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Health Insurance Advising for Nurses
Susan J. Penner, RN, MN, MPA, DrPH, CNLSchool of Nursing
University of San FranciscoJuly, 2010
Formal and informal advising
• Whether you’re a student nurse, an RN, a CNL or other nurse specialist...
• Patient and patient families have questions about their health insurance
• So do your own family members, friends and neighbors
• People trust their nurse!
California and across the US
• Some insurance advising programs have federal mandates and sponsorship
• Some programs are unique to states and even to local administration
Elderly, younger adults and children
• Programs and eligibility varies across age groups
• Medicare, COBRA and CHIP
• Everyone’s confused and concerned about their benefits
Where to start?
You don’t need the answers, just the resources!
Advising the elderly
California:• Health Insurance
Counseling & Advocacy Program (HICAP): 1-800-434-0222 free Medicare counseling available at California senior centers
• CA Health Advocates website provides information and locations of counselors for HICAP
US:• Health insurance advising
programs sponsored by the Administration on Aging (AoA)
• Use the Eldercare Locator to find Area Agencies on Aging and state aging departments for program information and locations of counselors
Advising non-elderly adults
California:• California Continuation
Benefits Replacement Act (Cal-COBRA) extends COBRA-like benefits to employees and dependents of firms of less than 20 employees
• County Organized Health Systems link families and individuals with managed Medi-Cal plans
US:• Consolidated Omnibus
Budget Reconciliation Act (COBRA) extends benefits after losing a job
• The Patient Protection and Affordable Care Act of 2010 extends coverage of many dependent adults up to age 27
• State and local health departments have information on additional programs
Advising children and teens
California:• Healthy Families
provides coverage for eligible children and teens
US:• Children's Health
Insurance Program (CHIP) has reduced eligibility restrictions with health reform and the Obama Administration
More help for your patients
• Social worker
• Discharge planner
• Case manager
More changes on the way...• California Managed Risk
Medical Insurance Board expect to begin temporary high-risk coverage for people denied insurance due to high-risk conditions in Sept. 2010—sign-up begins July 2010
• Patient Protection and Affordable Care Act of 2010 will be implementing regulations for health insurance coverage affecting all Americans
For more information about health care finance...
• CNL Health Care Economics and Finance 101 wiki• Resources for nursing students at USF
– Budgeting and other financial topics– CNL exam review for financial topics– Updated information and resources
• Developed by CNLs from the USF School of Nursing• If you’re not in the USF system, e-mail:
