Paying for Care in Tompkins County
1. Obtaining Health Insurance Coverage
- Get Covered Info Line: A service for Tompkins County residents that provides information about health insurance options, including free and low-cost plans through New York State. Call 211 from within Tompkins County. (A program of the Health Planning Council).
- The New York State Department of Financial Services provides a useful page on health insurance information for consumers.
- Enroll NY/MyBenefits
Enroll NY is an online entry-point for state-sponsored health insurance. Find out if you're eligible for Family Health Plus, Child Health Plus, or Medicaid.
Mybenefits.ny.gov provides easy registration and information about a wide range of New York State health and social services programs, including food stamps, heating assistance, etc.
- Healthy NY
Healthy NY is a state program designed to provide affordable health insurance to eligible small businesses and to certain working uninsured individuals.
In Tompkins County, Excellus BlueCross Blue Shield provides Healthy NY coverage and the rates are significantly cheaper than private insurance. The phone number for individuals is 1-800-462-0108 and for small groups, 1-877-872-9308.
- Child Health Plus
Child Health Plus is a New York State health insurance plan for children under the age of 19. It provides free or low-cost coverage for medical services, lab tests, check-ups, immunizations, and prescriptions for children who qualify. (Children covered by Medicaid are not eligible). Applications can be made through the Samaritan Center of Catholic Charities of Tompkins County (Call 800-231-0744), Mother & Babies Perinatal Network, or through Total Care. Information can also be obtained from the State Office for Child Health Plus at 800-698-4543.
- Family Health Plus
Family Health Plus is a public health insurance program for adults between the ages of 19 and 64 who do not have health insurance. Income, however, must still be below specified levels to qualify for Family Health Plus. Applications can be made through the Samaritan Center of Catholic Charities of Tompkins County (call 800-231-0744), Mother & Babies Perinatal Network, or Fidelis. If your family income exceeds the income limit, you may still be eligible for Healthy NY, another health insurance option offered by NY State.
- If I'm self-employed, are there other options?
Some small businesses, self-employed people, and individuals are able to purchase insurance through professional and trade associations. Local insurance brokers also sell health insurance to individuals who are self-employed.
The Tompkins County Chamber of Commerce offers health insurance plans to its members.
Healthy NY (described above) is also an option in some cases.
- Purchasing individual or family health care coverage
Buying individual or family coverage is expensive and not always user-friendly. Excellus BlueCross BlueShield, MVP Health Plan, Inc., and EmblemHealth sell health insurance directly to Tompkins County residents. Local insurance agents may be able to assist you in exploring other options.
- High-deductible plans
High-deductible insurance plans provide coverage for catastrophic care, but are not designed to pay for routine doctor visits and other preventive care. These plans are substantially cheaper than "standard" health care plans. Many local insurance agents can provide more information.
- What is COBRA and am I eligible?
If you leave a job in which you had health insurance, you are generally able to continue that health insurance coverage for a period of up to 18 months by paying for the coverage out of your own pocket. You must arrange to continue this coverage within 60 days of leaving your previous job. Those arrangements are generally made with the human resource office of your previous employer.
- Can I qualify for Medicare even if I'm not 65?
Persons who are younger than 65 and permanently disabled (as determined by Social Security) may qualify for Social Security Disability (if they have worked and paid taxes into the system for the required amount of time). Once a person has been on Social Security Disability for two years, he or she automatically qualifies for Medicare. For information, contact the Ithaca office of the Social Security Administration, 127 West State St., Ithaca, NY 14850. Phone: 256-3651. The national toll-free number for Social Security is 800-772-1213.
Assistance with Medicare can be obtained from the Health Insurance Information, Counseling and Assistance Program (HIICAP) of Lifelong at 273-1511.
The Medicare Rights Center is a good online source of information.
The Health Insurance Information, Counseling, and Assistance Program (HIICAP) of Lifelong (121 W. Court St., Ithaca, 273-1511) provides help with Medicare, Medigap, Long-Term Care Insurance, and other programs serving senior citizens.
The Disability Resource Coordinators Program of Workforce New York is an excellent resource that can help you sort out Social Security Disability, Medicare, and Medicaid. (272-7570, ext. 136).
The Finger Lakes Independence Center (215 Fifth St., Ithaca, 272-2433), through its peer counseling program, can provide assistance to individuals who are dealing with insurance forms and applications to financial assistance program (such as SSI, SSDI and medical benefits programs such as Medicaid).
2. What to do if no coverage?
- Ithaca Free Clinic
The Ithaca Free Clinic, a project of the Ithaca Health Alliance, offers integrative health and wellness services on Mondays from 2-6 pm, and Thursdays, 4-8pm at 521 West Seneca Street. (330-1254). The clinic provides health care, insurance screening and referrals to anyone uninsured for the services sought at IFC. Patients are seen on a walk-in basis, and services are provided by volunteer nurses, physicians, chiropractors, acupuncturists and herbalists.
- Cancer Screenings
The Cancer Services Program of Cortland and Tompkins Counties is part of the NYS Department of Health Cancer Services Program. It provides free breast, cervical, and colorectal cancer screenings to eligible individuals. Call 758-5523 for more information.
Planned Parenthood of the Southern Finger Lakes (273-1513) provides cancer screenings at low cost or no cost. Many people qualify for funding through the Cancer Services Program, Medicaid or other programs. Others pay on a sliding scale.
The Mary Lukacs Fund pays for MRIs for people at risk for breast cancer.
- If I can't afford insurance, do I automatically qualify for Medicaid?
No. Medicaid provides health coverage to some low-income New York residents, but not all low income people are eligible. In general, families with children, pregnant women, the elderly, and the disabled are the groups most likely to qualify. For information, contact the Medicaid Program at the Tompkins County Department of Social Services at 274-5327.
Medicaid Managed Care is available in Tompkins County through Total Care and Fidelis.
- Are hospitals required to provide care to me even if I don't have insurance coverage?
In general, hospitals are legally required to provide emergency care to stabilize a patient's condition without regard to the person's ability to pay, but they are not required to provide care beyond that. Cayuga Medical Center works with patients to arrange payment plans as necessary. Charity care is available under certain established guidelines and criteria. More information is available online or through the Billing Department at (607) 274-4400.
If you think you might have trouble paying for treatment, please talk with the hospital and your doctors as soon as you can, and before treatment begins (if possible). It's easier to establish payment plans and find assistance when your situation is known to them in advance.
- Planned Parenthood of the Southern Finger Lakes (273-1513) offers health care services on a sliding fee scale that is designed to meet the needs of uninsured persons. Medicaid is also welcome. Services include routine gynecological care, family planning services including emergency contraception, pregnancy tests, pregnancy options counseling and referral, abortion services, testing and treatment for sexually transmitted infections, HIV testing and counseling, and procedures that diagnose and treat abnormal cervical conditions (colposcopy, cryotherapy and LEEP).
- Hospicare and Palliative Care Services (272-0212).
Hospicare provides care to patients and their families when the patient's probable life expectancy is 6 months or less. Medicare, Medicaid and most private insurance carriers have a hospice benefit. No one is refused services because of inability to pay.
3. Help Paying for Medications
- The Prescription Meds Access Program (PMAP) is designed to help Tompkins County residents who don't have prescription coverage identify potential sources of low cost medicine. For more information, call Information and Referral at 211 and you will be connected with the program.
The TompkinsRx prescription discount card helps uninsured and underinsured residents reduce the cost of prescription drugs. Free TompkinsRx cards are available at many pharmacies, public offices, medical offices, and large supermarkets. Simply present your card at a participating pharmacy and save an average of 20% on prescription drugs. To request that a card be mailed to you, call Information and Referral at 272-9331.
The following are helpful prescription drug programs:
- Target Pharmacy $4 Prescription Program
- Wal-Mart $4 Prescription Program
- Wegmans $4 Prescription Program
- Xubex (Patient Assistance Program for Generic Drugs)
The Partnership for Prescription Assistance (888-477-2669) provides links to assistance from drug manufacturers.
- The Co-Pay Relief Program of the Patient Advocate Foundation provides some financial assistance for pharmaceutical products for insured Americans who financially and medically qualify. To be eligible, you must be affected by autoimmune disorders, breast cancer, colon cancer, diabetes, lung cancer, lymphoma, kidney cancer, prostate cancer, sarcoma, macular degeneration, or secondary issues as a result of cancer treatment. (1-866-512-3861).
4. Dealing with Insurance Companies
- I have a serious illness. Can I be turned down for coverage or will it cost me more than a "healthy" person?
In the State of New York, an individual cannot be turned down for health insurance or charged more for health insurance because of illness or health condition. However, if you have a "pre-existing condition," insurance plans have the right to not pay for care related to that condition for a period of up to one year. A pre-existing condition is defined as any condition for which medical care was received or recommended in the six months preceding your enrollment in the insurance plan.
Health reform legislation signed into law in March 2010 provides for the creation of health insurance plans for individuals with pre-existing conditions. In New York State, this new program is called the NY Bridge Plan and is administered by GHI. Call 1-866-693-9277 for more information.
- Will insurance pay for alternative or complementary treatments (e.g., acupuncture, massage therapy, etc.)?
In general, insurance coverage for alternative or complementary care is limited, but it depends on the specific insurance plan and on the specific type of treatment in question. Some insurance plans will cover certain alternative services; other plans provide the option of buying additional coverage (known as a rider) to pay for alternative treatments; and still other plans may offer discounts through specified providers. Do not assume what your insurance plan will or will not pay for in regards to alternative care. Call the member services number of the insurance plan to find out for certain.
- If I have a problem with my health insurance company, where can I turn for assistance?
The Empire Justice Center is a statewide, nonprofit law firm that works to improve the quality of life of low-income New Yorkers. It is a member of the Community Health Advocates Network which helps people who encounter problems accessing health care coverage or services. (888-614-5400)
The Consumer's Guide to Handling Disputes with Your Employer or Private Health Plan, provided by the Kaiser Family Foundation, may a lso be of some assistance. This guide will direct you in how to understand your insurance, get a referral if needed, and how a consumer can appeal to the insurance company.
The New York State Department of Financial Services is in charge of insurance regulation in the state. (518-474-6272).
The New York State Attorney General's Office protects and advocates for the rights of all health care consumers statewide. The Bureau operates a toll-free Health Care Helpline that assists New Yorkers with individual problems. To file a complaint by phone call the Health Care Bureau's Helpline at 1-800-771-7755 (Option 3); Fax a written complaint to 518-402-2163.
5. Living Expenses
- Veterans may be eligible for benefits through the Veterans Administration. (800-827-1000).
- Residents of Tompkins County dealing with chronic illness of any kind may apply to the Small Comforts Foundation for funds to purchase an item that will raise their morale or quality of life. Examples include room air conditioners, TVs, shower chairs, and talking wrist watches. Grants are limited to $250.
- The Samaritan Center of Catholic Charities (272-5062) provides referrals and assistance with emergency financial support to low income residents with urgent needs.
- Information and Referral (Call 211 or 272-9331) has up-to-date information on all human service programs available in Tompkins County.
- Special funds for Specific Diseases:
The Cancer Resource Center of the Finger Lakes's "Just a Little Breathing Space" Progam can provide $25 gift cards (Tops, Wegmans, or WalMart) for a person undergoing cancer treatment which can be used for medication, gasoline, food, or any other need.
The American Cancer Society offers a stipend of up to $100 for patients with the greatest need for assistance with transportation costs. Patients may call 800-227-2345 to begin the evaluation process.
The Leukemia and Lymphoma Society (716-834-2578) provides a limited amount of financial assistance to help patients with significant financial need and who are under a doctor's care for a confirmed blood cancer diagnosis. (Maximum of $100 per year).
Cancer Care provides excellent links to a variety of financial resources for persons dealing with cancer (1-800-813-4673).
For additional assistance, please contact the Cancer Resource Center
at 277-0960 or firstname.lastname@example.org.
(updated October 11, 2012)