If you have been keeping up with the news lately, you are undoubtedly aware of some of the sweeping changes being proposed to how many Americans obtain health insurance. It is a tenuous time, and now morethan ever it is important for those struggling with eating disorders to know how to navigate the insurance system, to obtain the right kind of insurance to maximize coverage and minimize cost. Here are a few helpful waypoints, to assist in the process.
1 Having PRIVATE Insurance is crucial for anyone with an Eating Disorder.
Unfortunately, government insurance programs like MediCare, MediCaid, and MediCalin California do not offer coverage for eating disorder treatment. The only options available are county mental health services or hospitalization in a county hospital. The intermediate levels of care, which are critical for supporting a sustainable recovery are not covered at all. Having private insurance is a MUST.
2 Private insurance is cheaper than you think
Thanks to the Affordable Care Act, obtaining subsidized private insurance is easier and less expensive than you might think. A quick bit of math: an average monthly insurance premium could range anywhere from $200-$600 from the ACA marketplace. Seeing a therapist without insurance will cost you close to $200 for a single session. Even the most expensive insurance plan starts paying for itself right away, especially with intensive therapy programs such as Cielo House.
3 Get your foot in the door
Even if you think you can’t afford a private insurance plan with a high premium, obtaining any insurance is better than none at all. Some of the plans with higher deductibles may seem intimidating, but many institutions have financial aid available or treatment financing through third parties that make it doable. Cielo House has a generous financial aid program for those who qualify, so just get your foot in the door with private insurance.
4 Take advantage of open enrollment
Open enrollment, which begins November 1 is the time of year in which individuals can switch insurance plans for any reason. You can still switch insurance outside of open enrollment if you have certain special life circumstances, but during open enrollment you are free as a bird to switch to the insurance plan that is right for you. Especially now, with the White House threatening to significantly disrupt the ACA insurance marketplaces, it would be wise to try and lock in a premium while you still can. Those who are already in the marketplace are more likely to have protection in the event something happens politically to disrupt the market.
5 Don’t Low-ball your income when applying
When applying for insurance through the ACA marketplace, which in California is called Covered California, be sure NOT to understate or underestimate your earnings. In 2017, if you declared that your earned or EXPECTED to earn less than $16,200 per year, you would not be eligible for private insurance and would be automatically qualified for MediCal, which as we mentioned earlier does not cover eating disorder treatment. Make sure not to underestimate your past or expected earnings. It does you little good to claim less income as that will not get you much of a better premium, and could bump you down to MediCal.
6 Not ALL insurance is created equal
When shopping for a plan, it is important you learn a little about the insurer’s history in covering eating disorders. Do some internet research and find out who are generally the insurers that provide better coverage and are easier to work with. You can call us at Cielo House to find out about that from our experience as well. Make sure you obtain a plan that covers eating disorder treatment. Ideally, try to find a plan for which the facility you are looking into is in-network. Cielo House is in-network with most of the major insurance companies, and constantly increasing our network participation, so call us to find out the updated list of insurance companies we participate with.
7 California is beautiful, why not move here?
California has one of the best and well-run ACA Marketplaces in the country. Even if the President tries to interfere with ACA, California is likely to be insulated because of our robust system and commitment to providing healthcare for our residents. If you find yourself outside of open enrollment, one of the qualifying life circumstances allowing you to switch insurance is if you move to a new area. So why not move to California?Cielo House offers transitional housing for those participating in our programs, and relocating to California for treatment and a fresh start could be a much-needed reset. We would be happy to walk you through the process and be supportive to you when you are out in the area.
The reality is that with an eating disorder having private insurance is a necessary part of life. It is almost equivalent to having a roof over your head, or auto insurance when you drive. At Cielo House, we spend so much time navigating the insurance waters on our end that we have become very knowledgeable about it, and can help you figure things out as well. With eating disorders, having the right insurance can make all the difference, and that way you can focus on doing the healing you need.
Written by Matt Keck, MFT. Matt is the Co-Founder and Chief Executive Officer of Cielo House Comprehensive Eating Disorder Treatment Centers.
Navigating the Confusing World of Insurance
