This post is the third part in a series about the steps you can take to deal with unaffordable medical bills (the previous parts of this series are available here and here.)

Almost nobody can afford to pay for the ever rising costs of medical care without insurance or other health coverage.  Even with health insurance you may incur costs that you can’t afford because of cost sharing or uncovered services.  This installment addresses the importance of public health coverage programs.  If you have private insurance, it’s important to listen up: public programs may be available to help you, too.

There are three main types of public insurance coverage: Medicare (for people over 65 and the disabled), Medicaid (for people with low incomes, especially those with children), and the Children’s Health Insurance Program, called CHIP.  Medicare is funded and administered at the federal level.  Both Medicaid and CHIP are administered at the state-level but receive partial federal funding, so eligibility requirements and regulations vary widely across states.  Young people with disabilities may qualify for Medicare or, in some states, Medicaid.  Young parents may be able to cover their children under CHIP and themselves under Medicaid.  There are fewer coverage options for single young people, but there still may be a program available to you in some states. Several states, and even some cities and counties, offer additional programs that can wrap around, or help you to pay for, private insurance coverage. 

Some public programs will pay retroactively for medical care received before applying.  Many Medicaid programs, for instance, will pay for health care received up to three months in the past.  Therefore, applying for public programs can be a key strategy to resolve medical debt.  These programs will also give you access to free or reduced-cost medical care in the future.

Here’s the point: You don’t need to memorize all of these programs or their eligibility requirements; you do need to know that public coverage may be available to help you. 

Here’s the first rule of thumb: if you have medical bills that you can’t afford, you should apply for public programs regardless of your insurance status.  In fact, many hospitals and other medical providers won’t allow you to apply for charity care without first filling out public programs applications.

Q: If I have a medical bill, how do I find out about public programs?

A:

1. Call up your medical provider’s billing office right away and speak to a manager of patient accounts.  Tell the manager that you want to pay your medical bills, but you want to see if you are eligible for any programs that might help to cover your medical expenses.
2. Ask the billing office not to send you to a collections agency because you are working to pay your bill.  Ask the billing office to update the status of your account to “pending.”  Say that you are working to pay your medical bills but that you need more time to figure out your insurance situation and apply for public programs.
3. Ask about applying to public programs.  Most hospitals have “financial counselors” or “patient advocates” that can help you to learn about and apply for public programs.  Also, every state has a government agency that oversees the Medicaid program.  These offices should be able to help you to apply for Medicaid and inform you about other available programs.  Find your local Medicaid office by searching for “Medicaid” and the name of your state in Google, or search for “state medical assistance office” under “organization type” through this federal website.  Note that some states have a state-specific name for their Medicaid program.  For example: MassHealth (MA), Medi-Cal (CA), SoonerCare (Oklahoma), TennCare (TN), etc.
4. Apply for public programs as soon as possible!  You want to make sure that you apply in time to receive retroactive coverage for your medical bills.  Fill out the applications the best that you can and send them off with copies of any documentation that they request.

Some people may hesitate to apply for public programs because they don’t want to accept a “hand out.”  In fact, most private health insurance is subsidized just like public health insurance, but by employers rather than the government.  There is no shame in having public or private help with insurance premiums because unsubsidized insurance of any kind is unaffordable for most people.  Most state, municipal, and federal employees, including politicians, have insurance coverage that is subsidized by public funds.  Publicly subsidized insurance coverage is usually more comprehensive than private insurance offered on the open market because consumer protections are required by law.

My next blog entry in this series will address how to deal with medical debt incurred despite private insurance coverage.

Do you have any experiences, either good or bad, with public programs?  How about private health insurance?