We live in the world’s wealthiest nation. Yet 14.5 percent of U.S. households—nearly 49 million Americans, including 15.9 million children—struggle to put food on the table. Therefore, it’s no surprise a lot of Americans can’t afford to buy health insurance.
In an article published on November 1, 2014 in USA TODAY, the statistics for the states where the poor are under-counted the most include the state of Florida, which ranked number 4 in the list. The article states that, “…nearly 20% of Florida residents lived in poverty — not only one of the largest deviations from the official poverty rate, but also nearly the highest supplemental poverty rate in the country. High out-of-pocket medical expenses likely explain in part the high supplemental poverty rate in the state, as one in five residents didn’t have health insurance in 2013, nearly the highest rate nationwide.”
Federal Poverty Levels are also used to see if you are eligible for Medicaid (though this depends on rules adopted by your state), to give exemptions from the requirement to purchase insurance, and to help you figure out if you will have to pay some of the Affordable Care Act’s taxes. They are also used for many other non-healthcare related assistance programs
“Like auto insurance, health insurance is a service you pay for but hope you will never need. It’s there for the unpredictable, unexpected and fundamentally uncontrollable problems that come up in people’s lives,” said Dr. Molly Cooke, a practicing internist who is president of the American College of Physicians and a professor of medicine at the University of California, San Francisco.
Most consumers want and value health insurance, but they can’t afford the coverage or have been shut out from the marketplace because they have pre-existing medical conditions, according to research by the Kaiser Family Foundation. “That’s about to change because the law includes new options to make health coverage more affordable and you can’t be denied coverage because of a pre-existing condition,” said Jenny Sullivan, director of Enroll America’s Best Practices Institute.
According to an article on US News & World Report, plans that shift less of the cost to consumers through coinsurance receive potentially higher ratings as well.
Be on the alert for the following factors when shopping for health insurance:
- The percentage of applicants denied enrollment, which is a measure of a plan’s selectivity. Some issuers offer plans but turn down two-thirds of applicants or more, based on concerns about their medical risk or other factors. A high denial rate may be an indication that, if you or someone in your family has medical issues, you may want to look at more inclusive plans.
- The percentage of applicants charged more than the stated premium. Just as some plans turn down many applicants for medical reasons, some issuers charge a high percentage of policyholders more than the stated premium for coverage. Plans may accept these policyholders anyway, but charge more because their medical history suggests that they are likely to use more services.
- Specific categories of care that aren’t covered by a given plan, such as cosmetic surgery, children’s eye exams and weight-loss therapy.
- Plans with a narrow scope of benefits or strict limitations that may leave you exposed to high medical costs related to catastrophic injuries or ailments. Generally speaking these are plans that are more likely to have received fewer stars in the U.S. News analysis. Always read the fine print before you settle on a plan.
- Plans with high deductibles (generally defined as $1,200 or more for an individual and $2,400 and up for a family) that may cover you for severe medical problems but could saddle you with mounting bills for routine care. Under the Affordable Care Act, a high-deducible plan purchased after March 2010 must offer free preventive care whether or not you’ve met the deductible. (If you’re healthy and want to minimize your monthly premium, you may prefer a high-deductible plan. They can be coupled with tax-deductible health savings accounts, which allow you to put aside money for routine medical expenses.)
- Plans that do not cover specific drugs that you need. Visit the plan’s website to see whether your medications are included in the plan’s formulary.
- Plans whose networks don’t include the doctors and hospitals where you get your care