No Medicaid, no insurance through a job. What do we do?

January 25, 2020 6:15 AM

My new wife and I missed the time window to add her and my stepson to my employer based medical insurance after a qualifying life event (our marriage). Now, I can't add them to my plan for another several months. They were on Medicaid, but I believe they are now ineligible due to being part of a household where my income is counted. I'm losing my mind with worry over their uninsured status. Please, please give me some guidance.

My wife and her son had been on Medicaid for the past several years, while I've always had insurance through my employer. Now, I've been told that because we missed the QLE window, they can't be added to my plan until July and their coverage can't start until after that.

My wife has been working odd jobs to stay afloat for awhile, but has not had employer based insurance in years.

I'm fortunate to have a middle class job, but there's no way that they will qualify for Medicare once my income is taken into account. How can we make sure that she and my stepson at least have medical insurance for the next several months? Is there any way that they can have dental insurance as well? Do we need to speak to anyone for professional guidance in this situation?

posted by anonymous to Work & Money (9 answers total)

Losing insurance is sometimes also a QLE, so if the loss is more recent than the marriage you may have a way to add her .
posted by AlexiaSky at 6:28 AM on January 25, 2020 [5 favorites]

Some states have remarkably high thresholds for kids getting Medicaid, even if everyone else is way over per the adult standard. Also, if* they've lost coverage, as AlexiaSky points out, that should have opened a new special eligibility window either with your employer or at very least the ACA Marketplace. If, right now, they do not have access to your employer's plan, it may not be at all inaccurate to report it that way.

*Please get this confirmed. Eligibility status can be super convoluted. My state usually cares about individual months more than the annual figures, but assets don't count at all and their definition of "asset" is somewhat unique. If I hadn't gone through the whole process and laid everything out for the agent, I never would have arrived at the conclusions they did on my own.
posted by teremala at 7:05 AM on January 25, 2020 [2 favorites]

My daughter's kids qualify for Medicaid while she does not and buys through the ACA. I don't think Medicaid has any sort of qualifying deadline period, so you could try to add your stepson while you are working on getting your wife insured.
posted by citygirl at 9:21 AM on January 25, 2020

Changing your address in the marketplace counts as a QLE, according to a VERY helpful Marketplace rep I talked to a few years ago.
posted by nosila at 9:32 AM on January 25, 2020

The MeFi Wiki ThereIsHelp page offers links to resources that may be able to assist with health insurance issues, including:

In the United States, according to the National Academy of State Health Policy, as states transform their health systems, many are turning to Community Health Workers (CHWs) to facilitate care coordination and enhance access to community-based services. While state definitions vary, CHWs are typically frontline workers with an understanding of the communities they serve.

To find a Community Health Worker (CHW) to help with health insurance, you can search the National Provider Identifier Database for Community Health Workers. Another option is to google the name of your state and "Community Health Worker," to help ensure access to the most updated information in your area. Links to local organizations may also be found at the National Academy of State Health Policy website by clicking on the "Organizations & Workgroup" tab.

In addition, many states offer help to consumers with health insurance problems through Consumer Assistance Programs (CAPs) to assist consumers experiencing problems with their health insurance or seeking to learn about health coverage options. State CAPs offer direct assistance by phone, direct mail, email, or walk-in locations to help consumers learn how to obtain or use their insurance effectively. A listing of CAP programs are available here.

posted by katra at 10:10 AM on January 25, 2020 [3 favorites]

I thought getting married would kick me off aca but it did not. this year they made me fill out an EXTENSIVE financial questionnaire. it was horrible. I almost didn't do it. but I persevered and they sent me back a notice that my husband doesn't qualify for medicaid (duh) but that I qualify for the advanced payment credit based on my predicted income for 2020. of course if I make more than I predicted I will need to square up with the irs at the end of the year. but that's expected. what was unexpected was I thought my husband's income would disqualify me for aca. it did not. to be clear what I did was apply for aca at my state's Healthcare site and they forced me to fill out an application for medicaid even tho I am sure I don't qualify. but you have to do that. and you have to be honest about every member of the household.
posted by cda at 8:16 PM on January 25, 2020

My state keeps you on Medicaid for a full year even if your income changes. Look into whether they actually are going to lose it.
posted by metasarah at 1:14 AM on January 26, 2020 [1 favorite]

I'm in the process of doing this now. I was on Medicaid for the last few months of last year. I picked up some contract work at the beginning of this month and reported my change of income to Medicaid. On their website it says that I no longer qualify for Medicaid

I went to the ACA site just now and reported my loss of insurance and they immediately approved my application and sent me to the enrollment section. As long as I complete my enrollment by Jan 31, I'm eligible for coverage beginning February 1st. I just need to send them proof of my loss of insurance in the next 60 days.

That's my as-of-today experience transitioning from Medicaid to ACA. I'm in Oregon, YMMV.
posted by bendy at 5:26 PM on January 26, 2020 [1 favorite]

Also, check with your employer to find out if them losing their insurance counts as a QLE. I wouldn't be surprised if it was.

Also, when you apply for ACA they ask if the applicants currently have insurance. Since they do not they can definitely apply. They may even be eligible for financial assistance based solely on your wife's income. It doesn't hurt to apply. Every time I've done it they've given me my eligibilty results immediately after I finished the application.
posted by bendy at 5:31 PM on January 26, 2020