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Health Insurance Programs

The Asthma and Allergy Foundation of America has several resources on health insurance topics that affect those with asthma and allergies:

• Health Insurance Marketplace Guide for People With Asthma and Allergies
• Health Insurance 101: Open Enrollment
• What to Do If You Can’t Afford Your Asthma Medicines

Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) is a state administered health insurance program that provides health coverage to eligible children through Medicaid and separate CHIP programs. CHIP provides health insurance for children up to age 19 in low-to-moderate income families who make too much income to qualify for Medicaid. In some states, CHIP also covers parents and pregnant women. Learn more about CHIP’s State Program information.¹

Routine checkups and dental visits are free under CHIP, but there may be copayments for other services. Some states charge a monthly premium for CHIP coverage. Although states have different prices for CHIP coverage, families won’t have to pay more than 5% of their income. You may enroll in Medicaid and CHIP programs at any time during the year.

See if you qualify and/or to enroll in Medicaid or CHIP.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions require group health plans to temporarily continue group health coverage that otherwise end. For example, you may lose employer-sponsored health insurance coverage if you leave your job, but you can choose to pay for it out of your pocket for a few more months until you find a new job.

COBRA requires employers to offer continued insurance coverage to covered employees, their spouses, former spouses, and dependent children. It usually costs more than the amount that active employees pay for group health coverage while they are employed.

If you become eligible to elect COBRA when you would lose group health coverage, look at all of your options before making a decision. You might find cheaper health insurance plans for you and your family through other group health coverage, such the Health Insurance Marketplace or Medicaid.Learn more about COBRA.²

Medicaid

Medicaid is a health care program for people and families with low incomes and limited resources. Medicaid is managed by the states according to federal rules and regulations. States are required to cover certain “mandatory benefits” and can choose to provide other “optional benefits” through their Medicaid program. Before the Affordable Care Act (ACA), Medicaid coverage was generally denied to individuals without dependent children under the age of 65, but now states may extend Medicaid benefits to individuals without dependent children that live below the poverty level (each state specifies how far below the poverty level). Contact your state Medicaid program to find out how you can apply.

Medicare

Medicare is a federal health insurance program for people over the age of 65, under the age of 65 with certain disabilities, and people with end-stage renal disease. Different sections of Medicare cover different services:

• Medicare Part A: Hospital Insurance
• Medicare Part B: Medical Insurance
• Medicare Part C: Medicare Advantage Plans
• Medicare Part D: Prescription Drug Coverage

Learn more about Medicare and how to apply for coverage.

Learn More

Affordable Care Act
The Affordable Care Act makes it easy for people to purchase health insurance plans through the Health Insurance Marketplace at affordable rates.
https://www.healthcare.gov/get-coverage

CHIP
Children’s Health Insurance Program is state-administered health insurance program that provides health coverage to eligible children through Medicaid and separate CHIP programs.
https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program

COBRA
COBRA health benefit provisions require group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated.
https://www.healthcare.gov/unemployed/cobra-coverage

Health Insurance Marketplace
Through this program created by the ACA, individuals can now compare and purchase affordable health insurance.
https://www.healthcare.gov/quick-guide

Medicaid
This is a health care program for individuals and families with low incomes and limited resources.
http://medicaid.gov

Medicare
This is a health insurance program for people over the age of 65, younger people with disabilities, and people with end-stage renal disease.
http://www.medicare.gov

Veteran’s Health Administration (VA)
If you served in the military and were not dishonorably discharged, you may qualify for VA health care benefits.
http://www.va.gov/healthbenefits

Asthma, Allergies, and Insurance

Health insurance companies have lists of prescription medicines they will cover. This list is all called a formulary. If your insurance company or health plan/program says a drug you take is not on their formulary, talk with your doctor about other medicines.

Here are some questions to ask your insurance company or health plan/program:

• “Are asthma or allergy medicines a covered benefit for me and other family members on my plan?”
• “How can I get a referral to a doctor who specializes in asthma and/or allergies?”
• “How often can I get prescription refills?”

More Information

• FAIR Health Consumer Cost Lookup
• U.S. Department of Health & Human Services Coverage to Care
• Kaiser Family Foundation FAQs: Health Insurance Marketplace and the ACA

References

1. Medicaid.gov. Children’s Health Insurance Program.http://medicaid.gov/chip/chip-program-information.html

2. United States Department of Labor. Health Plan and Benefits: COBRA.http://www.dol.gov/dol/topic/health-plans/cobra.htm

3. Medicare.gov.http://www.medicare.gov/

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