Augusta Healthcare for Women

General References

Health Insurance

Health care is expensive and few individuals can afford to pay the full costs. Having health insurance allows you to get the treatment you need without incurring huge medical bills.

Most Americans have private health insurance or participate in public programs, such as Medicare or Medicaid, but many Americans are uninsured due to finances and/or pre-existing conditions.

Under the Affordable Care Act, all Americans will be able to get health insurance regardless of income or health history. By October 2013, each state will have its own Health Insurance Marketplace, or "Exchange", with plans that offer comprehensive coverage.

Affordable Care Act

The 2010 Affordable Care Act will reform health insurance, over several years. Some new provisions are already in place; most changes will take effect by 2014. This law holds insurance companies more accountable, expands coverage for young adults, offers small-business tax credits, and provides access to insurance for uninsured Americans with pre-existing conditions.


States decide on the benefits provided under Medicaid, but Medicaid usually provides health care for low-income children and families, and people with disabilities.

Covered services usually include doctor visits, hospital care, vaccinations, prescription drugs, vision, hearing, long-term care, and preventive care for children.


Medicare is a government health insurance plan for people 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease. Medicare helps to pay for care in hospitals, skilled nursing facilities, hospice care, and some home health care. Coverage can also include doctors’ services and prescription drugs.

Replace Your Medicare Card – If your Medicare card is lost, stolen, or damaged, you can ask for a new one online.

COBRA: Keep Your Insurance If You Leave Your Job

The Consolidated Omnibus Budget Reconciliation Act (COBRA) can help you temporarily keep your health insurance even though you left your job. Eligibility for the program is based on the reason you left your job, and even if you get to keep your insurance, you may be required to pay the entire premium for coverage.

Health Insurance for Children: CHIP

The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for low-income children. Each state decides on the benefits provided under CHIP, but all states cover routine check-ups, immunizations, hospital care, dental care, and lab and x-ray services.

Free Vaccines for Children – Free vaccines are available for children younger than 19, who are medicaid-eligible, uninsured, underinsured, American Indian, or Alaska Native.

How to Appeal a Health Insurance Claim

If your health insurer has denied coverage for medical care you received, you have the right to appeal the claim, and ask that the company reverse that decision. You can be your own health care advocate. Follow these five steps:

  • Review your policy and explanation of benefits.
  • Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).
  • Request documentation from your doctor or employer to support your case.
  • Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company's internal review process.
  • If the internal appeal is not granted through step four, file a claim with your state's insurance department.

Reference: U.S. Government