The OHP/Medicaid program essentially provides health care benefits
at little or no cost to the participants. The rules on what
is covered and the member costs involved continue to change
from time to time due to State of Oregon budget considerations.
FHIAP, on the other hand, does not provide healthcare benefits. Instead,
it reimburses, those who qualify, for part of the premium
of an individual health insurance policy that the newly qualified
FHIAP person is expected to purchase. The premium reimbursement
level is 95%, 90%, 70%, or 50% depending on the
qualifying income level.
This presents a challenge in that many new qualifiers have
never had to buy an individual health insurance policy before.
Most are not aware of what their premium might be, that premiums
vary by age, or even what procedure to follow.
The first surprise might be that the premium for a $500 deductible
plan is $300 and, if they qualify for the 95% reimbursement
level, they would have to pay 5% or $15 a month.
The second surprise is that this $15 doesn't pay for medical care
like OHP/Medicaid, but instead only pays the premium. This
means that in addition to the $15 monthly premium payment,
they may have to pay the first $500 of healthcare costs themselves
and then 20% of the balance over $500.
The third surprise is that many don't qualify for an individual
health insurance policy due to strict underwriting requirements
in the health insurance industry today. This may require that
they apply for insurance a second time. This time it would
be the Oregon Medical Insurance Pool (OMIP), Oregon's high-risk
pool. Here they find out premiums are even higher and they
now might have to pay over $20 a month and still have a deductible
in front of them.
The fourth surprise is that only medical care is covered by an
individual health insurance policy. Other benefits like vision
and dental care are not usually covered under individual policies
available on the market today.
This information is provided by ehealthlink.com to help educate
potential FHIAP members in advance.