8311800-218-8408

www.dhfs.wisconsin.gov/womenshealth/wwwp

Wisconsin Chronic Disease Program

866-908-1363http://dhfs.wisconsin.gov/wcdp

BadgerCare Core800-291-2002

http://dhs.wisconsin.gov/

enrollment process for

been suspended because the total number of applications received is greater than the

waitlist has been created and those on the waitlist will be

able to enroll as space becomes available)


866-628-4282

Program

Cove

rage






premium




items,

conditions



Plan 1 is for people not eligible for Medicare and o"ers two deductible choices, and Plan 2 is only for people eligible for Medicare

Hospital and physician care, prescription drugs and insulin, maternity care and other services




BCP: including but not limited to doctor visits, mental, dental, prescriptions, hospitalization and more (o"ers same as Medicaid)





If screened and diagnosed for breast or cervical cancer may be eligible for complete health coverage through Well Woman Medicaid


o"ers assistance to Wisconsin residents with chronic renal disease, hemophilia and adult cystic !brosis

pays health care providers for disease related services and supplies provided to certi!ed

Program participants after all other sources of payment have

Doctor visits, Hospital services,

Some prescription drugs,

therapy, Speech therapy,

medical equipment, Disposable medical supplies, Dialysis/kidney-related services






Coverage

Elig

ibili

ty

GUARANTEED COVERAGE

employee


GUARANTEED COVERAGE



HIPP: Pays employer premiums for families that have high cost medical conditions and are

HIPAA:



underwriting


period



column

GUARANTEED COVERAGE

Must be under age 65

Must be Wisconsin resident

Must demonstrate uninsurability

o"ered group health insurance

comprehensive Wisconsin

Plus


GUARANTEED COVERAGE


Parents, children 1-19, pregnant women and infants at 185% FPL

Medically needy individuals up to 83% FPL


Wisconsin resident or documented immigrant

assistance or SSI

GUARANTEED COVERAGE

BCP: old without access to health

a monthly income up to 300% of

up to 200% of the FPL


GUARANTEED COVERAGE

Must be Wisconsin resident and have satisfactory immigration status 45 to 64 years of age with no insurance


GUARANTEED COVERAGE

participants are responsible for certain co-payments and annual deductible determined by the program. Participants

300% of the federal poverty level must pay a certain percent

before becoming eligible to

state seeks repayment of

GUARANTEED COVERAGE

have children or dependent children, under age 19 living

Have family income at or below

health insurance or employer coverage 12 months before

not currently have access to

Plus, Medicaid or Medicare.

GUARANTEED COVERAGE



Eligibility

Mon

thly

Cos

t


full premium





Premiums vary based on plan.Plan 1: deductible of $1000 and 20% co-pay with out-of-pocket

deductible of $2500 with $3500

co-paysPlan 2: $500 annual deductible

$0 or minimal share of cost Both: $0 to minimal share of cost

$0 $0 or minimal share of cost $0 or minimal share of cost 20% of the insurance premium M

onthly Cost

Wisconsin

101 800.234.1317

Dem

ogra


emographic

Small businesses

(2-50 Employees)


health plan


Individuals unable to obtain

private health insurance due to a medical condition


Children Children’s special health Women Pregnant Women

NativeAmerican

Indians

Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRA

Conversion Plansand then


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

WHIPWyoming Health

Insurance Pool800-442-2376307-634-1393

http://insurance.state.wy.us/whip.html

MedicaidEqualityCare

800-251-1268http://wdh.state.wy.us/

healthcare!n/equalitycare

services department

KidCare CHIP



800-994-4769 307-777-7494

http://wdh.state.wy.us/

Children’s Special Health Program

(CSH)800-438-5795307-777-7941


services department


307-777-6006800-264-1296

http://wdh.state.wy.us/phsd/

Best Beginnings Wyoming Baby

307-777-7275 http://wdh.state.wy.us/

familyhealth/bestbeginnings/

services department

Indian Health Services406-247-7107 www.ihs.gov Program

Cove

rage


If uninsured for previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply



premium





The pool plan options provide comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and

hospice, home health visits, rehabilitation, durable medical equipment, and mental health and substance abuse, among other services

The pool provides enrollees with two plan choices, the Brown Plan and the Gold Plan

is increasing to $750,000. The

will also increase to $1,000,000


hospitalization and prescription coverage

Treatment for special health problems like breast cancer, kidney problems, nursing home


KidCare CHIP: Inpatient and outpatient hospital services, doctor visits, laboratory and

well-child and well-adolescent care, including age appropriate immunizations, prescriptions, mental health services, dental services (no braces, only preventive and some basic, services are covered) $750

vision services (no contacts), physical therapy, other health bene!ts





coordination, specialty medical care, some equipment and medications, lab/X-rays related to diagnosis services, support services, and diagnostic evaluations

There is an annual limit of up to $40,000 Pre-Existing Health Conditions Covered

Medical assistance is available for most women through Medicaid if their breast or

were found to have breast or cervical cancer, including pre-cancerous conditions


Financial assistance for eligible women, pregnancy counseling and teaching, referrals to appropriate resources in the community, educational materials relating to pregnancy, smoking cessation assistance and referral, prenatal class/support group, parenting classes for parents of newborns, home visits for moms and babies, breast feeding support


services available through a Service Unit located on the

and three hospitals on the


Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:



underwriting


column

GUARANTEED COVERAGE

coverage for health reasons by one insurer

or

coverage more restrictive than the Pool

or

the Pool

Must be a Wyoming resident

Waiting periods may apply

the proper eligibility level based

2 is below 250% FPL, Level 1 is above 250% FPL

GUARANTEED COVERAGE

up to 133% FPL

Working Parents up to 52% FPL

Non-Working Parents up to54% FPL

Live in Wyoming

GUARANTEED COVERAGE

KidCare CHIP:

younger, No insurance within last 30 days


GUARANTEED COVERAGE

Your child must be a Wyoming resident under 19 years of age and suspected or known to have one of the medically eligible conditions, i.e. chronic illness or disability. Your child may also have insurance,

(Medicaid).

GUARANTEED COVERAGE

Women age 50 to 64 years Women age 30-64 may be eligible if they have not had a pap test in past 5 years

Women age 18-50 with certain abnormal breast or cervical

Income must be at or below 250% of federal poverty guidelines

coverage, including Medicaid

GUARANTEED COVERAGE

from county to county

Be sure to call your localo#ce

GUARANTEED COVERAGE


Eligibility

Mon

thly

Cos


full premium



varies$0 or minimal share of cost KidCare CHIP: $3-5 co-pays with

of $200


$0 or sliding scale share-of-cost

$0 or minimal share of cost $0 $0 or minimal share of cost Monthly Cost

Wyoming

www.coverageforall.org 102 Wyoming

Dem

ogra


emographic

Small businesses

(2-50 Employees)


health plan


Individuals unable to obtain

private health insurance due to a medical condition


Children Children’s special health Women Pregnant Women

NativeAmerican

Indians

Prog

ram


800-234-1317

Group Plans


www.nahu.org

COBRA

Conversion Plansand then


www.dol.gov


800-234-1317

Individual Plans


www.nahu.org

WHIPWyoming Health

Insurance Pool800-442-2376307-634-1393

http://insurance.state.wy.us/whip.html

MedicaidEqualityCare


healthcare!n/equalitycare

services department

KidCare CHIP



800-994-4769 307-777-7494


Children’s Special Health Program

(CSH)800-438-5795307-777-7941


services department


307-777-6006800-264-1296

http://wdh.state.wy.us/phsd/

Best Beginnings Wyoming Baby

307-777-7275 http://wdh.state.wy.us/

familyhealth/bestbeginnings/

services department

Indian Health Services406-247-7107 www.ihs.gov Program

Cove

rage


If uninsured for previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply



premium





The pool plan options provide comprehensive coverage of doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and

hospice, home health visits, rehabilitation, durable medical equipment, and mental health and substance abuse, among other services

The pool provides enrollees with two plan choices, the Brown Plan and the Gold Plan

is increasing to $750,000. The

will also increase to $1,000,000


hospitalization and prescription coverage

Treatment for special health problems like breast cancer, kidney problems, nursing home


KidCare CHIP: Inpatient and outpatient hospital services, doctor visits, laboratory and

well-child and well-adolescent care, including age appropriate immunizations, prescriptions, mental health services, dental services (no braces, only preventive and some basic, services are covered) $750

vision services (no contacts), physical therapy, other health bene!ts





coordination, specialty medical care, some equipment and medications, lab/X-rays related to diagnosis services, support services, and diagnostic evaluations

There is an annual limit of up to $40,000 Pre-Existing Health Conditions Covered

Medical assistance is available for most women through Medicaid if their breast or

were found to have breast or cervical cancer, including pre-cancerous conditions


Financial assistance for eligible women, pregnancy counseling and teaching, referrals to appropriate resources in the community, educational materials relating to pregnancy, smoking cessation assistance and referral, prenatal class/support group, parenting classes for parents of newborns, home visits for moms and babies, breast feeding support


services available through a Service Unit located on the

and three hospitals on the


Elig

ibili

ty

GUARANTEED COVERAGE


employee


GUARANTEED COVERAGE



HIPAA:



underwriting


column

GUARANTEED COVERAGE

coverage for health reasons by one insurer

or

coverage more restrictive than the Pool

or

the Pool

Must be a Wyoming resident

Waiting periods may apply

the proper eligibility level based

2 is below 250% FPL, Level 1 is above 250% FPL

GUARANTEED COVERAGE

up to 133% FPL

Working Parents up to 52% FPL

Non-Working Parents up to54% FPL

Live in Wyoming

GUARANTEED COVERAGE

KidCare CHIP:

younger, No insurance within last 30 days


GUARANTEED COVERAGE

Your child must be a Wyoming resident under 19 years of age and suspected or known to have one of the medically eligible conditions, i.e. chronic illness or disability. Your child may also have insurance,

(Medicaid).

GUARANTEED COVERAGE

Women age 50 to 64 years Women age 30-64 may be eligible if they have not had a pap test in past 5 years

Women age 18-50 with certain abnormal breast or cervical

Income must be at or below 250% of federal poverty guidelines

coverage, including Medicaid

GUARANTEED COVERAGE

from county to county

Be sure to call your localo#ce

GUARANTEED COVERAGE


Eligibility

Mon

thly

Cos


full premium



varies$0 or minimal share of cost KidCare CHIP: $3-5 co-pays with

of $200


$0 or sliding scale share-of-cost

$0 or minimal share of cost $0 $0 or minimal share of cost Monthly Cost

103

Appendices

104

A#ordable COBRAFor workers who were involuntarily terminated between September 1, 2008 and May 31, 2010, the government will subsidize 65% of their premiums under COBRA for #fteen months. "is subsidy also applies to healthcare continuation coverage if required by the state.

2nd Chance for COBRAFor workers who were involuntarily terminated between September 1, 2008 and the day the stimulus Law goes into e!ect, and who did not sign up for COBRA, will get an additional 60 days to do so and receive the subsidy. "is special election period opportunity does not apply to coverage sponsored by employers with less than 20 employees that is subject to State law.

Employer Noti!cationWithin 60 days of enactment, the Employer or COBRA Administrator shall provide an additional noti#cation to any Assistance Eligible Employee who became entitled to elect COBRA before enactment of this Law.

Tax Credit for EmployersTo o!set the employer’s expense, the employer may take a full tax credit for its expenditures out of its payroll taxes including both income tax withholding and FICA.

High Income ExclusionIf the modi#ed adjusted gross income (AGI) of a participant exceeds $125,000 a year, or a family’s AGI exceeds $250,000, their income tax will be raised by the premium reduction amount – e!ectively removing the subsidy.

Plan OptionsQuali#ed Bene#ciaries (QBs) under the stimulus will have the option to change plans to another product o!ered by the Employer with the following requirements:

Employer agrees to allow QBs to enroll in di!erent coverage"e selected plan does not exceed the premium for coverage in which the individual was enrolled at the time the qualifying event occurredPlan cannot be Dental, Vision, Counseling, Referral or FSACoverage is also o!ered to active employees

HOW TO UNDERSTAND

The COBRA Subsidy

104 105

OTHER SERVICES !BY STATE"AlabamaWIC (Women-Infant-Children)888-942-4673800-654-1385www.adph.org/wic


Vaccines for Children800-469-4599

Alabama Department of Insurance 334-269-3550800-433-3966 (in state) www.aldoi.gov

Alabama Department of Public Health334-206-5300 www.adph.org

AlaskaAnchorage Neighborhood Health Center907-257-4600www.anhc.org

Anchorage Community Health Services 907-343-4605

Women-Infant-Children (WIC) 907-465-3100www.hss.state.ak.us/dpa/programs/nutri/wic/default.htm

Alaska Division of Insurance 800-467-8725 (in state)907- 465-2515www.dced.state.ak.us/insurance

Alaska Health and Social Services800-211-7470907-562-3671 www.hss.state.ak.us

ArizonaWomen-Infant-Children (WIC) 800-252-5942www.azwic.gov

Health Care Group of Arizona602-417-6755802-247-2289

Federal EmergencyServices (FES)(for people who cannot verify


Arizona Department of Insurance 800-325-2548 www.id.state.az.us

Arizona Department of Economic Security800-352-8401www.azdes.gov

ArkansasWomen-Infant-Children800-445-6175501-661-2905http://www.healthyarkansas.com/breastfeeding/wic_about.html

DDS Children’s Services

501-682-8207www.medicalhomear.org

Immunization Program 501-661-2793

AR Family Planning501-661-2531

Women’s Health501-661-2480

Arkansas Department of Insurance 501-371-2600800-282-9134 http://insurance.arkansas.gov

Arkansas Department of Human Services501-682-1001800-482-8988www.arkansas.gov/dhhs

CaliforniaIndian HealthServices916-930-3927www.ihs.gov

California Children’s Serviceswww.dhs.ca.gov/pcfh/cms/ccs

Health Consumer Alliancewww.healthconsumer.org

programs and legal rights by county)

California Department of Health Services

TTY 888-757-6034www.dhcs.ca.gov

California Department of Insurance800-927-4357www.insurance.ca.gov

on all types of insurance)

California Department of Managed Health Care888-466-2219www.hmohelp.ca.gov

on all types of insurance)

BABY CAL

(800-222-9999)

WISEWOMAN800-511-2300www.dhs.ca.gov/cancerdetection

Women-Infant-Children (WIC)888-942-9675www.wicworks.ca.gov

ColoradoWomen-Infant-Children (WIC)800-688-7777www.cdphe.state.co.us/ps/wic

Colorado Indigent Care Program (CICP)

800-221-3943www.chcpf.state.co.us

Colorado Division of Insurance303-894-7490 www.dora.state.co.us/insurance/

Colorado Department of Human Services303-866-5700www.cdhs.state.co.us

106

ConnecticutWomen-Infant-Children (WIC)860-509-8084

Connecticut Insurance Department800-203-3447860-297-3900www.state.ct.us/cid

Connecticut Department of Social Services800-842-1508860-424-5016www.dss.state.ct.us

DelawareWomen-Infant-Children (WIC)800-222-2189www.dhss.delaware.gov/dph/chca/dphwichominf01.html

Immunization Services800-282-8672

Family Planninghttp://dhss.delaware.gov/dhss/dph/chs/chsfamilyplanning.html

Child Development Watchhttp://dhss.delaware.gov/dhss/dph/chs/chscdw.html

Delaware Insurance Department 800-282-8611 www.delawareinsurance.gov

Delaware Department of Health and Social Services800-464-4357800-273-9500www.dhss.delaware.gov

FloridaWomen-Infant-Children (WIC)800-342-3556www.doh.state.$.us/family/wic Florida Alzheimer’s Disease Initiative850-414-2000

Florida AIDS Insurance Continuation Program 305-592-1452www.doh.state.$.us/disease_ctrl/aids/care/aicp.html

Florida O"ce of Insurance Regulation 800-342-2762 www.$oir.com

Florida Health and Human Serviceswww.dcf.state.$.us/esswww.doh.state.$.us

GeorgiaGeorgia Insurance Commission 800-656-2298www.inscomm.state.ga.us

Immunization Program 404-657-3158

Tobacco Use Prevention 404-657-6611

Emergency Food Assistance404-463-2607404-463-8042404-657-3742

Georgia Department of Family and Children Services404-656-4507http://dfcs.dhr.georgia.gov

Georgia Department of Community Healthhttp://dch.georgia.gov

HawaiiPACE Hawaii(age 55 and older)808-832-6131

Hawaii Immunization Program800-933-4832808-586-8300

STD/AIDS Prevention Branch808-733-9281

Women-Infant-Children (WIC)Neighbor Islands: 888-820-6425http://hawaii.gov/health/family-child-health/

Hawaii Division of Insurance 808-586-2790808-586-2799 http://hawaii.gov/dcca/ins

Hawaii Department of Health808-586-4400www.hawaii.gov/health

IdahoIndian Health Services503-326-2020www.ihs.gov

Women-Infant-Children (WIC)800-926-2588http://healthandwelfare.idaho.

Idaho Department of Insurance208-334-4250 www.doi.idaho.gov

Idaho Department of Health and Welfare800-926-2588www.healthandwelfare.idaho.gov

IllinoisHealth Bene!ts for Workers with Disabilities800-226-0768www.hbwdillinois.com

Women-Infant-Children (WIC)800-843-6154

Illinois Department of Insurance877-527-9431http://insurance.illinois.gov

Illinois Department of Human Services800-843-6154www.dhs.state.il.us

IndianaWomen-Infant-Children (WIC)800-522-0874www.in.gov/isdh/19691.htm

Indiana Department of Insurance 800-622-4461317-232-2385 www.in.gov/idoi

Indiana Family and Social Services317-232-4946www.in.gov/fssa

107

IowaWomen-Infant-Children (WIC)800-532-1579www.idph.state.ia.us/wic/default.asp

Iowa Insurance Division800-325-2548515-281-5705www.iid.state.ia.us

Iowa Department of Human Serviceswww.dhs.state.ia.us

KansasKansas Foundation for Medical Care800-432-0770785-273-2552www.kfmc.org

Senior Health Insurance Counseling of Kansas800-860-5260

Kansas Insurance Department 785-296-3071800-432-2484 http://ksinsurance.org

Kansas Department of Social and Rehabilitation Services785-296-3959888-369-4777www.srskansas.org

KentuckyState Health Insurance Assistance Program(counseling for seniors and disabled)877-293-7447http://chfs.ky.gov/dail/ship.htm

ICARE877-422-7307http://icare.ky.gov

Kentucky O"ce of Insurance 502-564-3630800-595-6053800-462-2081 (TDD)http://doi.ppr.ky.gov/kentucky

Kentucky Cabinet for Health and Family Services800-372-2973800-627-4702 (TDD)www.chfs.ky.gov

LouisianaLouisiana KidMed800-259-4444www.la-kidmed.com

Public Health Units(community care) www.oph.dhh.louisiana.gov/ophregions

Louisiana Department of Insurance 800-259-5300www.ldi.la.gov

Louisiana Department of Health and Hospitals225-342-9500 www.dhh.louisiana.gov

MaineMaine Genetics Program207-287-4623TTY: 800-606-6015www.medicare.gov

Maine Rx Plus866-796-2463TTD: 800-423-4331

Maine Bureau of Insurance207-624-8475800-300-5000 TTY: 888-577-6690www.maineinsurancereg.org

Maine Department of Health and Human Services207-287-3707www.maine.gov/dhhs

MarylandFamily Planning410-767-6723www.fha.state.md.us/mch/fp_home.cfm

Vaccines for Children410-767-6030http://edcp.org/html/vaccine.html

Maryland AIDS Insurance Assistance Program410-767-5227800-358-9001

Maryland Insurance Administration 410-468-2000800-492-6116 800-735-2258www.mdinsurance.state.md.us

Maryland Department of Health and Mental Hygiene410-767-6500877-463-3464www.dhmh.state.md.us

MassachusettsMASS Medline866-633-1617www.massmedline.com

MASSCare (AIDS)617-994-9819www.mass.gov/dph/fch/masscare.htm

AIDS Action Committee Hotline800-235-2331617-437-6200617-437-1394 TTYwww.aac.org

Massachusetts Division of Insurance617-521-7794www.mass.gov/doi

Massachusetts Department of Public Health617-624-6000 617-624-6001 www.mass.gov/dph

Healthcare for Artists617-784-4652hfainfo@healthcareforatrists.orgwww.healthcareforartists.org

Health Care For All Help Line 800-272-4232 www.hcfama.org

The Access Project 617-654-9911

MichiganFamily Planning800-642-3195866-501-5656 TTY

Children’s Special Health Care Services800-359-3722

Michigan Department of Financial Insurance Services 517-373-0220 877-999-6442 www.michigan.gov/cis

108

Michigan Department of Community Health517-373-3740www.michigan.gov/mdch

MinnesotaDisabilities Linkage Line866-333-2466http://www.semcil.org/dll.html

Family Planning

800-783-2287www.stdhotline.state.mn.uswww.health.state.mn.us/divs/fh/mch/familyplanning


Minnesota Department of Commerce 651-296-4026TTD: 651-296-2860www.commerce.state.mn.us

Minnesota Department of Human Services651-431-2000TTD: 800-627-3529www.dhs.state.mn.us

MississippiChildren's Medical Program

800-844-0898

Mississippi Care For Yourself (Family Planning)800-421-2408www.msdh.state.ms.us/care

Donated Dental Services601-368-9823800-366-3640

Mississippi Department of Insurance 601-359 3569 800-562 2957www.mid.state.ms.us

Mississippi Department of Health866-458-4948 601-576-7400www.msdh.state.ms.us

MissouriMissouri CLAIM 800-390-3330 www.missouriclaim.org

Vaccines for Children800-219-3224

Missouri Department of Insurance573-751-4126www.insurance.mo.gov

Missouri Department of Social Services573-751-4815www.dss.mo.gov

MontanaMontana State Health Insurance Assistance Program800-551-3191www.dphhs.mt.gov

Montana State Auditor’s O"ce 800-332-6148406-444-2040http://sao.mt.gov

Montana Department of Public Health and Human Serviceswww.dphhs.mt.gov

NebraskaNebraska Health Insurance, Information, Counseling and Assistance Program (for seniors)800-234-7119402-471-2201 TTD: 800-833-7352

Nebraska Department of Insurance 402-471-2201 TTD: 800-833-7352www.doi.ne.gov

Nebraska Health and Human Services402-471-3121

NevadaVaccines for Children 775-684-5900

AIDS Drug Assistance775-684-3499

Nevada Department of Insurance775-687-4270702-486-4009 http://doi.state.nv.us

Nevada Department of Health and Human Services775-684-4000http://dhhs.nv.gov/

New HampshireFamily Planning603-271-4517

TTD: 800-735-2964

New Hampshire Medication Bridge Program603-225-0900

New Hampshire Department of Insurance603-271-2261800-852-3416www.nh.gov/insurance

New Hampshire Department of Health and Human Services800-852-3345www.dhhs.state.nh.us

New JerseySpecial Child Health and Early Intervention Services609-984-0755

Medicaid Dental800-356-1561


New Jersey Department of Banking and Insurance

800-446-7467

New Jersey Department of Human Services609-292-3717

109

New MexicoMEDBANK

800-432-2080www.nmaging.state.nm.us/medbank2.html

New Mexico Health Policy Commission505-827-6201www.hpc.state.nm.us

New Mexico Public Regulations Commission

888-427-5772505-827-3928www.nmprc.state.nm.us/id.htm

New Mexico Human Services Department505-827-3100888-997-2583www.state.nm.us/hsd/mad

New YorkWomen-Infant-Children (WIC)800-522-5006www.health.state.ny.us/prevention/nutrition/wic

Family Planning800-541-2831www.health.state.ny.us/health_care/medicaid/program/longterm/familyplanbenprog.htm

Growing Up Healthy800-522-5006 (in state)

NY AIDS - HIV Counseling and Testing

800-541-2437 (in state)

New York Insurance Department 212-480-6400800-342-3736 www.ins.state.ny.us

New York Department of Health866-881-2809www.health.state.ny.us

North CarolinaSafety Net Dental Services919-707-5480 www.communityhealth.dhhs.state.nc.us/dental/access_2.htm

North Carolina Health CARE LINE

800-662-7030TTP: 919-733-4851

North Carolina Department of Insurance 800-546-5664919-807-6800www.ncdoi.com

North Carolina Department of Health and Human Services800-662-7030877-452-2514 (TTY)919-855-4400919-733-4851 (TTY)www.dhhs.state.nc.us/

North DakotaChildren’s Special Health Services800-755-2714TTY: 701-328-2436

North Dakota Insurance Department 701-328-2440800-247-0560 www.nd.gov/ndins

North Dakota Department of Human Services701-328-2310800-472-2622www.nd.gov/dhs/

OhioOhio Department of Insurance800-686-1526614-644-2658www.ohioinsurance.gov

Ohio Department of Healthwww.odh.ohio.gov

Help Me Grow Program614-644-8389www.ohiohelpmegrow.org

HIV Drug Assistance Program614-466-6374

OklahomaSoonerStart(child development)405 522-5167www.okdhs.org/programsandservices/dd/ss/

Chronic Disease Service405-271-4072http://www.ok.gov/health/Disease,

Service

Family Planning405-271-4476www.health.state.ok.us/Program/whd/fpp.html

RX for Oklahoma877-794-6552

Oklahoma Department of Business Regulation405-521-2828 800-522-0071 www.oid.state.ok.us

Oklahoma Department of Health405-271-5600800-522-0203 www.ok.gov/health

OregonOregon Insurance Division503-947-7980www.oregoninsurance.org

Oregon Department of Human Services503-945-5944www.oregon.gov/DHS/

Oregon Health Authority503-947-2340877-398-9238www.oregon.gov/oha

Oregon Helps(Program screener tool)http://oregonhelps.org

PennsylvaniaAPPRISE (Medicare advice)717-783-1550www.aging.state.pa.us

Family Planning

877-724-3258www.dpw.state.pa.us/ServicesPrograms/

Women-Infant-Children (WIC)800-942-9467www.pawic.com

110

Pennsylvania Insurance Department877-881-6388www.ins.state.pa.us

Pennsylvania Department of Health877-724-3248www.dsf.health.state.pa.us

Rhode IslandRI Early Intervention(child development)401-462-2501TTY 401-462-6353

Immunization Program401-222-5960www.health.ri.gov/immunization

Rhode Island Pharmaceutical Program for Elderly401-462-3000TTY 401-462-0740www.dea.state.ri.us

Rhode Island Department of Business Regulation401-462-9500www.dbr.state.ri.us

Rhode Island Department of Health401-222-2231www.health.state.ri.us

South CarolinaSouth Carolina Family Planning Services803-898-3432

South Carolina Health Insurance Assistance800-868-9095

South Carolina Department of Insurance803-737-6180 800-768-3467www.doi.sc.gov

Women-Infant-Children (WIC)800-868-0404

South Carolina Department of Health and Human Services888-549-0820www.dhhs.state.sc.us

South DakotaIndian Health Services605-226-7531

South Dakota Division of Insurance605-773-3563www.state.sd.us/drr2/reg/insurance

South Dakota Department of Social Services605-773-3165www.state.sd.us/social

TennesseeTennessee Health Options Services888-486-9355


800-342-5942

CoverRX888-560-2649866-268-3786

Prescription Assistance888-486-9355

Family Planning615-741-7353http://health.state.tn.us/womenshealth/

Tennessee Department of Commerce and Insurance615-741-2218800-342-4029 www.state.tn.us/commerce/insurance

Tennessee Department of Health615-741-3111http://health.state.tn.us/

TexasWomen-Infant-Children (WIC)800-942-3678

Texas Family Planning512-458-7796

Texas Vaccines for Children800-252-9152

shtm

TX Children with Special Needs800-252-8023

Texas Department of Insurance800-252-3439512-463-6464

Texas Department of State Health Services888-963-7111

UtahRxConnect866-221-0265

Health Insurance Information Program800-541-7735

Utah Insurance Department801-538-3800www.insurance.utah.gov

Utah Department of Health801-538-6101888-222-2542 801-538-9936www.health.utah.gov

VermontVermont Refugee Health Program800-464-4343 802-863-7200

VScript800-250-8427TTD: 1-888-834-7898

Vermont Department of Banking, Insurance, Securities & Health Care Administration802-828-3301www.bishca.state.vt.us

Vermont Agency of Human Services800-287-0589 802-241-2800www.ahs.state.vt.us

VirginiaVirginia Bureau of Insurance804-371-9741877-310-6560www.scc.virginia.gov/division/boi

111

Virginia Department of Healthwww.vdh.virginia.gov

WashingtonWashington O"ce of the Insurance Commissioner800-562-6900www.insurance.wa.gov

Washington Department of Social and Health Services800-737-0617www.dshs.wa.gov

Washington D.C.D.C. Health Program for Refugees202-442-9380

D.C. Healthcare Alliance202-639-4030TTY: 202-639-4041http://doh.dc.gov/doh

Women-Infant-Children (WIC)800-345-1942202-442-9397http://doh.dc.gov/doh

District of Columbia Department of Insurance, Securities and Banking202-727-8000http://disb.dc.gov

District of Columbia Department of Health202-727-1000http://doh.dc.gov/doh

West VirginiaWV Birth to Three800-642-8522www.wvdhhr.org/birth23

WV Family Planning304-558-5388800-642-8522304-558-7164 (TTD)

West Virginia O"ces of the Insurance Commisioner304-558-3386

888-879-9842 www.wvinsurance.gov

West Virginia Health and Human Resources304-558-0684www.wvdhhr.org

WisconsinWisconsin O"ce of the Commissioner of Insurance800-236-8517608-266-3585 http://oci.wi.gov

Wisconsin Department of Health Services608-266-1865http://dhs.wisconsin.gov

WyomingWyoming Seniors307-856-6880www.wyomingseniors.com

Wyoming State Health Insurance Assistance Program800-856-4398307-856-6880

Wyoming Department of Insurance307 777-7401 800-438-5768 http://insurance.state.wy.us

Wyoming Department of Healthhttp://wdh.state.wy.us

National ResourcesCatalog of Federal Domestic Assistancewww.cfda.gov (Search tool for grants, loans and other bene!ts)

Department of Health and Human Serviceswww.hhs.gov (Various health care search tools)

Employee Bene!ts Security Administrationwww.dol.gov/ebsa

Department of Labor)

Government Bene!ts Finder

www.govbene!ts.gov(Search tool for grants, loans and other bene!ts)


866-628-4282

Health Resources and Services Administration

www.!ndahealthcenter.hrsa.gov

Indian Health Services (IHS)www.ihs.gov301-443-3024(Department of Public Health)

Medicare


Medicare Prescription Drug Program800-633-4227

Partnership for Prescription Assistance

888-477-2669

Self Help Clearing Housewww.mentalhelp.net/selfhelp(Search tool for people sharing information on hundreds of diseases, health conditions and other health care related situations)

Substance Abuse and Mental Health Services Administration

http://mentalhealth.samhsa.gov/databases/(Mental Health Services Locator)

Veterans Health Administration 877-222-8387www.va.gov

112

STATE#BY#STATE COMPARISONState

High-deductible

premium for 26-year-old

High-deductible

premium for 35-year-old

Guaranteed Coverage for Small Groups

Guarantee Issue

Employee Size

MiniCOBRA Groups< 20

High Risk

Options

Income-Based Buy-In

Plan

Medical Underwriting

for Individuals

Parental Coverage through

CHIP

Indian Health

Services

Alabama $50.00 $63.00 Yes 2 + No Yes No Yes No YesAlaska $60.00 $80.00 Yes 2 + No Yes No Yes No YesArizona $46.00 $52.00 Yes 2 + No Yes No Yes No YesArkansas $55.00 $60.00 Yes 2 + Yes Yes No Yes No NoCalifornia $47.00 $64.00 Yes 2 + Yes Yes No Yes No YesColorado $45.00 $54.00 Yes 1+ Yes Yes No Yes No YesConnecticut $41.00 $61.00 Yes 1+ Yes Yes No Yes Yes YesDelaware $45.00 $55.00 Yes 1 + No No No Yes No NoDistrict of Columbia $58.00 $78.00 Yes 2 + Yes Yes No Yes Yes NoFlorida $65.00 $90.00 Yes 1+ Yes Yes No Yes No YesGeorgia $50.00 $66.00 Yes 2 + Yes No No Yes No NoHawaii $86.00 $113.00 Yes 1+ No No Yes Yes No YesIdaho $33.00 $44.00 Yes 2 + Yes No No Yes No YesIllinois $48.00 $67.00 Yes 2 + No Yes No Yes No NoIndiana $46.00 $59.00 Yes 2 + Yes Yes No Yes No YesIowa $31.00 $40.00 Yes 2 + Yes Yes Yes Yes No YesKansas $60.00 $74.00 Yes 2 + Yes Yes No Yes Yes YesKentucky $35.00 $43.00 Yes 2 + Yes Yes No Yes No NoLouisiana $32.00 $36.00 Yes 2 + Yes Yes No Yes No YesMaine $100.00 $148.00 * Yes 1 + Yes No Yes No No YesMaryland $49.00 $66.00 Yes 2 + Yes Yes No Yes No YesMassachusetts $334.00 $334.00 * Yes 1+ Yes No Yes No No YesMichigan $57.00 $71.00 Yes 2 + No Yes No Yes No YesMinnesota $70.00 $80.00 Yes 2 + Yes Yes No Yes Yes YesMississippi $54.00 $72.00 Yes 1+ Yes Yes No Yes No YesMissouri $36.00 $46.00 Yes 2 + No Yes No Yes Yes YesMontana $75.00 $100.00 Yes 2 + No Yes No Yes No YesNebraska $39.00 $52.00 Yes 2 + Yes Yes No Yes No YesNevada $55.00 $81.00 Yes 2 + Yes No No Yes No YesNew Hampshire $79.00 $102.00 Yes 2 + Yes Yes No Yes No NoNew Jersey $157.00 $183.00 Yes 2 + Yes Yes No No Yes NoNew Mexico $45.00 $70.00 Yes 2 + Yes Yes Yes Yes No YesNew York $279.00 $415.00 * Yes 2 + Yes No Yes No Yes YesNorth Carolina $64.00 $70.00 Yes 1+ Yes Yes No Yes No YesNorth Dakota $47.00 $60.00 Yes 2 + Yes Yes No Yes No YesOhio $52.00 $68.00 Yes 2 + Yes Yes No Yes No NoOklahoma $52.00 $64.00 Yes 2 + Yes Yes No Yes No YesOregon $65.00 $90.00 Yes 2 + Yes Yes Yes Yes No YesPennsylvania $50.00 $59.00 Yes 2 + No Yes No Yes No NoRhode Island $100.00 $142.00 * Yes 1+ Yes Yes No Yes No YesSouth Carolina $50.00 $74.00 Yes 2 + Yes Yes No Yes No YesSouth Dakota $57.00 $74.00 Yes 2 + Yes Yes No Yes No YesTennessee $50.00 $77.00 Yes 2 + Yes Yes No Yes No YesTexas $62.00 $70.00 Yes 2 + Yes Yes No Yes No YesUtah $60.00 $71.00 Yes 2 + Yes Yes No Yes No YesVermont $394.00 $394.00 * Yes 1+ Yes No Yes No No NoVirginia $43.00 $59.00 Yes 2 + Yes Yes No Yes No NoWashington $57.00 $70.00 Yes 2 + Yes Yes Yes Yes No YesWest Virginia $153.00 $168.00 Yes 2 + Yes Yes No Yes No NoWisconsin $40.00 $65.00 Yes 2 + Yes Yes No Yes No YesWyoming $57.00 $69.00 Yes 2 + Yes Yes No Yes No Yes

Note: Premiums are based on the following information and may be subject to change — $2-5K deductible; male; nonsmoker; approximately 20% co-insurance; usually no o$ce visits.. Plans were generated by ehealthinsurance.com using zip codes from major cities. In most cases the second least expensive plan is shown.

* Coverage has serious limitations, short-term/12 months only or other restrictions.

113

THE UNINSURED IN AMERICA How does your STATE compare to the rest of America?

State Uninsured Population

% of Uninsured Eligible for

Government Programs

% of Uninsured with Income

$50K +

% of Uninsured that is

Short-term (Less than 1 Yr)

% of Uninsured that is

Long-term (More than 1 Yr)

Alabama 549,000 28% 32% 16% 23%Alaska 123,000 30% 32% 15% 22%Arizona 1,164,000 30% 32% 15% 22%Arkansas 451,000 33% 32% 14% 20%California 6,613,000 44% 32% 10% 15%Colorado 801,000 23% 32% 18% 26%Connecticut 326,000 33% 32% 14% 20%Delaware 96,000 52% 32% 7% 10%District of Columbia 55,000 53% 31% 6% 9%Florida 3,648,000 28% 32% 16% 24%Georgia 1,662,000 30% 32% 16% 23%Hawaii 96,000 56% 32% 4% 7%Idaho 209,000 24% 32% 18% 26%Illinois 1,700,000 30% 32% 15% 22%Indiana 717,000 31% 32% 15% 22%Iowa 275,000 38% 32% 13% 18%Kansas 345,000 24% 32% 18% 26%Kentucky 570,000 39% 32% 12% 17%Louisiana 776,000 27% 32% 17% 24%Maine 115,000 42% 32% 11% 15%Maryland 762,000 33% 32% 14% 21%Massachusetts 340,000 60% 32% 3% 5%Michigan 1,151,000 36% 32% 13% 19%Minnesota 433,000 41% 32% 11% 16%Mississippi 545,000 31% 32% 15% 22%Missouri 729,000 40% 32% 12% 17%Montana 146,000 30% 32% 16% 22%Nebraska 232,000 36% 32% 13% 19%Nevada 441,000 23% 32% 19% 27%New Hampshire 137,000 25% 32% 18% 25%New Jersey 1,348,000 24% 32% 18% 26%New Mexico 437,000 28% 32% 16% 23%New York 2,519,000 35% 32% 14% 20%North Carolina 1,510,000 31% 32% 15% 22%North Dakota 61,000 28% 32% 17% 23%Ohio 1,322,000 31% 32% 15% 22%Oklahoma 631,000 27% 32% 17% 24%Oregon 632,000 46% 32% 9% 13%Pennsylvania 1,176,000 48% 32% 8% 12%Rhode Island 113,000 55% 33% 5% 8%South Carolina 721,000 42% 32% 11% 15%South Dakota 80,000 33% 32% 14% 20%Tennessee 883,000 Texas 5,962,000 24% 32% 18% 26%Utah 340,000 26% 32% 17% 25%Vermont 69,000 60% 33% 3% 5%Virginia 1,135,000 25% 32% 17% 25%Washington 737,000 34% 32% 14% 20%West Virginia 254,000 38% 32% 12% 18%Wisconsin 451,000 37% 32% 12% 18%Wyoming 70,000 23% 32% 18% 27% Total US 45,657,000 34% 32% 14% 20%

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Agent A person who has a license to sell insurance in California. He or she might work alone or with a large #rm and may sell all kinds of insurance. Some agents work as an employee of an insurance company and sell plans just from that company.

Cal-COBRA Cal-COBRA (also called MiniCOBRA) is simply “continuation coverage.” It is a law that helps people losing their employee health plan stay insured. It is for companies with 2 to 20 employees. (See COBRA.)

Carrier Carrier is another name for insurance company.

CHIP Sometimes this is called S-CHIP (State Children’s Health Insurance Plan). Every state has a plan for children who are not eligible for Medicaid because the family income is too high or they don’t have access to group coverage. "e name of the program is usually called something like Healthy Families or Healthy Children and care is delivered by regular doctors through the state’s major insurance companies. In a handful of states, coverage is extended to the parents (as with Medicaid).

Claim A request for payment of bene#ts received or services rendered. A billing record is generated and submitted by a provider or subscriber using paper or electronic media.

COBRA COBRA is a federal law that helps an insured person keep their health insurance when they lose their employee health plan. It’s also called continuation coverage. COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It applies to companies with 20 or more employees. Cal-COBRA is for companies with less than 20 employees.

Coinsurance An arrangement under which the insured person pays a #xed percentage of the cost of medical care after the deductible has been paid. For example, the insurance company might pay 80% of the allowable charge, with the insured person responsible for the remaining 20%, which is then referred to as the coinsurance amount.

Conversion Privilege

"e right given to an insured person to change insurance without evidence of medical insurability, usually to an individual policy upon termination of coverage under a group contract.

Co-Pay An arrangement where the insured person pays a speci#ed amount for various services and the insurance company pays the remainder. "e insured person usually must pay his or her share when the service is rendered. Similar to coinsurance, except that coinsurance is usually a percentage of certain charges where the co-payment is a dollar amount.

Coverage Another name for “health insurance.” It refers to the scope of health bene#ts and #nancial risk protection provided under a contract of insurance.

GLOSSARY OF TERMS

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Coverage Termination

"e end of an insured person’s coverage due to loss of employment, reduction of hours, gross misconduct, covered employee and spouse divorce or become legally separated, or death of the covered employee.

Creditable Coverage

"ere are rules about when insurance companies have to start paying for your health bene#ts when you’re a new member or whether or not you get COBRA (continuation) coverage when your group plan ends. For example: to get COBRA, you have to have had insurance (creditable coverage) for 18 months.

Deductible An amount which an insured person agrees to pay, per claim or per accident, before the insurance company has to pay their part.

Employee Contribution

"e employee’s share of the monthly premium (payment).

Employer Based Coverage

Companies who o!er health coverage at no or minimal charge to the employee.

Employer Contribution

"e employer’s share of the monthly premium (payment).

Federal Poverty Level

"is is a percentage level assigned based on the number of people and income per household. "e percentages are created by the government, and then the public programs use those percentages in a chart to decide who can qualify for what programs.

Guaranteed Coverage

An underwriting term used to describe the fact that a small business group cannot be turned down for insurance because of poor health conditions either current or past.

Guaranteed Coverage for Individual Plans

"is means that no one can be turned down for insurance because of a health condition, or in other words there is no “medical underwriting.” Only three states have guaranteed coverage for individuals: Maine, New York and Vermont.

High Risk Pool Insurance

"is is health coverage for people who may have been denied access to a health insurance plan because of their serious medical conditions . In some states every insurance company must guarantee access to plans for these people. In other states there is an organization that oversees a program that involves a few plans from di!erent insurance companies.

HIPAA "e right to transfer from a group health plan to an individual plan if the insured person is leaving the company or their group plan is being terminated. HIPAA is a law that has to do with both portability and privacy of medical records. It stands for Health Insurance Portability and Accountability Act.

Income Based Buy-In Plan

Some states have plans for people who have no access to group coverage and aren’t eligible for Medicaid or other public programs. Similar to public programs, the monthly premiums are determined by the applicant’s income level.

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"is is a federal organization that has medical facilities in states where there is a high populations of Native American or Alaskan Indians. Services range from full health care bene#ts to mobile clinics that cater to the needs of local tribes.

Individual Insurance

Health Insurance policies which provide protection to the insured person and/or his/her family (also called dependents).

Max out-of-pocket

"e most an insured person will pay considering co-payments, coinsurance, deductibles, etc.

Medicaid Medicaid is a state health coverage program that primarily covers emergencies, pregnancy-related services, kidney dialysis and treatment for breast and cervical cancer.

Medi-Cal Medi-Cal is a California’s health coverage program that primarily covers emergencies, pregnancy-related services, kidney dialysis and treatment for breast and cervical cancer.

Medical Underwriting

Before you can buy a policy you must give the insurance company information about your health. "is process is called underwriting. "e company uses underwriting information to predict what the likelihood is that you will #le claims against the insurance policy. Each company has its own underwriting standards, which means one insurance company could reject your application but another may be willing to accept it.

Pre-existing Conditions

When applying for health insurance, the insurance company requests the applicants medical history. A “pre-existing condition” is an illness, physical or mental, that was treated before getting insurance.

Premium "e payment an insured person makes to keep their insurance policy, usually monthly.

Provider Your doctor, a hospital, clinic and anyone else that provides health care services to you is called a “provider.”

Qualifying Event

An occurrence (such as death, termination of employment, divorce, etc.) that changes an insured person’s protection under COBRA, which requires continuation of bene#ts under a group insurance plan for former employees and their families who would otherwise lose health care coverage.

Small Group or Small Business

A small group or business in most states is 2-50 employees, although some states consider a self-employed person or 1 employee to be a small group. Small groups or business are guaranteed health insurance coverage and can not be turned down for pre-existing conditions.

Stop Loss "is is a special type of re-insurance that protects an individual or group who goes over their coverage limit.

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For more information on your state’s health coverage options, we encourage you to utilize our other valuable health coverage resources.


800.234.1317

Foundation for Health Coverage Education “Coverage for All !rough Education”

© Copyright 2010 by Philip Lebherz and the Foundation for Health Coverage Education

Use the Income Worksheet(page “v”) to determine the Federal Poverty Level percentage of you or the person whom you are trying to assist. This percentage usually determines if an individual is eligible for various public programs.

Find your state’s Health Care Options Matrix for a complete list of private and public health coverage programs, along with additional valuable resources.

Consult the Appendices for COBRA subsidy information, state-by-state program contact information, uninsured statistics for each state, as well as the glossary of terms found within this book.

A state-by-state guide to helping Americans navigate their



Options

The U.S. Directory of H

ealth Coverage Options

Vol. IV, July 2010FH

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