Any healthcare navigators here?

[Glitterati]

I've made multiple calls to local navigators and can never get a call back.

I've called Humana who my insurance is with.

I've called healthcare.gov

and no one can answer my question..........

I'm getting desperate as the enrollment period is ending soon.

My daughter is 18. She's not making enough to qualify for a subsidy, but would qualify for Medicaid IF our ohsodelightful asshole Governor had accepted it.

However, during the enrollment process, she HAD to go through the application for Medicaid. Humana nor any other insurance company CAN sell her insurance until the state verifies that she doesn't qualify for expanded Medicaid.

We are still waiting on that notification from the state, so I can't add her to my Humana policy.

The enrollment period is ending soon.

Does this mean she will have no insurance for another year?????????

[Warpy]

1. Yep, pretty much

They're sitting on their hands while the enrollment period expires, too.

All you can do is educate every single person you come into contact with in the hope the truth of what not expanding Medicaid really means. It's not good fiscal policy, it's just spite and cruelty.

[Glitterati]

2. So she's just screwed?

For another year? For something completely out of her control?

[CTyankee]

3. Call any (responsive) representative you have...state and federal...

go to congressperson's website and get his/her number locally and in D.C. Ditto your senators...

Make as big a fuss as you can!

[Glitterati]

5. I have tried that as well

all my representatives are Republicans.

This is our state Insurance Commissioner:
Georgia’s Republican insurance commissioner Ralph Hudgens told a group of Republican women in November that having a pre-existing condition like breast cancer or asthma is like being at fault in a car accident and that insurance companies should rightfully be reluctant to cover you.

Hudgens made headlines earlier this year when video emerged of the commissioner bragging that his office was doing “everything in its power to be obstructionist” of the Affordable Care Act. He outlined the means by which he is intentionally sabotaging the training and certification of the ACA’s “navigators.” “Navigators” are personnel charged with helping consumers sort through the options available to them as a result of the ACA, which is also known as “Obamacare.”

[Warpy]

4. She's got a lot of company, too

While you might be able to make a hardship case for her, if her income is high enough to disqualify her for subsidy, she needs to bite that bullet in order to be insured.

If her income is low enough for Medicaid, she should qualify for a subsidy.

Republicans do love their "enrollment periods." I got screwed on one of those, too. I hadn't had insurance for 26 years at that point because I'm already sick, so it was only a nuisance.

[Glitterati]

6. She DOES qualify to be on my subsidized plan

But she can't get on it without that disqualification from Medicaid.

She's working part time, for $7.25/hr. The only kind of job available at this point.

[Warpy]

8. This is clearly insane, then

Welcome to the Republican idea of fiscal conservatism. I hope the disqualification comes through but knowing the way Republicans run government, I'm not optimistic.

At least she's 18 and unlikely to need a huge amount of care this year. If her job situation improves, she'll have to jump through the same hoops next year.

[Glitterati]

10. Her job situation WILL improve, she does seasonal work

that pays well over $10.00/hr, but during the winter has to do garbage work anywhere to make her car payment.

She's an area manager for a lifeguard/pool maintenance company.

[scorpiogirl]

7. We ran into a similar problem

We enrolled last month thinking we would start on March 1st. Turns out our kids who were on state insurance (Medi-Cal) at that point, were considered in ineligible, but we didn't realize it until we went to pay the premium (my husband started a job in Feb after long term unemployment). I thought when we enrolled they would automatically fall off Med-Cal, but no such luck. So we have had to wait another month. I got a letter from the state that they will be done with Medi-Cal at the end of March so that should be sufficient, but I'm still dreading trying to sign up by March 15th. I am a huge ACA supporter, but some things definitely could have been done better. It's a clusterf***! I agree with other posters, call your state and make a fuss. This is the only way to get things done. She shouldn't have to wait til next year, it's just not right. Especially with all the issues they've had, there should be some leeway.

As an aside, I'm annoyed with the state agencies that demand you do things by their deadlines, yet can't seem to get a letter with said deadlines to people in a timely fashion. Ridiculous!

Good luck and I hope you can get it worked out.

[Glitterati]

9. OMG, what a total clusterf**k!

I won't begin to tell you how many times I have tried to resolve this question over the last 3 months!

Just one day with Humana on the phone; 2 hours on hold, transferred to 8 different departments!!!!!!!

And, every time I call healthcare.gov, I get a new list of things I have to do and new information.

It's absolutely MADDENING.

My GAWD, why is this so effing hard?

[scorpiogirl]

12. Yes! The bureaucracy is the worst.

I have spent a lot of time on hold as well, though not as much as you, that's crazy! No one person seems to know what's going on. I admit I've wanted to throw my phone across the room! It is maddening, especially with deadlines constantly looming. I still have to send in all my proof as well, even though it was submitted online. I guess I'm tired of proving how much I'm worth after years of being poor and having to constantly prove that to get help.

Yeah, last week on Monday, I left an automated call back request while on queue with the state (I had no choice as it hangs up on you if they're too busy). They were supposed to call back within 24 hours, here I am a week later, no call. I also called my case worker and have left two messages over the last three weeks. The operator told me that each case worker has 800+ clients. Fat chance of ever getting called back. Yet, without my questions being answered by them, I can't meet their deadline.

I don't know why it has to be so hard. Feels like climbing a mountain though. You are not alone.

[Glitterati]

16. I just realized I have been working on this since November 1

Tell me that's not insane?

November 1 is the eligibility notice date from Healthcare.gov saying she qualifies for Medicaid and we have to wait for their "determination letter" to arrive.

[jwirr]

30. I wonder if a class action suit against the state would work in a state like Georgia where they are

doing this deliberately for political reasons.

I also think that when push comes to shove the feds will not say no to persons who are at no fault for not being able to sign up on time. At least that is my hope.

[Glitterati]

36. We need an attorney willing to bring this case

first and foremost.

And, honestly, after what the republicans in Georgia have done to the legal system here (tort "reform&quot finding one is nearly impossible.

[Cofitachequi]

11. Sounds a lot like my problem and why I will not get Insurance. I'll take the fine.

Because I do not make enough to get a subsidy, and South Carolina will not expand Medicare, the cheapest plan I could get is $280 with a $6900 deuctible.

That means I pay $3360 a year, and it will pay nothing until I put out another $6900. My annual income is $10,000 as I am a part-time student, so that means I pay $10,260 out of my $10,000 income before the policy pays one penny.

What a deal.

[missingthebigdog]

14. Your income is too low for you to be fined.

And consider talking to someone a little more about how deductibles work on these plans.

The plan I chose has a similar deductible, but it is basically a major medical deductible. Office visits are not subject to the deductible. Prescriptions are not subject to the deductible. All of the ACA plans require a basic level Of healthcare services be provided without charge and without deductible.
Now, a hospitalization will likely exceed the deductible. But you would owe the hospital around 7000.00 instead of 70,000.00 if you had a stroke, or were severely injured in an accident. Not small change, but manageable if you had to make payments.

[Cofitachequi]

41. yet, more than one third of my income cannot go to healthcare.

the aca was not written for those who are struggling to improve their situation, it was written for the politically "voiced" middle class.

[missingthebigdog]

43. As written, the ACA would be providing your care virtually free.

Your governor's refusal to expand Medicaid is the problem.

I wish things were different for you, and sincerely hope that things change for the better soon.

[Cofitachequi]

44. Reaaly? On my behalf you're going to HOPE for CHANGE. Thanks.

Actually, I'm in a no lose situation. If the ACA comes crashing down as a horrible failure leaving no one with insurance coverage, I'm no worse off. ACA somehow survives, it means nothing to me.

The poor are shit on no matter who is in power.

[missingthebigdog]

45. Excuse me for trying to be nice.

I retract my sympathy and well wishes, and apologize for offending you.

[Skip Intro]

13. My sis has been dealing with the incompetent navigators for weeks.

She left her husband but found out that if you are married and try to get insurance for only yourself and/or children, but aren't living at home with hubby, and including him, then you don't get a subsidy. She moved back in with the jerk (long story, he is abusive, mostly verbally), and called the obamacare hotline back in January! She has been told that her application has been "expedited" over and over again, only to call back after checking with the new insurance company (some co-op that was evidently created by the ACA law - that barely has any pain management doctors in the entire state of SC, judging from their online search tool - very sketchy "insurance" company to begin with), and being told that they have no record of her, then speaking with a different navigator who says there's no record of her application being "expedited" but that it was in process - for weeks now, over two months. She gets a different story every time she calls, and has spoken to supervisors who say things like, "oh, the request to expedite was entered incorrectly" and on and on, one excuse after another. She's been told repeatedly by people up and down the chain of command that her insurance will be retroactive until March 1 because of the trouble. I know it's bs. She still believes them. Yet, as of late last week, the insurer (Consurmers Choice something or other), has no record of the application. She's been dealing with debilitating back and leg pain, nerve related according to all local doctors we've seen, for about three years now. She is on expensive meds for this. She finally, after jumping through some hoops, has secured an appointment at Mayo Clinic in Jacskonville, FL for April 1 in hopes of getting to be bottom of the cause of the pain and having the experts craft an effective treatment plan. But Mayo can't tell her if this new insurance will be accepted until she can provide them with the insurance info - account number, group number, etc. The deadline for enrollment and her Mayo appointment are just weeks away, and she's still getting daily bs from these navigators. I've told her she should just cancel the current application and do a new one online, but she still believes them when they tell her they will make her coverage retroactive to March 1. This is important to her because she sees several doctors and she doesn't have the funds to pay them out of pocket for the visits to them this month. That doesn't matter that much to me, however, because almost none of them show up when you search the new insurance co.'s network anyway. I'm sorry, but this is the most incompetent, cluster-f*** bs I've ever seen anyone have to go through.

[Glitterati]

15. Oh, don't I know it!!!!

Here's the corker, too......I, too, have a chronic illness (Graves disease) which requires expensive meds for my thyroid - $300.00/month - and NONE of the money out of pocket BEFORE I signed up for insurance goes to this years deductible.

I'm sorry, but that SUCKS. I go to the doctor every month and have labs (bloodwork) that have to be done. This is killing me!

And not one dime counts!!!!!!

[Cofitachequi]

42. sucks when the right wing is right.

not defending aca any longer.

[Glitterati]

17. OK, the latest from healthcare.gov

She has to create an application separate from mine.

Nice, right? Well, here's the deal. While I found her the exact same plan I have, and it's only 38.55/month, as separate plans, WE BOTH HAVE TO MEET SEPARATE DEDUCTIBLES/OUT OF POCKETS.

And, only because I used her 2013 income as 2014 income even though I know she won't get close to it in 2014......

Nice......what the hell happened to "kids can stay on your plan until age 26?"

WTH!!!!!!

I'm going to sign her up for this plan. For 38.55 out of pocket, at least she's in the system and insured!!!!!!!! I can raise hell with someone about the deductibles later.

Right?

[Schema Thing]

18. her income will be considered for your "shared" out-of-pocket

in all scenarios, AFAIK.

[Glitterati]

19. Even if she's on a separate policy?

Seriously......the only way to get her insured BEFORE the cutoff date is to get her a policy of her own.

I had to go through the entire application process again. In her name.

on edit:
I did add my income to HER application under the "others living in the household" section. However, there was only one choice there....."Living in the household, but not applying for insurance." Which is not true....it's living in the household and already has an ACA insurance selection.

[Schema Thing]

21. well, no, it shouldn't be considered in that case

they don't seem to be considering your income wrt her policy, are they?

I just surmise that her deductible and your deductible separately will likely add up to approx what it would be if you were on the same policy.

I could be wrong about that.




What are your respective deductibles?

[Glitterati]

23. I went for a great plan - Humana Silver

which is 500/650 deductible, out of pocket.

I have no idea if they are considering MY income wrt her subsidy; but I have to ASSUME they are. It DID combine our income on the summary. That only affects her subsidy, however, not the plan she chooses. Her subsidy is $90/month regardless of which plan we choose. Without my income, however, she does NOT QUALIFY for a subsidy unless I say she's going to make much more than she IS going to make in 2014 (she's in college now and only working part time).

She falls in that window of horror created by the Supreme Court decision - low income enough to qualify for Medicaid, but the state refused the Medicaid.

[Ms. Toad]

20. Generally the way insurance works -

is that there is a per person deductible/out of pocket max and a family one (typically double, no matter how many family members there are).

So if it is just the two of you, what you were forced to do has the same result as if you had been able to put her on your plan.

But it isn't clear why you can't have a single family plan covering children through age 26. Mine is through my employer, but it covers my 23 year old daughter. (per person limits for all 3 of us that run separately until (1) one of us reaches the per person limit or (2) the three of us combined hit the family limit - with the family limit double the per person limit.)

[Glitterati]

22. OK, that makes sense

But it still makes no sense to have 2 separate policies.

I applied back in November for a family plan with both of us on it. I used both incomes in the application.

It was healthcare.gov that threw in the "your daughter qualifies for Medicaid" monkey wrench that we have been dealing with since November.

I got a DU mail with a great suggestion to call a local insurance agent who handles Humana (which is what I signed up for) which I plan to do in the morning. They have a great deal more experience dealing with this than I do and since we have 5 days left, I'll take the time and do it in the morning.

[Ms. Toad]

24. The separate policy doesn't make sense to me either.

They tried to pull that on us once, and I made them back down. But the reason was different.

There are 3 of us - same gender couple and daughter. Putting us on separate policies (our daughter and I on one, and my spouse on another) increased our out of pocket expenses by 50%, since we had a $6000 deductible on the "family" policy and an additional $3000 on my spouse's policy, instead of a $6000 maximum for the family. The company intended to offer family coverage, but had apparently not thought through the practical details of what it might mean (potentially double the out of pocket - if we had had 2 children, with each one biologically related to one of us). They were trying to avoid recoding their software (which required a gender for every family member, and wasn't set up to handle same gender couples). Their solution (which was the same identical cost for an adult only family) was just issue 2 separate policies. With kids in the mix, it dramatically increased our costs.

They did a work-around for the first year, and had rewritten the software for the state by the second year. Either they had never encountered a same gender family with children before - or the others all accepted, "Be thankful your family is covered at all," which was their first response. My response was, "no." and send me to the person who is your supervisor, and their supervisor, etc. I should check and see if my kindergarten report card said I played well with others...I suspect not.

[Glitterati]

28. The hoop jumping is insane!

Though our situation shouldn't be one of those they haven't encountered before.....a widow with a child in college.

I do, however, get the feeling that anything that isn't Mom, Dad and 2 kids is completely out of their league.

It's just another example that we see every day of our representatives writing rules that have nothing to do with our every day lives.

The sad thing is that my daughter is the perfect example of the people they NEED in the system to make it work.

If I wasn't working on this all these months, my daughter would have said screw it months ago and just continue without insurance at all. Between school and work, she simply doesn't have the time to deal with all this hoop jumping.

[LiberalEsto]

25. WHY do they have "enrollment periods" at all? It's ridiculous.

What I cannot understand is why a person needing health insurance can't sign up for it when they need it instead of waiting. It makes no sense at all.

[subterranean]

26. It does make sense.

If people could just sign up for insurance when they need it, many would just sign up for insurance when they need it (when they get sick or injured). Then instead of paying premiums every month, they'd drop the insurance until the next time they need it. You do see the problems that could cause, don't you?

[Hoyt]

27. Because that is how folks game the system. While most of us pay in

even when we don't need it, some folks want to take advantage and only pay when they are sick. That's why there has to be a mandate. Too many folks will cheat society. I'm not talking about folks who truly can't afford health insurance and live in states that are too right wing to expand Medicaid.

The OP is going through a lot of hassles/grief to do the right thing. Others want to game the system. We'll be better off when we get single payer and everyone contributes through taxes (based upon income). Until then, free riders need to quit griping about not being able to take advantage of the system for their own greedy purposes. It's almost as bad as the 1% sometimes.

[Glitterati]

29. The sad thing is

they're making it difficult for the very folks they need most in the system - like my daughter, 18 in college and working part time while living at home with parents.

I am assuming this is simply because of our state Insurance Commissioner I posted about above. Since I live in republican hell, they set out to exclude these kids to make ACA fail.

No one can tell me it has taken since November 1 for the Medicaid system in our state to figure out that my daughter doesn't qualify for an non-existent program.

There are major universities in this state like Georgia Tech, Emory, Georgia State, Morris Brown - do you have any idea how many kids like my daughter they're screwing out of insurance right now?

[bluestate10]

46. The problem is with the people leading your state and making decisions.

Vote in Democrats and things will change for the better. In red states that have Democratic Governors, the ACA has gotten pretty much implemented, there were laggards like Arkansas and New Hampshire, but in the end, those states moved in the moral direction. You have a chance in 2014, you have competent Democrats running, even a Carter for Governor, make those chances count, GOTV vote from everyone that can possibly be convinced to vote Democratic.

[Glitterati]

48. Well, the FIRST thing that has to happen is for DEMs to get on the ballots

Qualifying for 2014 just ended in my county. Not ONE Democrat is on the ballot.

Not. One.

[LiberalEsto]

31. My 30-year-old daughter hasn't had health insurance for years

because she can't afford it. Last year she had a part time minimum wage job at a book store -- the only job she could find.

Right now she and her boyfriend are in the process of moving from the West Coast to an eastern state, but they don't have an apartment yet and she doesn't have a job. They'll be staying with his mom while he starts his new job.

Once they have a place and get settled, and she finds work, she would like to get insurance. However unless she gets extremely lucky and lands a job with health insurance, she will continue to be without coverage until the next "enrollment period," whenever that is.

She isn't trying to "game the system," she just doesn't have a permanent address yet, or a job.
So what is she supposed to do?

[Glitterati]

32. Your daughter will qualify for Medicaid

in whatever state she lands in because she has no income. If she gets on Medicaid when she moves, she'll be able to move to ACA when she lands a job or stay on Medicaid, depending on her income.

There's no "enrollment period" for Medicaid........

[LiberalEsto]

33. Thanks! That's very good news. nt

[Hoyt]

37. That's different, and I get it. But, there are people who think it's OK to go without and then

sign up for insurance when they get cancer or something.

That isn't fair because insurance works when folks pay in when they don't need it at the moment -- money goes for those who are really sick and need it. Then when that person who has been paying in gets sick, other folks' money goes to cover them.

The "closed enrollment periods" are necessary to prevent just that (and it only works for 9 months or so).

Hope things work out for your daughter. Someday, we'll all have coverage from birth automatically. Then, all this BS will be a thing of the past. Until then, we need to do what we can to make the system work for everyone -- while voting for folks committed to improving the health care in this country.

[Glitterati]

40. It's stupid and arbitrary

I get that some people might game the system. Hell, it happens even when laws are created to prevent it.

But, what this is doing is to punish the very people they meant to "help" obtain insurance. You can't make that OK with arbitrary rules.

I get that it is republicans setting out to damage ACA, but we have to come up with some way to stop the republicans and not just shrug our shoulders and say "someone might get over on the rest of us" because someone does that every frigging day.

What "we" have done here is to give the republicans like in the state of Georgia the ammunition to hurt folks. They're reloading with us sitting there holding the ammo.

[bluestate10]

47. Enrollment periods come around every six months, so the next one should be in May.

Private companies with large numbers of employees may be on a yearly cycle, but those companies typically have top of the line plans that cover every employee except those that opt-out.

[Puzzledtraveller]

34. Medicaid caseworker here

[Glitterati]

35. Any idea what the delay is?

I'm really trying to figure out why we haven't seen this required "determination letter" since November 1.

Trying desperately to come up with some reason other than our hateful Insurance Commissioner and/or Governor has dictated that these delays are advantageous to their stated goals......

[Puzzledtraveller]

38. What state are you in?

[Glitterati]

39. Georgia n/t