employer insurance

Happy 50th Birthday to the AAATA. Are YOU Falling off Medicaid?

Happy 50th Birthday to  The Ride ! Cake picture from  sayitwithcake.ca .

Happy 50th Birthday to The Ride! Cake picture from sayitwithcake.ca.

The Ann Arbor Area Transit Authority, also known as The Ride, is celebrating its 50th birthday in 2019! People who ride the bus come from all over the county and have all kinds of insurance. But some bus riders may be losing Medicaid, and not know it.

That is why we are so excited to be partnering with The Ride on our Are You Falling off Medicaid? Campaign.

Through their generosity, we have placed posters in all buses starting March 1, 2019! We have timed this campaign to coincide with the mid-March increase in the minimum wage. Our hope is that we will be able to get people to visit or call us before their special enrollment period runs out. If done in time, people who lose Medicaid can get Marketplace or employer insurance.

Want a prize?

Snap a selfie of yourself with our poster and tag @coveragecounts on twitter, @healthcarecounts on facebook or @healthcarecounts on instagram!

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

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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.

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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.

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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.

 

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Buenas Noticias: Medicaid Puede Ser Su Seguro Secundario

Una Tarjeta de Identificación de Medicaid

Una Tarjeta de Identificación de Medicaid

NOTA: La información en esta publicación es verdadera para el estado de Michigan. Las reglas de Medicaid varían de estado a estado.

Hay muchas cosas buenas acerca de Medicaid - tiene cobertura médica, de visión y dental; copagos bajos; puede solicitarlo en cualquier momento; y usted puede utilizarlo como un seguro secundario.

¿QUÉ SIGNIFICA ESTO?

Imagínese que tiene un plan de seguro de empleador, pero tiene un deducible alto, y tiene que pagar de su bolsillo por sus primeros $ 3,000 antes de que el seguro pague cualquier cosa. Si usted es elegible para Medicaid, Medicaid será el segundo seguro (lo que significa que su seguro de empleador se factura primero), y Medicaid recogerá lo que el seguro del empleador no cubre.

Medicaid como un seguro secundario puede reducir significativamente sus facturas!

OTROS BENEFICIOS
 

Hay algunos otros beneficios, también. Por ejemplo, usted puede tener una buena cobertura médica, pero sin cobertura de visión o dental. Como seguro secundario, Medicaid puede pagar beneficios de visión y dental.

Nota: Medicaid no puede ser un seguro secundario para los planes de Marketplace. Si usted es elegible para Medicaid, no puede obtener cobertura de Marketplace subvencionada. Pero si usted tiene cobertura de empleador, a veces Medicaid como un seguro secundario puede ser muy útil.

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Are You A New College Grad? Your Guide To Getting Health Care

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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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Three Steps Toward Qualifying for a Health Care Tax Exemption

In 2015, maybe you...thought you had health care, but you didn't

...you missed open enrollment on the Marketplace

...you lost your job and didn't realize you could apply for Medicaid or the Marketplace

...you thought health care would be too expensive. 

Now, you're doing your taxes, and you realize that you should have had health coverage, and since you didn't, you might need to pay a penalty! The penalty for 2015 could be as much as 2% of your income.

1. Before you panic, take a look at your whole family, and each person individually, to see if all or part of your family qualifies for a tax exemption. 

Look at each person in your family separately to figure out who might qualify for an exemption.

Look at each person in your family separately to figure out who might qualify for an exemption.

If anyone does qualify for an exemption, you will need to fill out IRS form 8965. 

2. The IRS has some excellent resources.

Don't forget--if you are low-income you can do your taxes with free software, free filing, and no messy handwriting!   

Don't forget--if you are low-income you can do your taxes with free software, free filing, and no messy handwriting!

 

If you got a Marketplace exemption, you will get a letter with an Exemption Certificate Number. [Can't find your letter? Log into your account on healthcare.gov and download it again.] If you have an IRS exemption, you just fill it in on Form 8965. 

Common reasons for exemptions:

  • The insurance you were offered was unaffordable
  • You only missed coverage for a couple of months
  • You are a member of a federally-recognized Indian tribe.

Less common reasons for exemptions:

  • Someone in your house was out of the country for several months
  • Someone in your household is not documented
  • You had a special hardship, such as an eviction.

3. File your taxes! You can get free help at these locations.

And while you are doing your taxes, think about the implications for next year. If during the next year, you get married...divorced...get a new job...lose a job...have a baby...move...graduate from college...it would be prudent to get a health care check-up! That would be a good time to visit the Washtenaw Health Plan or get some other health insurance help!

 

 

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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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