Monday, November 18, 2013

ObamaCare Fun Update

I called the Health and Human Services 1-800 number this morning to find out what I was supposed to do in regards the notice of my County Medical Services Program eligibility ending. After being put on hold for a bit I ended up speaking with a nice lady.

She said some on certain county medical programs were being switched straight into MediCal with nothing needing to be done on their part. Others, myself included, did need to essentially fill out a new application. She said they would probably send me one in the mail, but she didn't sound too sure about it.

But, she offered to fill out the application with me over the phone. I accepted. It took 45 minutes to an hour (Connie said it wasn't as long as an hour) and we got 'er done. She couldn't tell me whether I'd be accepted or have to go to Covered California for the subsidized insurance. I'll be getting something in the mail to tell me my status.

One thing she brought up towards the end of the process was that you can agree to let them check your income via the IRS to avoid having to re- apply each year which is NICE. They let you chose that option for between 1 to 5 years. I chose five. Hey, I'm going to have to give them the information, anyway. I'd just as soon they go check my income themselves without me having to go through the reapplication hassle every year.

That assumes I'll be accepted for the MediCal option. If I'm not, I might have to remain without coverage and pay the penalty, depending on how the subsidized Covered California insurance works. She didn't seem too clear on how that worked, either.
The Sacramento Bee reports on some erroneous notices being sent to Californians on MediCal in regards them not being able to see their current medical providers anymore. I'm not sure if it's the same thing Connie got in the mail a few months ago.

She received a large booklet from MediCal or MediCare telling her she could no longer see the physician(s) she'd been seeing unless they were on a pre- approved list. She was pissed!

I told her that she should check with the billing people at her current doctors as they could probably tell her if that was completely true. She didn't believe it, taking what the booklet said verbatim. I suggested it was highly unlikely they'd tell her she couldn't go to providers she'd been seeing for years and that it was probably meant for new entrants to the program.  

She went to see one doctor and was told that the restrictions applied to patients who were only covered by MediCal. Since she's mostly covered by MediCare- the federal program- those restrictions didn't apply to her.


At 3:29 PM, Anonymous Anonymous said...

Thanks for the update. Looking forward to hearing the final outcome. If you're not eligible for MediCal, but are close, then you're definitely eligible for a (very heavily) subsidized plan through the Covered California exchange. For a male, age 45, just over the MediCal eligibility threshold, the lowest-priced exchange plans (the "Bronze" plans) have a premium of $1 per month after the subsidies. The coverage is better than CMSP, but not exactly stellar. For a "Silver" plan, with much better coverage, it is about $35-$45 per month, depending on which plan you choose.

It looks to me like they've designed the sliding scale subsidies so that it really makes no sense to decline to sign up for at least the "Bronze" plan and instead opt go without insurance while also paying a penalty. The "Bronze" plans aren't great, but are better than CMSP, much, much better than nothing at all, and cost next to nothing at the near-MediCal eligibility income level.

But if you can afford $35-$45 per month, you'll be much better off with one of the Silver plans. If you're older than 45, the premium may be a bit higher, I didn't check how much higher they would be if, for example, you're 55.

If your income given your family size is within the MediCal guidelines that I posted in a comment on your previous article, I wouldn't bother doing anything further at this time, since unless I'm missing something about the eligibility requirements, I believe that as long as you are a California resident (obviously you are) and your income meets the guidelines, you will qualify for MediCal.

But if you think there's a real chance you won't qualify for MediCal, and you're curious what your subsidized premium would be for the various private plans available through Covered California, you can find out using the Covered California website. In your last post I believe you said you had already done that, and came up with a figure of $300-$400 per month. That doesn't sound right to me at all, unless you're WAY above the MediCal eligibility level. Perhaps those are the numbers for the premiums, NOT INCLUDING the subsidy?

As far as how the subsidy works, I read somewhere that it kicks in automatically and is subtracted from your bill before you have to pay it, so you don't have to pay the premium and then wait to be reimbursed for the subsidy amount later. But offhand I can't recall where I read that. Possibly on the Covered California website, I'm not sure. I do think that information should be more prominently displayed/explained on the website, and certainly the folks at the Social Services office ought to know the answer to that.

There are a lot of people for whom paying $35-$45 a month, or whatever, for a "Silver" plan is entirely feasible (and certainly $1 a month for a "Bronze" plan is feasible), but who would nonetheless have a very hard time coming up with an extra $300-$400 a month and then waiting a while for reimbursement. So assuming that the goal is to get people on a plan and not have them remain (or become) uninsured, it would make little sense to require people to pay up front and wait for the subsidy to reimburse them. But then again we're talking about government programs, and a weird patchwork of private coverage and government subsidies at that, so I suppose it's not impossible that it might have been structured that way. But I doubt it.

At 9:36 PM, Blogger Rose said...

1984 has arrived.

At 6:39 AM, Blogger Fred Mangels said...

I can afford more than 35 or 40 dollars a month. The way it read to me is that you pay the 400 some dollars up front, then get a rebate later. The gal I spoke to on the phone seemed to say something along that same line, but she didn't seem very sure about it and I couldn't hear her very well (volume on the phone kept fading in and out).

I can't pay hundreds of dollars up front every month. If the subsidy is paid up front as you seem to think, it could be there's no problem. We shall see.

At 9:45 AM, Anonymous Alaska mounty said...

Pay the tax and pay for your own health care. It's the patriotic thing to do.

At 4:57 PM, Anonymous Anonymous said...

Fred, the way it's structured is as a tax credit that can be directly applied to the premium, or not, depending on your preference. You get to choose to either:

(a) have the tax credit paid automatically to the insurance company every month, in which case you just have to pay the remaining $35-$45 of the premium yourself (or whatever the amount is for your specific age, income, and number of dependents),


(b) pay the full premium yourself each month and get reimbursed with tax credit on your annual taxes.

So the bottom line is, no, you don't have to write a check for $400 a month, or whatever, every month, and then wait to get reimbursed later. You can choose to do it that way if you want, but you don't have to, and I assume most people won't.

At 6:16 PM, Blogger Fred Mangels said...

Thanks for the heads up.

At 8:49 AM, Anonymous Anonymous said...

Are you kidding this would make George Orwell wet his panties today's technocracy makes 1984 look like child's play...
When will people finally figure out everything the government tries to control they turn to s*** So let's see less than 2 million people have signed up for new coverage since the passage of the Affordable Care Act And over 5 million people have had their insurance Cancelled with another projected 20 to 50 million still coming Yeah this is worked out really good Its all those right wingers fault oh wait They wrote the Affordable Care Act along with the insurance CEOs


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