Certain aspects of Obama Care are already upon us, such as preventive services for women. Employers will also be putting some costs associated with your health insurance on your W-2’s for 2013, appearing as “income.” If you don’t know the difference between a Health Care plan and a Base/Major plan, or what constitutes an Indemnity plan, or “attached” vision and dental coverage, you may want to start doing your homework. Employer-matched Flexible Spending Accounts are also affected. I would love to educate the majority of workers, who “just do their eight and hit the gate,” about the nuances of these tax changes, but that is not the point of this article.
My real intent is to discuss a sort of “underground” health care system, which many people don’t even know exists, with respect to how Obama Care will impact it. I have personally participated in this shadow health care system for two years, and I literally couldn’t live without it.
I was always among the many who whined about “welfare” recipients getting “free health care.” When I suddenly found my income reduced by 90%, I attempted to go that route, and was stunned by the result. Government-paid health care is not that easy to get! Just because someone receives “public assistance” does NOT entitle him or her to a single dime in health care.
Such benefits are limited to children and the disabled, in almost every instance. A “child” is generally a minor under the age of 18. Disability is a different animal altogether, and is extremely difficult to attain. First, the “test of disability” is that used by the Social Security Administration, which essentially says you must be either temporarily or permanently prevented from performing any job, and only after you have already been disabled for a period exceeding six months. If you meet those requirements, only then are you placed on Medicaid. This information is readily available on the Social Security and Medicaid web sites. So, “good luck” trying to get “free health care” from the government.
But, for those who cannot afford health insurance, there is the shadow network! I stumbled upon it purely by accident, but I have reaped thousands of dollars in free or reduced cost health care over the past couple of years. That includes minimal cost doctor visits, free or reduced cost blood work, x-rays, MRI’s, sonograms, prescriptions, dental work, and even a nuclear stress test! Perhaps the best aspect is that these services are purely income-based. As long as you don’t make a lot of money, you can get whatever treatment you need, if you’re willing to shop around for health care services.
To avail yourself of these programs, you first begin at the local primary care level. Many family practice clinics offer what is known as a “sliding scale,” based on income and family size. I use one where a “normal” office visit costs $60 or $70, but my wife and I only pay $10, which is less than the “co-pay” for most people with insurance. In addition, any blood work, tests, etc., that are done in-clinic are included in the $10 fee. In one instance, my blood had to be sent out to an affiliated lab, and I got a $120 bill. When I called and told them I was on the sliding scale at the doctor’s office, the outside lab reduced it to $20. Believe me, they won’t “advertise” this, so you have to call around and find doctors or family practice clinics that offer a sliding scale.
Similarly, I found a dental clinic with a sliding scale. I get most services for $20 per visit, such as prophylaxis, full-mouth and bite-wing x-rays, fillings, etc., and I would only pay $50 for a “major procedure.” Now, I have to drive 50 miles to get there, but when you figure it costs $120 just to get your teeth cleaned, I still save a ton of money versus the $20 fee and the three gallons of gas to get there and back.
The next aspect of the unknown network is when one needs extensive tests or even hospitalization. I found a university teaching hospital that offers a charity care program. For a minimal co-pay of $20-$35, depending on the service, I can get almost any test on the planet, and everything else is covered at 100%. If I ever needed to be hospitalized, I would only pay a $100 “admission fee,” regardless of the length of stay, and that would even include the ICU. I also have access to the university pharmacy. I require one medication that costs $2.63 per capsule, and I require 270 capsules per month. Do the math, and that comes out to $710 per month. I only pay $4.00! In one case, I visited a specialty clinic at the hospital, had an MRI, and got an invasive procedure which required me to be put under anesthesia, all in the same day. The total bill was $120, and they even put me on a $20 per month payment plan! That was probably a “$2000 day” under normal circumstances. Again, I have to drive 100 miles to get there, but the $30 in gas for the round trip is far outweighed by the savings I get. Even simple x-rays can cost $200-$300.
Of course, there are certain exclusions, such as cosmetic surgery, organ transplants, and – my favorite – “penile implants” – and others, but just about anything else I would need is covered under the program, including cancer treatment.
Since all of these services are income-based, I put together a file that contains all the “usual suspects.” I keep my tax records, my pension statements, my medical expenses, birth certificate, marriage certificate, and all my bank statement in that file. Even if you don’t have your birth or marriage certificates, you can get copies for $10-$15. I usually have to “recertify” every year with the various programs, so everything is readily available in that file when I need it. Best of all, the income requirements are actually fairly liberal. You don’t have to be “dirt poor” to qualify, you just ned to be below the “median income” for your family size in your demographic area, in most cases. While “income” is generally based on pre-tax earnings, they will usually take into account your monthly bills, even including child care expenses and cell phone bills.
All of these tips have served me well for almost two years, and will continue through at least 2013. Unfortunately, it may only be a short term fix. Once Obama Care kicks into full gear in 2014 and 2015, and people are required to have “health insurance,” I have no idea if such services will still be available. Likewise, I don’t know what will happen when I become eligible for Medicare in a few more years. I’m sure the providers haven’t figured that out yet either. If everyone is already “insured,” or paying a penalty to “opt out,” will hospitals and clinics still provide charity care and sliding scales? I have no idea, but I will be asking those questions as the end of the year approaches, and again next year.
Until the whole scenario plays out, the best advice I can give to uninsured folks like me is, “Get it while you can!” Affordable health care is already out there, if you are of modest means. You just have to look for it. And, even if it means changing providers, they will have to transfer your records if your new provider or you request it. You may even encounter resistance. Most doctors have “admission privileges” and are affiliated with a particular hospital. They may be reluctant to refer you elsewhere. At the end of the day, you have the right to be referred to your provider or hospital of choice, just as you have the right to decide where you will buy your groceries. You should look at health care as a “shopping list.” Finding a sliding scale or charity care provider is like clipping coupons.
You shouldn’t be intimidated by the “health care snobs” either. You know those folks who will say, “I’ll die before I go to that doctor, or that hospital.” Yes, if you need that quadruple by-pass surgery, or suffer from a disease that affects one in two hundred thousand of the population, you may very well need the Cleveland Clinic or the Mayo Clinic. But the vast majority of us can get adequate and effective care, and maintain our physical and dental health almost anywhere. Medical providers are graded on their success rates, and will be dropped by the insurance companies if they don’t produce reasonable outcomes within the accepted norm for your condition, and the AMA and the ADA may sanction them as well. The insurance companies and professional organizations police themselves.
This is not about “getting over” on the system. It’s about “getting by” in today’s tough economic times. You only get one chance at life.