If you are currently struggling to pay for healthcare costs, don’t have health insurance, or can’t afford your health insurance, this article can help you. If your currently are able to pay for health insurance, or make more than 400% of the Federal Poverty Line ($4,020 a month for individuals, $6,807 for a 3 person family) this article is not meant to help you.
In the United States, 14% of the population, 43 million Americans, lives in poverty. Americans living in poverty make less than $1,005 a month as an individual, or $1,702 as a 3 person family. For many Americans, this number seems impossibly low, but for these brave men and women, this is their day to day reality.
According to the Kaiser Family Foundation, 60% of Americans make below 400% of the poverty line. (less than $4,020 for individuals, $6,807 for a family of 3) That is 126 million Americans.
Historically, Americans help each other. In his 1989 inaugural address, President George H.W. Bush called for Americans to become “points of light” for each other; providing help to those in need. Nowhere are these points of light more needed than in healthcare. For people who find healthcare costs painful or overwhelming, significant help is available, you just have to find it.
There are a variety of organizations and systems in both the public and private sector that work as points of light. Government Programs like Medicare and Medicaid, Patient Assistance Programs in Physician’s offices, Low-Income Assistance Programs in Hospital settings, and Pharmaceutical Company programs are just a few points of light.
Despite many points of lights in the US, many Americans have difficulty finding them because they lack familiarity or access too the Internet, or simply, cannot afford to take the time off work to search on their own. We invite you to share this article and become a point of light for Americans who cannot find light on their own.
How to Prepare to Get Assistance
Find Where You Lie on the US Federal Poverty Line
Most points of light determine who is eligible for assistance based on where they lie on the US Poverty Line. Using the simple method below, you can find your place on the poverty line. Armed with this knowledge, you can start to the help you desperately need, fast.
First, calculate your monthly income. If you receive child support or alimony payments, do no include them in your monthly income. If any other family members also work and provide income, add their income to your own. This combined income is called your household income.
If you need more help estimating your household income, visit Estimating Income Help at Healthcare.gov.
Second, calculate the number of members in your family that depend upon your household income. This can be children, grandparents, etc. Your pets however, do not count as dependent.
Third, compare your number to the chart below to see where you fall on the poverty line.
This chart takes the most important percentages from the Department of Health and Human Services 2017 Poverty Guidelines
Fourth, proof of income (tax returns or two months of pay stub or bank statements, or a written self-declaration of income). This proof of income is needed for points of light to ensure proper distribution of assistance.
Five, personal identification such as a state drivers license or government-issued ID card.
Six, if you need prescription help, then you need a written 90 day prescription with 3 refills from your physician.
Once these six steps are complete, you are ready to get help from a point of light near you.
The Brightest Points of Light
If you are receiving Medicare and make less than $1,377 a month, or $1,847 as a married couple, you can qualify for extra assistance.
There are several programs available. In order to understand and apply for these programs, please visit the Center for Medicare Services.
Medicare Extra Help- Is a program that provides help paying for the Medicare Prescription Drug Program. It can help pay premiums, annual deductibles, and co-payments. If you are already enrolled in a Medicare Prescription Drug Program, you can apply for Extra Help by visiting the Social Security Administration’s Extra Help Page.
If you are making less than the poverty line, ($12,060 or $20,420 for a family of 3), visit your state site as you may qualify for Medicaid, a healthcare program for low income individuals and families. Depending upon your state, different programs within Medicaid are available, please check with your specific state for more information. Healthcare.gov has an excellent tool that will tell you if you qualify for your state’s Expanded Medicaid program.
(For Georgia, you can find out more from the Department of Community Health)
If you enroll in Medicaid in the state of Georgia, but are not enrolled in Medicare, you must enroll in the Georgia Families program. This program guides you in choosing a primary care provider and health plan. Call 1-888-GA-Enroll or visit Georgia Families for more information.
3. Children’s Health Insurance Program
If you have children, this is by far the most important item in this article. The Children’s Health Insurance Program (CHIP) will provide health insurance coverage for your children at little to no cost. To get more information and learn how to qualify, please visit Medicaid CHIP Information and contact the state you live in using the list on this page.
4. Tax Credits
The IRS also provides a “tax credit” to help families pay their health insurance premiums. A tax credit is essentially money off your taxes that must go towards your insurance premium. It will help you pay only if your insurance was purchased through your a Health Insurance Marketplace. To learn more about tax credits visit IRS Premium Tax Credit or speak with a tax professional.
5. Hospital Financial Services
If you are admitted to the hospital and are below 400% of the poverty line ($48,240 for individuals) ask to see a social services representative before you are discharged. Most hospitals have a low income assistance program that will help you pay for or discount, surgeries, procedures etc. They also provide significant discounts for those who pay out of pockets. For examples of these programs in the Georgia area, see Piedmont (Athens Regional), Saint Mary’s or Emory Healthcare Financial Services.
6. Physicians Assistance Programs
Most physicians want to see you healthy and taking your medicine and are willing to write off some of the financial burden to their patients. These Patient Assistance Programs will typically help anyone who makes 200% above the poverty line or less. (For 2017 this number is $24,120 or $40,840 for a family of 3) For more information, contact the Physicians Circle for Patients (PCP) or visit their website at Physicians Circle for Patients.
7. Pharmaceutical Companies
Most pharmaceutical companies have low assistance programs and will provide medication at minimal cost to you for 1 year. Typically they require proof of income and a completed application. For a more complete list of medications and to find out if they have any discount or assistance programs, visit NeedyMeds.com. You can call PCP at 706-395-2269 or visit their website for assistance applying to these programs. Many other programs are available through the internet.
8. Non-profit Organizations
If you in a special category such as pregnancy, drug addiction, physical disability, etc, there are a wide variety of non-profit organizations available to assist you with grants for healthcare on a case by case basis. Many patient assistance programs like PCP will help you apply to those. Call your doctor’s office directly to see if there are any organizations they work with.
If you have a mental disability or illness, many states have special programs designed for your needs. In Georgia there are over 2.3 million people suffering from mental illness. You do not need to suffer alone. Organizations like Mental Health America of Georgia are dedicated to those trapped inside their own minds. For counseling services in the Atlanta area, visit Care and Counseling Center of Georgia.
If you need immediate help, please visit the Physicians Circle for Patients website, call the Physicians Circle for Patients (PCP) 706-395-2269 Monday-Friday 8:30am-5pm, or email firstname.lastname@example.org and ask how you can receive help on things like prescription costs, doctor’s visits and more. Our trained professionals can help you find resources you need to stay healthy.
We at Physicians Circle for Patients invite other points of lights to join hands to make healthcare costs affordable for all Americans.
Subodh K. Agrawal MD
Physicians Circle for Patients