The Cystic Fibrosis Foundation is committed to providing the information you need to make the best health care choices for you and your family.
Here, you can learn about different types of health insurance and important questions to ask when choosing a plan.
What are the different kinds of health insurance?
It is easier to maintain health insurance coverage than to have it and lose it and then try to sign up for it again.
There are several different types of health insurance plans to choose from. Some plans are open to anyone, while others have eligibility requirements. The three most common types of health insurance coverage are:
Group insurance plans may be offered by an employer, labor union, university or other large group. Plans vary greatly in what health services are covered and how much each individual must pay for premiums (monthly fees) and other out-of-pocket expenses. Employees are often able to add their spouse or dependents to a group insurance plan for a higher monthly premium cost.
Individual health insurance plans are purchased by individuals or families directly from an insurance company or through a health insurance marketplace. Unlike group health insurance, an insurance company may ask for more information about the person purchasing individual insurance. Starting January 1, 2014, most insurers cannot deny coverage to a person based on his or her health condition.
The federal government and all states offer health coverage options to those who qualify for public assistance.
- Medicare, Medicaid and Other Public Coverage Programs
Understanding Your Insurance Premiums
When exploring health insurance plans, these are the things to compare.
For example, you may have to pay a higher premium to get a lower deductible but it could ultimately save you money.
The example below may help explain this. These amounts are for demonstration only and are not actual numbers.
Let’s say you are offered two insurance plans.
The first plan has a monthly premium of $200 with an annual deductible of $5,000.
Your yearly cost would be $7,400 ($2,400 for premiums + $5,000 for the deductible).
The second plan has a monthly premium of $300 with an annual deductible of $2,500.
The annual cost would be $6,100 ($3,600 premium + $2,500 deductible). You would save $1,300 over the year for the higher-premium plan.
Federal programs: Eligibility requirements for public health coverage and assistance programs run by the federal government, such as Medicare, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), are the same no matter where you live. For more information, visit our Nationwide Programs page.
State programs: Other programs vary by state, as do the eligibility requirements for enrolling in these programs. Every state offers Medicaid and Children's Health Insurance Program plans (CHIP), but eligibility and coverage vary greatly.
Other health coverage programs your state may offer include:
- Children with special health care needs programs
- Adult cystic fibrosis programs
For more information, visit our State Health and Assistance Programs Map. You also may find out if you qualify for Medicaid, CHIP or premium assistance if you apply for insurance through your state’s health insurance marketplace.
If you have questions about your health insurance coverage or whether you are eligible for public coverage programs, please contact the Patient Assistance Resource Center at 1-888-315-4154 or firstname.lastname@example.org.
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What should people with CF think about when choosing a health plan?
When choosing a health insurance plan, it is important to think about what services and treatments you and your family need and how much the health plan will charge for those services.
While each individual’s needs and questions will be unique, people with cystic fibrosis should consider the following questions:
- Visits to your care center and hospital
- Are visits to my CF care center covered? Is there a limit to how many visits are covered?
- Does the plan cover inpatient hospitalization and outpatient procedures? Are there any restrictions?
- Pharmacy benefits
- What are the plan’s pharmacy benefits?
- What paperwork is required to obtain medications?
- Does the plan cover vitamins and nutritional supplements?
- Is durable medical equipment (such as nebulizers) covered?
- What are the prior authorization requirements?
- Which drugs are on the plan's preferred drug list?
- Out-of-pocket expenses
- What are the out-of-pocket expenses for each benefit?
- What is my monthly premium and annual deductible?
- What are my co-pays?
- Does co-insurance for any services or treatments?
- Other important factors to consider
- Does the plan have pre-existing condition restrictions?
- Does the plan offer physical therapy benefits?
- Does the plan include transplant coverage?
- Does the plan cover home health services?
If you need assistance in navigating benefits for a new health plan or want to learn about the benefits under your current plan, contact the CF Foundation’s Patient Assistance Resource Center at 1-888-315-4154 or email@example.com.
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