Memo to the "high risk" uninsured of Illinois

To:	Patients considered "high risk" and "uninsurable" to most healthcare agencies
Re:	Healthcare options
Note:	Many options apply to those who do not have group coverage either because they are self employed, unemployed or no group plan is offered. There are also options for the currently uninsured as well as those coming off of *COBRA. There are also ideas as to what an employer without a group plan could offer. The following is meant to give ideas as to what options are available but is not meant as a final solution. Other options may be available. Most of the information is meant for residents of Illinois. Information may vary depending on location. *If switching or coming off of a job it is important to continue with COBRA or the current healthcare provider for as long as possible or until other healthcare options are provided. If possible there should be no gap in healthcare coverage. If possible one should also obtain a letter from a physician or a copy of their previous health exam before approaching a new insurer.

Due a pre-existing medical condition, many people are considered a "high risk" to most healthcare insurers and will not qualify for coverage. However, different options are available. These include signing up with the CHIP program, Access to Care and The Free Medicine Foundation as well as switching to discount doctors under the registered Provider Program Administration or the PPA.

In summary the following options are available:

ICHIP is a healthcare program for patients who are considered "high risk" or "uninsurable" by other agencies. The premiums are about 35% higher than the regular agencies. Prices differ depending on the location of the patient, the amount of coverage as well as the deductibles. ICHIP and HIPPA CHIP claim to be the least expensive and safest options for the "high risk" pool and thus the best. HIPPA CHIP, a healthcare program that is available to the "high risk" patient who currently depends on COBRA, is available at a slightly lower cost and has a shorter waiting list. However, once the patient’s COBRA expires they no longer qualify. The phone number for the ICHIP program is (217) 558-6202. This is the best and nearly only full healthcare option available.

Another option would be to sign up with the ICHIP program only for major medical with a high deductible of around $5000 and prescription drug coverage. Because ICHIP does not offer the major medical without the prescription drug coverage the price would be slightly lower than the full program. The patient could then visit a discount medical center for all of their basic check ups and medical needs. These include public clinics, county hospitals or federally operated health centers. Doctors who are a registered in the Provider Program Administration or the PPA are also offered. These doctors are available to administer medical treatments, and provide routine doctor visits on a discount-only basis. For more information on doctors registered in the PPA visit:

http://www.ins.state.il.us/PPA/PPA_list.asp

Visiting the discount medical centers could be used in combination with or separate from an account that could be set up for the employee through their employer. This account would cover situations in which the employee might need immediate hospitalization and medical treatment. This plan would, in a sense, be creating a private or personal insurance plan instead of insuring with ICHIP or other plans. However specific terms must be agreed upon prior to creating this account regarding what would happen to the money in certain situations e.g. a layoff, quitting the job in which the plan was created or the need for money for other circumstances.

If at all possible, an addition could be added to employee’s paycheck to help them cover the medical expenses for visiting the clinics and help pay for any prescriptions as needed. This will not cover the employee fully should they need to be hospitalized for an extended period of time. It should be discussed thoroughly before deciding.

Employees will not be turned down for group insurance. That is, if health insurance will be provided for two or more people, then the insurance company cannot discriminate. However, the "downside" of this is there would be a chance that the healthcare premiums that everyone in the group pays will increase.

Access to Care is a not-for profit organization supported by grants to help those in need of health insurance. It is meant for residents in suburban Cook County with a family income less than 200% of the federal poverty guidelines. Those who have no health insurance or deductible of $500 or more than one person and are ineligible for Medicare or Public Aid. If the patient is eligible there is a non-refundable annual enrollment fee of $20 for one person, $40 for two people and $50 for three or more people living in one family. Access offers doctor visits for $5, prescription medications for $10-$30 and lab tests and X-rays for $5. For more information call (708) 531-0680. This is not a full healthcare provider and does not include hospital visits but it is a form of coverage.

The Free Medicine Foundation is available to help pay for any medicine that they may need while not receiving healthcare. www.freemedicinefoundation.com offers discount medicine to patients who are unable to afford the high prescription drug prices. This program is for patients who do not qualify for Medicare, Medicaid or any other government programs that cover prescription drug costs. It is also for those who do not have any prescription drug coverage while using the Free Medicine Foundation. Medicare does not necessarily disqualify the patient, so long as they do not receive any prescription drug coverage. There is a $5 fee for all of the prescriptions requested. The application process takes about 4-6 weeks and can be used to help fill the time gap between insurers. For more information and to request an application call (533) 996-3333. However, this is not healthcare and they will not permit their clients to receive healthcare drug benefits from other healthcare providers while in the foundation.

All of the options could be used in combination or alone. Combinations could be put together using pieces of separate plans to help assure that the patient receives the coverage that fits them best at the lowest price.

Some combinations of plans include:

• Going with the standard insurance plan from ICHIP: as stated above this is nearly the only full healthcare plan available but is the most expensive option. If the patient ever needed to be hospitalized for an extended period of time this would be the safest option.
• Another combination would be using the Access to Care option while setting aside an account for emergency medical reasons. This option will be more expensive than just having the account or just visiting the discount medical centers but will offer a fair amount of coverage and protection for the future.
• Along with using the discount medical centers, the patient could use The Free Medicine Foundation to help pay for his prescription drug price. This combination could also be used while setting aside an account for emergency medical reasons only. Without the account set up this combination offers a great amount of immediate day-to-day coverage but offers nearly no coverage for the future. With the account added this option offers a fair amount of coverage for the future.
• If a group plan could be set up that would be just as safe as ICHIP but would be a less expensive option.

Contact The Center For Ethics and Advocacy in Healthcare for any further help or for further information by sending an e-mail from the Request Information page or send a letter detailing the specific question as well as any contact information to: