Some of you may remember me. I have a daughter who has been working in China for the last year and a half. Job ended and she and her boyfriend have been backpacking through Europe. Thanks to the advice I received here, I bought her travel health insurance. Now, she is days from coming home. She will not have a job right away and she is too old for our health insurance. Thanks to someone here, I know she can apply for affordable health care. I went to our state exchange just to see what there was and I put in her income as zero and a window popped up saying that she might be eligible for Medicaid. Would we want that or would we be better off to buy her a bronze plan? I really would like her covered right away as I would believe that the travel health insurance would end when she reached US soil even though the policy goes to July 6th. Does that sound right? Help!
I’m not an expert…but I believe it can take up to several months to get processed for insurance in the Medicaid expansion states.
I personally would buy at market rate. Check the prices…and see what will work.
It can take several months to get processed, but the coverage will be retroactive to the date applied for. (This is true of both Medicaid and private insurance purchased on the exchange.)
If she’s eligible for Medicaid, that’s based on income, so you wouldn’t be able to get her a private plan unless her income is misstated on the application (which would catch up with her at tax time anyway). But the big caveat with Medicaid is this: If she’s NOT in an expansion state, then low income alone may not qualify her, in which case she’d be sent back to the marketplace with a juicy subsidy. So the first question is: Is she in a [Medicaid expansion state](Status of State Medicaid Expansion Decisions: Interactive Map | KFF)?
Yes, she is in an expansion state. So if I am understanding you, Lasma, if her income now is zero, she cannot get a private plan even if we pay for it?
She can get a plan outside the marketplace if you pay for it.
Going through the marketplace will force her into Medicate with a zero income.
Here’s what the official website says:
https://www.healthcare.gov/coverage-outside-open-enrollment/private-plans/
I’m only familiar with buying on the exchange, but I think I remember reading that it’s up to the carrier if they want to sell you insurance outside of open enrollment. If so, I’d think your D would qualify for a Special Enrollment Period. You probably want to call the carrier.
She qualifies for a Special Enrollment Period, because she is moving back to the US, which is a “qualifying event”. If she has no income, she would not qualify for subsidies on the exchange, but you can buy her a private plan with your own money.
Also, the carrier may want to see documentation of the qualifying event, so you might want to ask about that, and what docs they’d want.
Carrier may also want proof that your D had no lapses in medical insurance coverage, so have that available as well. If your D has always had BCBS coverage, for example, there is sometimes an available extension that you can pay for monthly while your child searches for a job. We used that for S, when his U policy ended and before the ACA change that required our insurer to cover our S until he turned 26. We paid from mid Aug until 12/31. It was available because he had always been covered by a BCBS policy, with no gaps.
Which state is she in? People might be able to give more detailed responses.
In general, for the insurance plan you are supposed to apply by the 15th of the month preceeding the month she wants to start the plan, so if you know her date of return, you would go by that.
Yes, in an expansion state she can get Medicaid until her income changes, you might want to put her on a silver exchange plan, I think you could overstate her income such that she received no subsidy, then just take a silver plan, IF you think she will take a job that pays more than the Medicaid limit, but with a low enough income to accept subsidies. The silver is the only plan to which you can apply the CSR subsidy (reduce out of pocket, premium, and deductible) so that would be an easy transition.
But another consideration, if she begins the year working in say, July, then her income for the year would be only that 6 months of income, so a $50k annnual salary would result in $25k on her tax return. If she has a lower income, then her total income may not be enough to skip the Medicaid option for 2015. Whether or not that is a major hassle seems to be both state and county specific, some areas are coping better than others.
She will be in Illinois. She did have income made in China although I doubt it came to over $15,000. I may have screwed this up already as she comes home next week. In my defense, we didn’t know when she was coming home. This is very complicated. Would it make sense to call and talk to someone? I can’t believe I am yearning for the days when you could just buy a premium (it might have been junk, but who knew at the time?) .
I would call and talk to an agent in your county, the premiums are the same whether you use an agent or use the exchange directly, but you have the benefit of the agent’s experience and knowledge.
S1 and his GF are both students with teeny tiny income and both are on Medicaid. They’ve actually been relatively happy with it, although of course their choice of providers is limited. S1 just got a pair of eyeglasses today and paid $0 for them.
Medicaid is generally fine if the primary need is for catastrophic coverage. My son was on medicaid from the time the ACA came in (while he was still in grad school) until he got a permanent job the spring following graduation. As far as I know he didn’t see a doctor that entire time --he didn’t get sick, he didn’t need it. But if he had become sick enough for an urgent care facility or an emergency room,… he would have been seen and wouldn’t have had to worry about the bill.
My grandson is on Medicaid and it has worked out well. Grandson broke his leg at age 3 and had a few other emergency room visits (he’s a very active kid) – plus all the routine visits for vaccinations that little kids have and the variety of common diseases like ear infections… and all has gone fine.
So if you are considering a bronze plan, your daughter is probably fine with Medicaid.
My answer would be different if you had a child with a chronic health condition who needs to see a doctor regularly – then I’d think you would need to do a lot more research on availability of care. It also depends on your daughter’s own attitude – if she spent a year in China followed by backpacking through Europe for a summer, she’s probably pretty resilient. After all, even with the traveler’s insurance, she had no guarantee of the quality of medical facilities that might have been available to her if she had needed treatment while traveling.
You haven’t screwed it up. I assume that since she is too old for your insurance then she must be at least 26? I would gather the information you can before she gets home and then let her look at it and have her decide whats best for her to do. She maybe she’s been holding off on seeing a doctor for something and she needs more than minimum coverage or maybe minimum is all she needs.
Even seeing a doctor and paying full price or the deductible shouldn’t make or break an individual. Insurance really is for major health issues, like when you (and/or family) exceed the annual maximum amount and you don’t want to lose all your assets (or a good chunk of them). I agree that gathering what info you can and then laying it out for your D to handle and take over seems like the appropriate course at this point.
Be aware that her income is calculated from July to the end of the year; it is not instantaneous. Therefore, if she will be working, you could estimate the income and purchase a plan. It will catch up to her at tax time if it is way off, though.
LasMa - no ‘juicy subsidy’ for those with zero income. If you live in a medicaid expansion state, you get medicaid. If you live in a state with no medicaid expansion, you get NOTHING! You still have to buy insurance or pay the tax penalty (although if zero income, there will be nothing to pay) but you can only get a subsidy for the policies on the exchange if you make 100/140% of poverty level.
You are not required to buy insurance if the insurance would cost more that <some fraction,=“” i=“” forget=“” what=“”> of your income. If you have no income, the insurance would cost too much and you would not be required to buy it. You wouldn’t have any insurance, but you wouldn’t face a penalty.
The thing for us is peace of mind having my kids with medical insurance. I have known too many folks who have racked up 5 figure medical bills very quickly for expenses of their kids. A trip by ambulance, to the ER, tests, surgery, some medication, and you can have a very staggering bill. Insurance can help reduce the out-of-pocket cost to you of such high bills by a lot. Insurers generally have negotiated much lower rates for their insureds.