Health care coverage should be affordable and accessible. In 2023, a job-based health plan is considered affordable if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 8.39% of your household income. Some things to consider when evaluating whether health care is accessible:
● How far away are in-network health care services?
● Are primary care providers accepting new patients?
● Are the issues most impacting the workers in your community adequately and appropriately covered by the health plan you offer?
If your organization does not provide health insurance for all workers and their families, or if it is not accessible or affordable, workers may qualify for Medicare or Medicaid or be able to purchase health insurance through the Affordable Care Act (ACA) Marketplace. Workplaces that help facilitate access to health care coverage help assure workers can get the care they need. Some things to consider:
● Provide resources to workers about the ACA Marketplace
● Have a specific person dedicated and available to facilitate or support applications
● Familiarize yourself with where to refer employees for help navigating Medicare/Medicaid and the ACA Marketplace (most states have dedicated staff to help their constituents apply for care)
Health care bills are one of the top reasons a person might go into debt or avoid seeking care. Some things to consider:
● Provide resources about medical bills and support for workers struggling with medical care costs
— Medical Expenses Support Information
— Navigating Medical Bills Issues
— Understanding Medical Bills Guide
— HSA Guide
● Provide resources to support workers with out-of-network costs
— Guidance on Reducing Out-of-Network Costs
— Guidance on Getting Out-of-Network Care Covered
— What You Need to Know Before Getting Out-Of-Network Care
— What happens if I need care from a doctor who isn’t in my plan’s network?
● Health care coverage of substance use-related health care is critical to getting care, treatment and recovery support. Health insurance should cover:
— Behavioral health treatment: counseling, talk therapy, trauma-informed therapy, cognitive-behavioral therapy
— Medications for addiction treatment: evidence-based medications relieve withdrawal symptoms and cravings
— In-patient treatment: a rehabilitation or recovery center or hospital where a patient receives treatment, usually a combination of medication and behavioral therapy, while staying at the treating facility
— Outpatient treatment: treatment and services provided to a patient in an outpatient community or hospital setting; patients receiving substance use and/or mental health treatment may need frequent outpatient visits or periods of more frequent visits
— Complementary medicine: treatment options such as acupuncture, yoga, chiropractic care, physical/occupational therapy
● Health care coverage of mental health-related health care is critical to getting care, treatment and recovery support. Health insurance should cover:
— Behavioral health treatment: counseling, talk therapy, trauma-informed therapy, cognitive-behavioral therapy
— Medication treatment: evidence-based medications that relieve symptoms like depression, anxiety
— Inpatient treatment: treatment provided in an inpatient hospital or recovery center where a patient receives treatment, usually a combination of medication and behavioral therapy, while staying at the treating facility
— Outpatient treatment: services provided to a patient in an outpatient clinic, community or hospital setting; patients receiving substance use and/or mental health treatment may need frequent outpatient visits or periods of more frequent visits
— Complementary medicine: treatment options such as acupuncture, yoga, chiropractic care, physical/occupational therapy
Health Care Coverage