Public Charge and Public Benefits

If public charge rules changes happen, there will be a notification period. DON'T end any public benefits now. #AllAreWelcomeHere

Want more information? Read the post, Welcome Immigrants—Opposing Public Charge Rules Changes, from December 2018.

#AllAreWelcomeHere

Print Friendly and PDF

Subscribe to our blog here!

What Are Special Enrollment Periods? (Or "I Missed Open Enrollment, Can I Still Get Marketplace Insurance?")

If you missed Open Enrollment on the Marketplace, you may be wondering if you can still get healthcare.

The answer is a Definite Maybe.

Are you eligible for Medicaid? Medicaid enrollment is always open, you can apply anytime.

Check to see if you are income eligible by clicking here. If you are not sure about your tax household size or how to calculate your income, give us a call (734-544-3030) and we can help you. There are also many blog posts on this website about eligibility and special circumstances. Search for self-employment, college/teens, income, or your circumstance. There may be a blog post specifically for you!

If not, here are the most common reasons people qualify for a Special Enrollment Period.

NOTE: Generally, Marketplace special enrollments last 60 days (not quite two months) from the change in status. Most employer special enrollments only last 30 days.

Loss of Health Care/Medicaid Denial

lossofcoverageSEP.png

If you are losing your health care, there are options. If your income is decreasing (loss of job, job change, adding a new member to your household), you maybe eligible for Medicaid. If you are losing your healthcare from your job but are over income for Medicaid, you will be eligible for a 60 day Special Enrollment Period on the Marketplace.

If you are losing Medicaid because your income is now higher, you probably have two choices. First, if your employer offers affordable health insurance, you need to enroll in your employer plan. Loss of coverage creates a 30 day Special Enrollment Period with your employer. Employers are not always aware that you qualify for a Special Enrollment Period when you lose other health coverage. This US Department of Labor document clarifies the policy.

You and your spouse may be be eligible for employer insurance but your children may stay eligible for Medicaid/MIChild, which has higher income limits for children. If your employer insurance is not affordable (official explanation of affordable), the second option is a 60 day Special Enrollment Period on the Marketplace. The 60 day period starts the day you lose your coverage.

Change of Immigration Status

citizenshipSEP.png

If you are lawfully present in the US, you may qualify for Medicaid or Marketplace insurance. If you are income eligible for Medicaid and have been here for 5 years, you are now eligible for full Medicaid. Apply for Medicaid and cancel the Marketplace. If your immigration status has changed, for instance if you had a work permit renewed or you got a permanent residence card, you qualify for a 60 day Special Enrollment Period on the Marketplace.

Divorce, Birth and Death

marriagedeathdivorceSEP.png

Divorce, Birth and Death all create special enrollment periods and may change your tax household and income. For the Marketplace, any of these events creates a 60 day Special Enrollment Period from the date of the event.

Moving

movedSEP.png

When you move from one county or state to another, you qualify for a Special Enrollment Period if you had health care at your previous address. You can apply for the special enrollment period before your move date.

Turning 26

If you are covered under your parent’s health care, when you turn 26 you will lose that coverage. Some employer plans will cancel you on the day of your birthday and some cancel you at the end of your birthday month. Occasionally they will continue your coverage until the end of the year. You can use the “loss of coverage” special enrollment period starting from 60 days before you lose coverage until 60 days after you lose coverage. Enrollment can start as early as the day after your coverage has been lost.

I was auto-enrolled in last year’s plan. What do I do?

ooops I did it again.gif

If you failed to update your application on the Marketplace and were auto-enrolled into your 2018 plan, you should still go in and update your application. To update your application, click on the 2019 application and select “report a life change” from the menu on the left side of the page. Update your application and your tax credit will be accurate for 2019. Unless you qualify for a Special Enrollment Period, you will not be able to change your plan, but at least you will have health care for 2019.


If you have questions, call us. We Help People figure it out. 734-544-3030.

Print Friendly and PDF

Subscribe to our blog here!

Welcome Immigrants—Opposing Public Charge Rules Changes

PIF.png

UPDATE: Over 200,000 comments were received while the public comment period was open. No changes can be made until the regulating body (Department of Homeland Security) responds to every comment. Then they can publish a final rule, which could incorporate changes based on comments received—or they could decide not to publish a rule. After the rule is published there is a waiting period before it takes effect.

Today—in fact—any day—is a good day to tell the world that you welcome immigrants to the United States. The Washtenaw Health Plan and Washtenaw County Health Department have submitted comments opposing the changes in "public charge" regulations. Comments could be submitted until December 10th, 2018.

What Is The Issue?

The Trump administration has published a proposed rule that would force many immigrants and their families to choose between accessing essential public services and keeping their families together. 

There are many reasons why immigrants may be denied permanent residence (aka a “green card”) or not be allowed to enter the United States. Public charge is one of those reasons. Under current laws, the government considers someone a public charge if they are found likely to become primarily dependent on government programs.

Currently, “public charge” is considered very narrowly—an immigrant can only be found to be a public charge if they use cash assistance (like TANF or SSI), or institutionalized long-term care (like living in a nursing home) through Medicaid.

The government is considering changes that would dramatically expand who is considered a public charge. making it much harder to get a green card or visa. These changes include:

  • Expanding the benefits that could classify you as being a “public charge” and

  • Assessing your income differently—meaning that your income would only be viewed positively if you made at least 250% of the poverty level (nearly $63,000 for a family of 4).

  • Adding assessments of age, health, education and skills. Children and seniors could be assessed negatively.

In addition to what the public charge proposed rule actually says (and at this point it is only a proposal), it can also have a “chilling effect,” and make people afraid to access any services, even ones that are not included in the rule. If the “public charge” rule is ­finalized in its proposed form, this would mark a significant and harmful departure from long standing immigration policy. The proposal would make -- and has already made -- immigrant families afraid to seek programs that support their basic needs. These programs help them stay strong and productive, and raise children who thrive. With about one in four children having at least one immigrant parent, this issue touches millions and is critical now and for our nation’s future. And that’s why taking action is so important!

According to the Michigan Immigrant Rights Center, at this point, “If you are applying for a green card within the U.S., the rules have not changed, and there is no reason for you or anyone in your family to stop receiving non-cash benefits (like Medicaid and food stamps) that they are eligible for.”

What Can I Do To Make A Difference?

When the federal government proposes a rule, they have to request comments. We have until December 10, 2018 to submit comments. Your voice matters!

The best way to comment is to go online to the federal public charge comment portal at regulations.gov. Click on “comment now” and either enter your comment in the text box (must be fewer than 5000 characters) or upload your comments as a PDF.

Any comments are good, but it’s best if:

  1. You write comments in your own words.

  2. You share research, experiences, and/or the stories of people you know (friends, relatives, community members). You can even include web links or upload supporting materials (research, or your resume, if you are a content expert).

  3. Look to the Michigan League for Public Policy for some great information about the positive economic impact of immigrants in our communities; use that information in your comments. Talk about why we value immigrants in Michigan!

  4. Talk about the role that access to benefits has played in your life, or the lives of people you know.

More details about comments can be found here.

In fact, there’s even a toolkit with specific comment suggestions. However, don’t worry too much about it, short comments are ok too!

phone tree.jpg

What Else Can I Do?

Use email, phone calls, and social media to get your friends and family to submit comments. (Hint: Share this post!)

You Are In Good Company

If you comment, you are in good company. Not only did the Washtenaw Health Plan submit a comment, but:

And special, special thanks to our partners at the Michigan Immigrant Rights Center for their knowledge, support, and advocacy. Read more about their campaign to Protect Immigrant Families here!

Print Friendly and PDF

Subscribe to our blog here!

A Word Of Advice: Don't Auto-Renew

donotautorenew.jpg

The new plans are out, and Open Enrollment is upon us! People who have been enrolled in Marketplace plans in the past may be getting notices offering for them to auto-renew their plans. That sounds easy, but it may not be in your best (financial, or health coverage) interests!

Provider Changes

EmojiRank-banner.jpg

First, a plan may sound the same, but providers may decide to affiliate or disaffiliate from year to year. So you always to want to make sure that your doctors take your health insurance.

Financial Changes

The plans that are offered may change also. For instance, in Washtenaw County in 2019, there will be a new health insurance provider—Oscar—that has not previously been in the Michigan health insurance market. And even without that new insurer, some insurers may decide to charge less or more for their plans.

The pricing of these plans matters, because tax credits are based on the actual cost of the second lowest silver plan. That is the benchmark from which all tax credits get calculated.

Let’s say that your income is exactly the same between 2018 and 2019, and you qualify for tax credits. If you auto-renew, you could find yourself paying a whole lot more. Even if the plan has not changed, and the full cost of the plan doesn’t have a big difference, there could still be a big difference in tax credits.

Costs With Plans2.png

In this case, in 2018 the Pacesetter A plan was the lowest-cost plan, and in 2019 it is the third-lowest-cost plan. Even though the full cost of the plan only went up by $20, the subsidized cost went up a lot more. In this example, for the same exact plan, and with the same exact income, you could end up paying $70 more per month ($840 more per year), more than double what you paid the year before!

The Moral Of The Story?

Do not Auto-Renew.

Instead, give us a call at 734-544-3030; walk in to our Ypsilanti office M-F 9-4; or find local help at this link.

Remember, Open Enrollment on the Marketplace runs from November 1-December 15, 2018.

donotautorenew.jpg
Print Friendly and PDF

Subscribe to our blog here!

Preparing For Open Enrollment - Employer, Marketplace and Medicaid

halloween.png

Don’t be frightened! Health care isn’t scary!

Medicaid Enrollment is Always Open.

alwaysopen.png

You can always apply for Medicaid. Anytime during the year you become eligible, you can apply for Medicaid. No qualifying events, no special documents. Check your income here and apply here. As always if you have questions, call us at 734-544-3030.

Employer Open Enrollment

employer-health-insurance.jpg

If you are offered health insurance through your job, chances are your open enrollment period is in the fall with a January 1, 2019 start date. Some employers (schools, universities, businesses with fiscal years based on other calendars) may have open enrollment during other times of the year.

Evaluate your options every year.

Each year your employer negotiates new benefit packages with health, dental and vision insurance companies. Your open enrollment may also include retirement options, disability and life insurance. When it comes time to evaluate your options make sure to look at each plan. If you don’t understand the details of a benefit, contact your HR department to explain it to you. Here are some tips for thinking about your particular family and your how you use your health insurance.

  1. How much health care do you expect to use?

  2. What is my deductible? What is my maximum out of pocket?

  3. Is my employer insurance affordable? Do I have another option?

You may be wondering if you can sign up on the Marketplace, read more about that option, Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes).

Marketplace Open Enrollment Nov. 1 - Dec. 15

healthcaregovdeadline.png

The Open Enrollment Period for the Marketplace (aka Obamacare, healthcare.gov, ACA) is November 1 to December 15. During open enrollment anyone who is eligible can sign up for health care coverage that will start on January 1, 2019. In order to sign up on the Marketplace ask yourself these 3 questions:

  1. Am I eligible for Medicaid? If yes, you are not eligible to enroll with tax subsidies on the Marketplace. If you are a family, children may be eligible for Medicaid/MIChild and parents may be eligible for the Marketplace.

  2. Does my employer offer affordable insurance? If your employer insurance is less than 9.69% of your income for the lowest priced, ACA-compliant employee only plan, you are not eligible to enroll with tax credits on the Marketplace. Read more here Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes).

  3. Do you have income and are you filing taxes? You must have income and file taxes to receive tax credits and enroll in health care on the Marketplace.

Information needed for a Marketplace application

checklist.jpg

Did you answer yes to all 3 questions? The next step is to gather the documents and information you will need to complete a Marketplace application and select your health care plan. You will need the following:

  • Names and social security numbers for everyone in your tax household. Your tax household includes anyone you will claim on your tax return.

  • Earned income information -recent paystubs for everyone who is working or self-employment records (Schedule C from the previous year’s return).

  • Unearned income information - pension, retirement, real estate income, social security (RSDI or SSI) income or capital gains.

  • 2017 Tax return including Schedule C, if applicable.

  • List of doctors

  • List of prescriptions

  • Marketplace Account information - user id and password.

    • If you don’t have an account and need to create one you will need an active email account that you can access immediately. You must be able to access the email to access a verification email.

The next step is to estimate your income for 2019. For some people this is easy, but for anyone whose income varies during the year, it can be tricky. (We have written many posts about income, click here to browse all the income blogs.)

Now go to the Marketplace website, healthcare.gov, complete an application and select your 2019 health care coverage. You can preview 2019 plans here.

If you have questions, if you need assistance with the application or if you need help with the whole thing, please call the Washtenaw Health Plan and make an appointment. Michigan residents, we can also answer questions over the phone. Call us at 734-544-3030. The sooner you call the better! If you are not in southeast Michigan, use this resource to find local help for healthcare.

happyhealthy.jpg

Washtenaw Health Plan

734-544-3030

We Help People - Like You!




Print Friendly and PDF

Subscribe to our blog here!

Open Enrollment Question: Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes)

employer-health-insurance.jpg

For many employees, Open Enrollment period for employer insurance comes in the fall, and is a short two or four week period where you have to make important decisions about health care for the coming year. This can be a lot of pressure, and so it turns out that a little preparation can go a long way. If you are a new employee at a job, you may be offered insurance right away, or after a period of 90 or 180 days.

Know your options, because if this were a relationship on Facebook, you might say, "It's Complicated!" What follows is a series of questions that will hopefully help you figure it out.

openenrollment clock.jpg

If you are going to turn down your employer insurance, you want to make sure you are clear about the alternatives. Although it doesn't matter to Medicaid if you have an offer of employer insurance, it does matter if you were hoping to get subsidies on the Marketplace. Don't turn down your offer of coverage without studying your options!

1. Does your employer coverage meet Minimum Essential Coverage guidelines?

This would mean the the employer coverage covers:

  • Ambulatory patient services(Appointments and procedures in a doctor's office);

  • Emergency services;

  • Hospitalization;

  • Maternity and newborn care;

  • Mental health and substance use disorder services, including behavioral health treatment;

  • Prescription drugs;

  • Rehabilitative and habilitative services and devices;

  • Laboratory services;

  • Preventive and wellness services and chronic disease management and Pediatric services, including oral and vision care.

If the answer is yes, continue. If the answer is no, consider Marketplace and Medicaid eligibility and enrollment.

BEWARE: Some employers offer very inexpensive medical plans that do not cover hospitalization or emergency services. These do not meet Minimum Essential Coverage guidelines.

 

2. Does your employer coverage meet Minimum Value standards? 

Minimum value standard is a standard of minimum coverage that applies to job-based health plans. If your employer’s plan meets this standard and is considered “affordable,” you won’t be eligible for a premium tax credit if you buy a Marketplace insurance plan instead.

A health plan meets the minimum value standard if both of these apply:

  • It’s designed to pay at least 60% of the total cost of medical services for a standard population

  • Its benefits include substantial coverage of physician and inpatient hospital services

If you are unsure, ask your employer to fill out the Employer Coverage Tool.  

If the answer is yes, continue. If the answer is no, consider Marketplace and Medicaid eligibility and enrollment. 

NOTE: If the answer is no to EITHER the minimum essential coverage or minimum value standard, and you are income-eligible, you should be eligible for advance premium tax credits.

 

3. Is your family income low enough for some or all of your family to qualify for Medicaid?

Look here for the income eligibility tables for Medicaid. If you (or some members of your family) are income-eligible for Medicaid, you can apply for Medicaid instead of or in addition to your employer coverage. Because the income cutoffs for children are higher than for adults, often children can be enrolled in Medicaid or MIChild while the parents enroll in employer coverage. You can also have both Medicaid and your employer insurance--Medicaid will pay co-pays and deductibles not covered by your employer coverage, and this can be useful if you have a high-deductible plan. 

 

4. What is the cost of your insurance, relative to your income? 

To figure this out, look at the lowest-cost plan your employer is offering that meets the minimum standards (see #1 and #2 above), and the cost for the health coverage for the employee alone. 

Example 1: The cost is $100/month for the employee alone, and the employee makes $1000/month. $100/$1000=10% of income.

Example 2: The cost is $100/month for the employee alone, and the employee makes $2000/month. $100/$2000=5% of income.

Generally, if the cost is more than 8% of family income but less than 9.69% of family income, you are exempt from having to take the insurance, but you are not eligible to get advance premium tax credits on the Marketplace. [You may, however, be eligible for Medicaid!]

If the cost is more than 9.69% of family income, you don't have to take your employer insurance, but you can buy on the Marketplace and qualify for advance premium tax credits.

 

5. What about the rest of the family?  The Family Glitch

The Affordable Care Act looks primarily at affordability for the employee only. Different people in a family can get covered in different ways. 

If the cost of insurance for the employee is affordable, and the cost for the rest of the family is not affordable, you fall into what is called the "family glitch." The rest of the family is probably not going to be eligible for subsidized plans on the Marketplace. At this point, help from someone familiar with insurance options can be a big help. You may very well be exempted from the mandate to have health insurance, but that doesn’t help with getting health care. On the other hand, other family members may get covered differently. Possibilities may include: 

Thanks to healthinsurance.org for the image.

Thanks to healthinsurance.org for the image.

Don't forget: in many cases, different people in a family are covered in different ways. For example, each parent may be covered by his/her own employer, and the children may be covered by MIChild.

 

6. What if employer coverage gets offered or dropped in the middle of the year?

Changes in employer coverage in the middle of the year create Special Enrollment Period opportunities. If employer coverage is offered, you should evaluate it. If you have Medicaid and will continue to qualify for Medicaid, you may not want to take it. If you have a Marketplace plan and the employer coverage meets minimum standards, you may need to take the employer coverage because you will no longer be eligible for APTCs. If you take it and have a Marketplace plan, make sure to let the Marketplace know!

If you lose employer coverage during the middle of the year, you may be eligible for Marketplace or Medicaid plans. The Special Enrollment Period on the Marketplace after you lose employer insurance is good for 60 days. Medicaid is open year-round.

3QuestionMark.png

If you have questions, call or walk in to the WHP office.

Washtenaw Health Plan, where We Help People like you!

Monday through Friday from 9am to 4pm

555 Towner, Ypsilanti, MI 48198

 

Resources

Employer Coverage Tool:  Use this tool to gather answers about any employer health coverage that you’re eligible for (even if it’s from another person’s job, like a parent or spouse). You’ll need this information to complete your Marketplace application. Complete one tool for each employer that offers health coverage that you’re eligible for.

Healthcare.gov: Apply here for Marketplace insurance. 

MiBridges: Apply here for Medicaid insurance. 

HealthSherpa:  Use this tool to compare health plans. 

Healthcare.gov Estimator: Compare or preview plans and rates with this estimator. Plans for 2019 should be available during the last week of October.

 

Print Friendly and PDF

Subscribe to our blog here!

2019 Medicare Open Enrollment Runs October 15 through December 7

Medicare is a program for people who are 65 or older and people with disabilities. You can read more about Medicare here. If you have Medicare now, then...

It's time to review your Medicare Plan!  

October 15, 2018 to December 7, 2018 is the annual Medicare Open Enrollment Period. During Open Enrollment you may:

OpenEnrollment.jpg
  • Change from original Medicare to a Medicare Advantage Plan

  • Change from a Medicare Advantage Plan back to original Medicare

  • Switch Medicare Advantage plans

  • Join a Medicare Part D Prescription Drug Plan

  • Switch Medicare Part D Prescription Drug Plans

IMPORTANT: Review your coverage--especially Part D and Medicare Advantage Plans--every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

Insurers tweak Medicare Advantage Plans every year, and those changes could mean that you can't see your favorite doctor or that you might need to pay more. 

So--review, review, review!

Note: Low-income individuals on Medicare may be able to change their plans more frequently. A MMAP counselor can explain your options.

MMAP Counselors Are There For You--For Free!

Every state has people who will help you figure out your Medicare options. In Michigan, these people--paid staff, and volunteers--work with the Medicare/Medicaid Assistance Program. In Michigan, you can find your local MMAP program here. Nationally, the SHIP (State Health Insurance Assistance Program) can help you find assistance locally. 

MMAP Counselors can help explain how Medigap and Medicare Advantage programs work, and can help you sift through your options for Part D plans. They can help you figure out if you can defer taking Medicare because you are still working. They can help you figure out if you qualify for extra help!

Some People Qualify For Extra Help

If your income is low, you may qualify for extra help. For instance, the Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1871.75/month and you must have less than $11,340 in assets (excluding a house and car).  For single people, your income must be less than $1391.67 and you must have less than $7560 in assets.  

If you think you may qualify for Extra Help, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor. 

Just MMAP It!

Washtenaw County is in a MMAP region that includes Livingston, Monroe, Macomb, St. Clair and Oakland counties. There are multiple ways to meet with MMAP counselors and MMAP and the Area Agency on Aging 1B have multiple events scheduled for Open Enrollment.  Call 1-800-803-7174 to schedule an appointment.  Call now because availability is limited!


 

 2019 Open Enrollment Washtenaw County Events - Medicare beneficiaries can make an appointment to meet one-on-one with a MMAP Counselor and review their 2019 Medicare coverage options.  Call 800-803-7174 to schedule an appointment.  Appointments are required.

Washtenaw ISD 1819 S. Wagner Rd. Ann Arbor, MI 48103

  • Tuesday, October 16 9am - 4pm,

  • Monday, November 12 9am - 4pm

  • Thursday, December 6 9am - 4pm

Milan Seniors for Healthy Living 45 Neckel Ct. Milan 48160

Call 734-508-6229 for appts

  • Thursday, October 18 9am-3pm

  • Thursday, November 15 9am - 3pm

Pittsfield Twp. Senior Center 710 W. Ellsworth Rd Ann Arbor 48108

Call 734-508-6229 for appts

  • Wednesday, October 24 9am - 2pm

  • Wednesday, November 14 9am - 2pm

Printable schedule of events for Southeastern Michigan  including Washtenaw, Livingston, Monroe, Macomb, St. Clair and Oakland.

New Medicare Cards

A quick note about Medicare cards. Medicare is no longer using your Social Security number as your Medicare number. Everyone (all 55 million people on Medicare!) will receive a new card before May 2019. You do not need to call to receive your card and no one will call you asking for your Medicare information to receive a new card. Read 10 Things to Know About Your New Medicare card.

Medicare cards will no longer include your Social Security number. Everyone should have a new cared before May 2019.   Read more.

Medicare cards will no longer include your Social Security number. Everyone should have a new cared before May 2019. Read more.

Print Friendly and PDF

Subscribe to our blog here!

Medicaid: A State By State Program

Medicaid differs state by state. The income limits for children’s Medicaid, Medicaid for low-income parents, and Medicaid for adults vary. Even some of the rules for immigrants vary. Most of the advice on our website is specific to Michigan. This blog post attempts to give you some more resources if you are located in a different state. But if the relationship between different states on Medicaid were a Facebook relationship status, it would be: “It’s Complicated.”

Find Your State—What Does Your State Offer?

Are you looking for information about your state? This map links to information about each state including eligibility, expansion, CHIP (Children’s Health Insurance Program) and enrollment. The map does not include links to enrollment sites.

State Overviews from Medicaid.gov

Covering Adults: Medicaid Expansion

The Affordable Care Act offered states the option to expand Medicaid to cover adults between the ages of 19 and 64 who are making up to 138% (133% + 5% disregard) of the Federal Poverty Levels. States voted to expand Medicaid and the federal government agreed to pay for 100% of the program from 2014 to 2016, dropping to 90% of the program after 2020. Currently 34 states including DC have expanded Medicaid, 3 states are considering expansion and 14 are not expanding. Low-income adults who previously had no healthcare could now be covered by Medicaid.

If you are from another state, find out the status of the Medicaid expansion in your state below.

Different states have given their Medicaid expansion different names. In Michigan, expanded Medicaid is called Healthy Michigan Plan. In Illinois, the program is called HealthChoice Illinois, and it is Medi-Cal in California. These plans do differ from state to state but must cover the essential health benefits set in the Affordable Care Act of 2010. Under the current administration, some states are requesting and being approved for waivers that include work requirements and other restrictions. Read more about current and pending waivers here. If you are really interested in waivers, check out the Kaiser Family Foundation’s (KFF) Waiver Tracker.

Need Help With Figuring Out Eligibility?

If you have questions about your eligibility, your child, your parent or someone else’s eligibility, call us at 734-544-3030 if you are in Michigan. If you are not in Michigan and need information about eligibility or enrolling, there are two resources.

The first is Federally Qualified Health Centers (FQHC). FQHCs are federally funded health centers that provide medical (and sometimes other) services. If you are looking for information about healthcare, an FQHC is a good place to start. Because they provide sliding fee scale services, they usually have information about Medicaid for adults, families and children, as well as patient advocates who can help you navigate the system.

FQHC Locator

The second resource for finding out about healthcare is the Marketplace’s Find Local Help (https://localhelp.healthcare.gov). This lists organizations and individuals who can help with the Marketplace and sometimes Medicaid. Choose your contacts wisely, brokers and agents are paid to sell insurance and may or may not be familiar with Medicaid programs and eligibility. Assisters are certified to enroll you on the Marketplace and should be familiar with Medicaid/CHIP eligibility in your area.

The Washtenaw Health Plan (left) is listed as an Assister; on the right, you find an Agent or Broker.

The Washtenaw Health Plan (left) is listed as an Assister; on the right, you find an Agent or Broker.

What If You Are Traveling and Need Emergency Care?

If you have Medicaid but need to go to an Emergency Room in another state, show them your Medicaid card and make sure to talk with the billing department before you leave. Most states have reciprocal agreements for emergencies for Medicaid clients—you cover mine and I’ll cover yours. Medicaid does not cover routine care in other states.

Planning A Move? Figure Out Your Health Care Options First!

If you are moving, make sure to cancel your Medicaid and apply in your new state. If you are wondering what your healthcare options are in your new state, use one of the tools above or go to this directory to find Medicaid contact information for any state.

Because different states have different rules, you may or may not be eligible for Medicaid in your new state. For instance, currently Texas has not expanded Medicaid. If your income is $1100/month (single person) in Michigan you could get Medicaid, but in Texas, you could not. Move from Texas to Michigan, and you’d be in luck.

For people who are in a state that did not expand Medicaid, if your income is below 100% of the poverty level, and especially if you are not a parent of minor children, you may need to rely on charity care programs. If you are above 100% of the poverty level, you may be able to go on the Marketplace. So when you are moving, don’t forget about the special enrollment period—it’s time-limited!

50colorfulstate.jpg
Print Friendly and PDF

Subscribe to our blog here!

Help! My Child Is Turning 26 And Will Lose My Employer Insurance. What Now?

One of the popular provisions of the Affordable Care Act is the piece that says that children can stay on their parents' employer-sponsored insurance up until they turn 26. Of course, many youth ages 18-26 have already gotten offers of employer-sponsored insurance--and taken them. But in other cases, youth turning 26 are working part-time jobs and/or going to school and/or parenting themselves. Parents who have spent their whole lives with employer-sponsored insurance are often confused and worried.

dontpanic.png

Don't Panic. 

Part of the Affordable Care Act means that there *are* options, even if your child has Type 1 Diabetes or a history of asthma.  

Help your child evaluate their options and make sure to include them in all discussions.  They are over 18 and in most cases you will not be able to make healthcare decisions for them, even if you still take them as a dependent. 

Household?

Take a look at who is in their household.  Are they married?  Are they single?  Do they have children of their own?  Do they claim any dependents on their tax return?  In most cases, your child is a household of one until they have dependents to claim or file jointly with a spouse.

Income?

dollarhand.png

Take a look at their expected household income.  Is their job seasonal?  Do they work part-time or full-time?  Take a look a the Federal Poverty Guidelines (FPL) and figure out where your child falls. What is your child's income?

Healthcare Options

doctor.png

Their choices for healthcare are Medicaid, Marketplace or Employer Sponsored Insurance.  If their job offers insurance, they will be able to enroll when their current insurance ends (read about special enrollment periods below).  If your child's last 30 days of income is below 138% of the FPL ($1396/month gross in 2018  for a single person), they will qualify for Medicaid.  Applying online is easy at MI Bridges.  If their income is above 138% FPL and their employer does not offer insurance, the Marketplace is where they will get their healthcare coverage.   

Plan Ahead! 

When your child turns 26, your employer may terminate their coverage on their actual birthday, at the end of their birthday month, or--rarely--at the end of the calendar year.  It is important to find out what the exact date is for the loss of coverage because they have a limited time to enroll in other coverage.  It is also a good idea to get a letter from the insurance company showing the date coverage ends for your child.

planahead.jpg

The loss of the parents' insurance creates a special enrollment period which enables your child to enroll in health care outside of open enrollment.  Medicaid enrollment is always open and your child can apply anytime. 

For employer insurance, the special enrollment is 30 days from the date of insurance ending.  Occasionally employers are not aware that loss of coverage creates a special enrollment period for an employee.  If the employer is unaware, please direct them to this explanation from the US Department of Labor.  The Marketplace special enrollment period is 60 days from the loss of coverage.  You can apply online at healthcare.gov

Start Early!

To avoid a gap in healthcare coverage, you should start this conversation before the coverage ends.  For Medicaid, employer and Marketplace insurance, you can complete the application or submission of paperwork before coverage ends.  

If you have any questions about eligibility or timing, please ask in the comments below or call us 734-544-3030.  We are always happy to help. 

Washtenaw Health Plan - We Help People!

Print Friendly and PDF

Subscribe to our blog here!

Breastfeeding - Good for Babies and Moms!

Join MDHHS-WIC and The Michigan Breastfeeding Awareness Network for the Breastfeeding Awareness Walk on August 8, 2018 from 11:30am-2pm in Lansing on the Capitol Lawn. Help normalize breastfeeding!

There are so many great reasons to breastfeed! And so much research to support how healthy it is! 

Good for Babies!    

bfeedingbaby.jpg

Breastfeeding is good for babies. In the first few days after baby is born, mothers make colostrum, a thick yellowish milk filled with antibodies and protein that are "liquid gold" for baby's first few days. Breastfed babies are less likely to get sick and have fewer digestive problems. When baby's immunities are at their lowest between 2 to 6 months, it's especially important that mom's antibodies and anti-viruses are passed along through breastfeeding. Breastfed babies are smarter and do better in school. There are so many good reasons for your baby to breastfeed. 

Good for Mothers!

bfeedingmom.jpg

Breastfeeding is also good for mothers. Breastfeeding helps new mothers relax.  When nursing, a hormone called prolactin, known as the mothering hormone, is produced. Another hormone, oxytocin, released shortly after birth, helps the uterus contract and return to its pre-pregnant size. Breastfeeding helps mom and baby bond and feel close. Breastfeeding helps reduce a mother's risk of developing certain cancers. And breast feeding is cheap. At one year, a breastfed baby will save between $900 and $2,160 dollars on formula.  

There's Help Available!

WIC (Women, Infants and Children)

Here in Washtenaw County, WIC is an excellent resource for breastfeeding. WIC (Women, Infants and Children) has many breastfeeding support programs for moderate to low income families. WIC's programs for pregnant women and families with children up to age 5 include:

  • Peer to Peer breastfeeding counselors 
  • Lactation consultants for breastfeeding support
  • Free breast pumps for mothers returning to work or school 
  • Food as food packages or Project Fresh booklets ($25 to spend at local farmer's markets)
  • Nutrition counseling including health care referrals and immunizations
  • WIC Connect app to help you connect with WIC services 

To contact WIC (?should this clarify that this is contacting the WIC peer counselors, not the main WIC number?), you can call 734-544-2995, email yourbreastfriends@gmail.com or connect through their Breastfeeding support facebook page @WashtenawWICBF.  

 

Marketplace (healthcare.gov) and other ACA-Compliant Insurance

Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.  This applies to Marketplace plans and all other health insurance plans, except for grandfathered plans.

These health insurance plans must also cover the cost of a breast pump. It may be either a rental unit or a new one you’ll keep. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when you’ll receive it (before or after birth). It’s up to you and your doctor to decide what's right for you.

 

La Leche League of Ann Arbor

La Leche League of Ann Arbor provides support and education for breastfeeding moms. Check out their facebook page! 

 

Washtenaw County Breastfeeding Coalition

Washtenaw County Breastfeeding Coalition is a group of volunteers made up of doctors, hospital based IBCLCs, WIC breastfeeding coordinators, peer counselors, private practice IBCLCs, La Leche League Leaders, birth and postpartum doulas, Certified Lactation Counselors, public health workers, dieticians, nurses, mothers, fathers, caregivers, business owners, and anyone else who is interested in promoting and supporting breastfeeding in the local area.

 

Maternal Infant Health Program (MIHP)

Maternal Infant Health Program (MIHP) is a home visiting program for pregnant women and infants with Medicaid. Services include education, service coordination, support, breastfeeding and nutrition support and referrals. To enroll, call 734-544-2984 or 734-544-9749 or ask your doctor for a referral.

 

 

As always if you have questions or need help with healthcare coverage, please call the Washtenaw Health Plan 734-544-3030. Or you can leave a comment/question below! 

Print Friendly and PDF

Subscribe to our blog here!