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Aleutians East Borough Health Insurance

Facts and Figures

  • Insurance
    Carriers
    13
  • Number of
    General Doctors
  • Number of
    Hospitals

Insurance Carriers

State Government Insurance Programs Offered

Alaska Comprehensive Health Insurance Association (ACHIA)


"Offers 6 different comprehensive PPO plans with different deductibles. Offers one traditional non-PPO plan paying 80% of the allowed charges after the $1,000 annual deductible is satisfied. After deductible and out-of-pocket maximum have been satisfied, ACHIA will pay claims at 100% " Must be a U.S. citizen or legal resident living in Alaska and at least one of the following: 1) You were rejected for health insurance in the last 6 months, or received restrictive riders that reduced coverage, or 2) You have a qualified pre-existing condition, or 3) You had exhausted COBRA, are uninsured, not eligible for any group coverage from private or public sources (e.g. Medicaid, Native Health Care, etc.), and you were covered under a group health plan in the prior 18 months with no break of more than 90 days, or 4) You are receiving Trade Adjustment Assistance (TAA). comprehensive PPO plans with different deductibles. Offers one traditional non-PPO plan paying 80% of the allowed charges after the $1,000 annual deductible is satisfied. After deductible and out-of-pocket maximum have been satisfied, ACHIA will pay claims at 100%

Pre-Existing Condition Insurance Plan (PCIP)


Inpatient and outpatient hospital services, physician services, prescription drugs, skilled nursing, home health, hospice, chemotherapy, anesthesia, prosthesis, durable medical equipment, x-rays and laboratory services, oral surgery, physical therapy, substance abuse treatment, mental health services, ambulance, maternity, PKU formula, Pap smear and mammograms. Pre-Existing Health Conditions Covered Must have been uninsured for at least 6 months prior to applying. Must prove being a U.S. citizen or legal U.S. resident, an Alaska resident, and having problems getting insurance due to a pre-existing condition.

Medicaid


Inpatient and outpatient hospital services, Mental health and substance abuse care, Rural health clinics, Nurse, Midwife, Dentist, Optometrist, Physician care, Prescription drugs, Physical therapy, Medical equipment and devices (prosthetics, eyeglasses, dentures, etc.), Preventive care and diagnostic services, Family planning, Labs and x-rays, Home health services (such as nursing services, home health aides). Must be U.S. citizen or qualified alien and Alaska resident. Income limits: Family: 185% FPL. Working disabled: 250% FPL. Aged, blind, and disabled: Singles with incomes up to 109% FPL and asset limit of $2,000, and couples with incomes up to 120% FPL and asset limit of $3,000.

Denali Kid Care


Prevention and treatment services such as: Doctor's visits, Check-ups and screenings, Vision exams and eyeglasses, Dental checkups, Cleanings and fillings, Hearing tests and Hearing aids, Speech therapy, Physical and Mental health therapy, Substance abuse treatment, Chiropractic care, Foot doctor’s services, Hospital care, Laboratory tests, Prescriptions, and Medical transportation. Pre-Existing Health Conditions Covered Must be a U.S. citizen and Alaska resident. Income limits: Children 0–18 with health insurance: 150% FPL. Children 0–18 with no health insurance: 175% FPL. Pregnant with proof of pregnancy from your health care provider with or without health insurance: 175% FPL.

Chronic and Acute Medical Assistance (CAMA)


Prescription drugs and medical supplies, limited to 3 prescriptions per month and no more than a 30-day supply of any drug. Physician services which are directly related to the medical condition that qualifies you for CAMA. Chemotherapy and radiation services for a recipient with cancer requiring chemotherapy, if provided in an outpatient setting. Outpatient laboratory and x-ray services. Pre-Existing Health Conditions Covered Guaranteed Coverage Must be a U.S. citizen or legal alien and resident of Alaska, and have one of following: a terminal illness; cancer requiring chemotherapy; chronic diabetes or diabetes insipidus; chronic seizure disorders; chronic mental illness; chronic hypertension. Must have no other resources to meet the health care you need. Income limit per household: At or less than $300 a month for one person. At or less than $400 a month for two people. Add $100 for each additional person. You must have $500 or less in countable resources that could be used to pay medical bills: cash, bank/credit union accounts, or personal property. CAMA does not count your home, one vehicle, income-producing property, property that is used for your job (boat, fishing gear, etc.), or a fishing permit

Indian Health Services (IHS)


IHS services are provided directly and through tribally- contracted and operated heal programs. From private care sources, tribal health program purchase services for Native American patients in areas where IHS facilities or services are not readily available. IHS-funded, tribally-managed hospitals are located in Anchorage, Barrow, Bethel, Dillingham, Kotzebue, Nome and Sitka. There are 37 tribal health centers, 166 tribal community health aide clinics and five residential substance abuse treatment centers. Pre-Existing Health Conditions Covered. Guaranteed Coverage Must exhaust all private, state, and other federal programs. Must be regarded by the local community as an Indian; is a member of an Indian or Alaska Native Tribe or Group under Federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; any other reasonable factor indicative of Indian descent; is a non-Indian woman pregnant with an eligible Indian’s child for the duration of her pregnancy through post-partum (usually 6 weeks); is a non-Indian member of an eligible Indian’s household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

Medicare


A federal health care system that provides coverage to America's seniors (aged 65 or older) or those under 65 but with a disability or end-stage renal disease. Medicare has 4 parts: Part A which covers hospital care is free of charge; Part B covers medical care. Members need to pay for Part B coverage at a minimal cost. Part C is a combination of the coverage of Parts A and B which members can purchase from Medicare-approved private insurers. Part D covers prescription drugs which are also purchased through private insurance companies.

Health Coverage Tax Credit


Inpatient and outpatient care (lab tests, x-rays, etc.), Doctor visits, Preventive and major medical care (surgery, physical therapy, Durable medical equipment, etc.), Mental health and substance abuse care, and Prescription drugs. Guaranteed Coverage Must be receiving TAA (Trade Adjustment Assistance), or Must be 55 years or older and receiving pension from the Pension Benefit Guaranty Corporation (PBGC). Must not be enrolled in certain state plans, or in prison, or receiving 65% COBRA premium reduction, or be claimed as a dependent in tax returns. Must be enrolled in qualified health plans where you pay more than 50% of the premiums.

Heath Care Reform

Through tax credits, small business owners can provide their employees with health insurance coverage without needing to spend so much on their premiums.

Medicare members who fell to the Medicare gap can expect to receive a rebate check of  $250.

Early retirees who are waiting to be eligible for Medicare can be assured of continued coverage because of a $5 billion support for health plans providing early retirement coverage.

Federal funding for Medicaid is now an option for Alaska.

The health care reform gives a $1.5 billion fund for scholarships for health care providers working in areas where there is a scarcity of medical professionals.

Funding is also provided for Community Health Centers in Alabama as well as for creation of new ones. This should make available health care to more residents.

Uninsured residents with pre-existing condition can now have coverage through a transitional high-risk pool. This is in preparation for 2014 when the health care reform’s provision that will prohibit insurers from denying coverage to applicants with a pre-existing condition.

Children until the age of 26 can stay on their parent’s policy as dependents regardless if they are still students, working (for as long as their employer doesn’t offer health insurance benefits) or still living with their parents.

No more lifetime limits on health plans. Annual limits will also be strictly regulated.

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