[quote=SK in CV][quote=bearishgurl]The vast majority of people who sign up for coverage on the exchanges DO take a subsidy. Why would anyone go thru all those layers of BS just to have a healthplan if they weren’t going to get a subsidy?
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Because they want and need insurance. And believe it or not, in some markets, there are very decent choices at identical rates as are available outside the exchange. I bought insurance on the exchange with no subsidy for almost a year. My wife purchased insurance on a different state exchange for almost 2 years with no subsidy. Neither of us ever had to enter any income data.
I did the same thing for my daughter on the CA exchange last year for the 3 months she was without insurance between school and her job starting. No income entered. And guess what? with her return she got a premium tax credit. It’s possible that just looking at her tax return, the state of California would have liked to push her into medi-cal, but they never got the chance. And they would have been wrong in doing so. But I never had to fight the fight.
Not everyone who purchases insurance through state and federal exchange receive subsidies.[/quote]Yes, SK, I have checked out your suggestion, above, with a CC enrolled agent-navigator who works out with me, which you made earlier to me on the election thread. If, God forbid, I am forced to continue my CC marketplace PPO into 2017, I am going to do exactly what you have suggested here during opening enrollment this fall. I will drop my request for a subsidy (I get a monthly healthcare allowance from my retirement assn and my subsidy is small, anyway). If I receive a premium tax credit in 2018 (and I should), then so be it. That will be great! This is far preferable than worrying about whether I actually have any coverage from week to week after having my monthly premiums taken out automatically the 1st of every month.
Here in SD, we don’t yet have “very decent choices at identical rates.” SD County (Region 19) is mostly sewed up with longtime Kaiser (HMO), Sharp (EPO) and Tricare (mostly HMO, some PPO) members, Most of the people I know who have HMO’s/regional EPOs (incl Anthem) like the “system” they are in and never take lengthy “road trips” like I do. Many of them stay in SD County and SoCal and just take staycations and day trips and so Sharp (in SD County only) works out fine for them because they were born here (or moved here as a young child 50-60 years ago) and have family here. However, I am out of state 4-8 weeks per year on the road (mostly visiting family) and need nationwide coverage.
I’d like to see the 6 PPO’s who defected from CA at the end of 2013 come back into SD County and offer competitive plans on the open market (above Bronze level). So far, that hasn’t happened.
If I could have qualified for Tricare for the rest of my life, I would have been on Tricare Standard (a PPO) and would not be having this discussion because I never would have signed up on the state exchange. Tricare Standard has a large network and nationwide coverage for whatever services I want to use (currently administered by UHP).
SK, your daughter’s situation was short term. Had she had to pay 100% of her premium long-term, it could have become cost-prohibitive for her, causing her to request a subsidy (and become inadvertent “prey” for trolling Medi-Cal workers to make “adjustments” to her reported income and bump her down to Medi-Cal behind her back). I understand when you say it would have be wrong to place her on Medi-Cal but she would have been on it a minimum of nine months had she been force-placed into it. Only a County Medi-Cal worker can “release” her from Medi-Cal. The truth is … CC and Medi-Cal don’t care if they made a mistake by bumping someone into Medi-Cal. The burden of proof is on the individual who was force-placed in Medi-Cal to appeal CDHS’ finding that they are “Medi-Cal eligible” or “Magi Medi-Cal eligible.” Your daughter (or any appellant) would have had to appeal the finding all the way to an administrative hearing, where, according to the CA agent/navigator blogs I’ve been reading, the ALJ is ruling nearly 100% on behalf of the appellants. It then typically takes Medi-Cal another 4+ months to adhere to the ALJ ruling and “release” the appellant from the “Medi-Cal vise grip” so they can buy some insurance (marketplace or otherwise). And that’s only with constant prodding by the appellant and/or their agent/navigator! This same appellant’s CC account could easily be hijacked subsequent times (after their ALJ win), causing them to be bumped into Medi-Cal again, with or without their knowledge. The incompetent bureaucrats who run Medi-Cal (and even the “pseudo gubment agency” that is CC) are essentially “immune” from all the egregious mistakes they make with people’s lives! It is disheartening that a lot of “middle class” people who, in good faith, signed up for marketplace plans with subsidies are essentially finding themselves constantly banging their heads against a brick wall to keep their rights from being trampled upon. Most people (esp the English-challenged) don’t have the knowledge or wherewithal to “fight the system” and that’s what CC/Medi-Cal count on to keep as many people OFF marketplace plans and ON the gubment dole, instead (with very, very few providers to choose from … IF ANY, in some locations). CC/MC doesn’t care about that little problem, either.
I’m happy to hear that your daughter landed a job with benefits quickly and I hope she is able to stay employed FT for the duration.
