"So basically you should just try not to need a doctor."
January 11, 2014 8:01 AM   Subscribe

The New York insurance website said I qualify for Medicaid. This means I'm not eligible for the regular subsidized plans and must pay full price for them if I want them. This makes no sense whatsoever, but nobody will budge on this. What can I even do?

Question explains it all. I am unemployed and do not currently have health insurance, and even though I am under 26 my parents either don't have health insurance they can put me on or aren't willing to put me on theirs (respectively).

Based on last year's income, the New York insurance website said I qualify for Medicaid. This means I'm not eligible for the regular subsidized plans. They said that if I defer Medicaid I must pay full price, which is FAR more than I can afford. This makes no sense whatsoever - if my income qualifies me for Medicaid surely it should qualify me for a subsidized real plan that doctors and therapists actually take - no one I am currently seeing takes it - but nobody will budge on this.

I have no health insurance for the month of January because the website wouldn't even recognize my identity in the system before the coverage deadline. (It also deleted my entire application several times and I had to re-enter it all.) The February coverage deadline is fast approaching. And supposedly there is a fee if I go too long without coverage.

I can't talk to my parents about it because they are very conservative and will turn it into an Obamacare rant, as they have every time I have been forced to bring it up just in the course of everyday conversation. It takes forever just to get past the health insurance's phone tree, let alone talk to a person, and I can't stand talking to companies on the phone anyway.

What can I even do? The only options seem to be uninsured or as good as uninsured, neither of which are very appealing.
posted by dekathelon to Health & Fitness (62 answers total) 8 users marked this as a favorite
Can you explain why you don't want to enroll in medicaid?
posted by anastasiav at 8:08 AM on January 11, 2014 [3 favorites]

Response by poster: Because:

- The coverage/benefits seem a lot worse, which would make sense.

- A lot of doctors don't take Medicaid. Study. (It is hard to find reliable studies that aren't politically motivated, but the fact that there is such strong partisan opinion surely filters down to the doctors too.) None of the people I am seeing take it. It is hard enough to find good doctors as it is. As I understand it, dental care (my teeth have been killing me for the past few months and I can't afford to do anything about it) and mental health care (as I understand it the really good therapists don't take ANYTHING, let alone Medicaid) are even harder. The reasons for this vary from low reimbursement rates to more run-of-the-mill "fuck Obamacare, fuck the poors" sentiment (my father was a doctor and I definitely remember hearing comments from the staff behind closed doors along those lines, and I doubt it's just those people.) I don't want to be the person that the doctor secretly hates.

- I don't feel right taking Medicaid when I'm not systemically poor, I'm just broke. It would feel like I'm from one of the hipsters on food stamps pieces that get made fun of on the Internet every few weeks.

- It just doesn't make any sense at all. Literally nothing about it makes the remotest amount of sense. To me, it comes off like I am being punished for not having the foresight to make an extra thousand dollars or so last year, on top of all the other ways I was already punished for it.
posted by dekathelon at 8:16 AM on January 11, 2014

Yes, Medicaid is meant for low-income folks who fall into certain categories. It was recently expanded (in many states; some are opposing the expansion, but not New York) to cover pretty much everyone who makes less than 138% of the Federal Poverty Level, and the federal government said it would pay for the increased cost.

The ACA subsidies are for people who aren't in poverty, but wouldn't be able to afford to purchase insurance on their own.

For what it's worth, if you had employer-provided insurance that meets the minimum requirements, you wouldn't qualify for subsidies even if you would otherwise because of your income — so you might be in the same boat.

Your options seem to be:
* Enroll in Medicaid
* Be uninsured
* Pay full price for another plan
posted by brentajones at 8:22 AM on January 11, 2014 [5 favorites]

Unfortunately, I think you might be stuck. Medicaid is administered at the state level and the subsidies are federal, which is why it would make sense that you can't ask the Feds to give you what the state already does. Politics, what can you do? In the meantime, something is better than nothing, so I would suggest enrolling in Medicaid for now.
posted by ThePinkSuperhero at 8:24 AM on January 11, 2014 [6 favorites]

- I don't feel right taking Medicaid when I'm not systemically poor, I'm just broke. It would feel like I'm from one of the hipsters on food stamps pieces that get made fun of on the Internet every few weeks.

Your situation is exactly what the Medicaid expansion is for.
posted by empath at 8:32 AM on January 11, 2014 [58 favorites]

What do you think your income will be in 2014? That will help me explain your situation.
posted by futz at 8:33 AM on January 11, 2014

I understand that there is a stigma, but you (and all of us) are going to have to get over it. Medicaid was made for you. It's not a bad thing and it's not a moral failing. Sure, a lot of doctors don't take it, but a lot do (and this will get better over time). Sign up! Aren't you living in one of the biggest cities in the nation? You'll find a doctor.
posted by Houstonian at 8:40 AM on January 11, 2014 [16 favorites]

I don't know the details of qualifying for insurance in New York, but I can assure you that having Medicaid is not the same as being uninsured, and if your choices are to have Medicaid or to be uninsured, you should choose Medicaid in a heartbeat.

You obviously realize that poor reimbursement is a problem with Medicaid patients making doctors reluctant to see them - all of that goes more than double for uninsured patients. If you're uninsured and don't have the cash to pay providers who take straight up cash, the only place you'll have to turn to for care is the emergency department, and 1 visit to the ED for the wrong problem can bankrupt you. Don't even consider going without insurance.
posted by treehorn+bunny at 8:41 AM on January 11, 2014 [14 favorites]

- I don't feel right taking Medicaid when I'm not systemically poor, I'm just broke. It would feel like I'm from one of the hipsters on food stamps pieces that get made fun of on the Internet every few weeks.

Your question reads an awful lot like "I'm too good for Medicaid" which is weird, since eligibility is based entirely on income. There aren't qualitative standards of "types of people who shouldn't be on Medicaid."

I think you need to accept that it's the only option for you right now.
posted by jayder at 8:41 AM on January 11, 2014 [36 favorites]

You deserve Medicaid as much as anyone else. Those 'hipsters on food stamps' pieces are bullshit garbage nonsense. The reason the social safety net is being shredded is exactly because as a society we are primed to believe that government aid is always meant for Someone Other (someone poorer, more abject, more deserving) than the real people who actually benefit. And fuck those doctors who hate the poor - they're way better off getting paid by Medicaid than not getting paid at all when you're meaningless cut-rate out-of-pocket health insurance sticks you with a $30,000 bill you can't pay and they wind up getting nothing at all. Regardless, that's not your problem.

You are not being punished - at least not more than you were last year, when you had no health insurance at all. Rather, you can sign up for Medicaid and you will at least be well-protected in the event of a catastrophe. You should sleep better at night knowing that if you end up in the ER, you're not going to be burdened with medical bills you'll be paying off for the rest of your life. No, you may not be able to get the kind of dental care and stellar mental health care you deserve, at least not right away, but lots of otherwise decent health care plans don't offer dental. (Mine doesn't.) If I were you, I'd take the money you'd save from having to shell out $150/month, or whatever you'd need to pay for a bargain-basement out-of-pocket plan, and put that towards at least one good cleaning and a dental checkup, plus visits to a therapist who offers a sliding scale. I bet you can find someone who'll see you for ~$60/visit - especially once you can demonstrate you're on medicaid.

You might not be able to get major dental work done, and that sucks, but if it becomes a true emergency, you can search out a clinic that will do it for a fair price. One of the big reasons dental care is such an issue for people who are on Medicaid is that a lot of those people lack the resources (time off work, internet, cell phone, askmetafilter) to actively search out the free care that's available. That's not your situation. This isn't ideal, but it's not an emergency, either. Sign up for Medicaid, and use the money you save to fill some of the gaps in your coverage.

Good luck.
posted by pretentious illiterate at 8:42 AM on January 11, 2014 [38 favorites]

I was on Medicaid in NYC when I was 23-26 because I was broke and not getting un-broke any time soon. It was the best insurance I have had in my adult life. Certain things weren't covered, but I had my teeth fixed and every doctors visit, test, procedure and operation was 100% free of charge.

I would think twice about denying yourself very good healthcare on grounds of rumor and self-conciousness. I'd still be paying medical bills had I not signed up.
posted by griphus at 8:44 AM on January 11, 2014 [49 favorites]

aren't willing to put me on theirs

This seems to be the point where you have some flexibility. I understand it might require listening to a thoughtless, painful rant about Obamacare, but your point about Medicaid patients not being accepted by many mental health professionals would actually give you some common ground for mutual sympathy, even if you privately disagree about how that should be resolved.

Is this parent refusing an added cost you could reimburse later?
posted by Monsieur Caution at 8:46 AM on January 11, 2014 [1 favorite]

The Medicaid path may be more appealing to you when you recognize that it should be a temporary answer, until you find employment that will offer coverage as a benefit.
posted by yclipse at 8:46 AM on January 11, 2014 [1 favorite]

If your income goes up in 2014 (if you get a job), won't that bump you out of Medicaid and into the insurance pool? Meaning: Medicaid is just a temporary situation, and you shouldn't sweat it too much.
posted by nacho fries at 8:47 AM on January 11, 2014 [2 favorites]

1) Take the Medicaid. If you qualify, you qualify, and it will save you from both massive debt from health care emergencies and any fees from not taking insurance. You can go off of it once you're employed again or find an affordable insurance plan that covers your doctors. There's really no reason not to take it in this scenario.

2) In the meantime, tell your doctors that changes in insurance due to the Affordable Care Act means that they are no longer covered by your insurance but that you'd like to continue to see them, and that you are interested in finding out if they offer cash discounts, payment plans or subsidies on their own to cover the gap until you can find an affordable insurance plan that covers them. You may be surprised by what they can offer. You don't need to tell them you're on Medicaid.

3) Write your local New York State representatives with your story and encourage them to change the exchanges so that subsidies are available for those in scenarios where individuals are temporarily unemployed and do not qualify for COBRA from a prior employer, so those in your scenario can have the ability to continue their coverage with the same doctors they have been receiving care from.
posted by eschatfische at 8:48 AM on January 11, 2014 [7 favorites]

Also, most of those Hipsters On Food Stamps articles are written by, if you pardon my language, classist scum. We pay taxes on everything, and taxes twice on our income in this city. Medicaid is something a) we deserve and b) a way we invest in ourselves. Our benefits here are so good because NYC understands that having a sick, broke populace is bad for everyone, so they city is willing to help people get and stay on their feet, if need be forever. If you pay taxes and if you intend on honestly paying taxes when you're no longer broke, you're not taking advantage of the Medicaid system. You're making sure you can pay into the system in in the future, instead of paying some hospital for the rest of your life.
posted by griphus at 8:49 AM on January 11, 2014 [55 favorites]

Trust me, if you don't think you have paid enough taxes yet to justify a year or so on Medicaid, you will do so over the next decade. Sign up now, save yourself the risk of massive debt in the shor-term, and give back over the long haul.
posted by rpfields at 8:53 AM on January 11, 2014 [2 favorites]

Are you single? In my state even if you qualify for Medicaid financially they won't accept you unless you meet other criteria such as severe disability or being pregnant. Don't know how NY works...
posted by futz at 8:55 AM on January 11, 2014

I don't know about your state, but there's a healthy chance that Medicaid is going to come with considerably lower copays, no deductible, and also possibly things like vision and dental care that most of the subsidized ACA plans do not.

No, some doctors don't take Medicaid, but for example, my current psychiatrist takes one and only one insurance plan aside from Medicaid and so I'd be just as SOL if I took insurance through a ton of other totally decent providers. This is just the way that the insurance system is annoying. If you had insurance through work and switched jobs, you'd likely have just the same problem with potentially having to switch doctors. You're almost never going to end up with NO provider options, and the number of doctors who take Medicaid may well be considerably larger than the number who take any one non-Medicaid insurance plan, because Medicaid is reliable income, even if it's low reimbursement rates.

Seriously, the reason a lot of states didn't want to expand it is that they'd rather have the ACA offer subsidies to get poor people onto WORSE non-state-run insurance plans. Your doctor is not going to hate you for having Medicaid, even if they're annoyed at Medicaid in general.
posted by Sequence at 8:55 AM on January 11, 2014 [1 favorite]

I should add that my state did not expand Medicaid. Did NY? If so, ignore my previous comment.
posted by futz at 8:59 AM on January 11, 2014

In my state even if you qualify for Medicaid financially they won't accept you unless you meet other criteria such as severe disability or being pregnant.

Qualifying for Medicaid (or Medicaid-managed care) in NYC is 100% based on income. Below a certain amount, you qualify for the "everything completely covered" plan. Above that, you qualify for a "most things covered, but with some co-pays." Above that, you don't qualify. That's it.
posted by griphus at 9:02 AM on January 11, 2014 [5 favorites]

Thanks griphus. My state sucks.
posted by futz at 9:09 AM on January 11, 2014 [2 favorites]

Likewise I have been on Medicaid for the past three years in NYC. My first few years here I was paid under the table and was thrilled to be able to have medicaid because I wouldn't have been able to afford private insurance at the time. I started a new, legit job (as a contractor, so no employer-based plan) a few months ago and was hoping that would mean I could be pushed up to a new Obamacare plan, and was similarly disappointed to discover that my eligibility was based on past income instead of future projected income, and my last years income thus far doesn't push me out of medicaid. But HOTDAMN I love me some medicaid. I haven't paid a single dollar for any prescription in the years I've been on it. I haven't paid any co-pay for any doctor's visits, or for the one time I was hospitalized.

I have paid zero dollars for my health care and my doctors have all been great and have treated me with the same care that I would expect from any doctor who doesn't accept Medicaid. Next year, things will be different. Yes, you might have to find some new doctors, but if you are broke, you can't afford the doctors you have out-of-pocket right now anyhow. So you might as well use this as an opportunity to get some care while you don't have to pay for it.

You really need to get over the stigma because that's your conservative parents' echoing in your head, and it is a program meant to serve people just like you and me.
posted by greta simone at 9:24 AM on January 11, 2014 [20 favorites]

The best part of banging your head against a wall is how good it feels when you stop. Enroll in Medicaid.
posted by kat518 at 9:25 AM on January 11, 2014 [8 favorites]

Why won't your parent add you to their health insurance? What if you offer to pay the additional premium cost?

Barring that, get Medicaid. It might not be as good as private health insurance, but it is NOT "as good as being uninsured."

I relate to your frustration - I was going to be in a similar situation until recently (I just got a job that now means I'm eligible for subsidies instead of Medicaid.) It's frustrating to hear all this great stuff about the ACA and then realize that you won't be able to reap the full benefit of it, at least right now. Especially when having mental health coverage is so vital, and when perhaps therapy is what is needed to help dig oneself out of the morass of unemployment.

But don't fall prey to black and white thinking of "Medicaid isn't perfect so I won't bother." (Or for that matter, the class stuff about being like a hipster on food stamps.) That's going to keep you in that morass. Get Medicaid, ask here or somewhere else for help finding decent primary care providers/clinics (and maybe even mental health clinics/therapists, although I share your suspicion that that will be tough) who take Medicaid, and find sliding-scale therapy options.
posted by needs more cowbell at 9:26 AM on January 11, 2014 [1 favorite]

Go get on the Medicaid. That's what you've paid taxes for. That's what I pay taxes for. Health care is a public good which everyone deserves.

I'm with griphus on the "grar I hate hipsters-on-food-stamps blather!" As far as I am concerned, keeping people fed and healthy is something any decent society does for its citizens. Medicaid and food stamps aren't "just" for poor people from the slums, or pink-haired hipsters, they're for anyone who qualifies.

I know a couple of folks who have been on Medi-Cal (California's version of Medicaid) since before health reform. They get good care. They have glasses, necessary dental work, and mental health care. And when one friend had a major health crisis that landed her in the hospital for two weeks, she had excellent care with kind doctors and paid NOTHING.

Take the Medicaid, take advantage of the care it offers, and think of it as a safety net for when you are unemployed. Once you are employed, you won't need it anymore.
posted by Rosie M. Banks at 9:41 AM on January 11, 2014 [1 favorite]

Response by poster: Clarifications: My mother is unemployed, probably indefinitely. I have not spoken to my father since I turned 18, with excellent reason. I assume he has insurance but it is not an option.

I have absolutely no idea what my income is going to be in 2014. I don't see myself ever being able to get a job again, my main income source from 2013 has dried up, for all I know I could be hit by a bus tomorrow (hopefully fatally, because I can't afford another hospital bill), and the idea of even having the slightest idea what I will make is ludicrous.
posted by dekathelon at 9:43 AM on January 11, 2014

Btw, speaking specifically to your dental health concerns, apologies if you have already looked into this and been unsuccessful but find a dental school nearby where they have a clinic. My father is a dental school professor and I think at his clinic, patients pay less than $100 to enroll and then everything is covered. Yeah, they're students but they're supervised by people like my dad who take over when his students get in over their heads (rarely, from what I understand). My father's been practicing for 30+ years and he's still in the clinic once a week.
posted by kat518 at 9:44 AM on January 11, 2014 [1 favorite]

Take the medicaid. It is better than nothing.
In my personal experience i had the most trouble with mental health. I have some pretty specialized issues and needed an very competent therapist. I self paid on a sliding scale, ultimately for me it was worth it because my long term health/mental health is so much better. Dont stick with somebody who is subpar because it is covered. The savings in terms of increased productivity, lessening of symptoms, and staying out of higher levels of care made it worth all the upfront costs. Medicaid will cover a ok psychiatrist.
I'm really unsure about dental coverage so I cannot comment on that.
This time will pass. You will be able to qualify for better insurance down the road. There are good doctors who take medicaid and it will meet your basic needs.
posted by AlexiaSky at 9:44 AM on January 11, 2014

I can't afford another hospital bill

Which is precisely why you should sign up for Medicaid. It may not be ideal, but it is vastly, vastly better than nothing.
posted by scody at 9:55 AM on January 11, 2014 [16 favorites]

Reading your update, it's a no-brainer: take the medicaid. Stop the self-discrimination. Just because you don't see "the poor" (whatever you associate with that term) whenever you look into the mirror does not mean that you are better/undeserving.
posted by travelwithcats at 10:00 AM on January 11, 2014 [2 favorites]

Take the Medicaid.
posted by futz at 10:02 AM on January 11, 2014

I believe that if you were hit by a bus and would qualify for Medicaid today that, on the up side, unlike other insurance, you can often get Medicaid *after* you get sick/injured, so there's that. But makes way more sense to do it now. Eligibility at least where I am is handled month-to-month, so if you apply now and get it, and then get a job in March, then it's not like they go back and tell you that you have to give it back for the months you had it. Unlike the ACA, there's no forward guessing.

Seriously. Get Medicaid, and then get a Medicaid-taking mental health provider, and you will be in a much better place as far as actually getting a new job and getting your life back on track.
posted by Sequence at 10:09 AM on January 11, 2014

I don't feel right taking Medicaid when I'm not systemically poor, I'm just broke.


I don't see myself ever being able to get a job again, my main income source from 2013 has dried up
You're broke, you have no income, and you don't think you'll ever get a job again, but you don't think you're systemically poor?

OK, I guess, but in any case, Medicaid is not for the "systemically poor" (whatever you mean by that). It's for people who meet certain eligibility requirements, financial and otherwise, which you meet. Medicaid is for you.
posted by Flunkie at 10:11 AM on January 11, 2014 [12 favorites]

Response by poster: Other clarification, because this is seriously getting way out of hand: Look. I come from an upper-middle class upbringing (my mother is more middle class now and arguably was before she got married, but I'm talking about my childhood); I have a college degree; hypothetically I could move in with my mother if I wanted to; I have access to resources that billions of people simply do not. There is a VAST difference between that and systemic poverty, which is why I try to say I'm "broke" instead of "poor" (this piece is technically about Girls which a lot of people are allergic to but explains it well enough) and be aware of my privilege in other ways and not feel entitled and all of that. It doesn't mean I think I'm better than anyone. If anything it's the opposite, it means that I don't want to take things that other people need more.
posted by dekathelon at 10:16 AM on January 11, 2014

Mod note: OP, we've been down this road before, thanks for clarifying and from now on please do not argue with people answering your question.
posted by LobsterMitten (staff) at 10:18 AM on January 11, 2014 [2 favorites]

It doesn't mean I think I'm better than anyone. If anything it's the opposite, it means that I don't want to take things that other people need more.

You need it. For real. Right now. And taking it for yourself doesn't mean that you're taking it away from someone else. The voice in your head bending over backwards to convince you not to take the solution that is literally right in front of you is the voice that says you're not worthy of love and wellness. That's your jerkbrain. Ignore your jerkbrain. Sign up for Medicaid.
posted by scody at 10:20 AM on January 11, 2014 [34 favorites]

Just to clarify, you accepting Medicaid does not mean that you're taking that health care away from someone else you may be worse off. If you both qualify then you both get access. It's not one or the other.
posted by fishmasta at 10:20 AM on January 11, 2014 [15 favorites]

Everyone here has access to resources that billions of people simply do not, and "I could move in with my mother" is not a disqualifying checkbox on the Medicaid enrollment forms. Again, Medicaid is not for people who can't move in with their mother. Medicaid is for people who meet certain requirements that you meet.
posted by Flunkie at 10:21 AM on January 11, 2014 [14 favorites]

My father worked for many years as a food stamps intake person, assessing peoples' eligibility to receive food assistance. His favorite clients were people just like you- people who were down on their luck and out of good options, but who, with government help, would eventually be able to get back on their feet. Of course he didn't begrudge helping people who were always going to need aid, they obviously needed and deserved help as well, but I think he got the most satisfaction from knowing that he was helping someone come back from the brink, rather than simply maintaining them on the edge of it.

Look. You're always going to be able to find someone who is worse-off than you. ALWAYS. But if everyone went by that criteria, only one person in the whole wide world would be allowed to suffer at any given time. That's just irrational.

You NEED Medicaid. And the fact that you now have access to it is amazing and wonderful and not something you should feel shame about for one single second. Civilized societies don't just let people fall into the gutter and die, and it is an occasion for JOY that Medicaid has been expanded to cover you. Even if your parents ARE 'middle-class'.
posted by showbiz_liz at 10:33 AM on January 11, 2014 [21 favorites]

Actually, one of the reasons that social services in the US are so much shittier than they are in Europe is precisely that they are only for/used by the most marginalized. My biggest hope for Obamacare/Medicaid expansion is that as middle class people start using it in large numbers, there will be sustained political pressure to make it work well. Social programs that are for everyone thrive; social programs that can be painted as handouts to the Poors die. You should use Medicaid because Medicaid needs people like you.

Also, with government programs - if they don't use all their funding this year, their funding will be cut next year. Believe me, Medicaid wants to spend money on you.

Also, class is not culture, even though class creates culture. You may be from a middle class background or have grown up with upper middle class ideas, but if you are sustainedly living the life of a working poor person, you are a working poor person for political purposes. Or in your case, a destitute person. If you had a trust fund and were living some kind of broke-hippie life, that would be different, but if you have no money and no real possibility of getting money, you're not functionally middle class. If nothing else, your question has really clarified for me the critique of theories of class which are primarily aesthetic/cultural rather than based on wealth and income.

Are you in therapy? If you're not actually going to lose your current therapist by taking Medicaid, you're not really going to be missing much. FWIW, here in the Midwest my excellent therapist takes Medicaid - I have insurance through work, but I know the practice takes it. And my therapist is top notch and has helped me immensely.
posted by Frowner at 10:54 AM on January 11, 2014 [38 favorites]

IIRC, it's based on your estimate of 2014 income. If you overestimate your income to get out of Medicaid and into the 100% subsidy range, and end up making less, I don't believe you're required to reimburse them for any amount. Underestimating income can result in having to repay the subsidy, but I don't think overestimating has a similar consequence.
posted by melissasaurus at 11:25 AM on January 11, 2014 [1 favorite]

The funds for exchange subsidies and Medicaid subsidies all come out of the same federal bucket. You aren't taking any money from other Medicaid people by using Medicaid. Likewise, you wouldn't be saving any federal money by using the exchange subsidies instead of Medicaid subsidies. It's all the same money source. If you think you are doing anyone any favors by using the exchange subsidy instead of the Medicaid subsidy, you aren't.
posted by JackFlash at 12:11 PM on January 11, 2014

A group of people in Albany decided that people in your situation are eligible for Medicaid. They could have said, people like you unless they have a bachelor's degree or people like you unless they could move in with a parent or unless they come from a middle class family. They didn't. Because sometimes poor people have bachelor's degrees, come from middle class families, and/or could move in with their mothers. It didn't matter to the aforementioned people in Albany. It shouldn't matter to you.

You don't get a special prize for not enrolling in Medicaid.
posted by kat518 at 12:29 PM on January 11, 2014 [8 favorites]

As I understand it, dental care (my teeth have been killing me for the past few months and I can't afford to do anything about it) and mental health care (as I understand it the really good therapists don't take ANYTHING, let alone Medicaid) are even harder

You're darn lucky then, because the fact that Medicaid covers dental work at all is a freakin' miracle. Otherwise you almost certainly won't get it with regular medical insurance for an adult.
posted by Jahaza at 12:39 PM on January 11, 2014 [2 favorites]

I come from an upper-middle class upbringing

There is no class test for Medicaid. There is no education test for Medicaid. There is only one test -- an income test. You qualify based on the only criteria the state has set forward.. Trust me that if the state had wanted to deny you medicaid on other grounds, they would have made regulations that would have done so.

Hurray for you that you are aware of your privilege. But, being aware of it doesn't mean that you somehow don't qualify for the social safety net, or shouldn't take advantage of it, or ... I don't even know what.

It sounds like your argument boils down to one of two things: either you are embarrassed to use medicaid, or you feel like you are somehow taking services away from others.

You are not taking services away from anyone. As for the embarrassment -- well, I'd rather be embarrassed and have access to (some actually really great) healthcare than keep myself from being embarrassed and end up with untreated illnesses or giant bills.

Stop being too proud to take advantage of the services available to you. You qualify. So sign up. In this case, the HCA is working exactly the way it was intended to.
posted by anastasiav at 1:24 PM on January 11, 2014 [10 favorites]

I don't know how you were paying for your doctors and therapists before, but you should not assume that any New York exchange plan would have covered them, especially if they are in the nicer parts of Manhattan or the close-in suburbs. The exchange plan networks are very restrictive, and nowhere more so than in New York where doctors have always been very picky about insurance to begin with.
posted by MattD at 1:34 PM on January 11, 2014

Man i just went and looked at your questions and you need to see a therapist, pronto. Pretty much all of them have this same self-defeating attitude which I think is making this particular problem seem harder than it really is. Like others have said, medicaid is for you. Doctors take it and if mental health coverage isn't offered then you can ask about a sliding scale or need-based assistance. But seriously, you deserve this even if you were raised to think you're too good for government help, or too white/rich/privileged to take advantage of it.
posted by masquesoporfavor at 1:42 PM on January 11, 2014 [10 favorites]

Hey, I was brought up comfortably middle class and I'm broke/unemployed too. I totally get your frustration about not qualifying for the subsidies and the hassle of having to find healthcare providers who accept Medicaid. It's happening to me too, and it's not fair, but part of the point of this healthcare reform movement is hopefully the stigma around receiving government help will start to change, more providers will start to accept Medicaid and we'll all be happier and healthier. Guess what? We deserve Medicaid because we/our families helped pay for it with our taxes all those other years we weren't broke. I believe you shouldn't have to be completely destitute and desperate or a victim of generation-spanning systemic poverty to receive support from the government. If we as a country had taken this view a long time ago, systemic poverty would maybe be less ingrained in U.S. society because people (like us) would have gotten help before they went over the brink.

Try to learn about how Medicaid will actually work for you (I know it can be difficult to get clear info from govt. websites, etc.). Medicaid is not "as good as being uninsured" as you describe it. In the "getting hit by a bus" scenario you mention, Medicaid will do exactly what you are seeking: save you from bankruptcy and the medical bills you cannot afford right now.

It's really not that big a deal. Get on Medicaid. You may have to spend energy finding new doctors which can be scary and frustrating but you can do it. Ask about their own subsidies and payment plans as other people have mentioned. If necessary, use the $ you seem to think you could be able to afford to pay to for federally subsidized private insurance and put that toward paying doctors or dentists who won't take Medicaid while you look for new doctors who will. There is a solution.
posted by dahliachewswell at 1:52 PM on January 11, 2014 [3 favorites]

I don't see myself ever being able to get a job again, my main income source from 2013 has dried up, for all I know I could be hit by a bus tomorrow (hopefully fatally, because I can't afford another hospital bill), and the idea of even having the slightest idea what I will make is ludicrous.

If you have no income, and especially if you don't see yourself ever being able to get a job again, then you should be on Medicaid. The subsidy programs still require you to pay a premium and often other costs (a deductible, etc), albeit likely the premium and costs are low if you're near but over 133% of the poverty level. Apparently you can't afford that.

If/when you do get a job and your projected income is over 133% of the poverty level, and if you don't have employer-sponsored health care from that job, you can go back on the exchange during the next open enrollment period, start a new application, manually estimate your income for the following year, and get subsidized insurance from a private company. If you feel an overwhelming need to get subsidized private insurance right now, on the federal exchange at least (and I would guess but don't 100% know that the same is true for the NY exchange), you can delete your current application and do the exact same thing (albeit you'll likely be overestimating your income in that case).

If you overestimate your income, you're supposed to get a reimbursement on your next tax return, and if you underestimate you're supposed to owe a payment (based on the difference between the subsidy you got from your projected income v. your actual income) but I haven't gotten a good answer as to how reimbursements will shake out if your projected income was overestimated and your actual income would have qualified you for Medicaid rather than a subsidy.

However, please consider that private insurance isn't necessarily better in your situation. Like I said, if you don't have income and won't have income in the foreseeable, Medicaid is likely the best choice, not least because it will actually provide the best coverage you can afford. Access can be somewhat complicated (though not necessarily more complicated than with any given private insurance provider, it depends on the location/situation) with Medicaid but the coverage itself is quite good.

The deadline for getting proof of insurance before the fee kicks in is (as far as I know, they keep pushing the deadlines back) March 31 and it sounds like you're already covered under Medicaid so I don't think that applies to you at all.

Providing medical care to the uninsured costs hospitals and taxpayers much more than providing medical care to Medicaid recipients, so you're actually taking money out of people's pockets by not going on Medicaid. You're not martyring yourself by not getting on it or some kind of insurance, you're martyring hospitals and taxpayers. I assume your heart is in the right place when you talk about being too privileged to be on Medicaid but honestly, to me it comes off as classist.
posted by rue72 at 2:21 PM on January 11, 2014 [4 favorites]

Take the Medicaid. It expanded under the ACA just for people like you in situations like you are in. It is for you. I'm not sure about NY, but in my state the new expanded Medicaid got a shiny new name and a bunch more doctors that now accept it. Don't not take it and then get caught with no insurance and a medical emergency. There is no stigma, and you are not taking care that might otherwise go to an impoverished waif.

If/when your income goes up, you can move to another plan. That's how it's supposed to work.
posted by lovecrafty at 3:20 PM on January 11, 2014

You are lucky to be living in NYC, which is filled to the brim with highly competent and compassionate doctors who accept Medicaid so that they can help low income individuals like yourself. That includes dentists and mental health professionals.

If you're having trouble applying online there are people who can help you with that.

Don't cut off your nose to spite your face. If you qualify for Medicaid then you deserve Medicaid, full stop.
posted by fox problems at 3:36 PM on January 11, 2014

Let me just add, from a billing perspective in NYC, having Medicaid is not "as good as being uninsured". It's a clear signal to any billing office that you have no money, and makes it impossible on many levels for them to come after you for out-of-pocket costs.
posted by ThePinkSuperhero at 4:14 PM on January 11, 2014 [5 favorites]

I don't know about your New York, but in my state people on Medicaid get great dental care, counseling services, vision care, physical therapy, and access to specialists and excellent doctors. I don't qualify for Medicaid, or I do, but only after I pay $3,500 on medical bills, which has never happened. I don't qualify for any dental or vision care, but I can get counseling or rehab, etc. through Medicare.

The ACA is mainly for people who are working but have no coverage through their company and cannot afford individual insurance coverage. It's silly to complain that you can't get coverage through the ACA when you do qualify for Medicaid, which is government-subsidized health care with essentially the same benefits - or more - than the ACA plans but run through the State.

I've been hearing for years that doctors won't accept Medicare patients or Medicaid patients. Well, that's not true at all for Medicare patients - I've never been turned away even from top-of-the-line specialists and I have no Medicare Advantage plan - just plain-old Medicare. I don't know about Medicaid, but I doubt that it's difficult to find a doctor under Medicaid now that it's been expanded as far as it has. I think you're worried about the stigma of being on Medicaid, but you're not getting the idea that you are the person Medicaid is supposed to be insuring.

So take it, use it, be thankful for it. Later on, when you do get a job and are supporting yourself, you can sign up with an insurance program through the ACA, the premiums for which will be based on your income.
posted by aryma at 4:37 PM on January 11, 2014

A lot of doctors don't take Medicaid.

Have you bothered to ask your current medical care providers if they take Medicaid? Many doctors won't take brand new patients who have Medicaid, but they will work with existing patients who are now on Medicaid. I experienced this myself, as a child, when I switched from my grandmother's health insurance to Medicaid coverage -- my care providers did not normally work with Medicaid patients, but because I was an existing patient they had no problem with it.

You're catastrophizing over this. This is not a punishment, this is not proof that you are not good enough or that you've done something bad. This is just health insurance coverage, and you'd be a complete fool NOT to take it, since the alternative for you right now is to have no coverage at all and either get no medical care or go deep into debt to get medical coverage.
posted by palomar at 9:44 PM on January 11, 2014 [3 favorites]

I am in the same situation in MN. Here, the Medicaid website has a database for all the providers who take Medicaid patients. All my local doctors do. Have you checked for something like this?
posted by Comet Bug at 11:28 PM on January 11, 2014

dekathelon, you may have class privilege but having mental health difficulties can functionally negate many of the benefits of class privilege. You don't have the privilege of resilient mental health. That's a pretty damn significant privilege and it is hard to navigate the world without it, especially once you've lost your footing a bit. Take the help available to you to help even things out.
posted by needs more cowbell at 11:35 PM on January 11, 2014 [9 favorites]


I come from an upper-middle class family and graduated from a pricey school with my family paying full tuition. After graduation, I was living in New York and flat broke. Just getting started with my adult life and had nothing to my name. I took advantage of free birth control through Planned Parenthood. I didn't pay a dime--just got brown paper bags (seriously) of my prescription.

Now, I could have pleaded the money from my parents or taken up a third part-time job or done any number of things to avoid taking this charity. However, it was on offer, I qualified, and I took the benefit.

A few years later, when I was professionally established and had some nice savings, I wrote a large check to Planned Parenthood which more than covered the benefits I received.

Point being, there is no shame in Medicaid. If you qualify, take it. And if you're in the happy position of being able to pay it forward later, consider a donation to a hospital or medical charity to cover what you couldn't afford at the time.
posted by whitewall at 4:06 AM on January 12, 2014 [4 favorites]

One more point: The ACA established a "navigators" program to help people who have questions about eligibility. Some of the questions you have may find answers there, although it sounds like there are long wait times. If you are in NYC, this link is a start.
posted by yclipse at 4:15 AM on January 12, 2014

Coming in very late on this, but hello! I am a NY doctor who has a lot of Medicaid patients. We are certainly out there, and there are in fact a lot of very good doctors who take Medicaid, especially at academic medical centers. Every academic medical center in NY takes Medicaid, it's part of their mandate.

I would like to reiterate the point above that Medicaid is not intended to, and does not, address issues of systemic poverty. It is intended to provide low-cost health care for people who do not have much money. Period. That is its limitation and its strength. There are certainly people out there who spend their whole lives on Medicaid, but I have a bunch of working patients who are on it periodically because their jobs are not stable or because they've had to take time off work due to illness.

NY Medicaid is really good, comprehensive insurance--much better for patients than Medicare, in fact, although fewer physicians accept it. It covers a lot of things that most Medicaid programs don't, including in-home care if you need it, and copayments for visits, medications, and supplies range from $0 to, like, $5. Your standard bronze plan through the ACA will not provide any of that and will also sock you with a deductible. And yes, I'm betting that a lot of private practices in NYC and the close-in suburbs won't take most of the bronze plans either. I'm always MUCH happier to see that patients are on Medicaid than on some of the crappier commercial insurance plans that have high deductibles or giant co-pays for visits and medications, or even Medicare alone, because having Medicaid means that I can have conversations with patients where I can focus on the risk/benefit of an intervention to their health and not whether they'll be able to pay for food for the month.

There are some not-awesome things about Medicaid. You'll have to recertify every few months, which is annoying and time-consuming, but if you miss a recert it will be valid retroactively once it's restarted. Finding psychiatric care on Medicaid can also be a sticking point, unfortunately. There are places to go, but the waits to be seen can be long and you may see a resident (who is supervised by an attending physician). However, it's not a reason not to sign up--if you have a therapist or psychiatrist who doesn't take Medicaid, you can at least use the money that you save on premiums and medications to help defray the costs of paying cash for visits. And who knows, you may find someone good.

NY directs most of its Medicaid patients toward Medicaid HMOs, and you will want to be careful which one you choose--most of the big hospital systems only accept a few of the HMOs, so you'll want to do a little research on which HMOs are accepted by whatever physicians you already see, or which medical center you think you'd be most likely to go to. And yes, do ask your current doctors if they will continue seeing you on Medicaid--many people do, for patients who are already established.

Good luck! Feel free to MeMail me if you have questions.
posted by The Elusive Architeuthis at 8:11 AM on January 12, 2014 [8 favorites]

Medicaid is a "subsidized real plan".

- I don't feel right taking Medicaid when I'm not systemically poor, I'm just broke. It would feel like I'm from one of the hipsters on food stamps pieces that get made fun of on the Internet every few weeks.

You're not taking it, you're using it, as it was intended to be used. Use it, and put the money [that you say you don't have] that you would have put toward other insurance [not sure how that was going to work] toward getting a new place without a lousy roommate.
posted by oneirodynia at 2:34 PM on January 12, 2014 [3 favorites]

The point of the ACA's expansion of Medicaid was to allow those with low incomes who couldn't afford insurance to take part in Medicaid even if they weren't absolutely destitute. This was because it was more efficient and more effective to put them on Medicaid than trying to give them some kind of subsidy for private insurance which they couldn't afford anyone. Ie, people like you.

I am sure there are plenty of doctors who don't take Medicaid, but there are plenty of doctors who don't take my own fancy employer-sponsored health insurance. You'd be in the same position of having to hustle to find in-network doctors even if you did qualify for an Obamacare plan through the exchange.
posted by deanc at 8:55 AM on January 18, 2014

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