Health Care: Who is Covered?
Posted by Peter Cutler
On our next election day at least one of the issues on the ballot will likely be associated with the subject of health insurance. I recently began to wonder just how many people in Maine are eligible to receive health care through currently available programs.
There are, of course, those who share monthly premiums in partnership with their employer for individual and family health insurance. Such plans provide varying coverage and options for workers and their families, dependent upon how much enrollees are willing to pay.
There are self-employed individuals who have access to similar plans if they decide that they can afford the premiums and there are those who are independently wealthy for who cost is not an issue.
Individuals who have reached age 65 are eligible for no-cost Federal Medicare once they are enrolled, but normally have out-of-pocket costs if they elect to select Medicare Plan B supplementation and the new medication plan. Certain other individuals can qualify for Medicare because of disabilities.
Medicaid, with a combination of Federal funding and supplemental state contributions, provides care for those who fall within specific income parameters based on the Federal Poverty Level.
Veterans and retired military personnel are eligible for health care benefits through the Veterans Administration health care centers and certain other military-related health care programs.
Finally, Maine hospitals are required by law to provide free care for patients earning up to 150% of the Federal Poverty Level and in some cases certain hospitals have been known to extend that limit up to 250%.
In addition, hospitals frequently write off the costs of health care in certain cases that are identified as "bad debt".
These commitments by Maine hospitals prevent scenarios experienced by other states that involve ill or injured people being shuttled from hospital to hospital in search of one willing to accept charitable cases. Indeed, Maine has been rated by some studies as high as third-best in overall health care in the nation
After reviewing this list, I am not sure if there is anyone residing in Maine who might not be able to receive emergency and life-sustaining health care. Please let me know if any of you reading this post are aware of any verifiable exceptions.
It would appear that indeed Maine has a good health care climate. There are, however, looming questions about health care insurance issues. That subject will be the topic of an upcoming column.
Posted by Peter Cutler
at 05:29 PM
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I forgot to include Dirigo, a state-sponsored plan that provides health coverage for 13,000-18,000 selected enrollees. Curently, Dirigo is a closed-enrollment program.
Posted by Peter Cutler
August 7, 2008 05:04 PM
Mr Cutler states that "t would appear that indeed Maine has a good health care climate." If by that he means that the uninsured can go to emergency rooms for care, that is true. If so, then why not write "t would appear that indeed Maine has a good emergency room climate?"
According to the 2006 federal government census and reported in this newspaper, 126,000 Mainers are without any health insurance -- any health insurance period.
Oh sure, that means they can go to emergency rooms, but people have to pay the FULL cost for services in the emergency room and in the hospital if they are over income guidelines and have NO insurance.
An that charge, twice the level paid by medicare, and almost twice the level paid by Anthem BC/BS, etc. So, who underwrites health costs? The uninsured -- if they paid their bills, and if they don't, well they can apply for bankruptcy.
So of Mr Cutler's statement that "it would appear that indeed Maine has a good health care climate?" These uninsured Mainers, many of whom work full time, have no access to doctors, prescriptions, etc.
Posted by
Peter B HaywarOctober 27, 2008 08:26 PM
Mr. Hayward,
You state that "These uninsured Mainers, many of whom work full time, have no access to doctors, perscriptions, etc". And yet you have agreed that the uninsured can go to emergency rooms, where they will receive those services.
This particular piece was devoted to health care coverage. The issue of health care insurance was addressed in a separate posting, "Health Care: Who Pays"
Posted by Peter Cutler
October 28, 2008 01:42 PM
Mr Cutler, in the end, people have access to the Tiffany diamond, but if they cannot pay for it, they will not be given it.
You do not get meds from the emergency room. You get a prescription which you then take to a pharmacy and pay the full cost. For example, a month's supply of antibiotics is $168 for the uninsured, for the insured, a co-pay is $30.
If you go to the emergency room for the flu, you will have to be seen by a doctor, but you will be charged the emergency room fee, which in Portland is $680. If you go to a doctor for the flu (like I did), the doctor does NOT have to see you if you do not pay up front.
Mr Cutler, I hardly believe you are suggesting that the uninsured go to the emergency room for these matters. But if that is what you believe, so state.
Posted by Mary Casey, Biddeford
October 28, 2008 03:05 PM
Ms. Casey,
No, I am not suggesting that anyone who is uninsured go to an emergency room for any and all ailments.
Although Maine hospitals are required by law to provide treatment without charge for patients falling under certain income guidelines, physicians in private practice are not bound by the same regulations - unfortunately.
Thank you for clarifying emergency room costs and procedures for obtaining medications.
Again, I wonder if there are not alternatives available for uninsured families such as yours.
Perhaps there is someone out there reading this who might have some suggestions?
Posted by Peter Cutler
October 28, 2008 08:48 PM
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