Fun with health insurance, part 2

I don't quite know how to categorize this post. Is it a "diary entry"? Kind of. Is it about politics? No, not really. Do I think you want to hear it? Maybe—it's certainly crazy enough to be funny, if you have the right sense of humor.

Is there any kind of important moral in it? I keep thinking there must be, but I haven't found it yet. So let's go with "crazy" for now.

Part 1 is way back here.

Set-up

This afternoon I talked with an insurance agent about health insurance. Of course under the ACA ("Affordable Care Act") I'm required to carry health insurance, and right now I'm covered by a COBRA plan left over from my work. But my official last day of work was in September  2021, so the 18-month COBRA continuation is about ready to expire. Time to plan for what to do next.

My state has a website where you can shop for plans under the ACA, and I've been doing that. But I don't trust it. Back in October 2021 I tried to use that same website to find a plan. I browsed, found one that looked affordable, clicked "Buy," … and found myself with a plan at literally twice the cost which had been promised me. That wasn't just a display error—it's what they billed my credit card. So this time I wanted a human being who understands this stuff to intervene.

Good thing, too. Turns out if I'd tried to barge through the website like I did last time, I would once again have gotten stuck with a full-price plan. (No discount.)    

Oh, and rates have gone up in the intervening 15 months, so the full-price today is considerably higher than it was then. (The subsidy is correspondingly larger, so my final price out-the-door shouldn't be all that different from what they offered me back then. But I sure don't want to pay full price!)

AS AN ASIDE: My situation back then finally got sorted out, though it took a while. I canceled the full-price plan immediately and activated my COBRA plan instead. (COBRA plans are famously expensive, so it is criminal that my COBRA plan was actually cheaper than the ACA plan!) But the state office had no mechanism to refund my money. On the other hand there was a field on my tax return (several months later) where I could claim it, and so I got it back as part of my tax refund. So yes, it took several months but it did get sorted out.

SO: What was (or "is") the problem, anyway? Ahh, thereby hangs a tale.

Back story

As I said, I logged into my state's website to buy ACA health insurance back in October 2021. My official last-day-worked had been in September (though I'd been out of the office for six months before that). My last paycheck was in September. So was the check that cashed out my unused vacation and paid me my severance allowance. All that was dated in September. It was enough money that there was no risk of my missing a meal in October, but I didn't have anything concrete set up for the future.

My state's website asked for a bunch of financial information, and one of the questions was about income. The question stated VERY EXPLICITLY that they were asking about THIS MONTH AND THE FUTURE, and not about any time in the past. So given that strict limitation, what specific sources of income did I know about? Umm … taking the question literally, on that day the answer was None. So that's what I answered. What about expenses? Did I have any of the following? There was a long list, many of which were inapplicable because, for example, I had no dependent children at home. But it asked about alimony, so I checked that box.

Then the application moved on to ask other things. I kept expecting questions about severance payments, because my state's Unemployment Office certainly asked about those when I applied for Unemployment Insurance. I also thought there might be questions about savings. But all of a sudden the tool told me I was done, and my application had been submitted. Wait, what?

A while later, I learned that I had been judged eligible for Medicaid. The grounds of eligibility were that I had an income of zero, and alimony payments of so much, so the resulting net income was negative. Any negative number is below the threshold for Medicaid.

This didn't seem right. The way I had always heard, Medicaid required that you exhaust your savings before they authorized even one thin dime. After several weeks I got a case worker on the phone, however, and she explained to me that that rule had recently been abolished. (Maybe just for the duration of the COVID health emergency—I forget the details.) She encouraged me not to worry about it.

So I didn't worry about it. Last fall I got forms in the mail asking me to verify my income. By then I had been taking distributions from my retirement funds, and I had started doing a little local consulting. So I counted both of those. No surprise, they added up to more than the threshold for Medicaid eligibility. So I figured I would get canceled.

After several weeks with no word, I started to ask the Department of Social Services what was going on; and after a couple of weeks of THAT, I got an answer. I had been renewed for another year.

This is crazy. The program was not designed for people like me. I THINK I heard someone say that one of the measures put in place at the time of the COVID health emergency was one that forbade states to kick anyone off of Medicaid for the duration of the emergency, for any reason whatsoever. I might have gotten that wrong, but if it's true it would explain why they renewed me. (And it's the only explanation I can think of.)

So what's the story today?

Here's what the agent explained to me: when I log into my state's ACA website and try to buy health insurance, the website checks first for Medicaid eligibility. When it finds I am eligible, the tool is programmed to conclude, "He doesn't need a subsidy because he's already getting health care for FREE. Charge him full price!"

So does that mean I have to call up and cancel my Medicaid, instead of just ignoring it? Not so fast.

If I cancel my Medicaid, that will take me off the lists of the insured. But it does nothing about my eligibility. I will still show up as eligible, which means that the ACA website will still charge me full price.

The agent I talked to explained that what I have to do, if I want to buy ACA-subsidized insurance, is to get Medicaid to REJECT ME BECAUSE I AM INELIGIBLE. It has to be that specific. Then I can go through the channels normally. Otherwise, not.

She suggested it might be easier to make an appointment to go see them in person, rather than trying to call. The phone lines are regularly swamped.

Or, you know, I suppose I could just rely on Medicaid until they finally kick me off in the due course of time. That feels wrong, because the program really wasn't meant for people like me. but logically I suppose it is a possibility.

Clearly my first step is to make an appointment with Social Services and talk to them about it.

Why am I telling you?

Well, the whole story is crazy. So I felt I had to tell somebody. I was going to write it all in a letter to Marie, but then I worried that it might raise her political hackles because it might sound like I'm mocking the ACA. Or like I'm freeloading on Medicaid. Or something. The blog I keep under my real name is specifically for professional topics, and this isn't one. I'm not on Facebook, it's not right for LinkedIn, and in any event social media would just attract hatred from all sides.

So I figure I'll post it here. The venue is pseudonymous. We're all friends. And nobody reads it anyway. It's perfect.

And crazy.