Is it irrational to buy health insurance when eligible for Medi-Cal?

April 15, 2014 12:56 AM

Because my livelihood currently derives from the regular receiving of a remittance from my family, I'm without taxable income and thus eligible under the Affordable Health Care Act for California's state-funded health insurance Medi-Cal. At the same time, I'm in a position to purchase low-grade private health insurance without terrible hardship. Medi-Cal seemed to make sense because it is basically free health care, and I signed up. Mefites have also written positively about it. However, looking now at the stripe of participating providers and hospitals, and, especially, looking at the extremely negative yelp.com reviews that have been posted of these providers and hospitals, I have become scared.

A close family member was in the hospital recently for an extended time. Which sensitized me to the very significant impact the level of competence of nurses and specialists has on patient survival. The nurses in intensive care were apparently highly skilled, and the hospital's specialists distinguished. However, in critical situations the designated people could make wrong calls, not notice truly life threatening developments for what they are, or have no good guess as how to diagnose serious issues. One was grateful if there happened to be someone around who is on top of things. I imagine with less skilled nurses and less distinguished specialists, the opportunity for inadequate response would only increase. I also imagine the skill levels of surgical teams and the like vary considerably.

So I am worried that if some major medical situation were to arise, my chances of making it out alive or intact or less severely damaged would be substantially less with the lower grade Medi-Cal providers than with the providers from, for instance, Blue Cross, with whom I've had insurance in the past. Less enough, anyway, to outweigh the advantage of Medi-Cal's being free. Free isn't so good if you end up, say, dead, when you wouldn't have been if you'd paid some.

What do you think? Is this a rational fear? Would it be wise to not eat out so much, etc., in order to stay with Blue Cross? Or is the probability of the differential I'm worrying about occurring vanishingly small?

I'm 46 years old and in more or less good health.

(Note: It's arguable that persons such as myself were not the real target to receive free health care when the Act was being conceived. But this is not my issue. I'm personally okay, ethically, exploiting, in effect, a loophole in the law as written if it otherwise makes sense. My issue is whether going with free health care will place me in greater danger in the case of a major medical situation.)

posted by bertran to Health & Fitness (18 answers total)

I believe Medi-Cal is just another form of insurance to hospitals - doctors/nurses are concerned with making you better, not caring what insurance you have.

Hospitals should not not care because they still get paid, they just get paid by the government vs. a private insurance company. No difference. If there are negative Yelp reviews about a hospital, I'd recommend finding one that offers great service, has good Yelp reviews, AND accepts Medi-Cal.

It's free, so why not? You've got nothing to lose.

Disclaimer: this is purely my opinion, not based on experience. Take it for what it's worth.
posted by dubious_dude at 1:08 AM on April 15, 2014

It's access, not a fear of "coach class" treatment by the same doctors you think are spending more effort on the blue-chip insured, you need to worry about. The problem is with whether or not your insurance will get you through the door, not how you're treated once you're through it. You won't get a color-coded flag on your chart, so to speak.* If the providers and hospitals you want will actually take MediCal, you've got access--IF they are still actively enrolling patients on this program (I don't think it's illegal for a private practice doctor to say, "I'm enrolled as a provider for X insurance plan but not taking new patients on that plan at this time" due to low reimbursement, paperwork hassles relative to other plans, etc.) AND if the wait list is not insane because they are the only X specialist in your area who is actively enrolling new patients on MediCal, etc. This is the case with any "budget" plan.

*The sort-of exception might be if your plan--any plan, not just MediCal--won't cover certain diagnostic tests, medications, procedures, specialists, etc. without a huge fight; then, based on experiences of friends and family, cost (to you) may be a consideration regarding what doctors may or may not reach for as an option.
posted by blue suede stockings at 1:44 AM on April 15, 2014

Your profile says you are in Santa Monica and UCLA is one of the highest rated hospitals and medical and dental universities in the country. All 3 take Medi-Cal. I live next to Cedars and would choose UCLA in a hot second in an emergency if time permitted....

I'm confused about these "bad reviews." Can you explain further ?
posted by jbenben at 2:26 AM on April 15, 2014

Does the cheapest private Blue Cross plan really offer a bigger network of providers (more access)? I'd be surprised, but that is your real concern here.
posted by J. Wilson at 5:33 AM on April 15, 2014 [2 favorites]

Like jbenben said, a lot of highly-rated hospitals take state Medicaid, because it's something a lot of people have and they want to get paid if you show up. In terms of which is better to have in case of an emergency, I would definitely pick Medi-cal, because there's no patient responsibility after they pay (I'm assuming, based on how Medicaid works in NY state). BC/BS might leave you with deductible or co-insurance payments.
posted by ThePinkSuperhero at 6:11 AM on April 15, 2014

Look at the yelp reviews for the providers you'd be using under the other plan. They're probably just as bad.
posted by mskyle at 6:28 AM on April 15, 2014 [2 favorites]

Just to follow up on the young rope-rider's point - I think income counting rules for Medicaid may be different depending on whether your family is sending you checks of x amount every month, or whether they are directly paying for your living expenses (sending rent to your landlord, buying you groceries, etc.) At any rate it's certainly worth looking into to make sure you're not receiving insurance you shouldn't be eligible for.
posted by black_lizard at 6:54 AM on April 15, 2014

Best answer: A couple of points.
1. For health care, online yelp style reviews are a horrible way to evaluate caregivers and hospitals and health plans. Use government reports or large consumer surveys and studies instead.

2. MediCal requires in Los Angeles county requires enrollment in LA Care. Which generally speaking, requires enrollment in an HMO plan. There are many. So make sure to look closely at what you end-plan will be and how that will work for you.
posted by SLC Mom at 8:02 AM on April 15, 2014

Just to be clear, I'm sort of seconding mskye's point. Online reviews lean heavily towards the negative and are low volume enough that you can't get a good picture.
posted by SLC Mom at 8:04 AM on April 15, 2014

Another thing to account for is if you have a doctor you would like to stay with and if they accept Medi-Cal. A great doctor, or one that has been seeing your family for years and knows your history, for example, might be worth paying more for each month.
posted by Vaike at 9:00 AM on April 15, 2014 [2 favorites]

Academic hospitals usually have the most distinguished specialists and sub specialists, doctors who are the most up to date on innovative and evidence based practice. The tradeoff is that you have to see medical students and residents if you go to a teaching facility. But most if not all academic/university hospitals take state insurance/Medicare/Medicaid, because part of their mission is serving the poor. Disclaimer: I work in an academic medical center.

I really wouldn't judge the hospitals and doctors based on Yelp reviews. It is often very hard to determine the facts of the situation and whether a person received good/standard care or not from a Yelp review. I often get patients who scream epithets at me and threaten to sue me and submit complaints via any avenue possible about me, but these are usually patients who have inappropriate expectations about the care I can provide them (i.e. want to come to the emergency department to get an elective MRI) rather than people who I am concerned I might have made a medical error on.
posted by treehorn+bunny at 10:02 AM on April 15, 2014

Well, take a look at the providers and hospitals in-network under the other insurance plans you can afford, and look at their reviews.

Like mskyle, I'd argue that those reviews are going to be just as bad.

People tend to only write online reviews if they're unhappy about the goods or services they received. It's rare that you find a "wow" review online of anything. That kind of skews your sample and you need to keep that in mind when looking at yelp or any other online review sites. (I say this as a yelper who has written positive, middling, and negative reviews of businesses.)

I'd suggest going about this another way: look for doctors and hospitals that have good reviews, then find out if they take Medi-Cal. If not, find out what insurance plans they DO take.
posted by tckma at 11:48 AM on April 15, 2014

Well, page 5 of the application booklet tells you to disclose "money you get from something other than your job" so I'd say you should keep your BCBS so as to not confuse "loophole" with "felony."
posted by WeekendJen at 11:51 AM on April 15, 2014

Response by poster: Thanks, all. An insurance agent assured me I qualify for Medi-Cal in my situation; but, strangely, the online application didn't include the question WeekendJen points to. I don't want to commit any sort of fraud, so I will double-check.

And it makes sense that I'm probably freaking out partly due to yelp distortion. And, yes, if UCLA is a Medi-Cal provider, my mind would be at ease. I didn't see that in the materials I've looked at so far; I'll have to look into more thoroughly.
posted by bertran at 12:23 PM on April 15, 2014

You're incorrectly conflating two separate ideas here. Lots of really good doctors accept Medical. Lots of really terrible doctors only accept private insurance. Many providers take both.

There is simply no correlation between the skill of the provider and the kind of insurance they accept.
posted by jesourie at 12:52 PM on April 15, 2014 [1 favorite]

I've never had a problem with my Medi-Cal not being accepted anywhere I've chosen to go, except when it was out-of-state. That includes UCLA, CPMC (in San Francisco), every Sutter doctor and facility in Sacramento, and every other doctor and service I've seen in the last 3 years.

As far as what income counts, I believe Medi-Cal follows similar rules to SSI, which I'm familiar with.

• Earned income counts.
• Unearned income - money given directly to you - counts.
• In-kind income - money paid on your behalf without passing through your hands - for rent, utilities, and food counts. (SSI only counts this up to a predetermined point. I don't know how Medi-Cal might count it.)
• Money paid on your behalf, without going through you, for any other purpose (phone bill, car payments, etc.) is not counted.

The rule I've relied on is that if there's any record anywhere that I've been in possession of the money, it counts as income and/or resources.
posted by WasabiFlux at 2:04 PM on April 15, 2014

Best answer: You can get better information about hospital quality and services from Hospital Compare, including patient satisfaction survey data. You can even select several hospitals to compare side-by-side. This is a Medicare site, but the information is relevant to everyone.

The information on Physician Compare is more sparse (public reporting of satisfaction and other measures for physicians is still at least a year away), but it can still be a useful tool.
posted by jeoc at 8:37 PM on April 15, 2014

Response by poster: After much research and several phone calls I have decided to drop Medi-Cal and stick with the private Blue Cross plan.

Mefite respondents had strangely off-target advice on this question, though it did help spur me to resolve this. Please note:

I am definitely, no question, eligible for Medi-Cal under the Affordable Care Act. As long as no one claims me as a dependent, in which case *their* income is what matters, the only income that counts for eligibility is what counts as income on the IRS 1040 form. Both a Covered California person and a Medi-Cal person emphatically confirmed that gifts of money of whatever kind do not count. (They were unable to point me to a statute that stated this, but affirmed unqualifiedly that this was Medi-Cal policy.)

Maybe it's different elsewhere, but as SLC Mom points out, in L.A. County Medi-Cal is through a selection of HMO plans. In these, all care except dire emergency room care goes through and must be approved by one's primary care physician. Moreover, the only specialists and hospitals that are available to one are those in the medical group of one's primary care physician. None of the primary care physicians available in these HMOs were affiliated with UCLA or St. John's hospitals, two hospitals nearby me. There were less than a handful who were affiliated with Cedar-Sinai, and these had offices a great distance from me. There were other primary care physicians available somewhat closer -- though really not that many, and with affiliations with distant hospitals of lesser reputation. It was not transparent who the specialists in any particular physician's group would be.

The cheap Blue Cross plan that's an option had many hundreds of nearby PCPs in network, as well as the UCLA medical center. It's also an EPO which is more flexible than an HMO.

I also looked for negative yelp reviews of doctors I know, as some mefites suggested. I mostly came up blank, but the one posted yelp review of the last PCP I had was both positive and accurate.

So, anyway, I remained frightened, and decided that expanded Medi-Cal eligibility is great for those who absolutely need it, but that I would stick with Blue Cross. Which is surely more in keeping with the spirit of the Affordable Care Act.

Thanks again for the responses.
posted by bertran at 10:35 PM on April 23, 2014 [1 favorite]