How do I get Obamacare

March 17, 2011 8:37 AM

Help me find health insurance. Moving back to the States with wife and two kids after being away for 10 years. May not have jobs when we return. What is the best way to find health insurance? I have no idea where to start or what my options are if we return unemployed. Moving to Texas if that is relevant.
posted by jasondigitized to health & fitness (22 answers total)

Obamacare doesn't exist, at least not in the sense you're talking about. The best option is to get group health insurance through an employer. Private policies are available all over the place, but they're insanely expensive. In your position, I'd look into Medicaid, at least for the kids. I work for the state of Tennessee dealing with Medicaid applications and case management, so I'm not an expert on the policies in Texas. From a quick glance of the information available here (http://www.hhsc.state.tx.us/medicaid/) it looks like their program is pretty similar to Tennessee's. Children can qualify, and so can parents, depending on income. But I would imagine their pogram is like ours- it takes very little income to make an adult ineligible for Medicaid, but it's uasually pretty easy to get kids enrolled (especially if they're young). Aside from that, you're looking at local Health Departments and free clinics, which are usually very limited in the assistance they can offer. The only real advice I can give you is to apply for Medicaid as soon as you relocate, and hope that the kids at least can qualify. If you have any questions about that process, I'm happy to help as much as I can- feel free to memail and I'll answer to the best of my abilities.
posted by kella at 9:03 AM on March 17, 2011

The Texas Department of Insurance runs this web page that describes choices available to you.

None of them are any good.

Unemployed, you're looking at the market for individual insurance (unless you're going to be very poor, but coming back from Bermuda that seems unlikely). It will be very expensive, it will not cover very much, and it will not cover any pre-existing conditions you or your wife might have. Even the Texas government itself, hardly a bastion of left-leaning anything, has "Go on the market for individual insurance" as a third or fourth option after options that boil down to "Get a job, you worthless fuck" or "Have you considered living in grinding poverty?"

The aspects of the Affordable Care Act that would help you aren't in force yet, and the Texas government and Texas contingent in Congress are leading the charge to make sure it never does.

The TDI's web page asserts that it has a search tool to help you navigate through private individual insurance. Good luck.
posted by ROU_Xenophobe at 9:04 AM on March 17, 2011 [1 favorite]

If I started my own business, would anything change as far as options?
posted by jasondigitized at 9:20 AM on March 17, 2011

What do independently wealthy people do? Just pay out the ass?
posted by jasondigitized at 9:21 AM on March 17, 2011

what my options are if we return unemployed

In Texas? You have no options. You should know that Texas is toying with the idea of playing Medicaid chicken with the Federal government. You should also know that the current incarnation of "ObamaCare" allows states to limit Medicaid payments if they have a budget shortfall (read: all of them) to cut adults who are not disabled or pregnant and whose incomes are above $19,285 / yr.

The bitter, ugly truth is that if you are unemployed your best bet for health care is abject poverty or moving to a different state. I would highly recommend the latter.
posted by Civil_Disobedient at 9:30 AM on March 17, 2011

Look around usa.gov for basic information. As a self-employed person I have learned that many states (like mine, Illinois) require a certain number of employees in a business to qualify for a group plan. A few states require your business to have only 1 or 2 employees to qualify for a group policy but I didn't see that information with my quick search. Maybe someone will know Texas's policy, but it being Texas I would assume it's not going to be to your benefit.

Basically, look into Medicaid for the kids but if you make anything close to a living wage you will not qualify for help for the adults. Going without coverage for more than 63 days (double check this number) will mean you can be discriminated against for any pre-existing conditions. These days in the U.S. simply going to the doctor for the flu or having a test preformed can stack against you, it's not just big, bad chronic diseases that can get you denied for an individual policy.

As it is, you'll need something confirming that you had coverage in The Bahamas but sometimes US insurance companies don't accept foreign insurance as proof of previous coverage. Good luck.
posted by Bunglegirl at 9:41 AM on March 17, 2011 [1 favorite]

What do independently wealthy people do? Just pay out the ass?

Even rich people have a hell of a time getting health insurance

My dad is a one-person S-corp in Michigan. He was able to get expensive and crappy (catastrophic only, I think) coverage in a group policy run by his local Chamber of Commerce. YMMV. I don't know what the laws are in Texas, but I'm guessing not tilted toward individuals.

Good Luck.
posted by rockindata at 10:00 AM on March 17, 2011 [1 favorite]

Go to ehealthinsurance.com and enter your details, and they'll give you basically everything you can possibly get. This worked out very well for my family in Washington state. It will suck and be expensive, but you'll at least have options.
posted by KathrynT at 10:06 AM on March 17, 2011 [4 favorites]

My husband and I carry private health insurance; that is, health insurance that is not provided by an employer. It's expensive, it really only covers catastrophic events (and not even all of those), and it complicates our lives more than I care to admit. For example, my son recently needed to have an x-ray. If we had "normal" medical insurance, I would just go to the nearest facility in my network and pay a co-pay, get the x-ray and be done. But because we don't have that option, and because we pay out-of-pocket for stuff like this, I spent four days calling around to find the best price for an x-ray. Think that's easy? It's not. The front desk people have no idea how much it costs. Doctors have no idea how much it costs. Billing does, but don't forget to ask them what the negotiated insurance rate is, because it's quite a bit different than the cost they put on the bill.

We have an HSA. Anyone who tells you those are great has never had an HSA. Sure, there's some sort of tax break on it, but it's not much and we have to make sure we have money in the account before any kind of procedure or bill paying. It's a pain in the ass, to say the least, and I'd trade all of it in a heartbeat for the medical insurance my parents had when I was growing up.

As much as I hate it, it's the best option we have right now. Actually, it's the only option we have right now. We can afford to do this because we're all relatively healthy. I have asthma, however, and none of my respiratory care is covered under my insurance. I get my medications from Canadian pharmacies and I save literally hundreds of dollars a year by doing so. Our insurance doesn't cover well-visits for my kids; no check-ups, no vaccinations, nothing. We can still see the doctor, sure. We just pay for it. Our county's health department is where we get vaccinations and flu shots because it's only $5 through them, vs. hundreds at the doctor's office.

It looks like several people have shown you what's available in Texas. I just wanted you to get an idea of what paying for private health insurance looks like. Now, if neither of you have pre-existing conditions, you probably won't pay as much as we do, and you'll probably get more coverage than we do. The asthma messes everything up, as does my son's ADHD and everything that goes along with it (medications, follow-up visits, psychologist visits, etc.). It's better than nothing, yes, but it still sucks. And thank god we can afford it.
posted by cooker girl at 10:09 AM on March 17, 2011 [2 favorites]

So is the solution to get a job at Target until I find work as a I.T. Project Manager or my wife as an Accountant?
posted by jasondigitized at 10:10 AM on March 17, 2011

If I started my own business, would anything change as far as options?

In my state, if you are a small business with two or more employees then health insurance companies are required to give you some kind of quote for insurance. However, your second employee cannot just be someone in your immediate family or your spouse. They're on to that! No pretending to be a business with just you and your wife. But, that's my state....

This site might have some relevant info for you.

And there's no such thing as Obamacare... unless you're referring to a series of ridiculous compromises that ensures not much for too many people.
posted by amanda at 10:13 AM on March 17, 2011

So is the solution to get a job at Target until I find work as a I.T. Project Manager or my wife as an Accountant?

Maybe, maybe not. Depends how fast Target's health insurance kicks in, and whether working at Target will substantially cut into the amount of time you have to look for another job. Starbucks gives health insurance options to part-timers.
posted by KathrynT at 10:13 AM on March 17, 2011 [1 favorite]

One thing to note about individual plans in Texas (and we seem to be alone in this regard) is that they do NOT cover pregnancy. So if your wife is planning on having another child you want employer group health insurance.

If you start a small business and you get coverage through that you will get better plans. You will also pay for them. If you are going to start a small business you should look for an insurance broker in your area and they will be able to show you options and set you up with a plan. If you are in the Austin area, I know of a couple (I used to work for one, but I'll also give you the names of others in the area too) if you want the information.

If you are moving into the coverage area, you might also want to look at the Scott & White Health Plan which is basically an HMO through one particular hospital network. I know a couple people on the plan and they really like it and the doctors/staff they have dealt with.
posted by magnetsphere at 10:15 AM on March 17, 2011 [1 favorite]

Can you join a professional organization or alumni organization? I just looked and both a professional organization I'm in and my alumni association have discounts on health insurance for members. I'm not sure how much it helps but it's something to consider.
posted by kat518 at 10:46 AM on March 17, 2011

Starbucks used to offer fairly good health care at 20 hours a week that kicked in pretty quickly. I don't know if that's still the case.
posted by cooker girl at 10:50 AM on March 17, 2011

One thing to note about individual plans in Texas (and we seem to be alone in this regard) is that they do NOT cover pregnancy.
You are not alone in that regard. My individual policy in Illinois does not cover pregnancy. It was offered as an add-on... and add-on that doubled the price of my monthly premiums and doesn't go into effect for 12 months after starting the policy.

Definitely check out any professional organizations you qualify for but check it against eHealthInsurance quotes. The health plans that my groups offered to me were all less attractive (premiums & what they covered) than I found at eHealthInsurance.

What do independently wealthy people do? Just pay out the ass?
My former employer has a descent amount of money and his own business (without enough employees to qualify for a group policy). He has an expensive catastrophic policy and is lucky he was even given that. All wellness visits, drugs and treatment of his diabetes and his wife's back problems are paid out of pocket. They may be able to negotiate with their doctors for reduced rates but I certainly haven't had success with that approach. I do however, shop around when I need a prescription or a service because prices can vary by hundreds of dollars for the same thing.

If you or your wife is denied an individual policy and have not had insurance for 6 months you can apply for PCIP, which is federally governed in Texas (and a result of "Obamacare"). If you just want a stop-gap short-term insurance policy to cover you until you get a job, eHealthInsurance offers those. Short-term insurance will probably be cheaper but also cover less and you will not be guaranteed renewal when it expires. It can take a long time to find a job these days.

Here is the CHIP information for Children's Medicare. Looks like your kids may qualify if you make under $45k per year.
posted by Bunglegirl at 11:56 AM on March 17, 2011

So is qualification for Medicare based on current yearly income / past years income or net worth?
posted by jasondigitized at 12:38 PM on March 17, 2011

It wouldn't be Medicare (for older people). It would be Medicaid (for low-income people). You would bring your whole family into the system. Here's what the Texas Health and Human Services Commission page says (the application is linked to this page):

A family with a parent or relative caring for a child under age 19 may receive health care coverage through Medicaid if certain income and resource requirements are met. HHSC looks at a family’s income and compares it with the amount the family pays for basic needs such as rent, utilities, child care and work-related expenses. Resources such as cash on hand, money in the bank and value of vehicles are also considered.

Those who receive Medicaid for Families can also get Temporary Assistance for Needy Families (TANF). Families can choose if they want to receive one or both types of benefits.

A family can receive Medicaid benefits as long as income and resource requirements are met. Before the end of each six month period of coverage, a renewal application is sent to the family.

It used to be true (and may still be true) that once you had a Medicaid card, this automated some of the process to get you on food stamps, Section 8 housing, free child clinic, and WIC as well, so you had less time to wait for these services.
posted by Houstonian at 2:21 PM on March 17, 2011

Having been self-employed and paid for my own insurance, here are some things others haven't mentioned you'll need to do:

- compile a list of all your current prescriptions, diagnoses, chronic illnesses/conditions, and dosages, as applicable (including medications, foods and/or other things you're allergic to that might require an EpiPen - bee stings, peanuts, codeine, what have you)

- write down every surgery and hospital visit for every family member for the past 5 years
- get fresh bloodwork for everyone while it's still covered and have it on hand to submit when you apply

- record each family member's height, weight, age and gender, date of birth, etc.

- Ask your current care providers to provide copies of your medical histories, if possible
- See if any of them have recommendations for doctors, specialists or dentists in the state/area you are moving

- Once you've narrowed your field of insurance options, check and see which ones accept or deny any specialist coverage you'd need (for pre-existing conditions, think diabetes, asthma, thyroid issues, etc.)

- Be willing and ready to endure a complete physical, including a fitness test, drug test and your children to have their hearing and vision tested

If there is ANYTHING you are worried about disclosing that won't show up on a new battery of exams, especially a pre-existing condition that doesn't require maintenance medication, I'd wait to disclose, if possible, and then get "diagnosed" by a doctor here the first time you experience a flare-up. By that, I mean, for example, if you have seasonal hives, have herpes, are allergic to shellfish, are prone to muscle spasms, etc. then try any means other than prescriptions/professional treatment to deal with them or enter the country with a 90-day supply of your medication. Sorry to say, minor things could disqualify you from getting coverage - that said, I'm not telling you to lie, I'm telling you how the insurance company will deal with evaluating you.

When I applied, the cheapest option I could find cost me about $600/month, didn't cover prescriptions, and refused to cover pre-existing conditions - like my asthma - for an eight-year "grace" period. And I am otherwise healthy, childless, etc. Oh, and this was in 2002. So, that's about 10 years ago, and it might be even more difficult/expensive now.

Good luck, seriously. Most people here that don't get insurance through work pray they don't get sick, and especially try not to get injured. There simply aren't many free clinics and/or hospitals, either, even in the largest cities in Texas.

Also, many companies withhold benefits for the first 30-90 days of employment. Hence, my recommendation that you bring any prescriptions that you can with you when you move. Best of luck.
posted by Unicorn on the cob at 5:49 PM on March 17, 2011

If you have anything that might possibly be objectionable to a health insurer, you should first contact a broker who has a lot of experience. Yeah, brokers suck since they're middle-men, but if you have possible pre-existing conditions, they work in your favor since they can provide a first level of screening.

It is bad to get rejected from a health insurance company - as you need to report that to all the other health insurance companies. A good broker would reject you before the health insurance company does, reducing some of the damage.

Are you sure you want to move back to America?

If you at all have a pre-existing condition, chronic condition, DO NOT MOVE HERE.
posted by veryblue1 at 6:31 PM on March 24, 2011

Some colleges will let you buy health insurance for yourself, spouse, and children as a part time student. Perhaps you or your wife would like to pick up a few courses for continuing education in your field.
posted by yohko at 11:14 PM on April 18, 2011

For California:

http://www.dmhc.ca.gov/dmhc_consumer/hp/hp_uninsured.aspx
posted by darkfred at 11:38 AM on February 3, 2012