I need a little help getting my head around what just happened with my health insurance.
For a little background, I signed up on the Marketplace late last year to start coverage on Jan 1. So I'm a little new to this but thought I'd figured it out mostly. We worked through some early kinks with a subpar insurance provider and are currently on an affordable plan that we like, that has the doctor we want in network. Seemed pretty hunky dory.
My wife is pregnant, but we didn't know until February (after I had enrolled). I can't remember if I'd ever disclosed this to the Marketplace but as far as I knew, I wasn't supposed to add a dependent or report a life change until after birth.
The hospital called to ask us to make our payment for her delivery costs (basically the entire deductible) ahead of time. They told us what our coinsurance would be after the deductible, and it was higher than I thought it would be.
I reviewed our finances and discovered that if we were to double our IRA contribution, we'd qualify for significant cost sharing that would both lower our deductible and reduce our coinsurance afterward significantly. Seemed like a slam dunk.
SO I go online to the Marketplace and report a "life change" --- since a change income of only $2000 is considered a "life change." I didn't realize it'd basically be resubmitting the entire application again but I chugged through it.
I get to the end and I see that my premium tax credit has been reduced by almost 2/3s. No clear explanation WTF is going on. Panic ensues. I called the Marketplace and was told that my wife qualifies for Medicaid, so she can't be on the same plan anymore. Profanity ensues.
I said that I liked our current plan, our preferred doctor is on the plan, my wife is due in a GD month is there anyway around this? (no.) I asked if I hadn't tried to change anything (I was working towards a "let's just delete that recent change" approach) would I have been penalized after the fact? (answer wasn't really clear.) I wasn't told explicitly that the pregnancy should have been reported but that seemed to be implied. I was told that I could appeal the decision. I was also told that after the birth I'd need to submit another application to get coverage for the child and that he may end up back on my plan. So if I understand correctly, my wife qualifies for Medicaid for the next ~40 days that she's pregnant, after which she might be transferring back to the same plan I'm on. Unless I appeal, which could take so long that by the time that's resolved, she's no longer pregnant and the ridiculous situation is moot. When I tried to get confirmation of this I was simply told that the Medicaid rules differ state to state. Holy ____ ____.
I was told that Medicaid would contact us to confirm my wife's eligibility. I *think* I was told that until she's on Medicaid she'd still be on my plan.
I don't understand any of this. I thought as my spouse, on a joint return, that our income would exceed Medicaid eligibility. Apparently when someone's pregnant that is not the case? This might be further complicated because Louisiana inaugurated a new governor who reversed the previous governor's decision not to take the Medicaid expansion. That would have taken place after we were enrolled. Not sure if that's playing a factor, but bottomline, I don't like being denied a choice to keep the insurance that we spent months getting settled into and want to understand if I have any option other than some (likely hopeless) appeal.
Now before the flame throwers get pulled out, I completely understand that this will probably *save us money.* That's not the point. Pregnant ladies don't like the rug pulled out from under them a GD month before the due date. I'm learning this very emphatically. A precursory check indicates that she wouldn't be able to keep her current doctor or even use the same hospital we'd settled on.
Has anyone run into a situation remotely close to this? Looking for suggestions on how to steady this rocking boat.