employer coverage

HELP! I got cut off of Medicaid!

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ASK: Why did I get cut off Medicaid?

Remember that you can get cut off of Medicaid because your income has risen, because the number of dependents has changed, or because you didn’t fill out an annual renewal (redetermination) form.

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So first, figure out whether the cancellation was correct.

Should Medicaid Have Been Cancelled?

Let’s take a few examples:

  1. You failed to fill out an annual redetermination form, but nothing else in your life has changed. Medicaid is renewed annually, and sometimes people in a household are on different cycles, so you may need to fill out renewals more than once a year. If nothing has changed, you should still be eligible for Medicaid, and should reapply at MI Bridges.

  2. Your income and/or household size has changed. Even a small increase in hours or pay/hour (minimum wage is going up!) can make a big difference. Especially if there are multiple earners in a household, things can get complicated. Here’s how to figure out if your income is still eligible. Income limits for Medicaid.

    Your household size also may have changed. Perhaps a child has grown up and is now on their own; perhaps you got a divorce; perhaps someone in your family died; perhaps parents or grandparents have moved into your household. While you are looking at income, don’t forget to look at household size.

    Remember that eligibility is a combination of both household size and income. If you feel the determination was made incorrectly, you can reapply, or file a hearing (Part 1 and Part 2).

But What If the Determination Was Correct, And You’re Not Eligible For Medicaid?

Good News: You Qualify for a Special Enrollment Period

Employer Insurance

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If your employer offers affordable health insurance, you generally are required to enroll. When your Medicaid ends, it opens a Special Enrollment Period for you to enroll in your employer health care.

It could be that the employer insurance is offered to someone else in the household, but you are eligible. With a Medicaid denial letter, you can get on their employer insurance with a Special Enrollment Period.

For an employer special enrollment period, you only have 30 days to take advantage of the offer, so don’t delay!

Marketplace (Healthcare.gov)

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If your employer does not offer you insurance, you can apply on the Marketplace (healthcare.gov), and you will likely qualify for good tax credits. [If you don’t, please give us a call. You may have fallen into a “family glitch” or answered a question incorrectly.]

For the Marketplace, you have 60 days from the day your insurance ends for the special enrollment period. You will need to prove that you have lost your Medicaid insurance with a denial letter.

 

Questions? We Help People.

Call us at 734-544-3030

Walk in to our office at 555 Towner in Ypsilanti,

Monday-Friday 9 a.m. to 4 p.m.

 

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Preparing For Open Enrollment - Employer, Marketplace and Medicaid

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

Medicaid Enrollment is Always Open.

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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

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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

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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

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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.

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Washtenaw Health Plan

734-544-3030

We Help People - Like You!




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Got Out Of Prison? Now You Need Health Care!

According to the Bureau of Justice Statistics, over 2.2 million people are in prisons and jails. So chances are good that you know somebody who is incarcerated, or has gotten out of jail or prison. Many people who are in prison or jail have physical health, mental health, and oral health needs--and those needs don't go away when they are freed.

Sometimes, people get information while still in prison about how to access medical care--but other times, they don't know what to do! In reality, the choices are very similar to people who have not been incarcerated.

Medicaid

If you are not working, or if your income is low enough, you will be eligible for Medicaid. Apply anytime!

NOTE: If you had Medicaid before you were incarcerated, while you were imprisoned you may have been listed in the Medicaid system as having Medicaid for Incarceration. When you are incarcerated, Medicaid only pays for inpatient hospital expenses. If you are STILL listed in Medicaid's records as being incarcerated, even though you are now free, you may need to call the Medicaid Beneficiary Help Line, (888) 367-6557, in order to tell them you are out of prison, and you should get full Medicaid. 

Employer Insurance

If you are employed, and your employer insurance is affordable, you will need to take your employer insurance. Getting out of prison should give you a 30-day special enrollment period, so be sure to get on the insurance right away, if you are eligible.

Marketplace Insurance

If your income, or your family income, is a bit higher, you can sign up for health care on the Marketplace. Getting out of prison entitles you to a 60-day special enrollment period. Don't delay, because if you miss it, you won't be able to get health insurance until the next open enrollment period (November - January)! 

If you have a Marketplace plan, and someone in your family becomes incarcerated, you need to report a life change to the Marketplace. People who are incarcerated are not eligible for Marketplace plans. 

will i owe a health care penalty for when i was imprisoned?

At the end of the year, if someone in your family was incarcerated, they will qualify for an exemption from the requirement to have health care during that time. For 2015, this was exemption F.  Be sure to mark the exemption when you fill out IRS Form 8965.

NOTE: The U.S. government just released more specific rules about the definition of incarceration, and when you are eligible to get health care on the Marketplace. You can read more here.

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Good News: Medicaid Can Be Secondary Insurance

A Medicaid ID Card

A Medicaid ID Card

NOTE: The information in this post is true for the state of Michigan. Medicaid rules vary from state to state.

There are lots of great things about Medicaid--it has medical, vision, and dental coverage; low copays; you can apply for it at any time; and you can use it as a secondary insurance.

What does this mean?

Imagine that you have an employer insurance plan, but it has a high deductible, and you have to pay out of pocket for your first $3,000 before the insurance will pay anything. If you are Medicaid eligible, Medicaid will be the second insurance (that means that your employer insurance gets billed first), and Medicaid will pick up what the employer insurance doesn't cover.

Medicaid as a secondary insurance can significantly reduce your bills!

 

Other Benefits

There are some other benefits, too. For instance, you may have good medical coverage, but no vision or dental coverage. As secondary insurance, Medicaid can pay vision and dental benefits.

Just note: Medicaid cannot be secondary insurance for any Marketplace plans. If you are eligible for Medicaid, you cannot get subsidized Marketplace coverage. But if you have employer coverage, sometimes Medicaid as a secondary insurance can be very useful.

--R. Kraut

 

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Minimum Wage is Rising! Will Your Insurance Options Change? Find Out About Special Enrollment Period Magic!

Friday, January 1, 2016, Michigan's minimum wage rose from $8.15/hour to $8.50/hour. Next January, 2017, it will go up to $8.90/hour, and the year after that, it will rise to $9.25/hour.

Minimum wage laws across the U.S. Source: US Department of Labor

Minimum wage laws across the U.S. Source: US Department of Labor

If you are a person struggling to get by on a minimum wage job, this is excellent news--but for single adults working close to 40 hours a week, it may mean that you are no longer going to be eligible for Medicaid. Currently, the income cap for a single person for Medicaid is $1,354/month (gross income), or $16,243/year. 

At $8.15/hour, a minimum wage worker would hit the Medicaid income cap if they averaged over 38.5 hours/week. But at $8.50/hour, that same worker could only work 37 hours/week, on average.

Average Weekly Hours A Single Person Could Work And Be Eligible for the Healthy Michigan Plan

In 2015 dollars, the maximum income for a single adult to qualify for the Healthy Michigan Plan is $1354/month or $16,243/year.

If you have had Medicaid, and you are getting a raise (for any reason--perhaps a promotion?!), then be prepared that you may no longer be eligible for Medicaid.  You may be over income. [For a fuller explanation of income guidelines for various types of Medicaid, visit this page.]

If you are going to be over income for Medicaid, don't panic. 

First of all, it's possible that you aren't over income for Medicaid at all. Under Michigan Medicaid policy, income can be calculated on a monthly or annual basis. If you work a job where you work a lot of hours at certain times of year, and much less at other times of the year (say you are a lifeguard or a teacher's aide), you may be able to use the annual assessment of income, which allows you to even out high-income and low-income parts of the year. 

Events that will qualify you for a Special Enrollment Period.  

Events that will qualify you for a Special Enrollment Period. 

But if you are over income for Medicaid, then most of the time you will be eligible either for the Marketplace or for employer insurance. What, you say? But it's March now, and Open Enrollment ended in January?

When Medicaid ends, you will have 60 days to qualify for a Special Enrollment Period through the Marketplace or at least 30 days through an employer's insurance. So Keep Calm, and Enroll On!  Seriously, if you need some guidance, give us a call year-round at (734) 544-3030.

--R. Kraut

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Help! I missed the December 17th deadline. Now what?

DON'T PANIC!

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The December 17th deadline was to get onto the Marketplace and enroll in a health plan that would start on January 1, 2016. Open Enrollment continues until January 31, 2016. Enrolling after December 15 changes the date your 2016 insurance starts.  

(medicaid is always open for enrollment.  If you qualify for medicaid, you can apply online at MiBridges.michigan.gov Anytime.  check your income here.)

 

I had Marketplace insurance in 2015 but I didn't update my application. 

If you had Marketplace insurance in 2015 and you didn't get onto the Marketplace, you have been re-enrolled into the same plan with a new tax credit based on your 2014 Tax Return.  You can still change plans before January 31, 2016.  If you waited you will have your auto-enrolled plan for January and new plan starting on February 1 (if you enroll before January 15) or March 1 (if you enroll after January 15). 

I did not have Marketplace insurance in 2015.  

If you didn't have health insurance in 2015, you still have time to enroll.  Enroll before January 15, 2015 and your coverage will start February 1.  Enroll before January 31 and your coverage will start March 1.  Not sure if you qualify for the Marketplace?  If your income is above the Medicaid income guidelines and you don't have an employer offer of coverage, you need to go on the Marketplace (healthcare.gov).

My employer offers insurance but I think it is too expensive.

Employer coverage tool from healthcare.gov  

Employer coverage tool from healthcare.gov 

If you have an offer of insurance from your employer, you must enroll if it is considered affordable.  The rules are slightly complicated, so you may want to visit an organization that can help you figure this out. Before you come to an appointment or call, have your employer fill out an employer coverage tool.  Having complete information about your employer's insurance offer is necessary in determining your options.  Find an agency here.

If the insurance meets minimum standards, and the cost of the insurance for the individual is less than 8% of the household income, it will definitely be considered affordable.

To find out if your employer insurance is affordable, have your employer fill out an employer coverage tool.  

I don't know what health coverage is right for me.  What do I do? 

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Find an agency who assists with health care and call them.  Nonprofit agencies in Washtenaw County are listed  Looking throughout Michigan? Look here.

Call the Marketplace (1-800-318-2596) or go to their website healthcare.gov/see-plans.

Start here to see what you and your family may qualify for.  It is not unusual for parents to be on the Marketplace and children to qualify for Medicaid or MIChild.

M. Buhalis


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