Does anyone have experience with state healthcare?

[momto10blessings]

In another thread someone mentioned state healthcare for kids. Does anyone have experience with this that they can share with me?

These rising health care costs are killing me.

[momto10blessings]

I was amazed at how high the threshold was with 10 kids! We just can't start paying more than our mortgage for healthcare and we only qualify for subsidies if the kids go on state care. My husband is very against it, but I just don't know what to do...

[momto10blessings]

Have you considered the Christian medical sharing programs, like Samaritan Ministries? (My apologizes if you are a different religion!)

 

This is what DH and I are looking into right now.

We looked into that several years ago and decided against it but I can't remember why. I'll probably research it again.

[LMV]

In another thread someone mentioned state healthcare for kids. Does anyone have experience with this that they can share with me?

These rising health care costs are killing me.

 

Are you talking about using your state medicaid program, or your state Child Health Insurance Program, or something else?

[momto10blessings]

Are you talking about using your state medicaid program, or your state Child Health Insurance Program, or something else?

State child health insurance. Chip/famis. We don't qualify for Medicaid but we do qualify for chip/famis.

[JustEm]

Our states healthcare for kids is fantastic!  They charge a monthly fee depending on income so either $0, $5, $15, or $20 per month, which isn't per child either.  They have covered everything 100% since the birth of my oldest 6 years ago, even specialists for when my dd was born with a hole in her heart and needed to be seen quite regularly.  I don't feel guilty about being on it at all because healthcare insurance costs are simply impossible for us to afford on our own and dh's job doesn't offer anything.

 

It may get really bad starting in 2015 because one of the insurance providers they are contracted with doesn't have a contract with the children's hospital in the area. Luckily, we have the option of the other provider but I imagine everyone will want the other provider and they won't be able to offer it to everyone.  

[LMV]

State child health insurance. Chip/famis. We don't qualify for Medicaid but we do qualify for chip/famis.

 

In some states CHIP is carried out as a medicaid expansion. In these cases the Medicaid/CHIP networks and formularies overlap.  In our state there are actually two forms of CHIP one which was a medicaid expansion and one which was a separate sometimes subsidized insurance which was a little different. In the latter the provider reimbursement was a little better and I think some pediatricians who would not take medicaid would take that.  In your case, I would look at whether the physicians your kids currently see will take the CHIP plan you are considering and then look at what the cost to you for the plan would be.  We haven't personally used CHIP but several of our children came into our family through foster care and have had Medicaid. That was sometimes difficult to find sub specialists who would take.  

 

On a positive note that is a nonissue now because our state insurance commission changed their rules on when Medicaid had to be considered primary. Now we are able to use DH's insurance as their primary, mine as their secondary, and Medicaid as tertiary. We no longer run into problems with DH's insurance denying the claims because technically the primary insurance was never billed.  [We did manage to get DH's insurance to reimburse us for some of the cost in the end but it took time and energy that we would have rather devoted to other things.] Now that we no longer have to consider the Medicaid primary we can just have sub specialists bill DH's insurance directly. 

[Loowit]

We got our kids on state health insurance when DH lost his job a few years ago.  At the time it was medicaide and it was free.  Each year we have to fill out paperwork to make sure we still qualify.  After DH got back to work we qualify for the children's health insurance with a monthly fee.  We are paying $60 a month for our three children.  It covers everything at 100%.  It has been a wonderful thing for us.  It has made it so we don't have to worry when we need to go to the doctor so much with our youngest.  He has ongoing health issues and we are still paying off doctors from years ago.  The only thing we have had problems with is dental.  The dentist will only see state insurance patients once a week and it makes it hard to get an appointment at times.  They also seem to treat the kids and I differently than when they were on DH's medical.  But overall I haven't had any complaints and they have gotten wonderful medical care.

[momto10blessings]

. The dentist will only see state insurance patients once a week and it makes it hard to get an appointment at times. They also seem to treat the kids and I differently than when they were on DH's medicalre.

This is the kind of thing I'm afraid of :(

[busymotherof4]

My kids were on Medicaid years ago. It worked very well for us. The only trick was you needed referrals for specialists. On the other hand we had a top notch pediatrician. When my son needed surgery they refered us to the children's hospital a few hours away. We never received a bill because it was 100% covered. We had a hospitalization and were treated very well. There were a few things not covered but because everything else was free it wasn't a big deal.

[Jilly]

My three kids are on state health insurance. It has been wonderful for us. I pay $29/month, and they cover everything 100%. This includes dental and visual. We have wonderful doctors, and although we have to wait for referrals, it has never been a huge wait and the referrals are always to great doctors. I couldn't be happier with the insurance. 

[LucyStoner]

With my husband working PT and in school and me home, we do qualify for the kids (not ourselves). We have excellent employer based health benefits (my husband works at a hospital). We also have a child with autism who has several regular appointments a week for SLP, counseling and behavior. The copays on those would be $200-300 a month, plus more OOP for so things. The state insurance is their secondary insurance and picks up all of the copays and anything our insurance doesn't cover. It is a lifesaver for us these last 2 years because without it, it would be that much harder to get my son what he needs and for my husband to stay in school.

[NoPlaceLikeHome]

Have you considered the Christian medical sharing programs, like Samaritan Ministries?  (My apologizes if you are a different religion!)

 

This is what DH and I are looking into right now.  

Just so you know it says right on their web site that it is not health insurance and that there is no guarantee of coverage. With regular health insurance there is a guarantee of coverage that is spelled out  in their brochures plus every state has an entity that oversees health insurance which could also help you if you ran into problems unlike a ministry. 

[Ottakee]

My kids get state insurance through their adoption.  It has been wonderful and for the most part easy to work with.

 

We did look into the Christian sharing ministries but they will not even consider dh and I as I had heart surgery 40 years ago and dh had a heart attack.

 

While I don't think the latest health insurance system is perfect, right now it is what we have, it is legal and I think that if you qualify, you should apply for it, esp. for the kids.  I don't consider it taking advantage of the system, etc. as we all pay taxes and this is the government approved method of getting health insurance at the moment.

[MomtoCandJ]

My girls have Medicaid, we haven't had any issues. We live in MI. I think next year the girls will be on CHIP since dh is so close to the limit now.

[TeenagerMom]

My kids have been on CHIP on & off through-out the years and I have NO complaints. DS is disabled & so far, we have been through 6 surgeries with top surgeons with NO issues. We have even gone out of state for second opinions with no issues on payment (you have to make sure it is a reciprocal state). I wouldn't hesitate to use it if there are good providers in your area.

[AmandaVT]

VT has a great state program for children - Dr. Dynasaur. Our former governor, who was a practicing physician before going into politics, started it. Families pay a sliding scale based on income monthly and children up to (I think) 25 are covered. Any child in the state that does not have insurance can enroll. Higher income families pay more and lower income families pay less. Pretty much every Dr's office, dentist, etc, will take it because so many kids have it here. We have coverage through DH's work, but it's very nice to know that if he ever got laid off and we were without insurance for a time, we could get DS covered easily. 

 

Good luck!

[AimeeM]

I don't, but I have friends who have experience trying to get it. Apparently, depending on the state, it can be hard to qualify for. My friend's family's income is around 40K, which is middle class here, definitely, but the cost of healthcare (insurance through her husband's work) is killing them, they do not qualify for subsidies through Obamacare for some reason, and still do not qualify for medicaid. I think they might qualify for CHIP, but I'm not sure (that's kind of like Medicaid, but has co-pays, I think).

My sisters have their state's version of Medicaid for their children, and while it is *good* I would say to approach the dental with caution. My nephew used medicaid to have some dental done around age 3, and because it was medicaid it would only pay for extractions (I know they pay for fillings too, but didn't in this situation for some reason), even though he had the same extent of damage to his teeth that my middle son had (different causes, but similar problems) - and we even used the same dentist... but because my son had private insurance, they were able to use a nice white filling on my sons, place a prosthetic, etc... but because nephew had medicaid, they just yanked them (which can cause issues with speech at that age). I think it boiled down to medicaid not paying for "aesthetics"... and I know they also didn't pay for sedation (required by the ped's dentist, but sister had to pay out of pocket for sedation, which was a couple hundred).

It can be difficult, they've said, to find a ped's office to take on more medicaid patients at times, as well. I believe it has to do with the doctors being paid much less per medicaid patient, so they limit the number they take. Both of my sisters were able to find ped's, I think it just takes a bit of time, some good luck, and I think it's more difficult to just "quit" an office if you do not like it, because you may not have another option readily available.

Differs by state, obviously.

[ThisIsTheDay]

In another thread someone mentioned state healthcare for kids. Does anyone have experience with this that they can share with me?

These rising health care costs are killing me.

 

  I am familiar with it from the eligibility side.  It's great coverage, low co-pays, very low.  I would love to have it for my family. It's a "step up" from Medicaid, basically the same coverage, except for the very reasonable co-pays.  The income limit is ~200% federal poverty level, at least in my state.

 

It should be very easy to file an application. In my state, you can do a paper app, online, and over the phone. 

[Clear Creek]

In my state the insurance company that is used for CHIP is the same one on the healthcare marketplace exchange (Superior HealthPlan), so providers don't know if you have it because you are a low income family or if you got it through the exchange. The only difference that I can tell is I pay $35/year total for my kids to be covered instead of several hundred dollars a month. They still see the same doctor and receive the same level of care that they would if we bought the insurance through the exchange. I have a moderate co-pay for office visits and prescriptions.

 

The dental insurance is MCNA Dental, which also has private plans, so providers don't treat us any differently - we can be seen any day of the week and we can choose our dentist from a large network of dentists. The only issue is that the covered amount is quite small, but it grows with each consecutive year that you have the insurance and are seen on a regular basis. I think the first year our benefits were right around $250.

 

The only issue I have had with CHIP is actually getting covered. The office that processes the applications is staffed by the most incompetent individuals in my entire state. On the paper that I send in as proof of income I have to mark what is the net income, what is the deductions, what is the pay period, and what is the gross income or they can't understand it. I sent in an unmarked photocopy of the paycheck three years in a row (which would be rejected as insufficient proof of income) followed by an identical photocopy with the areas clearly labeled before I learned to just label the paper the first time. One year they never sent me an acceptance letter or proof of insurance and I didn't realize the kids even had insurance until nine months later when I received the renewal application to fill out. Another year they assigned my kids to a PCP in a different area of the state and refused to change them to one closer than three hours away. Last year they received my renewal packet within the required time frame (with a couple weeks to spare) and never processed it, so my kids' insurance lapsed. They could give no reason for why it wasn't processed, it just wasn't. They were very apologetic, but since it wasn't processed in time it was treated like I didn't submit it in time. In other words, they received it, noted that it was received, let it sit there until the renewal time limit had passed, sent me letter noting that my kids' insurance was ending, and tossed my renewal application because once the benefits terminate I have to send in an initial application - they can't use the renewal! So it is a headache trying to apply for CHIP, but the insurance itself is great.

[bethben]

We had to go on Obamacare after my husband lost his job.  The choices are either you take subsidies based on income or you don't.  There is no in between.  So, we all got put on Medicade.  In the brochure, it says something like "Don't worry, you have dental insurance too!"  The problem is, medicade doesn't pay dentists or doctors enough to cover their costs, so you have to have a large dentist/doctor or deal with limits.  For example, the dentist we have gone to for 16 years is maxed out on their patients they can accept with this program so it doesn't matter how long you have gone there, they won't accept your insurance.  Thankfully, we are able to still access a dental plan through COBRA for my husband's workplace.  When my son was on this state healthcare program and needed oral surgery, I couldn't find an oral surgeon who would take this insurance and wound up paying out of pocket.  Also, my oldest gets incontinence products through Medicade (state program).   It took me calling every provider of these products to find the one who would do it.  Most of them lose money.  

 

So, state programs may be great for some, but just know there are doctors who have limits.  This is why a national health care will not work.  The rich will continue to get great health care because they will be able to pay out of pocket, the rest of us, not so much.

 

 

[goldberry]

DD was on the state program several years ago when we first moved to Colorado.  We had absolutely no problems with it and it was great coverage and service.  We were bummed when we didn't qualify any more.

[goldberry]

The only time I ever had dental was when DD was on the state program.  We have never even been covered for dental otherwise and always had to pay out of pocket, even when I had employer health coverage.