US health insurance fuckery

December 5, 2021 9:12 PM

I'm angry in general that health insurance is tied to employment and especially frustrated right now. I lost my contract job and therefore my health insurance on November 20th. I have several doctor appointments and major med expenses in December and I feel trapped. What should I do?

I've had Medicaid in my state for a large part of the last five years - great coverage, everything was free - but I applied a couple days ago and was denied.

I applied for Obamacare today and was accepted but it wouldn't start until January 1, 2022.

I seriously sprained a finger in August and have PT and OT and a second appointment with a hand specialist scheduled in December. I also have an appointment with the NP who prescribes my meds. Out-of-pocket, my meds are about $750/month.

I have a dentist appointment this month that will cost at least $400.

I really need to update my glasses.

I have some freelance work right now which will pay the bills but I it won't cover all the medical expenses.

My priorities are meds and the appointment with the NP. I'm not sure that I need all the hand appointments. The plans that cover dental and/or vision and/or my meds are close to $1000/month.

Options:
- sign up for Obamacare and postpone all the hand stuff (OT, PT and hand specialist), dental, and vision until January and pay for meds and NP appointment out of pocket
- pay for everything out of pocket and go deeper into debt
- sign up directly for a health plan with a company that I know will be prohibitively expensive

fantasyOptions:
- become a Canadian citizen
- go to appointments and then skip town
- marry a random person who can cover me with their health insurance

posted by anonymous to Health & Fitness (11 answers total)

Your job and the insurance ended on Nov 20? Not the end of the month? Is COBRA an option to cover you for that one month?
posted by bluedaisy at 9:20 PM on December 5, 2021 [13 favorites]

Because you lost insurance you had through a job, you should be eligible for a special enrollment period for marketplace plans and not have to wait until January. Have you called the Marketplace hotline? It can be a little bit of a wait to get through but they were really helpful last year when I had all sorts of weird issues trying to apply.
posted by augustimagination at 9:20 PM on December 5, 2021 [19 favorites]

Did you apply for medicaid before or after the end of November? Did you make it VERY clear that you no longer had a work contract, that your insurance was ending, and that you had upcoming medical expenses?

Find out some things. When you apply for medicaid in your state, how far retroactive is it? (In mine, it's at least to the start of the month you applied in.) Also, there's a specific amount of days of income that applies. Find out what that is. Keep applying, every month if necessary. Yes, even if you give in and sign up for a plan, because it should overrule it - but doublecheck for your state.

By January, you're almost certain to be coverable by medicaid, if not sooner.
posted by stormyteal at 9:29 PM on December 5, 2021

Put in the application for COBRA now, to cover December’s appointments. You will have to pay the premium for that. Hey onto the ACA plan in January.

Sorry you’re going through this. You are right about our system being messed up.
posted by SLC Mom at 10:44 PM on December 5, 2021 [3 favorites]

Buy a month or two of COBRA coverage will be the best way to cover that gap.
posted by kschang at 3:30 AM on December 6, 2021 [1 favorite]

I know that COBRA payments can be too expensive for many people. When I was a freelancer and had no insurance, I was able to go to a free clinic locally for non-urgent things. For your meds, you probably already know about GoodRX. The benefit is much reduced prescription costs in most cases. The drawback is less privacy in terms of the meds you are taking (according to something I read a while back and cannot locate at this moment). Your situation sucks, I am so sorry.
posted by Bella Donna at 3:50 AM on December 6, 2021

Try googling "health insurance broker near me". I've had good luck with my broker over the years and that's how I found her. You don't pay for their services, they get commissions from the insurance companies. They'll often have options that you won't find on the Obamacare market, plus he or she will be able to tailor you plan to your needs. Not to mention they'll be able to explain in plain English why they are recommending one plan over another.
posted by Short Attention Sp at 5:39 AM on December 6, 2021 [1 favorite]

Hopefully you won't have to go this route, but it might be worth making a few calls to social service agencies to get some assistance with your meds. Some options that spring to mind are your local UJA-funded Jewish social service agency (find one, for example, that also provides case management and a food bank, not a Jewish community center with a pool), Catholic Charities, and St. Vincent de Paul. Many agencies are in a position to offer $100 here and there.

I am all too sympathetic because my psych Rx are extremely expensive. Seconding GoodRx. If you look around Ask, there may be some "alternative" options recommended--I'll look and see if I can find them.

Does your NP have samples or give-backs? Now's the time to ask for them explicitly. If you keep taking the medicine with no complaints, they may not know that there's a problem and may not offer.
posted by 8603 at 6:23 AM on December 6, 2021 [1 favorite]

I second calling a local insurance broker - they are very good at navigating our terrible system.

And dental and vision insurance in general aren't that great. Many providers give pretty good discounts if you don't make them jump through the insurance hoops, so it may be worth a call to ask them about costs if you're currently uninsured.
posted by writermcwriterson at 8:51 AM on December 6, 2021

First, you should figure out how much COBRA costs. Your former employer is obligated to send you a letter informing you of your option to purchase it... but some employers can be deadly slow about sending them out. You may need to reach out to former-employer's HR and ask them to expedite it. I had to do this a few times after changing jobs.

If you are going to contact HR anyway, you may also want to ask for a "termination letter" or some other formal documentation of your separation from the company and effective end date of your employer-paid insurance plan, so you can substantiate the oncoming gap in coverage if needed.

If you can afford to purchase COBRA, I think that is likely to be the least-painful solution, since it will let you keep the insurance you are currently on, without any changes or need to find different providers.

I can't really comment on Obamacare, having never used it myself, but I sure thought it was supposed to cover gaps like loss of employment without waiting for the beginning of an open enrollment window. If COBRA isn't an option, I'd definitely push back. The termination letter from your former employer (see above) may help with this.

For the glasses, do you need a new eye exam and Rx, or just physically replace the glasses? If it's the latter, you would probably do well to get your prescription and buy glasses online. I haven't bought glasses (frames or lenses) in a physical store in years. Even Warby Parker is kinda pricey compared to what I can get online from overseas (most of the well-known online shops dropship from China/India/Pakistan, in my experience). Your optometrist Rx will contain everything you need except your pupil distance in mm, which you can determine pretty easily with a friend and a millimeter ruler.

For your meds, if they are produced by a major US pharma company, there should be a number on the box somewhere for their "patient support line" or something like that. Call that number and talk to them... there are very specific words you want to use to trigger the outcome you want: "I lost my insurance", "I cannot afford my prescription", and "I'm going to have to stop taking my prescribed medication". That should get you routed to either the pharma co's in-house patient benefit department, where they may be able to get you a substantial discount on (or sometimes free) medication, or in other circumstances they can hook you up with a "charity" that will do it. Do not feel bad for taking these "charitable" benefits. It's all part of the system that the pharma companies have created to get around Federal anti-kickback laws (since, if you are on Medicare / Medicaid, what they are doing is de facto a kickback, which would be illegal... but if a "charity" does it, then it's not, and the fact that the charity is funded mostly by contributions from pharmaceutical executives is just a, uh, happy coincidence, because they are such nice folks).

If your medication is generic and/or manufactured overseas, the manufacturer may not have such programs. Perversely, it may make sense for your NP to prescribe you the big-name / non-generic brand specifically, so you can get access to payment assistance. (This is literally the thing Medicare/Medicaid want to avoid, and why these schemes are illegal on their face if paid for by the pharma companies for Federal benefit recipients, but... eh, the system is so fucked, what's a little additional fuckery between friends?)

Talk to your dentist and see if the cost can be reduced for paying cash. Sometimes, prices can suddenly become negotiable if the provider knows they aren't dealing with an insurance company, but a straight cash-on-the-barrel-head transaction. This is also probably illegal or in violation of some level of agreement with the insurance companies, but again... fuck 'em if they can't take a joke.

If there's no price breaks available from the dentist, I would perhaps look to have at least some of the work done (whatever you need right away to be comfortable or stop a bad situation in your mouth from deteriorating further) at a low-cost dental clinic. Your local health or social services department might be able to point you in the right direction towards one. In general, I would probably put off having any cosmetic or "nice to have" type work until you are back on an employer plan; for some reason, off-the-shelf consumer dental plans are startlingly expensive, far in excess of what I know my employer pays for my plan. I have never gotten a good explanation of why.
posted by Kadin2048 at 11:31 AM on December 6, 2021 [2 favorites]

Great advice above, re: dentistry. I made it clear to my dentist that I had no dental insurance and was unemployed and she gave me a significant discount. It is worth asking about. My sister found lower cost dental treatment at the dentistry school at a major city, if you happen to have such available. Good luck!
posted by Bella Donna at 1:54 PM on December 6, 2021