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Health insurance costs month to month (medicaid/enrollment/etc)

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rated:
Sorry for the topic title. I'm not really sure how to summarize my situation in a blurb - but I'm hoping some people can share their knowledge...

The basic story is that I am trying to save several hundred $$$ a month by not paying for private insurance and only using the state's "Medicaid".
But - I have concerns as to what might happen if I become ineligible (for a short period) for the medicaid?

Details:

I've been unemployed since the end of last year and didn't carry any health insurance for me and the family for about a month.
I got coverage from the Marketplace to start in January of this year and have been holding that for the past 3 months.
The coverage is horrible though, it costs be about hundreds a month (that is with the tax credit) - and the deductibles are through the roof (something like $10,000).
There aren't really any co-pays or anything either, so I'm essentially paying out of pocket for all our health care needs until we reach several thousand dollars.

Now, my income from unemployment just dropped again and so we have become eligible for the state sponsored (free) healthcare
So I could call up my current provider and drop them effective today and use the state healthcare.
The problem is that I could lose the state healthcare if I become ineligible...for example - if I happen to get too much income (say in a side job) next month, then for that month I would be ineligible.

If I cancel my current insurance and my state insurance gets cancelled (or revoked temporarily), then I am completely uncovered.

On the one hand - I don't see this is a huge concern because as it stands now I'm already paying for all our visits because the deductible is so high.
OTOH - if I have no coverage at all, won't I be subject to the non-negotiated rates from the doctors/hospitals?

A relatively simple doctor visit with some labs could cost say $300-400 easily with the rates negotiated by my provider.
But, if I am totally uninsured - couldn't they cost much more?

I really don't understand the current state of purchasing health care, as the marketplace made it sound like I could only enroll at the beginning of the year (open enrollment).
Is there anything to stop me from purchasing new coverage again at any time?

In short - my idea is to stop paying for private insurance and just have the state medicaid. †But I'm concerned as to what happens if I become ineligible (temporarily) due to an income too high to qualify or some other unknown factor.

Anyone have knowledge or experience of this?

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rated:
https://www.healthcare.gov/glossary/qualifying-life-event/

There are 4 basic types of qualifying life events. (The following are examples, not a full list.)

Loss of health coverage
Losing existing health coverage, including job-based, individual, and student plans
Losing eligibility for Medicare, Medicaid, or CHIP
Turning 26 and losing coverage through a parentís plan

rated:
Ok - thanks for that - but logistically, I'm not sure that solves all the problems.

For example, let's say I'm on the Medicaid plan at the beginning of May.
We go to the doctor and rack up say $1500 in bills on 5/1.
Later in the month of May I earn $1500 on a side project.
Because my monthly income exceeds the Medicaid eligibility, they tell me that my coverage for May is revoked.

So my Medicaid claim might be denied. If I keep my private insurance then at least it would be processed under the negotiated rates, even if I still need to pay $1500 (it is probably better than the $4000 of non negotiated rates, right?).

I really feel it is a waste to spend hundreds of dollars on private insurance when I can get the Medicaid - but I'm worried as to what happens if the Medicaid goes ineligible.

Am I crazy here or do I have a concern?

rated:
Do you have any assets to protect? That's the point of health insurance. If 10k would bankrupt you as easily as 100k I'd seriously consider going uninsured.

rated:
TravelerMSY said:   Do you have any assets to protect? That's the point of health insurance. If 10k would bankrupt you as easily as 100k I'd seriously consider going uninsured.
Yes - I have assets to protect.
But I'm concerned more than the worst case scenario of a horrible accident that costs hundreds of thousands.

Is the only option to keep the private insurance.?

From the way the state explains it, I will present both my insurance cards to the provider and anything my private insurance doesn't cover will then be submitted to medicaid.
So if I have a $500 visit, my private insurance won't cover that because the deductible isn't met - so the doc will then submit that to the medicaid, which will probably cover it.

I just feel it is a waste to pay hundreds for the private when the medicaid (when eligible) should cover all this.

I can't be the first person in a scenario like this, but its hard to find real world experience...

rated:
Do you expect to have healthcare costs in any given month? Or is this more of a 'what if' scenario?

Is it likely your income will be intermittent and that you are likely to have periods in and out of medicaid eligibility?
You said : " if I happen to get too much income (say in a side job)" That too sounds more like a 'what if' scenario.

rated:
FoolishGold said:   Later in the month of May I earn $1500 on a side project.

I think this is where you're thinking is flawed. I have a flavor of Medicaid. My eligibility is determined once per year via tax data. I can spike by the month with no loss in coverage.

​I think you also need to†think about splitting up your family.††All members alone so that what happens to you won't affect the kids or the wife, and what happens to the wife won't hurt you or the kids, and I doubt the kids will be making enough money anytime soon to affect either of you.
††

rated:
I am†in a generous state where most people playing the numbers receive no-cost gov insurance and do not pay co-pays.

However, what is a little surprising is there is a free after 5PM clinic with rotating real medical doctors not far away with little waiting because most people already have primary care set in place.

The doctors in the clinic are expert at prescribing generic†meds that are very low cost.† Unlike primary care doctors, they are very savvy about planning medical care for little or no cost.

So my suggestion to save money is to see if you have a free clinic that might replace your traditional primary care.

rated:
Chyvan said:   
I think this is where you're thinking is flawed. I have a flavor of Medicaid. My eligibility is determined once per year via tax data. I can spike by the month with no loss in coverage.

​I think you also need to†think about splitting up your family.††All members alone so that what happens to you won't affect the kids or the wife, and what happens to the wife won't hurt you or the kids, and I doubt the kids will be making enough money anytime soon to affect either of you.
††

††
I think your statement about splitting up the family is preposterous - but I did call to confirm and spoke with another rep who cleared things up.
While they do ask for your "monthly" income - it is based somewhat on yearly income.

Basically, as long as your income is under the prescribed amount when you apply you are eligible for the services.
As soon as your income will place you above the amount, you need to contact them to let them know the income.

Then, your coverage will be cancelled after a short grace period and they will not retroactively cancel your coverage.

Example:
In January I have no job and no income. I apply and get accepted to the Medicaid.
I use the services until October and they cover $xxx amount of medical care for me.
In November I get a job (or win the lotto) and receive income checks in the amount of $15,000 (or whatever the ineligibility threshold is).
I notify the state and they will say that my coverage will end in 10 days because I am no longer eligible.

At this point I would need to go and seek private insurance again through the "qualifying life event" of losing Medicaid eligibility.

So - in short it looks like I am safe to cancel my private insurance as it isn't doing me much good with the Medicaid.

Upon cancelling my insurance I found out that Marketplace plans won't cancel immediately (or allow a retroactive cancellation). The earliest they will terminate a policy is 14 days after notifying. AND you are responsible to pay the premiums for those 14 days even though you no longer want the insurance. I've never had this pre-marketplace when cancelling private insurance (which I've done at least 2 other times in my life). What a BS rule with absolutely no logic behind it other than to milk another 2 weeks of premiums.

My bill is currently due for April - what will happen if I just don't pay?

rated:
FoolishGold said:   My bill is currently due for April - what will happen if I just don't pay?
††
Same thing that usually happens when you don't pay bills.

They send it to collections and it hurts your credit.


rated:
FoolishGold said:   
Chyvan said:   I think you also need to†think about splitting up your family.††All members alone so that what happens to you won't affect the kids or the wife, and what happens to the wife won't hurt you or the kids, and I doubt the kids will be making enough money anytime soon to affect either of you.
††
I think your statement about splitting up the family is preposterous


You may have misunderstood: I think that Chyvan did NOT mean splitting up your family as in getting a divorce, but simply "splitting up" the medical insurance coverage for your family -- some people do that and it's been mentioned often on FW.

I recall that there is a frequent FW contributor from Oregon who has his children on his state's Medicaid coverage for kids, and I think he and his wife are on a Marketplace plan and/or an employer plan, maybe together, maybe separately.

.
FoolishGold said:   
but I did call to confirm and spoke with another rep who cleared things up.


It's a good idea for you to call and speak to someone about your specific situation. Medicaid and marketplace insurance rules do vary quite a bit by state.††

.
FoolishGold said:   
While they do ask for your "monthly" income - it is based somewhat on yearly income.
Basically, as long as your income is under the prescribed amount when you apply you are eligible for the services.
As soon as your income will place you above the amount, you need to contact them to let them know the income.


I am not positive, but I think that in my reading about marketplace insurance, the reporting rules on income changes might be a little different than that advisor told you.
(Or maybe that advisor was helping you with your state's Medicaid, and not giving you information about your state's marketplace plan. Or maybe that's how your state's marketplace plan deals with income fluctuation, either officially or unofficially.)

I think that it's been pointed out that one of the problems with marketplace insurance is that people can be in a situation of needing to go on and off it several times during a year due to their income fluctuation -- I have read some information on the KFF.org FAQ about marketplace insurance to that effect.

It sounds like you've already given up your marketplace insurance, but if you want detailed info on it (at least what the rules were prior to January of this year), I would suggest you read the whole KFF.org FAQ about it -- it's long and detailed, addressing many common questions.

====
I have not studied in depth everything that you've written, but some other things that I would think about are:

1. If national and state laws change in this calendar year on Medicaid, on marketplace insurance, or on both -- which it's possible that they might (since that is what the country's leadership wants) --

Which program are you more likely to be kicked out of or priced out of, if rules and regulations change and become less generous/less consumer-friendly?

Which program would it be best for you to be in at the end of 2017, in terms of rolling your family over easily to their 2018 coverage, whatever that will be?

2. If they change the rules on pre-existing conditions (which some folks in Congress dearly want to do), but they make it so that anyone who has held insurance in the past continuously for x-number of months can still have their pre-existing conditions covered -- especially given that last year, your family already went 1 month without coverage, starting the clock for them --

Which type of plan would it be best for you to be in now, in order to jump through that possible future hoop, and do all that you can to keep your pre-existing conditions covered?

Will the possible changes in the law penalize people who move from Medicaid to marketplace insurance in the future, in terms of counting their pre-existing conditions against them (because they had not kept coverage of "retail" insurance in the open marketplace, or some kind of slippery exclusion like that)?

How could this affect your current potential decision not to pay your marketplace plan for the last month of it -- would that re-start the clock for your family in terms of spending some time this year not "officially" being under any insurance plan at all?

3. Every state seems to have different rules and procedures for moving from Medicaid to a marketplace plan - I think some take up to 2 months to start coverage, while some are retroactive, etc. I think that the country's leadership possibly changed the rules on this in January, but I'm not sure. You need to learn exactly how this works in your state, because your family might be facing a 2-month wait to start on a marketplace plan if your income puts you beyond the scope of your state's Medicaid program.

Again, that might be a situation where you decide it's best for your kids to simply stay on the state's Medicaid plan for the rest of the year while you and your wife wait out one or two months of having no coverage until you can get on the marketplace plan.

----
I don't know how this works exactly, so I'm not saying that is the way it will be, or if these options are even possible.
I am just saying that these are some of the considerations that I would want to know the answers for, for my particular state, before changing insurance plans after the open enrollment period.

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