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Obamacare-"Family Glitch" means no help for my child.

Posted: Mar 26, 2014

WARNING - vent below!

After 2 miserably failed attempts to get my 19-year-old child coverage on healthcare.gov, I went to an insur. agent today.

No subsidy for my daughter even though we fall under the income threshold for both the cost adjustment and the tax credit because:

1. I have employer offered insurance (which is so BAD I will NOT put her on it).

2. We are going to claim her on our taxes as a dependent as she is still a student.

Per the agent - those answers mean no help. What is wrong with this picture folks?

This is SO wrong - if you meet the criteria, you should be able to get it. Agent said there are MANY family glitches.

So, I got her a good plan (850 deduct, 2000 OOP, $15 PCP, etc.) for 165.00 a month, which is $35 a month less than what it would have cost to add her to my lovely plan through my employer. So that is indeed a good thing.

But I wanted this $50-$75 a month insurance, or even free, that everyone keeps talking about for young people.

Agent also said many people are not paying the premiums, so they really have no idea of how many are actually covered. In my opinion, this thing is just (insert bad word of your choice that mean "wrong"). LOL They could have fixed the pre-existing and the few other actually good things without all of THIS.

And while I'm venting, I'm really tired of the people who CAN qualify bragging about it and not caring one bit for those negatively impacted.

OK. rant over. Back to work. LOL

;

Ocare - longtimemt

[ In Reply To ..]
My experience has been horrible with Obamacare. I got signed up, got a policy and it pays crap and it is the middle level, will not even pay much on medications until my deductible of 5000 is paid. Will not pay for any of my asthma medication. Actually the 2 I was prescribed went from 113 without insurance to 102 with insurance, big discount for having insurance. Have to pay half for labs or any tests after my deductible is met, 500 for ER and then they turned my visit down as being not medically necessary, could not walk due to sciatica had to be wheeled in and have tests but this was only after the doc office had continually tried to confirm my enrollment so I could get the test in the office, never did get it confirmed until I went to the ER. I have acutally probably paid out more being on Ocare than I was being uninsured and I am one of them who is going to quit paying the premiums and pay the penalty.

not everything is subject to the deductible - sm

[ In Reply To ..]
This does not mean that your insurance will not pay until you are $5000 out of pocket. For example, a PCP visit is almost always covered by a copay. You pay the copay for the PCP visit. You don't pay the full PCP fee out of pocket.

I don't have Obamacare, but I do have to pay the full PCP - wannie

[ In Reply To ..]
fee out of pocket until I reach my deductible. I also have to pay for all lab work, x-rays, etc. until I reach that deductible. I paid a higher premium to get prescription coverage, but there was no option for a plan that had PCP co-pay. I got this insurance through the company for whom I work. Because that company offers insurance, I didn't qualify for Obamacare.

that is a condition of your private insurance - - not Obamacare

[ In Reply To ..]

That's true, but I did check some of the ones - wannie

[ In Reply To ..]
available through Obamacare before going with my employer's and they were very similar unless you wanted to pay a big premium.

just seeing "deductible of $5000" doesn't mean you pay - out-of-pocket for covered services

[ In Reply To ..]

It pretty much does with this plan. - and it is ACA approved.

[ In Reply To ..]
We get the physicals and other mandated care (a few labs), etc., but everything else is subject to the deductible. Sad but true.

I think the grandfathered plans, while technically - ACA approved

[ In Reply To ..]
Do not offer the kinds of coverage or premiums the actual exchanges do.

Why this is allowed and why they should not have to implement the full ACA regulations is a mystery, again those all powerful insurance companies exerting their desire to nickel and dime us to the last minute, just like the MTSOs.

I would like to write to my congressman, senator and President Obama about this, but right now too busy working 2 jobs and one of them sitting in front of the computer way more hours than I should be waiting for work.

That grandfathering, to my mind, is Obamacare's biggest failure.

Not that I "can't keep my insurance" but that I "HAVE to keep my insurance" because the insurance company and my employer can get away with offering garbage only and like it, suckers.

My deductible is 2500 before it pays for anything except - wannie

[ In Reply To ..]
for yearly mammogram, colonoscopy if over 50, and 1 physical per year. Everything else (except medications) is out of pocket until I reach that 2500. I know my insurance plan.

you can't go to your PCP if you have a cold? - nm

[ In Reply To ..]

Sure we can go but we pay all of contracted rate. - Not wannie but same plan

[ In Reply To ..]
We are truly serious. Our insurance covers nothing... nothing ... until deductible is met. For her $2500, for me $7500 because I have to cover my spouse. (I could not sign him up separate on ACA with any assistance either, and his policies for anything better than mine was over $800 for just him.)

We should get the contracted rate, which will save us money but it will still be much more than the average copay.

All plans are affected by ACA. see message - OP

[ In Reply To ..]
If we did not have this horrible employer plan, we would qualify for the help on the ACA plans. And to be fair, this crappy plan costs my employer a lot per month as well.

I live in a Red state and went to healthcare.gov. and looked at the plans.

To get coverage at my age (and no I do not smoke), w/o the subsidies, it was at least $900 a month for a plan with a decent deductible and copays. Very discouraging.

This is truly pushing me more to doing what I should have done at least 3 years ago - get out of MT. :(

Why w/o the subisidies? or do you mean you - wouldn't qualify for subsidies?

[ In Reply To ..]
I too tried to figure out what my premiums would be under the ACA and had a shock, but then I figured in the subsidies and the premiums became way more affordable and pretty minimal, the way it should be IMHO. And yet, thanks to my employer offering a sad grandfathered alternative, I cannot get it.

I went on the ACA site when it was first starting out and it was difficult to figure out the premiums, not sure if it's any better now.

Someone mentioned ehealthinsurance.com and if you go on there you can get an estimate of your subsidy, the plans available to you and the premiums. The first page though you need to click the highlighted thing in the middle that says "check if you're eligible" for a govt subsidy and that tells you what your subsidy would be per month.

If they don't ask your income and if you have any dependents, you cannot find the true price of premiums, and the subsidies make a big difference for anyone trying to truly find out what their premiums would be.

I think the next thing is they should offer a choice between employer and ACA because a lot of us low income people who have jobs which offer the bare minimum grandfathered insurance have zero choices and it's not fair.

Obama wanted a single-payer plan. - sm

[ In Reply To ..]
Of course, the Republicans were against that.

Healthcare should have NO profit motive involved. It's downright immoral that the very idea of paying for one's ability to keep breathing should depend upon the amount of dollars that person has in his/her bank account.

If we moved to the single-payer option and put the health insurance companies out of business, that would be a good plan.

And I don't want to hear about people losing jobs in the insurance companies because companies insure a LOT of different things. IMHO, there is just no place for them as regards healthcare.

We may work for same company - see message - OP

[ In Reply To ..]

I almost went with PPO for the pharmacy benefits as well but decided it just was not worth the extra per month, so I took the high deductible.

Low and behold, our HD plan does have CVS Caremark, and believe it or not, my monthly cost was less than with the prior insurance company and was not subject to the deductible. The paperwork was very misleading.

Crazy.

That is incorrect with the - the MTSO policy I work for

[ In Reply To ..]
Everything, INCLUDING GP visits, x-rays, lab tests, etc., are out of pocket except the preventive care until you hit the deductible of $2500, and then cost sharing comes in. The OOP is $5000 but does NOT include medications. It is nothing more than a disincentive to use the insurance for anything but disasters, when you will still be hit with a huge bill.

I wish we could choose between ACA and employer based, I would most certainly choose ACA.

How do you know that ACA would be better? - sm

[ In Reply To ..]
Is it entirely dependent on someone's own situation? Does home ownership or money in the bank have an impact? TYIA.

I know because I checked on - ehealthinsurance

[ In Reply To ..]
You can see if you are eligible for a subsidy on the first page, then I checked it for my whole family, and were we able to take that option it was most definitely better and cheaper than employer option with the subsidies.

If you are trying to find out what you would pay they don't ask if you own a home or money in the bank, just your income and the amount of people on the policy, ages, etc.

Thanks for speaking up. - no mess

[ In Reply To ..]
c

I have NO co-pays at all till spouse/I pay 7500 OOP. - OP

[ In Reply To ..]
Hard for me to believe too but it's the fact.

We will get contract rates on it, so that will help and is the only reason I did not refuse the insurance and pay the fine.

Waiting periods - sm

[ In Reply To ..]
Anytime I have changed jobs and had to change insurance, my insurance never went into effect for at least 30 days to maybe 60 days, so I would think there would be a similar period now. Also, I can see where the emergency room would say a nonemergency diagnostic visit is not medically necessary. I would doubt that you would even know how much the visit would cost at this point. I had a physical in very early February,just got the bill this week (almost April) showing that I would have paid almost $500 without insurance (lots of labs) but that I will be paying about $30.00. I have a $5,000 deductible. I guess that just dropped down to $4970 for the year :-) I have some expensive medication and I pay about $12.00 a month for about $150 worth of prescriptions.

Physicals are required for all ACA approved plans. - see message

[ In Reply To ..]
Nothing really to do with waiting periods in our discussion, except for as you say people who get a new job or change to employee status.

I feel sure our physicals and other mandated things will not equal the 7500 we have to pay before my plan covers anything, as with no copay we pay contracted rate for everything, even an office visit for the flu or other nonemergency evaluation/treatment.

Copays often do not count towards your deductible, check your plan.

longimemt was concerned about immediate treatment. - sm

[ In Reply To ..]
I am saying it is not reasonable to sign up and expect to get immediate care without all the i's being dotted and t's crossed. It takes some time.

The $30 was for $300 worth of labs. - nm

[ In Reply To ..]

I don't understand how you were negatively impacted - sm

[ In Reply To ..]
You were able to cover your 19-year-old for $35 less per month. That sounds like a positive impact to me. You're upset that you couldn't get it for free? The inexpensive coverage for young people might well be available to your child if you were not claiming them as a dependent. It's for young people who cannot afford their own insurance; not for young people whose parents are paying the premiums and claiming the child as a dependent.

Perhaps if you were to let your child enroll under his/her own income, there might be another plan available to them.

Fair question - see message - OP

[ In Reply To ..]
I have personally been negatively impacted by my employer offered plan is absolutely horrible (no co-pays for office visits, and a $7500 deductible before my plan pays for anything). With this plan, I won't go for anything but my physical or absolute emergency care and my physical. I see that as a definite negative impact.

Back to my daughter: We meet the income requirements for assistance in 2013 and we as A FAMILY would get help - BUT I have an employer offered plan.

Not saying this well, it's late and I'm sorry.

Trying to be short and sweet - why shouldn't she be able to get help if we meet the income requirements?

Free cheese - sm

[ In Reply To ..]
Way back in the early 80s, there was a surplus of cheese (Reagan years). Rather than tossing the cheese and driving the farmer's milk prices down to putting the farmers out of business, they started giving away cheese to the poor and people who needed it.

I knew someone who was always complaining about the lazy poor being on welfare. He just could not stand to see all those lazy poor get the cheese, so he got in his shiny new pickup and went right down to the agency that was giving it away, got in line, and got his free cheese.

Sounds sort of like an Aesop's fable, but it is true.

Reminds me of the times we still live in.

Wish they still gave away that - cheese...

[ In Reply To ..]
I know this is off topic, but that was some of the best cheese ever!

If you buy the block unsliced American cheese - (not processed)

[ In Reply To ..]
It looks similar to those blocks of yellow-processed-chemistry-experiments-gone-wrong cheese sold in the yellow boxes, but is solid American cheese--I think it will be similar to the free cheese.

LOL - and I love people who judge others. Karma. - OP

[ In Reply To ..]
I can assure you none of my vehicles are shiny and new, and that we are far from lazy.

Perhaps some of us are just tired of being the ones that work for others to put their hand out, and finally said .. WTH, I might as well go for this too.

First time EVER in many many years I have even considered trying to get assistance from the government, and yeah, the subsidy and cost adjustments are assistance, just like the cheese, only to find out - yeah, you meet our criteria but nah, you can't get it.

While I watch other people I know WITH the new cars getting $300-$750 a month assistance simply because they don't have employer offered plans.

You don't meet the criteria. I don't understand - why you think you do meet it

[ In Reply To ..]
when you obviously don't.

I meet it because our income is below the ..see message - OP

[ In Reply To ..]
the levels for assistance.

Maybe my vent should be about the employer offered plan I have that is so bad I won't even use it except for emergencies and physicals. Why did ACA approve THEM?

We are struggling financially as many people are. I won't bore you with the details, but our income is down by at last 40% in the last 5 years.

So yes, I do feel I should be able to get my kid decent coverage that other people that meet the income requirements are able to get.

That's exactly what your vent should be - the grandfathered plans

[ In Reply To ..]
For a low-middle income person, this is the worst possible outcome. You can see if you were eligible for ACA you would be in a much better situation, yet prevented because employers/insurance companies get together and say what's the least we can offer to comply with the law?

I know the plans are supposed to comply with ACA, but why are they so much worse, less comprehensive and less choice than what is offered under the ACA plans? I think it must be to do with the grandfathering.

The sooner they give us a TRUE choice - do you want the employer junk or to participate in the ACA - the better.

Question on your plan..... - Laura

[ In Reply To ..]
How does the government even know that you have a plan that isn't up to their standards? Just a reminder here that this is the GOVERNMENT that is behind Obamacare and the government usually doesn't have a clue what is going on in the real world. What motivation is there for an insurance company or for that matter, an employer to immediately make changes - is there an incentive for either one to comply, like financial, or can companies just slide through and nobody will know about it unless somebody reports them....just curious. The insurance companies complied with Obamacare because they were offered tax dollars to subsidize their plans - maybe that isn't the case with either your employer or your insurance.....who is going to know? The IRS is supposed to keep track of the fines, but they are clueless right now about how they plan to do that. They are still busy trying to defend their actions in front of congress right now. (and that's another story).

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