Help me get marketplace insurance for my 19yo
February 27, 2024 4:37 PM Subscribe
I need to get insurance for my 19yo. I've never had to do this before and am overwhelmed. Walk me through it?
I've always had insurance through either my own or my (now ex) partner's employer. Currently, I'm on Medicaid, and my ex is unemployed. I need to get my 19yo insured. He is not eligible for Medicaid because of a modest inheritance earlier this year that puts him over the asset limit.
I am just overwhelmed by this, so please talk me through it: go here, consider these criteria, etc.
It seems likely my ex will be employed soon, so we may be needing only a stop-gap insurance, say 30, 60, 90 days. In case that makes a difference.
I've always had insurance through either my own or my (now ex) partner's employer. Currently, I'm on Medicaid, and my ex is unemployed. I need to get my 19yo insured. He is not eligible for Medicaid because of a modest inheritance earlier this year that puts him over the asset limit.
I am just overwhelmed by this, so please talk me through it: go here, consider these criteria, etc.
It seems likely my ex will be employed soon, so we may be needing only a stop-gap insurance, say 30, 60, 90 days. In case that makes a difference.
Go to healthcare.gov. Use the "Check if you can enroll/change" green button on the page. It will walk you through determining eligibility for coverage (if he had coverage with your ex but lost it, he should be eligible), help you find plans and pricing, and get you to the right website if your state has their own exchange website.
You can also get access to a trained "navigator" who can walk you through the process for free. I can find the ones for my state by googling "North Carolina health care exchange navigator". If you're comfortable sharing the state your son is in, we can point you to the exact resources for that state.
Plans on the exchange will be in one of four levels (bronze, silver, gold, platinum). Bronze plans are cheaper but you have to pay more out of pocket for care because they cover less of the cost of care. A gold plan would cost more but would cover more of the cost of care. Which level of plan to choose depends on your health. If your son is healthy without any chronic conditions or ongoing medications, a bronze plan might work to ensure he has coverage for a catastrophic event. If he needs to have care more frequently, a higher metal level plan may make more sense.
Do not buy a plan that is not from the official health care exchange. The plans from the exchange are required to cover key health care needs. Plans that aren't from the exchange don't have those requirements, and can amount to basically scams masquerading as insurance. If he's lower-income, the plans from the exchange will likely be surprisingly affordable.
A lot of work has gone into making this process accessible, both in terms of figuring out what and how to buy, and from a cost perspective. You can do this!
posted by jeoc at 6:02 PM on February 27 [5 favorites]
You can also get access to a trained "navigator" who can walk you through the process for free. I can find the ones for my state by googling "North Carolina health care exchange navigator". If you're comfortable sharing the state your son is in, we can point you to the exact resources for that state.
Plans on the exchange will be in one of four levels (bronze, silver, gold, platinum). Bronze plans are cheaper but you have to pay more out of pocket for care because they cover less of the cost of care. A gold plan would cost more but would cover more of the cost of care. Which level of plan to choose depends on your health. If your son is healthy without any chronic conditions or ongoing medications, a bronze plan might work to ensure he has coverage for a catastrophic event. If he needs to have care more frequently, a higher metal level plan may make more sense.
Do not buy a plan that is not from the official health care exchange. The plans from the exchange are required to cover key health care needs. Plans that aren't from the exchange don't have those requirements, and can amount to basically scams masquerading as insurance. If he's lower-income, the plans from the exchange will likely be surprisingly affordable.
A lot of work has gone into making this process accessible, both in terms of figuring out what and how to buy, and from a cost perspective. You can do this!
posted by jeoc at 6:02 PM on February 27 [5 favorites]
Response by poster: These answers are really helpful. Thanks jeoc especially for holding my hand right through it.
posted by Well I never at 8:00 PM on February 27
posted by Well I never at 8:00 PM on February 27
As evident on this .gov page, the ACA got rid of Medicaid asset limits for anyone not on disability or older than 65 (and doesn't say anything about that not being the case even in non-expansion states, in case you happen to live in one), so unless the inheritance was classified as taxable income, I think there's a good chance it won't in fact affect your son's MAGI-based Medicaid eligibility.
But either way, filling everything out through healthcare.gov (or your state's marketplace, if applicable) will shuttle him into a Medicaid plan if he qualifies for one, so jeoc's instructions are still the way to go.
But if it's ambiguous exactly how to enter that inheritance windfall into the online forms, it might be worth calling up the marketplace help line and asking directly.
posted by nobody at 10:29 PM on February 27 [3 favorites]
But either way, filling everything out through healthcare.gov (or your state's marketplace, if applicable) will shuttle him into a Medicaid plan if he qualifies for one, so jeoc's instructions are still the way to go.
But if it's ambiguous exactly how to enter that inheritance windfall into the online forms, it might be worth calling up the marketplace help line and asking directly.
posted by nobody at 10:29 PM on February 27 [3 favorites]
One more thing to note about medicaid eligibility: if you're googling for eligibility info, and if you include "inheritance" or "assets" in your search terms, it seems that most of the search results you'll see -- as well as google's infobox excerpts/answers -- are likely to be specifically about (and only applicable to) being on medicaid while on medicare, without anything clearly specifying that on the page. It's really terrible.
posted by nobody at 10:57 PM on February 27
posted by nobody at 10:57 PM on February 27
People who are on Medicaid who then become eligible for Medicare are referred to as "dual eligible" if you see that language on the .gov website. I just wanted to let you know in case the site uses this terminology and you are left wondering what that means.
If your son is not eligible for Medicaid in his state, he could very well be eligible for subsidies for marketplace policies. I would suggest trying to connect with a free navigator. Sometimes local agencies, like non-profit health agencies, provide health care navigators who are well-versed in Marketplace insurance and are free to use. I called an FQHC (federally qualified health clinic) in my city when my young-adult child became uninsured, and was offered a navigator who helped us find a policy for her. She signed up on the spot.
posted by citygirl at 11:50 AM on February 28 [1 favorite]
If your son is not eligible for Medicaid in his state, he could very well be eligible for subsidies for marketplace policies. I would suggest trying to connect with a free navigator. Sometimes local agencies, like non-profit health agencies, provide health care navigators who are well-versed in Marketplace insurance and are free to use. I called an FQHC (federally qualified health clinic) in my city when my young-adult child became uninsured, and was offered a navigator who helped us find a policy for her. She signed up on the spot.
posted by citygirl at 11:50 AM on February 28 [1 favorite]
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posted by metahawk at 5:30 PM on February 27 [3 favorites]