Make the Most of Summer Fun with Preventive Care

 

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Whether you’re on a healing hike or hitting the beach, make the most out of your summer by staying healthy with preventive care.

Get the most out of your health coverage this summer by getting the preventive care you need.

Did you know? Most health plans cover shots and screening tests — at no cost to you. This means your plan can’t charge you a co-pay or coinsurance – a share of costs – for preventive services. This is true even if you haven’t met your deductible.

What is preventive care?

Screenings, check-ups, and counseling that prevent illnesses, disease, and other health problems, or other healthcare services designed to detect illness at an early stage – it’s all considered  preventive care.

Why is preventive care important?

It helps you stay healthy and happy throughout your life and can detect illness at earlier stages, when treatment is most likely to work best.  Preventive care counseling can help you make healthier lifestyle choices – better diet, no smoking, curbing excessive drinking – that lead to good health and well-being.

Preventive services for all adults include: blood pressure, cholesterol and diabetes (Type 2) screenings. For adults over age 50, preventive care includes colorectal cancer screenings. Lung cancer screenings for adults at higher risk because they are heavy smokers or have quite within the last 15 years are also covered for ages 55-80. Immunizations and flu shots are always  included.

Women have their own set of covered preventive care services, including annual “well-women” visits and mammograms every 1-2 years for women over 40. Beginning at age 60, osteoporosis screening for good bone health is included. Contraception and STD screenings are both considered preventive care for women.

There are extensive preventive care services for children, each suited to the appropriate life stage, from autism and developmental screenings beginning in infancy to lead and vision screenings and even obesity and diet counseling as they get older. Immunizations are always covered as preventive services for children.

No matter where your summer takes you – to the beach or to the woods for healing hikes – stay healthy with preventive care.

Learn more about preventive care and all the services included: https://www.healthcare.gov/preventive-care-adults/

#Coverage2Care #PreventiveServices #Immunizations

Have questions about how to best use your #HealthCare coverage? EFOF’s licensed & certified navigators are here to help. Call 877-553-7453 for answers.

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When going without health insurance is not an option

Family Health
Hector Salgado and his wife, Liliana Pinzon depend on an affordable ACA policy to stay healthy and happy.

For Liliana Pinzon and her husband Hector Salgado, the Affordable Care Act (ACA) has been a blessing. Her husband has diabetes and depends on health care coverage to get the regular check-ups and prescription medications he needs.

For this family, going without healthcare is just not an option.

“When my husband changed jobs and lost his health insurance, we were able to get a new healthcare policy through the ACA at a reasonable cost,” Pinzon said. “This has allowed us to have access to good doctors and hospitals when we need them.”

Pinzon and her husband pay $500 a month in premiums. Her five-year-old daughter Maya is on Kidcare.  Before the ACA, the family paid $2,000 a month in premiums, an unsustainable amount that became impossible after Hector switched to part-time work because of his health.

Pinzon is very grateful to have an affordable policy, too. A few years ago she had a complicated pregnancy that resulted in termination due to a fetal abnormality and knows how it important it is to have health care coverage, especially women’s well-care.  

Her Florida Blue HMO healthcare policy allows her to receive care at a Community Health Center where doctor visits cost $3 and labs are free or very low-cost. She has thyroid disease and requires annual blood exams and monthly medications.

 “The ACA offers families like mine the opportunity to choose among many different healthcare policies with different prices,” Pinzon said. “This allows you to pick a healthcare plan that meets your needs – financially and health-wise, depending on your personal circumstances and health concerns.”

According to the Commonwealth Fund, among adults ages 19 to 64 who purchased or looked for a health plan through the ACA marketplace, 70 percent had two or more plans available, an even higher percentage than options available through employer plans. In addition, thirty percent of consumers buying marketplace plans said they had five or more plans to choose from. The number of options increases in more urban areas like South Florida.

 

For her husband, Hector, age 63, the various options available in Broward County, Florida meant finding a healthcare policy that included his doctors and had a good diabetes treatment program. Salgado works part-time as a college instructor where he has no health insurance.

“Thank goodness the Affordable Care Act has been available to me,” Salgado said. “Without it I wouldn’t have been able to stay healthy and helping to support my family.”

 

Choosing a Health Care Plan can be complicated.  You can learn more about how to pick a plan here: https://www.healthcare.gov/choose-a-plan/

The Epilepsy Foundation of Florida has licensed healthcare navigators who can help you make a decision about what policy is best for you and your family. Call our statewide toll-free number to speak to a navigator and set up an appointment for a personal assistance: 1-877-553-7453. For more information on the EFOF navigation program: http://www.efof.org/acanavigation/

Read the Commonwealth Report: http://www.commonwealthfund.org/publications/blog/2017/jun/health-plan-choice-in-aca-marketplace

No need to go without Health Insurance if you qualify for a SEP

SEP Photo couple

Coverage Matters. Even though it’s outside the open enrollment period, there’s no reason to go without health insurance for the rest of 2017. You may still be able to enroll under special circumstances or if you qualify for Medicaid.

There are certain change of circumstances – or life events – that would make you eligible.

These include:

        • Loss of health coverage
          • Losing existing health coverage, including job-based, individual, and student plans
          • Losing eligibility for Medicare, Medicaid, or CHIP
          • Turning 26 and losing coverage through a parent’s plan
        • Changes in household
          • Death in the family
          • Getting married or divorced
          • Having a baby or adopting a child
      • Changes in residence
      • Moving to a different ZIP code or county
      • A student moving to or from the place they attend school
      • A seasonal worker moving to or from the place they both live and work
      • Moving to or from a shelter or other transitional housing
  • Other qualifying events
    • Changes in your income that affect the coverage you qualify for
    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming a U.S. citizen
    • Leaving incarceration (jail or prison)
    • AmeriCorps members starting or ending their service.

Learn more about Special Enrollment Periods and see if you qualify here: https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

If you don’t qualify for a SEP, you or your children may still get health insurance year-round if you qualify for Medicaid.  Kidcare, the children’s insurance program, is also available year-round.

The Epilepsy Foundation of Florida has licensed healthcare navigators statewide to assist you with enrollment. Please call to schedule an appointment today: 1-877-553-5433.

 

 

“Kids Oughta Be Covered”

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Children #Enroll365 kidcare

If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP) – known in Florida as Kidcare –  which provides low-cost health insurance in families who earn too much to qualify for Medicaid.

Enrollment in Kidcare is year-round. Enroll this summer and your children can get the physicals and immunizations they need before school starts in August.

Most families pay $15 – $20 in monthly premiums for health coverage, which includes doctor visits, immunizations, prescriptions, emergencies, hospitalizations, as well as dental and vision care.

There are more than 2.4 million children covered by Florida Kidcare. But there are still more than 172,000 children estimated to be eligible for free or low-cost health coverage in Florida who are still not enrolled.

The Florida Kidcare tagline is “Kids Oughta Be Covered.” So what are you waiting for?  Enrolling is easy: You can apply by visiting floridakidcare.org or call 1-888-540-5437.

EFOF’s licensed healthcare navigators can also help you enroll through the healthcare insurance marketplace. Our free assistance is statewide with offices in South Florida – Palm Beach, Broward and Miami-Dade County – as well as Pensacola, Jacksonville, and the Gainesville-Ocala area.  Call 1-877-553-7453 for an appointment.

Passage of the Affordable Care Act helped reduce the number of uninsured children in Florida. From 2013 to 2015, the number of children with health insurance coverage increased by more than 234,000. During that same period, Florida experienced the nation’s second largest reduction in the uninsured rate, dropping from  11.1% to 6.9%.

Learn more about the Children’s Health Insurance Program (CHIP) under the Affordable Care Act: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program

Learn more about Florida Kidcare at: www.kidcare.org

 

Medicaid: Largest Public Health Insurance Program Covers 1 in 5 Americans

Doctor with child Medicaid graphic

Medicaid and the Children’s Health Insurance Program (CHIP) – known as Kidcare in Florida – provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Even though Florida hasn’t expanded Medicaid to cover all people below certain income levels and you may not qualify based on income alone, you should apply for Medicaid because Florida still has coverage options for children, pregnant women and those with disabilities.

 If you qualify, coverage begins right away as there’s no limited enrollment period for Medicaid or Kidcare.

EFOF’s licensed healthcare navigators can help you  apply for Medicaid or Kidcare  through the Health Insurance Marketplace. Call our toll-free number 877-553-7453 to make an appointment.

Medicaid is the country’s public health insurance for low-income children, adults, seniors, and people with disabilities. The program covers 1 in 5 Americans, including many with complex and costly needs for medical care and long-term services, including seniors in nursing homes. Most people covered by Medicaid would be uninsured or underinsured without it.

Medicaid graphic

Cuts to Medicaid would hurt rural Floridians – and children in particular, because 57 percent of Florida’s rural and small-town have Medicaid. Under reforms to the Affordable Care Act being considered, there could be a more than $900 million cut to Medicaid funding over the next decade, according to a recent report by the Urban Institute.

Learn more about applying for Medicaid here: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

Essential Health Benefits under the ACA

Dental visit photo fr kidsGetting health coverage is just the first step to healthy and happy. Knowing how to use your health coverage effectively is what comes next.

Every health insurance plan purchased on the health marketplace comes with “Essential Health Benefits (EHBs).”

Under the Affordable Care Act (ACA), every health plan sold on the health marketplace and in small group markets must carry a set of 10 categories of services, including doctors’ services, inpatient and outpatient hospital care. These also include: prescription services, pregnancy and childbirth, and mental health. Some plans cover even more than is minimally required. Children covered under the ACA also receive dental benefits.

These are a given, no matter how much your deductible is, co-pays or co-insurance.  Make sure you know your EHB’s:  

·         Emergency services

·         Ambulatory patient services (outpatient care you get without being admitted to a hospital)

·         Hospitalization (like surgery and overnight stays)

·         Pregnancy, maternity and newborn care (both before and after birth)

·         Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

·         Prescription drugs

·         Rehabilitative and rehabilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

·         Laboratory services

·         Preventive and wellness services and chronic disease management

·         Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Including these benefits in every policy has made health insurance coverage more comprehensive for consumers. This also protects them from unforeseen medical bills for essential services, including maternity and prescription drugs. Those consumers with pre-existing conditions benefit, too because insurers can’t “opt out” of certain expensive services, like diabetes or asthma coverage.

Learn more: https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

Have more questions on how to use your health coverage? Contact the Epilepsy Foundation of Florida navigation services at 877-553-7453. We’re here to help!

#EssentialHealthBenefits #Coverage2Care #CoverageMatters #AffordableCareAct

ACA offers healthcare & financial security: David Mendoza’s story

David Mendoza knows how much health coverage matters. It was a hard-won lesson that nearly cost him his life. But it could have also cost his family’s financial security.

 

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David Mendoza with his son, Kai

 

 

Mendoza owns a small tree-trimming business in Miami, Florida.  In 2016, while removing tree limbs from the roof of a garage, the chainsaw he was holding slipped and landed on his left arm, severing tendons and major blood vessels. He was rushed to the emergency room where the wound was cleaned and closed.

The accident came just two weeks after he had signed up for a health insurance plan through the federal Health Marketplace. For many years he didn’t think he could afford health insurance. But with the Affordable Care Act, he was able to find a plan where he paid $50 a month in premiums, with financial assistance. 

Nearly 93 percent of the 1.3 million Floridians who signed up for an ACA plan in 2017 received financial aid to pay their monthly premiums. One million of these consumers, about 75 percent, also qualified for financial aid to reduce out-of-pocket costs, including deductibles and co-pays for doctor’s visits and medications.  

 “I had never had an accident like this in my life,” Mendoza said. “So I had never really thought about having health insurance.”  As a healthy 35-year-old, Mendoza had never previously experienced any serious illness, either.

 

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Mendoza’s accident nearly cost him his life but the medical bills without insurance would have threatened his family’s future financial security.

The emergency treatment was followed by a visit to hand specialist (to make sure he regained movement in his hand), surgery to repair torn tendons and relieve a pinched nerve and six weeks of physical therapy.

Without health insurance to cover the costs of treating his injury, Mendoza said he might owe $100,000 in medical bills, or have gone without the necessary surgery and rehab that let him go back to work to support his family.

 “If I don’t have insurance and I get injured again, the medical bills I would incur would destroy me financially for the rest of my life. If I can’t afford health insurance in the future, I would have to close my business.”

Health care costs are a major burden for low- and middle-income wage earners like Mendoza. Before the Affordable Care Act, going without healthcare was often the only option.  A 2014 survey from the Kaiser Family Foundation showed that affordable health care relieves these families of problems with medical bills while also allowing better access to the medical services they need:

 “A primary goal of expanding health insurance coverage is to help people access the medical services that they need. The survey findings reinforce other findings that insurance facilitates access to health care, indicating that adults who gained coverage in 2014 are more likely to be linked to regular care, less likely to postpone care when they need it, and more likely to use preventive services than those who remained uninsured.”

Nationally,  more than half (53 percent) of low-income families and more than one in four (42%) of middle-income families that gained coverage in 2014 received financial assistance to afford their healthcare policies. Without financial assistance to purchase health insurance, these families would not have health insurance and would struggle to pay medical bills:

Finances graphic without insurance

 

Source: http://www.kff.org/report-section/how-does-gaining-coverage-affect-peoples-lives-issue-brief/