Insurance crap (Questions regarding mother's insurance)

[Meresgi]

So just got a call from my mom, apparently their insurance won't cover ANYTHING because of pre-existing conditions. (She and step-father have back problems, and other stuff from getting older). They didn't know any of this until today when they got a letter basically saying they have to pay $3k for a MRI, and multiple more bills, along with no coverage on drugs or anything.

They can't drop coverage either because you can only do that in November each year.

So they are paying $87/week now...for nothing. Insurance covers nothing. Unless they get cancer or something even worse now. They have no money to cover these sorts of things, they barely can even make mortgage payments..shit is pissing me off since i'm 3 states away.

After a year they will cover it pre-existing condition stuff (apparently when Obama said they can't deny you, he forgot to mention they CAN but only for 1 year???)

This was the cheapest plan she could get, going through healthcare.gov...

Because their employer offers health insurance, they don't get any subsidies...because they basically have to be broke and on welfare to get any benefits..but they are just BARELY over the "fucking poor as shit" cutoff.

Anything they can do about this? My Step-father works at a factory/mill and has his entire life. Mother was laid off doing medical transcription and can work BARELY part time now...


edit: They can't go on welfare either...because a lean would be placed on the house, so if they die the state gets the house...fucking system...

[BaneTheBrawler]

call the hospital, explain the situation, ask if there's any compassionate care programs. lots of foundations out there to help with shit like this. ive used 'em before.

[archibaldcrane]

I'm confused. How long have they had this plan? They got it from healthcare.gov, or from your stepfather's job? If they are going through healthcare.gov, but his job offers insurance, why?

edit: are you sure she's not just confused about out of pocket limits and deductibles or something? Being "covered" doesn't mean everything is included with no out of pocket. MRIs are expensive, and if you have coinsurance and/or a large deductible, you will still have to pay a bit for it.

Any ACA-qualified health plan does not care about preexisting conditions. She's either misrepresenting something or is confused, or is not covered by an ACA-qualified health plan.

[archibaldcrane]

Also, what state is she in?

[synistar]

Is the "fucking poor as shit" line below $60k annual income? If so, they will be getting some sort of subsidy, albeit smaller once you approach 400% poverty line income, the real poor as shit line. Don't know how that works though whether it's a tax credit for the year or a discount on the premiums.

[archibaldcrane]

You only qualify for a subsidy if your employer doesn't provide an ACA-eligible plan. It sounds like his stepfather's work does provide such a plan, so they won't be subsidy eligible. $87/week is not a bad price at all for two people in their late 50's or early 60's though.

[Meresgi]

Is the "fucking poor as shit" line below $60k annual income? If so, they will be getting some sort of subsidy, albeit smaller once you approach 400% poverty line income, the real poor as shit line. Don't know how that works though whether it's a tax credit for the year or a discount on the premiums.

The subsidies are based off a total % of the HOUSE income and not just the individual and since her job offers insurance (At a crazy high rate) there's some extra stuff in there.

State is New York (asshole of the north)

@Archi. Stepfather lost his job about 6 months ago, the leather mill closed down suddenly w/o warning (they gave all the employees a week's notice). So he lost his insurance for a few months before getting a new job and having to work a bit until he was eligible to get insurance. because of that gap in coverage, their insurance is allowed to deny them for pre-existing conditions.

$87/week is not a bad price at all for two people in their late 50's or early 60's though.

It's not a bad price if it was covering anything, but they are forced to pay that per week AND pay out of pocket for all the medicine/treatment/visits for pretty much everything. She has issues with her wrists, back, nerves, and esophagus. He has issues with his back and heart. They are in their 50's so pretty much ANYTHING is a pre-existing condition at this point for them.

I asked if she spoke to a navigator or w/e the people were that help guide you through the healthcare.gov site and she said she had, and that the best plan on the site was too much for them to pay for.

Do you happen to have a link stating that ACA insurance can't deny pre-existing even if there is a gap in coverage? And not even for the initial 1st year?

[archibaldcrane]

Ok - just to get this straight - stepdad lost job/coverage in...November 2013? Then they went a few (how many?) months without coverage, then got coverage via healthcare.gov (what level plan? catastrophic, bronze, silver, gold?) in February - and when your stepdad has enough time at the new job, they'll switch to his work insurance, correct? When did she get the MRI that she's getting billed for now? On the old insurance, the new insurance (since February or whatever?) or when uninsured?

[archibaldcrane]

To your question about coverage gaps, I see nothing whatsoever that allows an insurer to refuse payment for treatments of "pre-existing conditions" because of a prior coverage gap. Tons of people who are just getting insurance now via the ACA have "coverage gaps" coming into them. When you apply via healthcare.gov, they don't even ask medical questions other than if you smoke - I don't understand how the new insurer would even know if a condition was pre-existing...

Something doesn't add up in this story.

[Meresgi]

Clarification:

Lost his job last year I think around August/September roughly. He got a new job about 2 months later, but in order to qualify for insurance he had to work the new job for a month or 2. During that time they had no insurance at all.

His insurance through the employer is the one denying them coverage, but according to my mother, the cheapest plan they qualify for is around $150ish/week so almost double what they are paying now or a little more. I asked her about this since it would be better to just pay extra per month then pay out of pocket for expenses but it's something they can't afford even at that rate.

The MRI and everything is on the new insurance through his new employer. From the sounds of it, this was a surprise to them so they were not notified they wouldn't be covered for these things until after the fact.

The hospital she works for also offers insurance, but from what she told me she either doesn't qualify or it's too much, I think the latter. Due to that, because their employers offer insurance, it has to pass a certain % of their income to allow them to get subsidies from what she said, and they don't qualify according to the website/navigator

I don't know too much about the things related to ACA since my job provides great health coverage, so I havn't had to deal with it. I figured people here may have had this issue and may fall into the same income bracket. I would much rather they go on welfare, but because of the lean on their assets and wanting to leave the house to my brother, that isn't an option I guess. They also don't qualify for medicaid because the cutoff is a really fucking low amount (I was on it in my early 20s and I remember being dropped if I made like $200/week or maybe even less)

[archibaldcrane]

Ok, that helps a little. The MRI in question - was it before Jan. 1st, 2014 or after? Also, what does this mean:

His insurance through the employer is the one denying them coverage, but according to my mother, the cheapest plan they qualify for is around $150ish/week so almost double what they are paying now or a little more.

The plan they "qualify for" is $150ish/week...I'm sorry, this is stepdad's new work plan or no? I thought they were paying $86/week or whatever? Where is that plan from?

[Meresgi]

The $87/week plan is through his work at his new job. The $150+/week would be from healthcare.gov site if they shopped for the lowest plan they were eligible for. Not sure on the MRI date but i'm guessing it was within the last 2 months.

[Cream Soda]

Obama doesn't care about black people

Shit sucks I know their feel. They want to fuck me too (i'm just gonna pay the fine, $113/month I can't afford and it'd give me about the shittiest coverage you can get)

[archibaldcrane]

Obama doesn't care about black people

Shit sucks I know their feel. They want to fuck me too (i'm just gonna pay the fine, $113/month I can't afford and it'd give me about the shittiest coverage you can get)

Cream, given that I assume your income is less than 133% of the poverty line for the year, you won't be fined. Since your state didn't expand Medicaid that you would otherwise qualify for, you won't be facing a tax penalty.

• Some earn too much money to qualify for Medicaid, but not enough to obtain ACA subsidies
• 26 states decided not to expand Medicaid after the Supreme Court's decision
• Those who can't get Medicaid or subsidies won't pay a fine for not having health insurance

[Cream Soda]

That's good at least. Better to be fucked in an emergency than fucked in the emergency and have to pay a fine for it

[archibaldcrane]

The $87/week plan is through his work at his new job. The $150+/week would be from healthcare.gov site if they shopped for the lowest plan they were eligible for. Not sure on the MRI date but i'm guessing it was within the last 2 months.

If the MRI was after Jan. 1st, and they were insured, it doesn't make any sense that "pre-existing conditions" matter. Are you sure that the $3000 isn't the "post-insurance" cost of the MRI? I have insurance and still had like $2400 in bills after getting a cut that required stitches. Also, is it possible that the MRI was performed at an "out of network" facility, which would increase the cost to them?

[Meresgi]

If the MRI was after Jan. 1st, and they were insured, it doesn't make any sense that "pre-existing conditions" matter. Are you sure that the $3000 isn't the "post-insurance" cost of the MRI? I have insurance and still had like $2400 in bills after getting a cut that required stitches. Also, is it possible that the MRI was performed at an "out of network" facility, which would increase the cost to them?

I think they were told in a letter they were going to be billed the full amount for everything due to pre-existing conditions. I want to say his insurance kicked in after Jan 1st, maybe even February. I can't remember for certain but I visit in January for Christmas and I think we were talking about it going into effect later that month or soon.

That's good at least. Better to be fucked in an emergency than fucked in the emergency and have to pay a fine for it

I hear ya man. Shit is crazy, my dad before he died had to pay out of pocket for all his insulin because medicaid wouldn't finish filing the paperwork and required "verification" meetings once a month and never got shit done, resulting in him not taking proper care of himself and finally dying. gg system gg!

[archibaldcrane]

I mean, it's...technically possible I think that the job health plan isn't ACA-compliant, but that seems unlikely. How big is stepdad's new company? I think it's possible that the plan offered by his new employer could be "grandfathered" if it was the same plan they've had since 2010, meaning it doesn't have to comply with all the current ACA requirements (such as not covering pre-existing conditions) - but if they aren't offering an ACA-compliant plan then your parents would be eligible for subsidies to buy a plan on the healthcare.gov.

[archibaldcrane]

Also, finding out the date (or month) that the MRI occurred in would help close that part of the mystery.

[Meresgi]

MRI was done in March.

Insurance became active February 9th

He went to a doctor, then went to get the MRI, then had to go back to doctor. They got a letter today saying they wouldn't cover because of a pre-existing condition.

Mother says, insurance company can go back 6 months before insurance began. If you got treatment or anything, they can claim that as a pre-existing condition. He went to see a doctor back in the fall about his back and it falls within that time frame.

Found this about grandfathering:

Grandfathered plans are plans that were purchased before March 23, 2010. These plans have a grandfathered status and don't have to follow ObamaCare's rules and regulations or offer the same benefits, rights and protections as new plans.