‍

What To Do When You Lose Health Insurance Coverage

‍

Losing health insurance coverage is a very stressful event for a person living with diabetes! We need access to medications, technologies, and health care providers to manage blood sugar levels and stay healthy, but now all of that is in jeopardy. Living with diabetes is stressful enough without this added uncertainty and burden! What steps should you consider when you are faced with loss of coverage?

‍

Step one is try not to panic. Adding that emotion doesn’t help and only makes things worse. You are not the first person with diabetes to lose their health care coverage. You need to work the problem and develop options and resources. This is obviously one of your new top priorities so where to start?

Health Insurance Options:

1. Spousal Coverage: If your spouse has access to health insurance through their employer, you are automatically eligible to join that plan due to the loss of your current coverage being a qualifying event.  You do not need to wait for their open enrollment period.  Your spouse should contact their employer’s HR department as soon as you know you are losing your current coverage.  If you have a notice period from your former employer, use that time to get the paperwork moving.  You should have no break in coverage in this scenario.

2. Medicaid: If you are now unemployed or make an amount below your state’s Medicaid eligibility level, sign up for Medicaid immediately.  Each state sets their own income limit for Medicaid so check your state’s levels to see if you qualify (https://www.medicaid.gov/). Some tips:
   1. Apply by Phone: Apply by phone versus online. Let the case worker know that you or a family member have a chronic health condition with urgent needs.  You should also apply for SNAP (food stamps at this time). This should escalate your case for a faster decision. Otherwise, it could easily take 45-60 days or more before you have an insurance card.
   2. Proof of Income: They may ask you for your most recent paycheck, but you are now unemployed.  Do not send them what you were making from your old job.  They will assume you are still employed and deny your coverage.  Instead, submit an affidavit of loss of income to prove that you now qualify for Medicaid. The affidavit sounds serious, but it is a simple document; however, we recommend you go to a bank with a government issued ID and have your signature notarized. See below for an example.
   3. 30 Day Lag Time: It typically will take 30 days from the time of enrollment until you are approved. If approved, you will get a state Medicaid card, and your coverage begins retroactively to the day you applied. This card will work in a hospital but not at the pharmacy.  Now that you’re approved, the final step is choosing a Medicaid plan in your state. Once enrolled in that specific plan they will mail you a card that can be used at a pharmacy and for supplies.

3. Health Care Exchanges: If you make too much income to qualify for Medicaid, then you will need to look at the individual health insurance exchanges.  Your loss of coverage qualifies as a life event and allows you to sign up immediately and not wait for the normal open enrollment period.  You can start this journey at https://www.healthcare.gov/.  There may also be insurance brokers who specialize in individual exchange policies in your state.  They are there to guide you and get paid by the insurance plans so it will not cost you any additional money.

You may be eligible for a Premium Tax Credit (PTC) to reduce your premium costs if your income is less than 4 times the federal poverty level.  You can calculate this on the website, and it is applied on a sliding scale basis depending on your income level.  Note that the PTC is applied at your time of enrollment so your costs are lowered immediately; however, the PTC is recalculated when you file your income taxes (requires a Form 8962) and will be adjusted up or down if you made more or less than you estimated upon enrollment.  You cannot use Married Filing Separately if you are taking the PTC. Your insurance broker should be able to assist you with this process as well.

Tax tip: If you took the PTC when you enrolled but find that you don’t qualify in April based on your actual earnings, consider making a contribution to an IRA to lower your taxable income. At least then, you keep the amount you would have lost, and you are investing in your future.

‍

4. COBRA: If you are losing health insurance through your employer (with 20 employees or more), you will be eligible for COBRA continuation of coverage for 18 months post-employment. This is often a very expensive option as employers can charge 102% of their actual plan costs to COBRA participants so definitely check the exchange plans.  

You have 60 days from your termination date to elect COBRA coverage, but importantly, the coverage is effective retroactively to the date of termination as long as you pay the premiums for those 60 days at time of election. If you are seeking another job that you expect will provide health insurance, it may be wise to use backup supplies and delay appointments for 60 days and pay out of pocket for just those items you absolutely need. If during the 60-day period, you have unforeseen or unfortunate medical expenses that are more than the COBRA premiums, then you can make the retroactive election to have those costs covered by your prior employer’s plan.

Tip: If you have already met your deductible in your previous employer’s high deductible health plan, it may be advantageous to pay for COBRA until the beginning of the new plan year before transferring to the exchanges or your new employer’s plan; however, do not delay enrolling in your new employer’s plan at time of hire beyond your window to opt in or you may have to wait until the next open enrollment period.  

Other Options to Consider:

1. Inventory All Drugs and Supplies:  If you lost your coverage, immediately take an inventory of your drugs and supplies.  You need to know what you are going to run out of first and work to get those critical items in time.

2. Prescriptions: Contact your doctor to let them know you’ve lost coverage.  Get an up-to-date prescription for all the drugs you need to avoid a delay in filling with through a new plan. Note that these will come in handy if you apply for manufacturer’s patient assistance programs.

3. Patient Assistance Programs: These may be available directly from a manufacturer if you are uninsured and don’t have Medicaid or Medicare. The application process can take a while so start early and work through your emergency supplies in the interim.
   1. If you have applied for Medicaid but don’t have it yet, don’t tell the manufacturer site that you’ve applied.  Take whatever help you can get while you are waiting as Medicaid may be denied or take too long to get processed.
   2. You may need to certify that you’ve lost your job and coverage. See the affidavit example from the Medicaid application section. Don’t attach your prior W2.
   3. You may need to submit a fresh prescription from your doctor as part of your application.

4. Site Links:
   1. Insulin:https://Getinsulin.org is a great site to see all insulin manufacturers’ programs in one spot.
   2. Dexcom PAP: https://assistance.dexcom.com/PAP_SelfService/. They currently offer a 90-day supply of sensors for $45 if you qualify. You can use the program twice in a 12-month period.
   3. Abbott Customer Service:  https://www.freestyle.abbott/us-en/support/contact-us.html
   4. Tandem Payment Plan: https://www.tandemdiabetes.com/support/benefit-programs
   5. Medtronic Financial Support: https://www.medtronicdiabetes.com/financial-support-programs

4. Free Clinics: Find a free clinic that may be able to help with insulin or supplies as well as doctor visits if you are uninsured. Two sources to help you locate a clinic in your area:
   1. National Association of Free and Charitable Clinics: https://nafcclinics.org/find-clinic/
   2. Health Resources and Services Administration: https://findahealthcenter.hrsa.gov/

5. Emergency Rooms: If you are having an emergency or are in crisis, then go to the ER. They must treat you and may give you medications for the next 30 days. Yes, this comes at a cost, but the bill isn’t due at time of service, unlike the pharmacy counter, and in many cases can be negotiated. This is a last resort option, but do not jeopardize your health in an emergency situation. Seek care immediately.  When you’re there be very specific about your needs and advocate for yourself.  Things to say while in the ER:
   1. “I have type 1 diabetes and am in crisis from not having access to  _______ (insulin, sensors, supplies, etc.).”
   2. “Please help me with a vial of ____ and a paper script for 3 additional months that I can take to my pharmacy tomorrow.”
   3. “Please help me by looking for a CGM sample that I can leave with. I don’t feel safe without a CGM.”
   4. “Please help me by recommending a free clinic.”
   5. “Please help me by finding a social worker that can help me apply for Medicaid.”

6. Everyone in an ER is busy and it is easy to feel overwhelmed. Keep repeating yourself until you have what you need. If you feel embarrassed or ashamed because you’re asking for yourself, don’t. You are worthy of help. Imagine you are asking for a small child. Your needs aren’t shameful. Your needs are important and this is what you would want for that small child as well. Be strong.

6. Food Stamps: When you are applying for Medicaid, you should also apply for SNAP.  This is the same person you spoke with for Medicaid. Put aside any shame or pride and sign up for this program.  It is there to help people in crisis.  

7. GoodRx: This is a quick and easy source to get coupons for discounted drugs that are below retail list price and often below an employer or other commercial coverage especially if you are still in your deductible period. The coupons are good at any retail pharmacy. Note that you will not get deductible credit from your insurance plan for using GoodRx coupons, but the cash savings may still be worth it. This is a good gap filling option while you’re waiting for your Medicaid application to be approved or in an emergency where your child’s sensor fell off and you can’t get a refill yet through your insurance. https://www.goodrx.com/

8. Medicaid Waivers for Children with Disabilities: If you have a child with multiple disabilities, you may want to see if your child is eligible for a Medicaid waiver. The waiver allows the child to be eligible for Medicaid based on their income level versus the parent’s income. Kids Waivers is an outstanding resource for exploring these options: https://www.kidswaivers.org/

Authors:

• George Huntley, CEO – Diabetes Patient Advocacy Coalition

• Sarah Long, Patient Assistance Advocate – T1 Mod Squad