Getting Health Insurance When You Have Lupus
Health insurance is important for everyone. But for people with lupus — or anyone who needs more frequent medical care — it’s especially important to have health insurance to help lower your overall health care costs.
If you have lupus, it’s a good idea to learn about how health insurance works, try to choose a plan that will work best for you, and know what to do if you lose your health insurance coverage.
About Health Insurance
Health insurance helps to cover the cost of medical care. When you have health insurance, the insurance company is agreeing to pay for some or all of the cost if you get sick or need health care.
It’s important to know that even with insurance, most people still have to pay for some of the cost of their health care themselves. Still, having health insurance coverage is one of the best ways to make your care more affordable.
Finding Coverage
If you don’t have health insurance, getting coverage is one of the best things you can do to protect your health and protect you from unexpected high medical costs.
There are many different types of health insurance plans available. The type of coverage you can get will depend on several things, including:
- Whether you have a job, and if your job offers health insurance
- Your age
- Where you live
- Whether you’re in the military or are a Veteran
- Your income
- Whether you’re a United States citizen
Types of health insurance that you may be able to get include:
- Employer-sponsored insurance — One of the most common ways to get insurance in the United States is through a job. Employer-sponsored insurance often will cover the employee and their family members, such as a spouse, partner, or children.
- Medicare — This is a federal program that provides insurance for people over age 65 or for people who have disabilities — including disabilities from lupus.
- Medicaid — This is a program funded by the federal and state governments that provides insurance for people with low incomes or disabilities. Each state sets guidelines for who qualifies for coverage through Medicaid.
- Insurance through the Health Insurance Marketplace — You can use the Marketplace to compare insurance plans, buy a plan, and find other resources for paying for health care.
- Children’s Health Insurance Program (CHIP) — If you have children, you may be able to get them health insurance through CHIP. Like Medicaid, CHIP is a partnership between the federal and state governments that provides insurance coverage for children. In some states, CHIP provides coverage for pregnant women too.
- Insurance options for Veterans and active duty service members — These include VA Health Benefits for Veterans and TRICARE for active duty service members.
Keep in mind that Medicaid and CHIP programs in your state may go by a different name. You can look up what your state’s programs are called.
Our health insurance guide can help you understand your insurance options and choose a plan.
There’s a lot to know about health insurance, and it can be hard to understand all your options for getting covered. That’s why we created a Health Insurance Guide for People With Lupus — to help people with lupus and their caregivers navigate insurance and paying for their care.
It covers health insurance basics, lupus-specific considerations for health insurance, ways you can advocate for yourself or your loved one, and other ways to pay for your care.
Read our full Health Insurance Guide for People with Lupus.
What to do if You Lose Coverage
Losing health insurance coverage — for example, because of losing a job — can be extremely stressful. But there are steps you can take to regain coverage. You can:
- Check to see if you’re eligible for coverage under Medicare or Medicaid — programs that provide insurance for people over age 65, who have low incomes, or who have disabilities.
- Use the Health Insurance Marketplace to shop for a new plan and find other resources for paying for health care.
And, if you lost employer-sponsored insurance, you may be able to get covered again through COBRA (Consolidated Omnibus Budget Reconciliation Act). This law makes it possible for you to keep the same health insurance plan that you had through your employer.
Through COBRA, you can keep your coverage if you pay the full cost of the plan’s monthly premiums. This generally costs more than you were paying before, because employers typically help cover some of the cost of the premium. But, even though it’s expensive, COBRA can help you stay insured temporarily (usually up to 18 months) until you can find another insurance plan.
If you lose your health insurance and you’re not sure what to do, talk to your doctor. They may be able help you navigate finding coverage or offer other support, like reduced rates on their services while you’re uninsured.
Learn More
There are many resources that can help you navigate health insurance and learn about other ways you can manage your health care costs.
Check out these resources to learn more about insurance and health care costs specifically for people with lupus:
- Health Insurance Guide for People With Lupus
- Your Guide to Lowering Health Care Costs
- Your Guide to Managing Finances
To find local resources to help with health care expenses, call 2-1-1 or visit 211.org/get-help/healthcare-expenses.
Visit these pages to learn more about state and federal health insurance programs and find out whether you qualify:
- Medicare
- Medicaid
- Children's Health Insurance Program (CHIP)
- Medicaid and CHIP program names in your state
You can also:
- Get tips for using the Health Insurance Marketplace — it’s where you can shop for or compare insurance plans
- Find out more about COBRA insurance — it lets you keep your group health insurance for a limited time if you lose your job
- Learn about the Affordable Care Act — a law that sets rules for health insurance in the United States