One of the Problems with Health Care

[Deleted]

Since my DS has been having issues with seizures/kidney stones and is now living and working in a different county, we looked at moving his Medicaid down there.

Apparently, making minimum wage at McDonalds and working his 32 hours a week they cap him at so they don't have to offer benefits, he no longer qualifies for Medicaid. He has to have gross income below $1400 a month.

I told the worker this is what makes people quit working and go on welfare.

His alternative is to buy a policy on the exchange. When I looked into doing that, they all had $10K+ out-of-pocket requirements before the "insurance" paid anything. He's been in ER 5 times in the last 2 months. One more trip with "insurance" and he will be in debt for years.

So, how is anyone supposed to live on less than $1400 a month gross or pay that kind of OOP on his income? He can barely pay his rent/transport costs to work now and still buy food. And, his rent is well below market because he's renting from a family friend.

At this point, his new "job" when he gets back from the LPA convention this weekend is to save every dollar he can and fix his vehicle, so he can then start applying for every job he can find with health insurance.

They told us his Medicaid will stay active for 3 months, then they will likely cancel it unless he quits his job and moves home. They don't seem to care that the only access he has to therapy is where he is now living. 

So frustrating. 

[resolution]

He should look into the "cost sharing reduction" on the exchange. It should reduce his copays and his deductible if his income is below 250% of the federal poverty level ($31k for a single person).  It only works with silver plans, so have him enter his income and household size and then look at silver plants to see how much the out of pocket expenses are reduced. If he looks at bronze, gold, or platinum he won't get the cost sharing reduction and they will likely cost him more out of pocket than the silver plans.

If he can't get their system to show him the cost sharing reductions, there will probably be someone at the exchange he can call and talk to. California has its own system so its different than the other states, but they should still have some kind of assistance.

[Deleted]

Jun 27, 2019 9:19:03 GMT -5 resolution said:

He should look into the "cost sharing reduction" on the exchange. It should reduce his copays and his deductible if his income is below 250% of the federal poverty level ($31k for a single person).  It only works with silver plans, so have him enter his income and household size and then look at silver plants to see how much the out of pocket expenses are reduced. If he looks at bronze, gold, or platinum he won't get the cost sharing reduction and they will likely cost him more out of pocket than the silver plans.

If he can't get their system to show him the cost sharing reductions, there will probably be someone at the exchange he can call and talk to. California has its own system so its different than the other states, but they should still have some kind of assistance.

He has one option for coverage in the county he's currently living in. Just the premium is $445 a month. And, it still has a lot of out of pocket costs. He can't afford that. At all.

[resolution]

Jun 27, 2019 9:51:58 GMT -5 @rockhounder said:

Jun 27, 2019 9:19:03 GMT -5 resolution said:

He should look into the "cost sharing reduction" on the exchange. It should reduce his copays and his deductible if his income is below 250% of the federal poverty level ($31k for a single person).  It only works with silver plans, so have him enter his income and household size and then look at silver plants to see how much the out of pocket expenses are reduced. If he looks at bronze, gold, or platinum he won't get the cost sharing reduction and they will likely cost him more out of pocket than the silver plans.

If he can't get their system to show him the cost sharing reductions, there will probably be someone at the exchange he can call and talk to. California has its own system so its different than the other states, but they should still have some kind of assistance.

He has one option for coverage in the county he's currently living in. Just the premium is $445 a month. And, it still has a lot of out of pocket costs. He can't afford that. At all.

That sounds like the amounts before the advanced premium tax credit. Someone at his income level should have low premiums because they should be a percentage of his income. If you are looking at the amounts without entering his household size and income, try entering that info to see if it changes the rate. If it doesn't, he should get on the phone and talk to someone at the exchange to find out how to set up the advanced premium tax credit and cost sharing reduction.

[resolution]

I agree with you that the best bet is for him to find a job with insurance, but I'm just making suggestions on what to look for on the exchange in the mean time.

[adela76]

I agree with looking for another job, but in the mean-time, he only needs to cut his hours back slightly to stay under the income limit for Medicaid.  28 hours instead of 32.

It sucks and it's a broken system.  The law was theoretically intended to be beneficial to workers by requiring companies to offer health insurance to full-time employees.  Instead, it hits low-income people with a double-whammy of not being allowed to work full-time hours (without working multiple part-time jobs) AND not have health insurance.  

[jelloshots4all]

Jun 27, 2019 9:59:08 GMT -5 resolution said:

Jun 27, 2019 9:51:58 GMT -5 @rockhounder said:

He has one option for coverage in the county he's currently living in. Just the premium is $445 a month. And, it still has a lot of out of pocket costs. He can't afford that. At all.

That sounds like the amounts before the advanced premium tax credit. Someone at his income level should have low premiums because they should be a percentage of his income. If you are looking at the amounts without entering his household size and income, try entering that info to see if it changes the rate. If it doesn't, he should get on the phone and talk to someone at the exchange to find out how to set up the advanced premium tax credit and cost sharing reduction.

I don't know CA Ins laws at all, but my guess is his premiums are so high due to pre-existing conditions.  

I just purchased a "gap" policy on the exchange for my kids and I until I am eligible for my new companies Ins Sept 1.  I could have opted for COBRA, but that would have required I pay half of April, all of May-August at $1600 a month.  

I did research about the exchange before I had to elect COBRA, and found a great policy for $425/month for July and August.  HOWEVER, we have no medical conditions.  No questions were asked about my income nor did I offer it.  I'm sure if I did, the rates would have been triple. 

I hope I never have to test it over the next 2 months, but with it being summer, I didn't want to chance it as we are all active.  And I think the deductible is $1500, and office visits are $40 as well as Urgent care.

If you would like more info send me a message.  But it might be state specific.

Good luck!!  Yes Ins needs to be reformed (and I say this as I am negotiating my companies renewal options)

[Deleted]

Jun 27, 2019 18:46:31 GMT -5 adela76 said:

It sucks and it's a broken system.  The law was theoretically intended to be beneficial to workers by requiring companies to offer health insurance to full-time employees.  Instead, it hits low-income people with a double-whammy of not being allowed to work full-time hours (without working multiple part-time jobs) AND not have health insurance.  

Yeah and while I hate both parties in DC, I think a group against Obamacare mentioned this would happen when you mandated employers to provide coverage.  They also mentioned that exchange rates would skyrocket once the government dollars ended.  

So we knowingly wrote a law that would fail, then our representation voted on it to find out what all was in the 1000+ pages.  Should we be surprised it doesn't work (note the heavy sarcasm if it didn't come across).

[Deleted]

Jun 27, 2019 9:51:58 GMT -5 @rockhounder said:

Jun 27, 2019 9:19:03 GMT -5 resolution said:

He should look into the "cost sharing reduction" on the exchange. It should reduce his copays and his deductible if his income is below 250% of the federal poverty level ($31k for a single person).  It only works with silver plans, so have him enter his income and household size and then look at silver plants to see how much the out of pocket expenses are reduced. If he looks at bronze, gold, or platinum he won't get the cost sharing reduction and they will likely cost him more out of pocket than the silver plans.

If he can't get their system to show him the cost sharing reductions, there will probably be someone at the exchange he can call and talk to. California has its own system so its different than the other states, but they should still have some kind of assistance.

He has one option for coverage in the county he's currently living in. Just the premium is $445 a month. And, it still has a lot of out of pocket costs. He can't afford that. At all.

If he is under age 26, he can be on your family plan.  Is that cheaper?

[Deleted]

I have Medicaid and he is on my group for that currently. Since we were a household of 3 and all had low incomes, it worked out so he could work more and we all still qualified. 

I called them up today and they said they think they can get him the 93% Silver plan with his income and the subsidy would drop it down to about $100 a month with a bunch of co-pays, but at least not a ton of out-of-pocket. I don't think his health info will matter because it's an exchange plan, not sure.

This is his project for when he gets back from the convention this weekend. He needs to apply and see if it ends up being affordable or makes sense for him to change it. If they exclude his pre-existing conditions he may find himself moving back here so he can continue to receive care. 

[resolution]

They shouldn't be able to exclude his pre-existing conditions or charge him extra because he is signing up due to a qualifying life event (losing the medicaid).

[buystoys]

They don't exclude pre-existing conditions.  That is part of the reason the policies cost more.  The younger people are also paying part of the premium for the older people because there's a limit on how much the gap can be in policy costs.  Thirdly, the cost varies from county to county as does the availability of policies. 

Yes, it sucks.  I've bitched about it for years.

[resolution]

Jun 28, 2019 7:49:40 GMT -5 buystoys said:

They don't exclude pre-existing conditions.  That is part of the reason the policies cost more.  The younger people are also paying part of the premium for the older people because there's a limit on how much the gap can be in policy costs.  Thirdly, the cost varies from county to county as does the availability of policies. 

Yes, it sucks.  I've bitched about it for years.

Considering that he was born with a pre-existing condition, he wouldn't be able to receive coverage at all if it weren't for those rules.

[buystoys]

Jun 28, 2019 8:15:43 GMT -5 resolution said:

Jun 28, 2019 7:49:40 GMT -5 buystoys said:

They don't exclude pre-existing conditions.  That is part of the reason the policies cost more.  The younger people are also paying part of the premium for the older people because there's a limit on how much the gap can be in policy costs.  Thirdly, the cost varies from county to county as does the availability of policies. 

Yes, it sucks.  I've bitched about it for years.

Considering that he was born with a pre-existing condition, he wouldn't be able to receive coverage at all if it weren't for those rules.

I understand that, but what we have now isn't any better for him.  The OOP and max are so high he isn't likely to reach them.

Even a cost sharing silver plan means spending a lot on medical care. 

[NomoreDramaQ1015]

The problem is as I've noticed is that A LOT of clinics are now refusing to see patients without insurance unless you can pay 100% at the desk. We're talking full sticker price.

Some still offer payment plans but they set your bill no paying $5 a month for eternity like my MIL claims you can.

Or more often now they have credit cards you have to apply for and then you pay that off.

Even the ERs around here are hocking credut cards before you can walk out the door.

I agree the insurance plans on the exchange can be crappy but in this country you are still way better off with even a shitty insurance plan than without one all together. It gets you in the door and you get the negotiated rate.

It really is a crappy situation where the patient is always the loser.

[Deleted]

Jun 29, 2019 8:23:32 GMT -5 NomoreDramaQ1015 said:

The problem is as I've noticed is that A LOT of clinics are now refusing to see patients without insurance unless you can pay 100% at the desk. We're talking full sticker price.

Some still offer payment plans but they set your bill no paying $5 a month for eternity like my MIL claims you can.

Or more often now they have credit cards you have to apply for and then you pay that off.

Even the ERs around here are hocking credut cards before you can walk out the door.

I agree the insurance plans on the exchange can be crappy but in this country you are still way better off with even a shitty insurance plan than without one all together. It gets you in the door and you get the negotiated rate.

It really is a crappy situation where the patient is always the loser.

Even more insane is if a doctor contracts with insurance companies, they won't see you if you want to pay cash. They claim they aren't allowed to because of their insurance contracts! 

We had a relative offer to pay OOP for my son to see a qualified neurologist when his seizures started and were all day affairs, NONE of them in CA would accept a cash payment. They all had 6 month minimum waits and would only see their accepted insurance patients.  I called at least 20 different offices and they all said the exact same thing.

This was the same when we tried to get him into the FND clinic at Stanford. Without their "accepted" insurance, they can't/won't see you. Period. Even if you pay cash.

At this point, my sons have no choice but to get their own insurance via the exchange. I plan to move out of state next year, so they will get kicked off my case here anyway. Plus, they both make too much money and it limits what I can make since they look at us like a "family unit". I'm hoping it motivates them to get a better job or more education.

My son who's in Chico is 3 classes from an AA degree and wants to teach. He's guaranteed admission to Chico State. If he can find a way to pay for it and have a place to live, we are all pushing him to do everything he can to do it.

Right now, he can drive but his car is broken down in my driveway. We are all planning to work extra this month and try to get it running so he can then go back to school and get a better job without having to rely on the bus and Uber. Right now his monthly Uber bill is higher than his rent...

[plugginaway22]

I work in healthcare and do not understand this.  Around here, there are incentives to pay cash up front, a discounted fee schedule similar to medicare rates.  We encourage it, no claims filing! No follow up with insurance companies and patients!  Now if you want that discounted rate to pay cash, it is pay in full.  No we cannot run a business with you paying $20/month on a $600 invoice.  I hope your son finds a solution, there is no question healthcare is broken in this country.

[countrygirl2]

I don't know about the cash issue, wow.  I can't even imagine, we have always made sure we had insurance but I see now this is not always possible.  This sh** needs fixed, this country is nothing if we can't have decent health care.  I had a cashier yesterday telling me her hubs has a couple of scrips costing them $600 to $800 a month and they  have insurance.  We are keeping up with ours and can add more rentals for income or pay but this is not sustainable for the average person.  What a crime this is and our congress, who is supposed to represent us won't fix it.  It's down right criminal and now the stupid dems that have a chance to take over are advocating medical insurance for illegals.  How damn crazy can you get?  We aren't even taking care of our own??

[teen persuasion]

Jun 29, 2019 9:43:12 GMT -5 @rockhounder said:

Jun 29, 2019 8:23:32 GMT -5 NomoreDramaQ1015 said:

The problem is as I've noticed is that A LOT of clinics are now refusing to see patients without insurance unless you can pay 100% at the desk. We're talking full sticker price.

Some still offer payment plans but they set your bill no paying $5 a month for eternity like my MIL claims you can.

Or more often now they have credit cards you have to apply for and then you pay that off.

Even the ERs around here are hocking credut cards before you can walk out the door.

I agree the insurance plans on the exchange can be crappy but in this country you are still way better off with even a shitty insurance plan than without one all together. It gets you in the door and you get the negotiated rate.

It really is a crappy situation where the patient is always the loser.

Even more insane is if a doctor contracts with insurance companies, they won't see you if you want to pay cash. They claim they aren't allowed to because of their insurance contracts! 

We had a relative offer to pay OOP for my son to see a qualified neurologist when his seizures started and were all day affairs, NONE of them in CA would accept a cash payment. They all had 6 month minimum waits and would only see their accepted insurance patients.  I called at least 20 different offices and they all said the exact same thing.

This was the same when we tried to get him into the FND clinic at Stanford. Without their "accepted" insurance, they can't/won't see you. Period. Even if you pay cash.

At this point, my sons have no choice but to get their own insurance via the exchange. I plan to move out of state next year, so they will get kicked off my case here anyway. Plus, they both make too much money and it limits what I can make since they look at us like a "family unit". I'm hoping it motivates them to get a better job or more education.

My son who's in Chico is 3 classes from an AA degree and wants to teach. He's guaranteed admission to Chico State. If he can find a way to pay for it and have a place to live, we are all pushing him to do everything he can to do it.

Right now, he can drive but his car is broken down in my driveway. We are all planning to work extra this month and try to get it running so he can then go back to school and get a better job without having to rely on the bus and Uber. Right now his monthly Uber bill is higher than his rent...

As a student, can be get health insurance thru the college?

[resolution]

I have seen the cash issue a few years ago at an urgent care here in MD. The people ahead of us in line got sent away because they had no insurance wanted to pay cash. They had the actual money to pay for everything but the urgent care refused to serve them.

[Deleted]

He's not currently enrolled in school due to the medical and lack of transport. He's aiming for fall.

I refuse to be put on any long-term medication at this point. It's a pain to get things filled if you have Medicaid. They make you go to the doctor every.single.month or they won't refill anything, and the costs will just continue to grow.

CA is adding millions to the Medicaid program and the local clinics are already complaining. I've been trying to get into the dental clinic for a few years. They said they are getting tons of calls already and after the expansion it will be completely nuts. 

I have to call every morning until I can get put into a cancellation of an existing Medicaid patient and then I can be seen at the clinic. I've called every day for the last 3 weeks, but I will keep calling. I have a tooth that's cracked in half and needs to be fixed or removed...

I have my own opinions on illegals and the necessary farm labor they perform and have for decades, but giving illegals access to CA's medicaid system is just plain bullshit when we don't have providers for legal citizens...