Thursday, October 26, 2006

NY Health Insurance....or lack of it....

Thousands slip between the cracks once again, making it impossible to obtain affordable health insurance within New York State. Despite the efforts by Governor George E. Pataki in regards to promoting NY State’s health insurance system, there is a ‘gap’ in our current programs, which leaves many New York residents to suffer without recourse.

Many health care providers and residents implore Governor Pataki to take further action and amend the current standards set, which allows immigrants, prisoners, and even those waiting for deportation, health insurance coverage, yet leaves many residents helpless and distraught when medical attention cannot be sought for the lack of financing.

The fact that the medical profession dominates the top 15 highest paying jobs in America with only two of the 15 being non-medical occupations, clearly indicates our health care system is a business for profit.

It brings to mind a statement made by Tom Hanks in the movie, You’ve Got Mail, which fits the attitude of our medical society today, “It’s not personal. It’s business.” At who’s expense, is the question?

In New York State, there are three levels of public health assistance programs, Medicaid, Child Health Plus (for newborns up to age 19) or Family Health Plus (ages 19-64). In addition, Governor Pataki and the Legislature enacted legislation in 2000 that increased the availability of health insurance in New York with the Health Care Reform Act with the program entitled "Healthy NY"(http://www.ins.state.ny.us/website2/hny/english/hnyoth.htm).

Medicaid is available for NY residents who cannot afford health insurance. It is also available, regardless of alien status. According to the Medicaid requirements an individual may be eligible if that person’s income did not exceed $692 per month and a resource limit of $4,150. (Pregnant women and children can have higher income levels and no resource limits.) You may own a home, a car, and personal property and still be eligible under this program. For more information on this program, contact Oswego County Department of Social Services at 315-963-5000 or your local Department of Social Services.

Child Health Plus and Family Health Plus are also public health insurance programs that are available to those with incomes too high to qualify for Medicaid.

Child Health Plus is open to children under the age of 19. Depending on income, a family may be required to contribute toward the premium for coverage.

Family Health Plus (FHPlus) is available not only to residents of New York State but also opened to United States citizens or those who fall under one of many immigration categories. Non-citizens are eligible as citizenship and immigration status requirements are the same as those under the Medicaid Program. Immigrants in many categories, including lawfully admitted permanent residents (green card holders) and persons permanently residing in the United States under color of law (PRUCOL) are eligible if they meet all other FHPlus requirements. In addition, those otherwise eligible qualified aliens who entered the United States on or after August 22, 1996 may also qualify for FHPlus benefits. For further clarification contact your local county department of social services. In Oswego County, contact Oswego County Opportunities at 315-598-9361 Ext.1 or Oswego County Department of Social Services at 315-963-5000.

An individual would be eligibility under the Family Health Plus Program, with an income limit up to $817 per month and a resource level up to $12,450.

Here lays the ‘gap’ for insurance coverage in NYS. If that individual has income of only $818, they would need to consider Healthy NY as an option for health insurance coverage. The majority of individuals discover that the premiums are beyond their capability.

The Healthy NY program differs from the other programs as it offers reduced cost insurance coverage for NYS residents. It is designed for small employers, 50 employees or less, to be able to offer their employees and dependents health insurance coverage at a lower cost. It is also available to eligible working uninsured individuals, including sole proprietors. There are no limits on resources to be eligible for this program.

Eligible individuals choose to become members in one of the Healthy NY participating insurance companies. Members are charged a monthly premium for coverage. In addition, covered services are subject to co-pays. Each company offers plans with or without the drug coverage. Currently, the four participating in Oswego County are Aetna Health, Inc, HealthNow New York, Inc., Excellus Health Plan, Inc., and MVP Health Plan, Inc.

The premium rates vary according to the county you live in and the plan you have chosen. The current rates for Oswego County, for an individual person, ranges between $199.98 up to $224.20 per month with the drug plan included.
This added expense can create a grave hardship for the person with an income of only $818 per month to pay even the lowest premium of $199.98, plus the required co-pays necessary to maintain health insurance. Everyday living expenses, such as rent/mortgage, heat, utilities, car insurance, gas and food would easily gobble up more than the small remaining income of $618.02.

The benefit, if you opt to think of it that way, might be that once you have paid the insurance company their share of your income, the reduced income remaining would most likely entitled you to welfare benefits for assistance with rent, food and HEAP, depending on your resource level. Contact your local Department of Social Services for further information.
Logic dictates that in the majority of the cases an individual, or family, with income in the low-end range set forth, could not afford the premiums required by participating insurance carriers under the Healthy NY program without seeking assistance for other needs to be met. Many are trapped in a cycle where the wish for independence is a distance dream.
Check out this website for further details on the availability of health insurances in NYS, http://www.health.state.ny.us/health_care/.