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Too poor for health insurance exchange but don't qualify for Medicaid ( my state notdoing expansion)

 
 
Reply Fri 14 Jun, 2013 11:10 am
I live in a state which is not planning to go with Medicaid expansion . I was planning on getting insurance through the health insurance exchange which opens on october 1. however it says you must be at 133 percent of the poverty level or above to use the exchange. I am 19 years old, a full time college student, and only work part time so i will not qualify . But I also do not qualify for Medicaid because I have no dependent children . ( isn't it sad that if I had a baby, I would qualify?) it seems discriminatory that others whose parents have private insurance can keep insurance until 26 but because my dad died ( he carried our family's insurance) we have no private insurance todo this! Others who make more than me , can get help getting insurance, but I cant???Also, am I going to get fined for having no insurance? This seems unfair !
 
tsarstepan
 
  3  
Reply Fri 14 Jun, 2013 11:17 am
@OrphanGirl,
Yep. The up and coming system is flawed. Just curious, do you get social security benefits because your father's death? You should look into that. It wouldn't be much or wouldn't last for too long considering your age (you might be too old at this point to collect).

You should consider moving to a state where you can be both a student and qualify for health care.
0 Replies
 
OrphanGirl
 
  1  
Reply Fri 14 Jun, 2013 11:24 am
I did receive social security until I turned 18, but they cut you off then! At this time I can't afford to move , and if I went to another state to go to school, it doesn't give me residency! I also have a great scholarship where I am going to school now! If Medicaid and Obama Care are FEDERAL program, and are funded by federal funds, it shouldn't matter where I live in the USA!!
0 Replies
 
Butrflynet
 
  3  
Reply Fri 14 Jun, 2013 01:44 pm
@OrphanGirl,
Which state do you live in? That info will help anyone wanting to help you research your options.
0 Replies
 
MNMom07
 
  1  
Reply Sun 14 Jul, 2013 07:28 am
This is exactly what I am trying to research. So it is true that if you are below 133% of FPL then you don't get to participate in the state or federal exchanges starting October??? What is the point of this new wonderful system then for people who live in a state like North Carolina but are extremely poor like the OP or elderly who are not working but not old enough to draw SS. My mom isn't working. I support her financially - can't add her as a dependent on my work insurance because she isn't my spouse or domestic partner. I was hoping starting 2014 she would be able to get coverage through ACA. Are they going to do something about this flaw?
0 Replies
 
Peter Frouman
 
  5  
Reply Sun 14 Jul, 2013 09:50 am
@OrphanGirl,
This seems to be based on a misunderstanding of the eligibility requirements. The income level eligibility requirement is not a minimum but a maximum. Thus, you can't be too poor to qualify. In states that are rejecting Medicaid expansion, the maximum income level to qualify for subsidized exchange coverage will be at least 133% (actually 138% based on the new formula for calculating modified adjusted gross income).

There is some more info on this at http://www.apha.org/advocacy/Health+Reform/ACAbasics/medicaid.htm

You also may want to check these ACA calculators to get an estimate of what your coverage would cost under the new rules:
http://laborcenter.berkeley.edu/healthpolicy/calculator/
http://kff.org/interactive/subsidy-calculator/
MNMom07
 
  1  
Reply Sun 14 Jul, 2013 04:33 pm
@Peter Frouman,
The medicaid website you provided doesn't provide any information about the eligibility Health Insurance Exchange.

At the website, under the section called "Who Can't Participate in the HIX Health Insurance Exchange", the first bullet is: Anyone who doesn't qualify for Medicaid (under the new ObamaCare Medicaid expansion). This includes people under 133% poverty line. This will help to make healthcare more affordable as everyone will be pitching in a more equal share.
http://obamacarefacts.com/obamacare-health-insurance-exchange.php

Maybe I'm reading this wrong but it clearly states that people under 133% poverty line will not be able to participate in the HIX. If I'm wrong (which I hope I am), then please direct me to your source.

Thanks!
Peter Frouman
 
  4  
Reply Mon 15 Jul, 2013 01:58 am
@MNMom07,
It seems that other web site you found got it wrong or used confusing language to incompletely describe the eligibility requirements.

I haven't found anything from a reliable source that indicates that anyone with an income at or below 133% of the federal poverty line will be excluded from the federally run exchanges in 2014. The only people with an income at or below 133% of the federal poverty line who will be excluded from the exchanges will be those who can enroll in Medicaid either because their state has chosen to accept federal funding to expand Medicaid or because they are already eligible under current eligibility requirements. That may have been what the web site you found was trying to state.

It's always a good idea to look at the original source to get the most accurate information.

Here is the relevant part of a document by CMS (Centers for Medicare and Medicaid Services) summarizing the new regulations:

http://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidCHIP-Eligibility-Final-Rule-Fact-Sheet-Final-3-16-12.pdf

Quote:

Beginning in 2014, the Affordable Care Act extends Medicaid coverage to all individuals
between ages 19 and 64 with incomes up to 133 percent of the federal poverty level, or
$14,856 for an individual and $30,656 for a family of four (based on the 2012 federal poverty
level).



Here is the relevant part of the final regulation:

Medicaid Eligibility Final Rule 42 CFR Parts 431, 433, 435, and 457 “Medicaid Program: Eligibility Changes Under the Affordable Care Act of 2010”-3/16/12

Quote:

Sec. 435.119 Coverage for individuals age 19 or older and under age
65 at or below 133 percent FPL.

(a) Basis. This section implements section 1902(a)(10)(A)(i)(VIII)
of the Act.
(b) Eligibility. The agency must provide Medicaid to individuals
who:
(1) Are age 19 or older and under age 65;
(2) Are not pregnant;
(3) Are not entitled to or enrolled for Medicare benefits under
part A or B of title XVIII of the Act;
(4) Are not otherwise eligible for and enrolled for mandatory
coverage under a State's Medicaid State plan in accordance with subpart
B of this part; and
(5) Have household income that is at or below 133 percent FPL for
the applicable family size.

JPB
 
  3  
Reply Mon 15 Jul, 2013 05:35 am
Thank you, Peter, for your clear and calm responses to the threads on the upcoming exchanges. I'm sure there will be many more of them as we get closer to October.
0 Replies
 
ossobuco
 
  1  
Reply Mon 15 Jul, 2013 01:27 pm
@Peter Frouman,
Thank you, Peter, for your clarity. (I never not read your posts)
0 Replies
 
tsarstepan
 
  1  
Reply Mon 15 Jul, 2013 01:45 pm
@Peter Frouman,
Peter Frouman wrote:

You also may want to check these ACA calculators to get an estimate of what your coverage would cost under the new rules:
http://laborcenter.berkeley.edu/healthpolicy/calculator/
http://kff.org/interactive/subsidy-calculator/

According to the calculator, I will have to spend at least $132 a month after the alleged subsidy for my health insurance. I'll translate that into lay terms: I will still be unable to afford health insurance without sacrificing things like food, etc.... FRAK!
roger
 
  2  
Reply Mon 15 Jul, 2013 02:00 pm
@tsarstepan,
At least you can just pay a fine and have the same coverage as before - which is none.
roger
 
  1  
Reply Mon 15 Jul, 2013 02:01 pm
@roger,
Or is it a tax? I'm so forgetfull.
tsarstepan
 
  1  
Reply Mon 15 Jul, 2013 02:07 pm
@roger,
roger wrote:

Or is it a tax? I'm so forgetfull.

Rotten pot(ay)to/rotten pot(ah)to. Confused
0 Replies
 
ossobuco
 
  1  
Reply Mon 15 Jul, 2013 02:11 pm
I've long been for universal health care: I think it is more important than war-material supplies to the many countries waiting for ammunition and the weapons to work those widgetables, and the profits thereof.

I was once taken by a post or two by Robert about health care in Costa Rica, where he got very good help one time. I wouldn't consider speaking for him, what an idea, so I wish he would pipe up one of these days.
0 Replies
 
MNMom07
 
  1  
Reply Mon 15 Jul, 2013 03:50 pm
@Peter Frouman,
Using the calculator below - I entered in my mom's information and it just said "Medicaid"...because she works part-time (way below 100% of FPL). What does that mean when we live in a state that already chose to opt out of Medicaid expansion?
JPB
 
  1  
Reply Mon 15 Jul, 2013 04:09 pm
@tsarstepan,
Yeah, "affordable" is certainly relative to one's situation.
0 Replies
 
Peter Frouman
 
  1  
Reply Tue 16 Jul, 2013 07:23 pm
@MNMom07,
Apparently I was wrong and there actually will be a huge Medicaid coverage gap affecting those earning below 100% of the federal poverty line who aren't already eligible for Medicaid in states that have rejected Medicaid expansion.
http://www.dispatch.com/content/stories/national_world/2013/07/02/medicaid-coverage-gap-looms.html has some more info about this.
I put some hypothetical numbers in the calculator at http://kff.org/interactive/subsidy-calculator/ and the results were crazy.

A 64-year old with income of $11,490 per year in a state that has rejected Medicaid expansion would would pay 3% ($230) of the premium for coverage in the federal exchange and receive a credit for the rest while a 64-year-old with income of $11, 489 per year would pay the entire estimated premium of $9, 054 (78% of total income!) and not get Medicaid or any premium credit. However, according to the article linked to above, at least those people won't have to pay the penalty for not having coverage.


ossobuco
 
  1  
Reply Tue 16 Jul, 2013 08:18 pm
@Peter Frouman,
Thank you for looking into it so seriously.

I'm covered, but I well remember not being so.
0 Replies
 
roger
 
  1  
Reply Tue 16 Jul, 2013 08:36 pm
@Peter Frouman,
Well, that's not good news at all, but thanks for getting back to us.
0 Replies
 
 

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