Forcing into Medicaid?

[MORGRUTH]

I have looked all over for information on this and I am wondering if it is true. Will the PPACA force some currently insured folks onto the Medicaid rolls?
Take me for example- I have an individual BCBS plan I enrolled in when I first got my licenses. I quit my job and saved up a nest egg and started as a p/c/life producer for my grandfather's agency. I am paid on a commission+ basis, and my income this last year was down (thanks to loss ratios I didn't get a bonus). According to the rules, my income this year would put me right out of the exchanges and right into Medicaid. I saved up a lot to do this, and now, thanks to a lower income, could I lose my coverage? I don't know if my plan is grandfathered or not as it does not include prenatal care by my choice. (Why would I pay for something I don't need/want?) Premiums could go up to, in order to cover this, and I don't know if that would be affordable for me. Sorry if this question is stupid, but I have only been doing this for about two years and I know nothing about the health side of insurance and what I have read is more and more confusing. It doesn't help that the agent I used to begin with has gotten out of the business/retired. Any help or input would be appreciated.

 

[Ann H]

If your income is low enough to qualify you for Medicaid, you are ineligible for a subsidy in the exchange. If you apply for a subsidy, you will be auto enrolled in Medicaid. If you have a grandfathered plan (and it sounds like you might), then you can keep it as long as the insurer keeps offering it. You might want to call the carrier and ask if your plan is a grandfathered plan.

 

[MORGRUTH]

Thanks for answering. So, as long as I don't try to apply for the subsidy and my income stays above the threshold, I can't be 'forced' into Medicaid. I live in a low cost of living area, own my own home, and have budgeted accordingly so I can afford to have coverage. I just feel like being forced into Medicaid (which I don't qualify for now) when I am responsible enough on my own is not something I want. Very few doctors accept it in this area and those that do are not that great. They see over 100 patients a day in their clinics and spend less than 10 min with their patients (if you even see the doctor at all)!

I guess I will just have to work harder so I can earn more, huh? Then I won't worry about this at all, and the government will pay about 75% of my premiums for me... The bad thing is, our carrier has slapped a 1% growth limit on us, so I can't just write more policies there. I'll come up with something. Maybe try to pick up another carrier? My grandfather is captive, but I'm not. I'll check out the other forums for something.

 

[Ann H]

Thanks for answering. So, as long as I don't try to apply for the subsidy and my income stays above the threshold, I can't be 'forced' into Medicaid. I live in a low cost of living area, own my own home, and have budgeted accordingly so I can afford to have coverage. I just feel like being forced into Medicaid (which I don't qualify for now) when I am responsible enough on my own is not something I want. Very few doctors accept it in this area and those that do are not that great. They see over 100 patients a day in their clinics and spend less than 10 min with their patients (if you even see the doctor at all)!

I guess I will just have to work harder so I can earn more, huh? Then I won't worry about this at all, and the government will pay about 75% of my premiums for me... The bad thing is, our carrier has slapped a 1% growth limit on us, so I can't just write more policies there. I'll come up with something. Maybe try to pick up another carrier? My grandfather is captive, but I'm not. I'll check out the other forums for something.

You have a great work ethic. I wish more people were like you! Good luck to you, and be sure to let us know how we can help.

As for Medicaid, there are other ways that the govt can end up trying to auto-enroll you, but in most states, if you have other coverage (like your grandfathered plan), then either you are not eligible for Medicaid or Medicaid pays second.

 

[bluediamond]

I can't see them putting anyone who has assets above a certain amount into Medicaid regardless of their income. Will they not take the same formula to qualify for Medicaid as they do for senior's to qualify for help with LTC?

 

[MORGRUTH]

I can't see them putting anyone who has assets above a certain amount into Medicaid regardless of their income. Will they not take the same formula to qualify for Medicaid as they do for senior's to qualify for help with LTC?

I have no idea, but I do know that I don't qualify here in TX because I don't have children but I would if I were to get pregnant with no insurance I could claim it for myself and the child with an income less than $20000 or so.

The main problem with me is stability. I want to know that my insurance is the same every time I go to the doctor, and that if something were to happen and I did get sick or hurt and was unable to work, I wouldn't be forced into Medicaid when I needed good coverage the most. Anything I might get from an accident policy or Aflac, etc would provide lost income, but might not count towards the income for the eligibility requirements.

There is too much uncertainty for me when I already had worked everything out on my own. Grandfathered or not, I am worried that I won't be able to afford the coverage I currently have if it goes up because of this and I am forced into the exchange or Medicaid based on eligibility rules. I know premiums for us in our twenties will climb because of the rules saying older people can't be charged more than a certain amount more than us, but aren't we cheaper to insure? I got premium back last year thanks to the MLR, but I wasn't looking for it.

I'm not just worried for myself, but others as well. I have friends who have part-time jobs and are still on their parent's policies. I know they don't earn more than the threshold, so they would go from good insurance to Medicaid? It makes no sense to me, and I don't see how we are going to pay for it as a country. I like the idea of everyone having coverage, but I don't see how this can work, especially with people like me falling through the cracks. Maybe that's why 'children' can stay on their parents policies until they are 26. Many of those same 'children' who don't have good paying jobs won't find out until everything has gone into effect and they have lost their access to good healthcare when they age out of their parent's policy. Maybe then we will have 'Occupy Congress' instead.