Help understanding ACA, subsidies, and Medicaid/CHIP

[iluvzbeach]

I believe lhamo posted this up thread, but why don’t you go by the office of an insurance broker who can help you with this? There should be multiple brokers locally who can get you signed up, in-person, in a single setting. This would happen at no cost to you.

[frugalnacho]

Sounds like a mess.  There is fee for service Medicaid (aka straight) and Managed Care Medicaid.  Very few doctors take fee for service around me.  I have like 8 different Managed Care Plans, each plan has its own Provider network.  Each MCO plan should have a web site to create a sign on with and look at your account, change PCPs, examine claims. 

Since we are still in a PHE (public health emergency) no one loses coverage right at least through April.  They will decide in April whether to add another 90 days.

Yes this sounds the same as mine.  It's a bit confusing because they sent a fee-for-service handbook which explains it a bit, but the first line of the letter they sent me says "You or your family members must join a Medicaid health plan in order to receive Medicaid benefits."

It's still unclear to me how to find a doctor or facility that accepts straight medicaid, other than individually call each one that accepts one of the health plans.

Priority Health Choice was the best rated plan out of the 8 choices I was given.  I was able to find a pediatrician with very good reviews close by, and a general care physician for my wife and me, if I'm understanding it correctly.

I already tried to create an account directly with priority health choice using my mihealth number.  They said they will review and get back to me in 2 business days...so by Monday I guess?

[seattlecyclone]

My experience in Washington was they said "we have five plans available, we picked an arbitrary one on your behalf to start. Feel free to switch any time effective the first of the next month." Seems to make more sense than having a sixth plan that they don't really want anyone to use but that you'll nonetheless be on until you choose otherwise.

[frugalnacho]

I believe lhamo posted this up thread, but why don’t you go by the office of an insurance broker who can help you with this? There should be multiple brokers locally who can get you signed up, in-person, in a single setting. This would happen at no cost to you.

I didn't anticipate this much trouble and thought it could get resolved online.  But at this point I think I just have to wait until February, then call MI Enrolls back and tell them the plans I want and the doctors we want and verify they are in the plan and accepting new patients. 

My experience in Washington was they said "we have five plans available, we picked an arbitrary one on your behalf to start. Feel free to switch any time effective the first of the next month." Seems to make more sense than having a sixth plan that they don't really want anyone to use but that you'll nonetheless be on until you choose otherwise.

And also there isn't a list of providers that accept the 6th plan, you just have to call them all up and ask. 

I wonder if she is wrong because that seems so crazy I feel incredulous.

[lhamo]

I'm sorry to keep beating a dead horse but is there some reason why you have not tried to get in touch with a healthcare navigator as I have recommended multiple times?   Open enrollment has now ended and they should be easy to book appointments with compared to a couple of weeks ago.

I understand the DIY impulse, but in my case it cost me several thousand dollars before I figured out the benefit of working with a navigator.  They have saved me more than 10x that since.   They are paid by the system and cost you nothing out of pocket.  Save yourself the stress and trouble and call one tomorrow.

[frugalnacho]

I'm sorry to keep beating a dead horse but is there some reason why you have not tried to get in touch with a healthcare navigator as I have recommended multiple times?   Open enrollment has now ended and they should be easy to book appointments with compared to a couple of weeks ago.

I understand the DIY impulse, but in my case it cost me several thousand dollars before I figured out the benefit of working with a navigator.  They have saved me more than 10x that since.   They are paid by the system and cost you nothing out of pocket.  Save yourself the stress and trouble and call one tomorrow.

Because it's been in the works now for a couple weeks and didn't seem necessary.  Once my application went through it seemed like a done deal.

Does it even make sense to call at this point?  I'm locked out of doing anything online and a navigator won't be able to get me access.  My application is approved and I have my cards.  I just need to pick specific plans and I can do that via phone in February and I know which plan we are going to do and which doctors to choose. 

[jim555]

With fee for service you need to call each Provider to verify if they take it.  Doctors move around MCO plans so I had to change plans to keep the doctors I have.

[JGS1980]

PTF

[frugalnacho]

So this is pretty cool.  I timed my resignation to get my last paycheck in January so my February income would be $0 so I could qualify for medicaid.  I get my final paystub today, and my vacation time isn't paid out.  Apparently they will pay the vacation out in February for some unstated reason.  So now I will have no employer insurance in February, but will have enough income ($5k gross) to disqualify me from medicaid.

Now my plan is to just not use any medical services in February.  If we need to see a doctor we will try to negotiate uninsured rates.  If there is a genuine emergency I have 60 days to sign up for COBRA and have coverage made retroactive, but this will cost me about $1400/mo.

I went to my regular doctor this week and got all my prescriptions re written.  I can't get them refilled again before insurance expires, but I was able to take them to the pharmacy and use a goodrx coupon to get a 90 day supply of everything for around $30.  This should put my supply of medication lasting until mid to late June.  I should be able to figure out the situation before then. 

[jim555]

Since we are in a PHE you will not lose coverage no matter what your income.  The PHE goes through April, maybe more, they extend it in 90 day blocks.

PHE = Public Health Emergency

[frugalnacho]

Since we are in a PHE you will not lose coverage no matter what your income.  The PHE goes through April, maybe more, they extend it in 90 day blocks.

PHE = Public Health Emergency

Is that applicable to me since my 2021 tax return is going to show over $100K income, my January income was over $6k, and now my February income will be over $5k?

I signed up anticipating my income was going to drop to $0 in January.  They've approved me and sent me cards, but it's based on inaccurate information and I technically should not have been eligible yet.

[jim555]

Since we are in a PHE you will not lose coverage no matter what your income.  The PHE goes through April, maybe more, they extend it in 90 day blocks.

PHE = Public Health Emergency

Is that applicable to me since my 2021 tax return is going to show over $100K income, my January income was over $6k, and now my February income will be over $5k?

I signed up anticipating my income was going to drop to $0 in January.  They've approved me and sent me cards, but it's based on inaccurate information and I technically should not have been eligible yet.

If they are fully aware of your situation then I wouldn't worry about it.  No fraud or bad intent is involved.  Just make sure you have good docs to back it up if ever questioned.

I have reported over the line income and they keep me in.  Just keep reporting as required.