How to Solve Your Health Care Money Messes

“There are layoffs at work, and I might lose my medical coverage.”

Start Here: Ask your benefits department how long employer-sponsored medical insurance would last after a layoff. “Coverage varies by employer, but it often runs to the end of the month, though it may end immediately or last longer,” says Vincent Birardi, senior wealth adviser at Halbert Hargrove in Long Beach, California.

What comes next: Consider these three options, all of which are typically available as long as you sign up soon after you’ve lost your coverage. First, if you’re married and your spouse has ­employer-sponsored health insurance, you can enroll in your spouse’s plan within 30 days of being dropped from yours. Second, you can continue your employer’s medical coverage for 18 to 36 months under the law known as COBRA — you have 60 days to apply — but you would pay both your and your former employer’s share of the premium. Third, you can secure individual coverage — again, within 60 days — through the ACA’s Health Insurance Marketplace at healthcare.gov.

“I need a medical procedure that I can’t afford.”

Start here: If your insurer is denying coverage for part or all of your needed care, file an appeal. In 2023, people on Medicare Advantage plans succeeded in reversing prior authorization denials 82 percent of the time, while traditional Medicare users got a reversal in 29 percent of cases in 2022. And healthcare.gov insurance plan buyers saw a decision change in 44 percent of appeals, according to KFF, a nonprofit health policy research organization. Review your plan materials for appeal instructions and ask your medical provider for information that could help you challenge your insurer’s denial.

The government also offers several financial-assistance programs for Medicare enrollees that are underutilized, says Juliette Cubanski, deputy director of KFF’s Program on Medicare Policy. These include Medicare Savings Programs, which help pay for Medicare Part A and B expenses; the “Extra Help” program, which assists with Medicare drug coverage (Part D) costs; and Supplemental Security Income, which automatically enrolls you in Extra Help and usually makes you eligible for Medicaid. At shiphelp.org, Medicare users can get help with the appeal process and signing up for assistance programs.

If you’re not yet on Medicare, nonprofits like the Patient Advocate Foundation offer appeal guidance. Or you can try Counterforce Health, a free AI-based service at counterforcehealth.org that crafts customized appeal letters and gathers supporting research on your behalf. Consider applying for Medicaid too, as this state-administered program covers many medical costs for low-income households.