Are you toast if you miss the ACA deadline?
December 6, 2017 4:34 PM   Subscribe

We're trying to set-up insurance via the Marketplace for our son. Complications ensue...

So, when we plug-in his estimated earnings for next year, marketplace.gov gives us a page saying he might qualify for Medicaid, which we weren't expecting. The only option is to submit info to Medicaid to see if he does qualify. That's all we are allowed to do. We cannot view any Marketplace insurance plans.

Complications:
~ Indiana Medicaid approval could take a couple of weeks. Obviously, this would run way past the open enrollment period.

~ If he is denied Medicaid coverage, what, then, are his options for securing health insurance, since we will be past the open enrollment period? Will he still be able to get insurance, but it just doesn't take effect on 1/1? My wife is of the opinion that he will be screwed and not be able to get any insurance at all. She spoke with a Marketplace person, but they weren't able to answer her questions.

This is in Indiana.

Please hope us.
posted by Thorzdad to Health & Fitness (16 answers total) 1 user marked this as a favorite
 
A workaround might be to estimate his income slightly higher, get an ACA insurance plan, and after that, submit an application for Medicaid with revised income figures. Caveat: I'm just trying to suggest something straightforward that ought to work. I have no experience with Indiana ACA or Medicaid.
posted by JimN2TAW at 4:41 PM on December 6 [3 favorites]


Are there any legal aid nonprofits near you that assist with Medicaid or other public benefits? I know of a couple organizations (in a different state, so not helpful for you) that do that kind of work.

If you can’t find an answer in time, I’d probably do what the above comment suggests - get an ACA plan, wait for the Medicaid application, then cancel the ACA plan if appropriate. Generally, you can’t enroll in an ACA plan outside of open enrollment unless it’s based on a qualifying event (examples: moving to a new state, or losing your job and the associated health insurance). A question to research could be if a Medicaid denial would count as a qualifying event; my guess (but it’s a guess!) is that it would not.
posted by insectosaurus at 4:49 PM on December 6


Why do you think he would be eligible for Medicaid? You should be able to look up the criteria and figure it out. Whenever I've used healthcare.gov, it said I could be eligible for subsidies but in the end I never was.

Have you looked at the places available and decided on your favorite? Because it's possible you can sign up directly without going through healthcare.gov. That's what I did, mainly because the ACA website was giving me trouble. Maybe if you know what plan you like, you can contact the insurer directly and ask if they stick to the same deadline as the ACA if you enroll on your own.
posted by AppleTurnover at 4:52 PM on December 6


I think if you are eligible for a subsidy, you might need to get your insurance thru healthcare.gov.
posted by still_wears_a_hat at 4:58 PM on December 6


Call them and ask. On healthcare.gov, there's a link for get contacted.

It's my understanding that if he's not eligible for Medicaid, he could choose a plan, but I am not an expert.
posted by theora55 at 5:18 PM on December 6


~I think if you are eligible for a subsidy, you might need to get your insurance thru healthcare.gov.
~Call them and ask. On healthcare.gov, there's a link for get contacted.


This is on healthcare.gov. My wife called the number, and the person was pretty unhelpful.

............................
~Why do you think he would be eligible for Medicaid?

Because that's what healthcare.gov gave us when we entered our son's information. It gave us no other option. It would not let us see any marketplace plan options.
posted by Thorzdad at 5:24 PM on December 6


Sorry for threadsitting, but I feel I need to fill in the blanks.

A workaround might be to estimate his income slightly higher, get an ACA insurance plan, and after that, submit an application for Medicaid with revised income figures.

My wife adjusted his income up three different times and still got the "You may be eligible for Medicaid" roadblock each time. We aren't sure how high you need to adjust income in order to get around it. I mean, he makes under 17k/year. Would we have to push that well into the 20's to get around the Medicaid thing? And, wouldn't doing that give him plans that he can't afford?
posted by Thorzdad at 5:39 PM on December 6


Is he an adult, household of one? Indiana expanded Medicaid, but even with that, doesn’t sound like he’s within their income eligibility guidelines. (See https://www.in.gov/medicaid/members/59.htm)

Have you tried reaching out to a navigator? They should be more helpful and are state-based so should know specifics about Indiana’s marketplace and Medicaid expansion. (See http://www.in.gov/healthcarereform/2468.htm)
posted by inevitability at 5:51 PM on December 6


Go to localhelp.healthcare.gov and put in your zip code. This will get you a list of local places that can help you in person or over the phone.
posted by mcduff at 5:53 PM on December 6 [6 favorites]


You can see the exchange policies and estimated prices without actually applying here

Have you tried the Indiana Benefits Screening Tool to see if it says your son is eligible for Medicaid too?

Here are the income guidelines for Indiana Medicaid. It looks like around $17,000-$18,000 annually is the cutoff for a single adult. It's generally said that there is no penalty for overestimating your future income and any additional subsidy you should have been eligible for will be added to your tax return at the end of the year. Every state has implemented the gap between the exchange and medicaid differently though, so it's possible that if your son overestimates his future income and gets a plan on the exchange, but it ends up earning an amount that should have made him eligible for medicaid, there may not be any additional subsidy available.

I've heard people say that if someone overestimates their future income, takes a subsidized plan on the exchange, but should have been eligible for medicaid, they would actually owe their entire subsidy back. While from a (super poorly implemented) policy perspective, I suppose this is theoretically possible, I don't actually think this happens. Every time I've ever heard this, it is always in one of those "my cousin's friend's girlfriend's roommate said" type situations-I've never actually met or heard of a real person who has suffered this fate.
posted by mjcon at 6:17 PM on December 6 [1 favorite]


Enroll him in an ACA plan so you don't miss the deadline. Inflate the income if you have to. ACA is based on expected income, so he won't have to prove that he can or will actually earn that expected income in order to sign up for a plan.

Then apply for Medicaid. Medicaid is based on actual income, based on tax returns. If he gets Medicaid, then just say oops we estimated the expected income badly, and put him on Medicaid, and take him off the ACA plan.

People have income fluctuations all the time. Especially at that income level. Unpredictable ups and downs. A local healthcare navigator will have seen it a hundred times before.
posted by Former Congressional Representative Lenny Lemming at 6:53 PM on December 6 [2 favorites]


If you apply for Medicaid during the Open Enrollment Period and the state doesn't give you an answer in time, you might very well qualify for a Special Enrollment Period to buy a Marketplace plan later, which is meant to accommodate people in pretty much this exact scenario (scroll down to "Be determined ineligible for Medicaid or CHIP".) But I agree with the advice to try and get some local help with this, especially to make sure he gets coverage as close to 1/1 as he can. See what your options are and don't panic just yet. Good luck.
posted by jameaterblues at 7:23 PM on December 6 [2 favorites]


If he is denied Medicaid, he will qualify for a special enrollment period! I used to be an ACA navigator. If he is denied, you can go back to the website, answer that he was rejected from Medicaid, and you should be able to continue to apply.

Go ahead and apply for Medicaid.
posted by bearette at 7:38 PM on December 6 [9 favorites]


If he is denied Medicaid, be sure to save the denial letter. You may be asked to provide proof later.
posted by bradf at 6:40 AM on December 7


Also, if you are having difficulties you can search for local "in-person assistance" on the healthcare.gov website. You can also call the 800 number. Sometimes there are glitches with the site for whatever reason. The navigators should be able to help with your Medicaid application too, because if someone didn't qualify for ACA due to income, we would help them apply to Medicaid.
posted by bearette at 9:05 AM on December 7


Thanks all. My wife spoke with an Indiana-based facilitator, and she agreed completely with you all. So, she went in, bumped-up his estimated earnings enough to get around that Medicaid roadblock, and got to the policies.
posted by Thorzdad at 4:59 PM on December 7


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