Saturday, November 30, 2013

Obamacare Adventures Continue

Regular visitors here know I've been told I'll be booted from the County Medical Services Program (the county administered version of Medi-Cal) by December 31 because of Obamacare. I recently called the Medi-Cal 1-800 number and a worker helped me fill out an application for regular MediCal. I received a letter in the mail yesterday telling me I don't qualify.

I'm a bit confused by their explanation. Oh, and they start out by writing, "Congratulations! You qualify for health insurance through Covered California.". Nice lead on, huh? Here's the pertinent information from the letter:

"You do not qualify for Medi-Cal health coverage because your income is above the Medi- Cal limit".

"You do not qualify for Premium Tax Credits, Enhanced Silver Plan because: You are not a member of the primary tax filer's tax household. There can be only one primary tax filer per application. If you will not be claimed as someone's tax dependent, you may apply again as an individual".

They go on to tell me to go to the Covered California web site to choose a plan. WHAT?

Something is screwy here. I don't get what they're saying about not being a member of the primary tax filer's tax household, or being someone's tax dependent. I thought we filled out the application for me as an individual, not the two of us.

I'd also think I'd be considered the primary tax filer in the household. After all, I'm the who goes to see the accountant for tax preparation and the only one with income that needs to be calculated.

I'm guessing we made a mistake when we filled out the application? I don't think I can go back and contact the gal who helped me fill it out. It looks like I have no choice but to try doing the online application and see what happens. Maybe I'll take a crack at that tomorrow?


At 8:35 AM, Anonymous Anonymous said...

this is done to gather a list of uninsured so they can hunt them for money

At 11:31 AM, Anonymous Anonymous said...

O.K., so it sounds like you are above the income level for MediCal. So they've referred you to the Covered California website. That part seems pretty straightforward.

I agree that the second italicized paragraph is confusing. I'm not sure what they mean by "you are not a member of the primary tax filer's tax household."

If you want, you should be able to get advice/assistance locally, through a local certified Enrollment Counselor. The Covered California website lists several certified Enrollment Counselors for our area, including Andrea Page and Charlotte LeVaugh-Paul, both at the Open Door Clinic, 959 Myrtle Ave, Eureka. The phone number given on the website 826-8633.

Or you could just try using the website yourself (worked fine for me, by the way), and if it turns out that you need assistance with your online application, there is an 800 number listed on the website. Or, again, if you try applying through the website and encounter difficulty, or just have some uncertainty about which Covered California private plan would be likely to work best for you, and you'd prefer to get help locally, in person, you could then seek help from the Open Door Clinic folks.

At 12:45 PM, Blogger Fred Mangels said...

Thanx for the heads up. I'll try the web site first. If that doesn't work I'll try something else.

At 1:48 PM, Blogger TOA said...

No problem. And by the way, they pushed back the deadline for enrolling from Dec 15th to Dec 23rd.

That means that as long as you are enrolled by Dec 23rd, your coverage will take effect Jan 1st. But you'd still be wise to move forward ASAP, as you indicated that you're planning to. The closer we get to the deadline, the higher the chance that there could longer waits for phone or in-person assistance.

Another hint: When you are using the website, once you start the actual application process (not just the "preview plans" function), you select a username and password. If at some point something is not clear or you have a question or whatever, and you can't finish the process right then, having the username/password allows you to save the data you've entered so far, so that you can come back to it later, call the phone number and seek assistance that way, or whatever. Then when you go back to the website, you don't have to start all over from scratch.

Of course, if possible, it's probably best to have the website with your partially-completed online application open right in front of you when you call the helpline, so that the person helping you can just talk you through it as you proceed past whatever obstacle or question and on to the next step.

One last reminder: At the end of the application process, you'll need to provide proof of residency and income in order to qualify for your premium tax credit (subsidy).

If you have a scanned copy of your 1040 showing your income, and a scanned copy of your driver's license, then at the end of the application process you can simply upload those two documents right online (the website prompts you to do that, and makes it easy to do so), and then you're all done with the application process. If not, I guess the final step would be submitting the income verification part by mail (or maybe in person?). I'm not sure, since I did mine online. It was easy and quick. I hope your experience is similar.

At 2:19 PM, Blogger Fred Mangels said...

Ok.Thanx. To be clear, did you have to pay any money up front? Once you had the plan lined up? That's what this letter I got suggests.

I'm still wondering how much I pay per month. With the subsidy they said $2.00 a month (last time I tried it). That was after the "tax rebate". The cost of the plan was hundreds of dollars a month without the rebate.

To clarify; If they say I have to pay $400- $500 dollars a month to sign up for it, that's not gonna happen.

At 5:59 PM, Anonymous Anonymous said...

No, you can choose to have your "advanced premium tax credit" applied directly to your monthly premium, so that you only have to pay the difference between the full cost of the premium, and the amount the government is paying through the tax credit (subsidy). So as long as you get enrolled in time, including providing your proof of income, there should be no problem. I believe the article from TPM noted that the deadline for paying your first premium (again, just your portion of it) has been pushed back to January 5th or 6th. So you should be fine.

Keep in mind that this "advanced premium tax credit" is still basically a tax credit, and by having the government pay it directly to your insurer, you're essentially taking an "advance" on this tax credit.

The amount of tax credit you're qualified for, and therefore the amount they're willing to advance you, is based on what you're reporting that your income is now. The lower your income, the bigger the tax credit, and therefore the bigger monthly "advance" they will apply to your premium for you.

If your income turns out to be higher in the future, the amount of your tax credit will go down, and you will be expected to pick up more of the premium cost yourself.

But the way the sliding scale is designed, the difference should be modest unless your income increases very sharply. And, of course, if that happens, the idea is that with your sharply higher income, you're going to be better off despite having to pay a larger portion of your premium.

By the way, unless there was a typo in your comment, you said that your part of the premium (once the subsidy was accounted for) looked like it would be around $2. When I was going through the process, the only premiums I saw at that level were the "Bronze" plans, which are a lot better than nothing, but do leave you exposed to much higher co-pays and deductibles for routine care than the other plans. By comparison the "Silver" plans for my age and income level (similar to yours, it seems) were $25-$35 a month (after the subsidy), and had much lower co-pays and deductibles. The "Gold" and "Platinum" plans looked great, of course, but the premiums were way out of reach for me. So oone of the Silver plans was the best deal for me.

Anyway, you've got a little time, so do take the time to look at the different plans and different companies. It takes a little fiddling around on the website, but you can compare not just premiums, deductibles, and co-pays (which all tend to be pretty similar within each "metal tier"), but also which doctors are "in-network" for each of the insurance companies.

In my case (and maybe yours), there are only two companies offering Silver coverage, and fortunately both of them provide plenty of local "in-network" providers. Only one of them, however, has my current doctor as one of their "in-network" providers, and that matters because I like my current doctor, and if they were not "in-network" then I'd have to pay more to use them. So if you already have a doctor or clinic that you usually go to, and you're happy with them, you're definitely going to want to check which plans include them "in network," and which plans don't.

At 7:58 AM, Anonymous Anonymous said...

First of all the government is not paying for any of this its healthy people like me that are going to be forced to buy insurance that'll make up for your premiums subsidies Second of all the law is over 10000 pages long that's a order of magnitude longer than the Bible nobody knows what the law says because nobody has had the chance to read it According to the government only two million people have enrolled in either the state or the Federal exchanges that means The chances that you have enrolled successfully are very small But hey maybe I'm wrong and the government really loves us and wants to give us free s*** And Fred I gotta say for a libertarian you seem to be embracing the Socialism with open arms I hope you enjoy my wealth redistribution....

At 8:18 AM, Blogger Fred Mangels said...

Anyone who accesses the health system using insurance- whether it be public or private- is taking from everyone else. People with chronic or serious health problems are the big "takers", whether using private or public health insurance. There's no getting around that.

I'm open to suggestions. Do you have any?

I've been paying out of pocket for my own medical expenses the last four years or so. Eventually, I'll have to have some sort of insurance to help with the inevitable more serious conditions that come to people when they get over 50 years old.

What would you suggest? Just let nature take its course? That is always an option.

At 12:39 PM, Anonymous Anonymous said...

No but I would suggest letting people have the option to opt out instead of mandating that they have to buy a private insurance From your experiences on the web sites does it look like premiums got cheaper or more expensive isn't the whole idea of this Affordable Care Act to make it cheaper for people And again I would point out that there are several countries with socialist Government systems if you want to live in a socialist system move to one of those countries I mean what's next I gotta share my wife with my neighbor because my wifes prettier or he doesn't have a wife or I'll have to start giving up half my food to the rest of the people in my community because they're too lazy to work to buy their own don't get me wrong I know there are severe problems with our medical system but I don't think this helped any of them but unfortunately I don't think the vast majority of America will realize what they got themselves into until the death panel start denying them services... overlook according to your Costco card you buy half a gallon of alcohol a month you're not going to get that new liver buddy or according to your Safeway Club Card you buy a pint of ice cream a day you're not going to get that new heart transplant either but again I hope I'm proven wrong in the long run

At 12:59 PM, Anonymous Anonymous said...

I would also like to point out that the majority of the chronic health issues plaguing America are from people who do not take care of themselfs people that overeat and do not exercise and now I'll be forced to pay for their un responsible behavior...THC

At 1:34 PM, Blogger Fred Mangels said...

I fully agree with you on forcing people to buy health insurance. I objected to Obamacare from the outset because of that. I do, however, understand why they feel the need to try to force people into the program.

If they just set it up as they have and let people join by choice it would be much more palatable to me. The problem is, they need enough people to pay for the "takers", but that's an issue with regular, private insurance, too.

And that's how any kind of insurance pool work- whether government run, or private. Certain people that are real sick, the "takers" are going to be the ones taking advantage of the money pool, while those who don't use medical services aren't. That's just the way it is. That's true of even car insurance.

I remember right after the wife had her bone marrow transplant we were still on private insurance- Blue Shield, I believe. The premiums for both of us jumped from $600 to $700 a month within a couple months of her transplant. I had to wonder if maybe the transplant had something to do with that as I saw the hospital bills and they were staggering. I thought it probably wouldn't take more than one or two people on a plan with bills like that to jack up everybody's premiums. Everybody is gonna have to pay to keep the plan solvent.

In that regard I thought it probably made sense to just have people in her condition on MediCal/MediCare, as she is now. At least with M/M they're actually "taking" less than they are with private insurance. Problem is, more and more doctors don't accept M/M and I'm not sure if UCSF accepts them for bone marrow transplant.

Private insurance pays better reimbursement rates than government insurance. So, while one is still a "taker" they're actually taking less, as far as money goes, from the pool than they would be with private insurance.

For instance, me, on CMSP: I suppose I should be ashamed, but not really. I pay out of pocket and the only costs to the taxpayer for the last four or five years have been administrative ones. If I did need to use CMSP, their reimbursement rates are very, very low- they might be less than ten cents on the dollar now (and are getting worse). I might well be ripping off the medical providers, but I'm taking less from the pool of taxpayers than I would be if I were taking from private insurance pool.

But the bottom line is I need to have some sort of insurance, so I'll see what kind is available and will take whatever works. It may still become unaffordable as I think they're going to jack premiums real high, eventually, to cover all the pre- existing conditions they're having join the insurance pool. For right now, I'll take whatever I can get. I don't really have a choice.

At 7:42 AM, Anonymous Anonymous said...

I understand how insurance companies work that's really not the problem the problem is the lawyers And the CEO's of big for profit hospitals the real problem is greedy people suing hospitals for malpractice with no good reason and doctors that have seniority that can't be fired or who are protected by the union most of the expense you pay a Hospital does not go to the doctor it goes to the jacked up prices of products the hospitals are pushing and the malpractice insurance the hospital has to carry it's the middleman and the lawyers that has caused the expenses to skyrocket I remember when I was a kid about 9 my family doctor came to my house to reset my shoulder that popped out of socket and didn't even charge my mom nowadays you can't even call your doctor on the phone and talk to him hell you barely get a chance to talk to him in the office before you're are ushered away and now the CEOs and lawyers have written the Affordable Care Act do you really think it's going to benefit the people or the CEO's and insurance companies the only way to stop un constitutional laws is to not follow them until we as a country figure this out we're f*****

At 8:15 AM, Blogger Fred Mangels said...

There's going to be any number of problems with the medical system down the road, especially with Obamacare. As it is, more and more doctors are refusing MediCal/ Medicare patients as reimbursement rates are so low. Private insurance generally pays better than government, but I read something recently that- as part of the ACA- private insurance companies under Obamacare will be paying lower reimbursement rates along the line of government insurance. That will exacerbate that problem of doctors bailing from the system, if what I read is true.

Part of Obamacare, also, is new taxes on hospitals and medical equipment, if that makes any sense.

Then there's the income verification and adjusting individual premiums to their changed income. Essentially that means if you get a better job with resulting higher income, your premiums will automatically increase with your income, at least to some degree.

That could become a major downer for many in the years to come as I predict everyone might be forced into the system eventually. As the government needs more and more money to fund the subsidies, they'll keep adding to the premiums and you'll have no way around it since your income verification is integrated into Obamacare. Get a raise at your new job, and you'll pay even more. They'll be able to raise your premiums to any level and you'll have no choice. Just my prediction.

The whole thing may well collapse, but hopefully not in my lifetime.

At 8:24 AM, Anonymous Anonymous said...

From what I can tell this was designed to collapse so they could Usher in a true single-payer program the people that wrote the law aren't stupid but there are other provisions in the law to help keep cost down its called the Independent Payment Advisory Board (IPAB) and anybody with any deduction skills could tell you what that really means did you know that our government now has a lower approval rate then King George did something is about to collapse but it's not just Obama care...

At 8:32 AM, Anonymous Anonymous said...

Of course while we're all busy b******* about the Affordable Care Act the real coffin nail the TPP is being hammered right now say night night to the constitutional republic of America I'm not even a religious man but Jesus Christ even the Pope is now backing gay marriage abortions and socialism but that's a whole nother topic

At 8:39 AM, Blogger Fred Mangels said...

From what I can tell this was designed to collapse so they could Usher in a true single-payer program.

There are many who believe that's exactly what's going on. I'm not sure I'd go along with that since subsidized private health insurance pretty much started off with the right wing and libertarians.

I could be wrong but I believe I even heard the late past Libertarian Party presidential candidate, Harry Browne, suggest it as an option. If it wasn't him, I know I heard it from some other non- leftie(s).

At 9:43 AM, Anonymous Anonymous said...

I think what you fail to realize Fred is that the Republican and Democratic and quote unquote Libertarian Party's are all of the same controlled by the same corporations and after the same agenda we no longer have a two party system that represents the majority of Americans we have a fascist system control by corporations with the illusion of a free vote


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