Pretty complicated question

Reply Sun 29 Jun, 2014 07:59 am
Ok, so when I went through the Marketplace to get coverage I was employed. I've paid about 4 months in premiums and receive a subsidy of around $120 and pay a premium of $113. At the time I also had a pending application for SSI that dates back 5 years and I never thought I'd be granted disability. Well, I lost my job (first) then found out my SSI had been approved finally. All within the same week. I lost the job before I knew about the SSI. Well, I am currently undergoing some treatment and my insurance that I got through the marketplace is covering my treatment 100%. Medicaid won't cover my doctor visits and they are $250 each time (monthly). On SSI I cant afford that. I don't want to give up my insurance because honestly it's better than Medicaid. I know that I probably don't qualify for it anymore because of my Medicaid eligibility, but I can't possibly afford my treatment without my insurance coverage and I don't want to change doctors in the middle of my treatment. My question, I guess is, what will my liability for not discontinuing my insurance and only being covered by Medicaid.? I have been to several websites and they only talk about underestimating my income, but mine has drastically been reduced. Additionally, since I'm technically not eligible for it anymore what could the possible repercussions be for not updating my information so I can keep my insurance? I mean I was eligible when I signed up and I really am not aware if the program runs month to month or annually. I really don't want to lose my insurance because my deductible and out of pocket have already been met and now almost all of my medical services are covered 100%. Most of my prescriptions are free and I have a minimal office co-pay. If I dropped all of that I feel like I would be starting over with Medicaid and in the end Medicaid would end up costing me more on a monthly basis than if I pay my premiums. I'm not eligible for Medicaid coverage until 7-1-2014 and I was just going to use my insurance as my primary and Medicaid as my secondary, which might reduce my costs even more thereby saving me more money. I'm just so confused as to how this will effect me and I really don't know what to do. When I signed up the ACA was great for me and it gave me everything I needed, but now I just don't know. Being new to SSI I don't know how this will impact my tax liability at the end of the year and I don't know what will happen in regards to my medical coverage. To make matters more complicated I'm being treated for a substance abuse issue and am currently undergoing Suboxone treatment which is a specialty drug and waiting lists for doctors for this treatment are long and sometimes it takes months to get an appointment with a provider. My current doctor does not accept Medicaid payments, but the insurance I have pays for my office visits completely ($250 monthly). I just don't know what to do or where to turn for answers. FYI my substance issues are a part of disability claim, but not the reason for its approval. So, the SSA is aware of the problem. This treatment has been life changing for me and to stop it now could have devastating implications on my recovery. So, if anyone out there has any answers or advice I'd really appreciate it. It's sad that I actually am a nurse and I don't understand this whole thing. I just don't see how normal people like me are supposed to navigate through this stuff. It's like you need a law degree and Ph.D. in Healthcare Administration just to understand this stuff. So any advice will be appreciated.
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Type: Question • Score: 3 • Views: 1,602 • Replies: 3
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bobsal u1553115
Reply Sun 29 Jun, 2014 08:46 am
There are a lot of simple problems here that add up to a big problem.

I am assuming you are nurse with a back injury who became addicted to pain relievers in treatment and you are under 60 years old.

I think by putting the fires out in order of severity, and by approaching the correct authority with the right question you can get through what would be a very hard time to cope with for anyone.

Whats the immediate first question you need to get answered?
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Reply Sun 29 Jun, 2014 07:17 pm
I don't see how you can figure that Medicaid coverage would cost you more out of pocket than your private pay medical insurance.

bobsal u1553115
Reply Mon 30 Jun, 2014 06:58 am
Depends on her income and her private plan.
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