special enrollment period

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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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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Open Enrollment Tips, Part 3: Should I Choose A Dental Plan?

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After you choose a health insurance plan on the Marketplace (healthcare.gov), you generally will get a screen that says that dental insurance is not included. Would you like dental insurance?

If you answer yes, you will be directed to look at some of the dental insurance plans on the Marketplace.

How does individual dental insurance work?

In general, individual dental insurance is similar to individual health insurance in two ways:

  1. You pay a monthly premium.
  2. Preventive care (cleanings and x-rays) are covered 100% and are encouraged. Other procedures will be covered at different percentages (50%, 80%, 100%) depending on the procedure, the dental network, and the company. Just like with most health insurance, dental insurance works with a "network" of providers, and out of network providers may be covered at a much lower cost, or not at all.

Individual dental insurance is different from individual health insurance in two ways.

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  1. More significant procedures (fillings, crowns, extractions, root canals, bridges, dentures) often have a waiting period of 6 or 12 months before you can use the benefit. 
  2. Most individual dental insurance has a maximum dollar amount that can be spent on you in any year. This is the opposite of medical insurance, where once you hit a maximum out of pocket costs, everything is covered.  With dental insurance, if you need a couple of expensive procedures, you will likely hit the point where the dental insurance has maxed out.

 

Can you use tax credits for dental insurance on the Marketplace?

In general, no. Dental coverage is an essential benefit for children under the age of 18. If it is not included in their health plan then you can use tax credits (if you have any left over) toward their dental plan.  Adults cannot use tax credits to buy dental insurance.  Marketplace dental information.

Are there other options?

Yes, there are (at least) three other options.

1. Take employer-offered dental insurance. If you are buying health insurance on the Marketplace because your employer health insurance is unaffordable, their dental insurance may still be affordable--and may not have the waiting periods that individual dental insurance has. You can only choose this during employer open enrollment or a special enrollment period.

2. Buy off the Marketplace. Since you are not using tax credits, you should look around. You can work through an insurance broker or directly with companies that offer dental plans like Blue Cross, Delta, Golden, etcetera. You can only do this during Marketplace open enrollment or when you qualify for a special enrollment period.

3. Set money aside each month for dental expenses as if you were paying a dental premium. Call around to find a dentist you like and who is affordable. Dentists' rates vary. Pay out of pocket for cleanings, fillings, etcetera. [You can also use money from a health savings account or flexible spending account to cover dental expenses.] You can choose this any time of year.

Read more about dental care, insurance and coverage here.

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Enroll Anytime: Domestic Violence and Special Enrollment Periods

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Life changes happen, and they will qualify you for a Special Enrollment Period. There are some Special Enrollment Periods that are less typical, and the details are important! 

Survivors of domestic violence are eligible for enrollment in the Marketplace when they leave their batterer, regardless of the time of year. This special enrollment period is available to both men and women, and goes by the "honor system," meaning that no proof (like medical report or court documentation) has to be submitted. It is important that the individual uses the specific term survivor of domestic violence.

Not only are victims of domestic violence eligible for special enrollment periods, but they are also allowed to "break" a big rule that applies to most others. Normally, if you are married you must file joint taxes with your spouse to receive tax credits. Domestic violence survivors, however, are able to get tax credits even if they are filing taxes separately while still married. 

The exception allows people in these situations to still get help with health coverage without compromising their safety. In order to push the application through, the individual must mark on their application that they are not married.

Chart developed by the National Health Law Program and Community Catalyst

Chart developed by the National Health Law Program and Community Catalyst

If you are in a domestic violence situation, help is available. In Washtenaw County call (734) 995-5444 or visit safehousecenter.org. Anywhere else, call (800) 799-7233 (799-SAFE). 

Note also: For safety reasons, survivors of domestic violence may choose to use two addresses: a safe mailing address and a home address.  The home location should be where the applicant is living in order to access the correct health plans.

Have any tips or tricks to share about the Marketplace? Comment below so we can blog about them!

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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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Still Going Without Health Coverage?

It's might not be too late to GET COVERED in 2015!

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Special Enrollment Period March 15 - April 30, 2015

Special Enrollment Period (SEP) for healthcare.gov March 15 to April 30. Find out if you qualify.

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