I hate the ACA

[maize]

Could your husband talk to the Medicaid folks to get any errors or omissions sorted out?

 

I kinda think it would be good for you to step back from dealing with it for awhile.

Edited December 28, 2016 by maize

[Mergath]

Applied for medicaid before turning down Cobra. Was never told about this program. Did tell the medicaid interrogators that we had to turn down Cobra because we could not afford it.

 

It might help your peace of mind if you don't think of the social workers as "medicaid interrogators," but rather as regular people trying to do their jobs. They aren't the ones who legislated the amount of paperwork. They just get stuck in the trenches forced to implement it.

[Mergath]

 

Here is a place to look for pharmacies on medicaid... https://tchp.healthtrioconnect.com/public-app/consumer/provdir/entry.page  I have already gone out 20 miles and there are none. I cannot even use medicaid for pharmacy. 

 

Many pharmacies will ship you your medications. There must be one somewhere in your state that takes Medicaid and will mail you your prescriptions.

[maize]

Janeway, I do not think that search feature is accurate. I searched using my old San Antonio zipcode and the nearest pharmacy it brought up is in Austin. There is no way that San Antonio does not have a single pharmacy servicing Medicaid patients.

 

There must be another way to find pharmacies.

[Charlie]

Could your husband talk to the Medicaid folks to get any errors or omissions sorted out?

 

I kinda think it would be good for you to step back from dealing with it for awhile.

 

That is a good idea. If my husband saw me this stressed, he would have intercepted long ago.

[Corraleno]

I am under stress because...the application is messed up. I never said my son was elderly and disabled and I never said he was my spouse. But he is listed like that. I cannot use medicaid where I live, but because of this law, either all my children go on medicaid or I am fined. I cannot find a way to legally correct this application. And since I did not fix it within 10 days, I could be charged with perjury.

 

Here is a place to look for pharmacies on medicaid... https://tchp.healthtrioconnect.com/public-app/consumer/provdir/entry.page  I have already gone out 20 miles and there are none. I cannot even use medicaid for pharmacy. 

 

The point is simple...I should not be legally required to go through this, based on income. That is discrimination. The medicaid is unusable.  Now I am afraid I will face criminal charges over committing perjury. The application is so long that it is hard to even pin point all the places where perjury has been committed.

 

So the basics is...medicaid is not usable where I live. So my choices are, leave them on medicaid and take chances with being caught for the mistakes on the application, which could mean criminal charges. Or cancel the medicaid and pay the $2000+ fine at the end of the year. All this because of the ACA. When my husband was laid off 10 years ago, we were not fined for it. Life was allowed to go on and we could focus on the kids, our lives, and finding a new job. Heck, we even spent time doing things like playing games with the kids, going to the park, and museums. Now, instead, we spend hours and hours trying to meet the requirements of the ACA and worry about all the criminal penalties we will face for every mistake and there is NO ONE that is there for ME to help me with this application, or the fixing of it.

 

And if this is my punishment just for my husband being unemployed for a few months, I can just imagine the pain people are in who are unemployed or otherwise low income for the long term. 

 

You are stuck in this loop obsessing about going to jail and paying "criminal" penalties for simple mistakes on a form, when people are telling you over and over that you will NOT go to jail and any fees imposed for refusing insurance are NOT criminal. If your son is accidentally listed as your elderly disabled spouse, that is CLEARLY an accidental error and not perjury.

 

The only issue you have that could remotely be considered fraud would be not listing your retirement assets, so you do need to correct that ASAP. Just explain that you found the forms confusing and didn't realize that IRAs/401Ks needed to be listed. Then answer the rest of the questions about your kids honestly, let them get signed up for Medicaid, and move on with your life.

 

Deciding to just leave your kids uninsured because it's too much hassle to fill out and/or correct the paperwork is very shortsighted. You may feel like it's pointless because you plan to just pay out of pocket for basic doctor visits, but if you're in an accident and one of your kids is airlifted to a trauma center, or is diagnosed with a life-threatening illness requiring expensive tests and treatment, how far will your savings go then? Choosing to go without health insurance because you don't expect anything catastrophic to happen is like choosing not to have car insurance or homeowners insurance because you "plan" to never have a serious accident or a house fire. Life doesn't work that way!

[Janeway]

OK..spoke to the Ombudsman office (just now) and the person there took time to walk through the stuff showing on my end on this webpage. She says for some reason, the pages are mixed together, as in, ..ok..I cannot state as in..she used letters and numbers to describe which forms are mixed in with which. She assured me that the papers are filled out correctly and on her end, she has our correct income and correct husband, correct home address, etc. 

 

I took her number and name so I can call her back again if I have anymore questions. She really helped. In case anyone else is reading this and really needs help, pm me and I will send you the number.

 

 

[Alessandra]

Another way might be to get this done in person. Many states often in-person help through community organizations. Here is a link for Texas:

 

http://texashealthcareguide.org/applying-coverage-online-or-person-help

 

You collect all your paperwork and bring it to someone who knows how the system works. It may take awhile and you must be willing to share, but you would have a real life helper person to talk to.

[Carol in Cal.]

 Do you think it would be good to ease into change, by, for example, extending Medicare down to 55+ folks, expanding Medicaid to include those of somewhat higher incomes (perhaps on a sliding scale), raising the age of young people eligible for SCHIP, and extending who is eligible for the VA and Tri-Care?  

 

 

This is similar to what I proposed upthread.

 

Medicare to 55 instead of the ACA would have given primary coverage to a lot of the uninsurables who were holding onto jobs they didn't want just to keep their employer coverage, or who were unable to get independent policies.

 

I also suggested expanding Medicaid, and retaining the 'to age 26' provision in parents' plans--coverage for people in their 20's is generally pretty cheap, so that would not cost very much. 

 

Then also a 'shared risk' pool like they have with auto insurance, to take care of uninsurables between 26 and 55, and there you go--pretty much coverage for all, but not such a radical shift. 

 

One advantage of this approach is that the traditional high deductible, cheap plans would have remained available, for truly catastrophic situations.  People I knew who had these started to pay more than their mortgages for them when the ACA kicked in, or dropped having insurance completely.  And the newer plans have done so much cost shifting that even though they are technically not 'high deductible' plans, they are financially similar to them, for the people I know, except far more expensive.

 

I don't know very much about the VA or Tri-Care, so I can't comment on those.

 

 

 

[maize]

OK..spoke to the Ombudsman office (just now) and the person there took time to walk through the stuff showing on my end on this webpage. She says for some reason, the pages are mixed together, as in, ..ok..I cannot state as in..she used letters and numbers to describe which forms are mixed in with which. She assured me that the papers are filled out correctly and on her end, she has our correct income and correct husband, correct home address, etc.

 

I took her number and name so I can call her back again if I have anymore questions. She really helped. In case anyone else is reading this and really needs help, pm me and I will send you the number.

I'm so glad you were able to talk with someone who was helpful.

 

Did you ask her about reporting IRA and 401K accounts?

[Carol in Cal.]

Here is information on Medicare Part B coverage for chiropractic care. It is very limited. You will note, however, that it clearly states that you can receive non-covered services, but you will have to pay for them. If your chiropractor is choosing not to provide non-covered services, then it's time to find another practitioner. 

I looked for years to find this type of chiropractic care.  This is literally the only practice in 30 miles that offers it.  The next closest one is 50 miles away.  I have no issue with paying cash for these services, (except that it's expensive, but it's totally worth it), but if she won't treat my husband once he is on Medicare I don't have any other options.  Obviously I can't force her to do so, and accusing me of 'holding onto this falsehood' is really not productive on any level.  Here's what I know about the law--it's complicated, and it's very hard to get an overview--you need someone to net it out comprehensively and to assure you that you have the *whole story* before you make changes.  I am not in a position to that for this practice, and I am not in a position to find a different practice.  It stinks.

[ChocolateReignRemix]

nm 

 

Edited December 29, 2016 by ChocolateReignRemix
Stop picking a fight.

[Carol in Cal.]

nm 

 

Edited December 29, 2016 by Susan Wise Bauer
Don't engage.

[Ravin]

Yep. And the extremeness of this paperwork and fear of being prosecuted or what will happen to us or what if I make a mistake led me to have a huge anxiety panic attack today. With all these social workers calling and asking all these questions that go on and on, what if they don't like my answers and take my children away???? I didn't vaccinate the baby!! I only selectively vaccinated my 5yr old. We already recently saw the dentist and the social workers are saying we have to go to their dentists! I don't make my 15 yr old do autism therapy. Are they going to take him and put him in a group home or something because they now make the decisions? In addition to all, my time is considered worthless and I have to do all these meetings. What if a child has a tantrum during a meeting? What happens to us?

 

I don't think low income or no income should mean that the state has the right to control our lives and bodies. I feel like I have lost my rights as a parent now. It has been horrifying. What if one of the many social workers I have to answer to now are against home schooling?

 

Because this medicaid thing has put me through so much, I actually told my husband to call back that one company and see if the job is still available. I have close to a year worth of salary saved up. I have a house worth enough that I could easily live in one half the price here, where I am now. But, because of fear of breaking the law and whatever control the state has over my children now, I am looking at greatly increasing my debt and setting us back financially to escape this control and stress. I am completely folding under this stress. Another social worker is trying to reach me for something. I got MORE paper work in the mail today. I saved hard and have always been frugal to provide for my family at a time like this. This is my husband's 4th lay off. But by law, I no longer have the same parental rights I used to have. And I now answer to social workers, any time of day, any amount of time they want, they own me. They can call me at 2 in the after noon on Christmas Eve and I just have to drop everything to answer their intrusive questions. But, they don't have to tell me if I made a mistake on the paperwork. I start every one of these conversations with "I don't know if I filled it out right, I could have made a mistake." Did you know you can go to JAIL for lying on medicaid paperwork? When I don't even use the medicaid to begin with!

 

edited to add: you know how people say they think we should be free to home school and should not have to answer to school staff for what we teach or how we teach, etc? But this law has made it so that low income people have to let their kids be tracked or be in violation of the law. 

 

You are ascribing power to these caseworkers they do not have. The only thing they are gatekeepers to is approval or denial of medicaid. That's it.

 

I homeschooled DD while receiving medicaid and food stamps for years. We selectively delayed vaccinations. No one ever questioned it as long as we had our forms filled out correctly.

 

Yes, the paperwork is a PITA. Sometimes it can feel like a shifting target when person A tells you X and then person B tells you Y. 

[Ravin]

Janeway, I know that you don't have money at throw at things.  But, putting together enough money to join hslda.org and maybe that parent one (I read about it on freerangekids.com).   What you need is cheap access to a lawyer(s) that you can call with an SOS if CPS gets overbearing.  It seems to me that the threat of having your kids taken away is like a PP said about a parent with end-stage cancer.   You don't worry about the shoulds and just do what you need to do.  

 

This would be a waste of her money.

[maize]

This would be a waste of her money.

I agree, with one reservation: if a membership would significantly lessen OP's anxiety, it would be worthwhile.

 

I sometimes do things that don't make practical sense because they have a significant psychological impact in reducing my stress.

[purplejackmama]

You have a lot of nerve accusing me of lying. And you don't have CERTAIN KNOWLEDGE of what you have asserted.

I'm repeating what she said.

I believe her to believe this.

I don't know that anyone here knows the whole story or the whole extent of the law. I'd be very surprised if anyone knew it well enough for her to stake her practice on. The downside risk of making a mistake in something like this is drastic for the practitioner. It's ridiculous.

And you are rude and abusive in your language on these boards.

Carol, my dad has the same issue. She called him a liar too. I'm sorry.

 

ETA: my dad's issue is meds that aren't covered. But the issue is essentially the same. He's buying them from Canada.

Edited December 28, 2016 by purplejackmama

[Charlie]

I agree, with one reservation: if a membership would significantly lessen OP's anxiety, it would be worthwhile.

 

I sometimes do things that don't make practical sense because they have a significant psychological impact in reducing my stress.

 

I don't think membership to a legal foundation that thrives on scaring people into not trusting the government is particularly good for lessening anxiety.

[Tanaqui]

So accusing me of repeating so-called lies does not equal accusing me of lying?  That's ridiculous.

 

No, it doesn't. Otherwise, we'd have to call every kindergartener in the world a liar because they tell other kids what "Santa" gave them.

 

And additionally, expecting me to lawyer up for someone else's business is nuts, too.

 

We're not expecting you to "lawyer up". We're expecting you to act like an adult and research claims rather than simply believing them with no evidence. "I trust this woman" is not evidence. "The website run by the government to explain what Medicare does and does not cover" is evidence.

 

Lastly, accusing someone you don't even know of lying and being unethical is quite a stretch.  How nice for you to be so brilliant that you can see into everyone's heart, people you don't even know.  Newsflash:  it reveals yours, not theirs, when you make slanderous claims like that.

 

Accusing somebody of slander is exactly the same as accusing them of lying. Now, all anybody accused your chiro of is of misunderstanding the law at best and oversimplifying at worst. That's hardly the crime of the century. I think we've all done the former and nearly all of us have done the latter.

 

(And you don't need to "see into everyone's heart" to determine if a claim is factual or not. You just need to be willing to do a little bit of research. If the ability to use google makes us all brilliant, well, yay. I'll take my Nobel, now.)

Edited December 28, 2016 by Tanaqui

[Corraleno]

I looked for years to find this type of chiropractic care.  This is literally the only practice in 30 miles that offers it.  The next closest one is 50 miles away.  I have no issue with paying cash for these services, (except that it's expensive, but it's totally worth it), but if she won't treat my husband once he is on Medicare I don't have any other options.  Obviously I can't force her to do so, and accusing me of 'holding onto this falsehood' is really not productive on any level.  Here's what I know about the law--it's complicated, and it's very hard to get an overview--you need someone to net it out comprehensively and to assure you that you have the *whole story* before you make changes.  I am not in a position to that for this practice, and I am not in a position to find a different practice.  It stinks.

 

Perhaps you can direct your chiropractor to this document which spells out, explicitly and in detail, EXACTLY the legal requirements that chiropractors must follow in treating Medicare patients. As you can see, it is certainly not illegal for her to continue treating your husband. If the treatment happens to be the ONE service that Medicare covers (medically necessary manual manipulation of the spine to correct subluxation), then she does have to bill Medicare for it if she treats him, although as a nonparticipating provider she can ask you to pay upfront, and then submit the paperwork to Medicare who will reimburse you directly for the portion Medicare covers.

 

If the treatment is one that Medicare will not cover, she just needs to provide you with a form called an ABN (only one per year is needed for recurring treatment), and you check option 2: treatment is not covered, you agree to pay out of pocket, and the provider does not bill Medicare.

 

If she genuinely believes that it would be *illegal* for her to continue treating your husband under any circumstances, then she is misinformed. If what she really means is that it would be illegal for her to treat your husband without filing the required Medicare paperwork, and she really doesn't want to be bothered, then she should be upfront with you about what the real issue is.

[ChocolateReignRemix]

Ok.

 

Why do you think people buy supplemental coverages?

[shanvan]

I am just so sorry. Anyone who thinks that people even ing aid are lazy has never been part of the practically full time job it is to jump through the right hoops. I pray things improve for your family.

Agree, and this is why I do not want to see drug testing as an added hoop to jump through.

[Tanaqui]

Agree, and this is why I do not want to see drug testing as an added hoop to jump through.

 

Totally agreed for two reasons:

 

1. People on drugs still need to eat and get medical treatment and live somewhere. If you cut them off of welfare (and SNAP, and Medicare, and public housing) then they're not going to become less addicted now that you've made their lives even harder. They're just going to sleep on the street and eat out of the garbage.

 

2. Besides, we've found that we spend a lot more money running drug tests (and pulling up negative after negative) than if we just kept those people on the rolls.

 

Though I'd be darkly amused if politicians who called for drug testing before providing benefits were themselves subjected to random drug screening before they could pick up their paychecks.

 

[catz]

It might help your peace of mind if you don't think of the social workers as "medicaid interrogators," but rather as regular people trying to do their jobs. They aren't the ones who legislated the amount of paperwork. They just get stuck in the trenches forced to implement it.

 

:iagree: Just as an aside, I think there are just so many problems with call centers and paper work oriented places.  I don't know if the people who work there aren't qualified or trained well or the system is poorly designed or some combination.  I spent hours and hours a couple weeks ago trying to resolve a problem with my son's college board account so he could see his PSAT scores.  I was told misinformation multiple times before I got someone competent on the phone who fixed my problem in minutes. 

 

I've had similar experiences with insurance claim mix ups and we have great insurance from my DH's employer.   Or lost UPS boxes or mixed up orders, etc.  I have about developed a phobia for making phone calls to resolve any sort of issue.  I don't think that's an income dependent thing necessarily.  

[Mergath]

Totally agreed for two reasons:

 

1. People on drugs still need to eat and get medical treatment and live somewhere. If you cut them off of welfare (and SNAP, and Medicare, and public housing) then they're not going to become less addicted now that you've made their lives even harder. They're just going to sleep on the street and eat out of the garbage.

 

2. Besides, we've found that we spend a lot more money running drug tests (and pulling up negative after negative) than if we just kept those people on the rolls.

 

Though I'd be darkly amused if politicians who called for drug testing before providing benefits were themselves subjected to random drug screening before they could pick up their paychecks.

 

 

:iagree:  I've never understood the mindset that people battling addiction don't deserve food or shelter. They're the ones who need help the most so they can focus on getting well.

[maize]

:iagree:  I've never understood the mindset that people battling addiction don't deserve food or shelter. They're the ones who need help the most so they can focus on getting well.

And even if they're not getting well or even making an effort to get well they're still humans who need food and shelter.

[displace]

I haven't filled out forms for Medicaid before, but I wonder if part of the anxiety is maybe multiple mentions of fraud, illegal, fines, jail, etc, on the forms or during the orientations?

 

Just a thought...

[abcmommy]

Single payer gives the government absolute power over what health care one can receive.

That's not workable in this country. 

 

 

This is patently false.  It gives the govt absolute power over what health care you can receive at govt negotiated prices.

 

Nearly every country which has single payer ALSO has insurance markets where you can buy supplemental plans.  These are available to those who can afford them for "luxury" healthcare costs not covered on basic national plans.

 

Further, OP, while I sympathize with your experience, you could have made this MUCH easier on yourself with some prior research.  Yes the ACA website is a pain.  But I do not believe 1000/ month was your only option for you and your husband.  

 

I was in this exact situation 2 years ago and was certainly disappointed with my options, but our whole family could be covered for 800 a month with NO SUBSIDY.  (My ex was a high earner and had already made 80 or 100k before he lost his job).  

 

It was certainly an unpalatable option as it had a 10K deductible, but one good car wreck can cost that.

 

 

HEALTH SHERPA is an exceptionally easy to use website which helps people navigate the ACA plans available to them and has been widely used and publicised.  Look into it if you need info and share it, bc its so helpful.

 

https://www.healthsherpa.com/

[maize]

This is patently false. It gives the govt absolute power over what health care you can receive at govt negotiated prices.

 

Nearly every country which has single payer ALSO has insurance markets where you can buy supplemental plans. These are available to those who can afford them for "luxury" healthcare costs not covered on basic national plans.

 

Further, OP, while I sympathize with your experience, you could have made this MUCH easier on yourself with some prior research. Yes the ACA website is a pain. But I do not believe 1000/ month was your only option for you and your husband.

 

I was in this exact situation 2 years ago and was certainly disappointed with my options, but our whole family could be covered for 800 a month with NO SUBSIDY. (My ex was a high earner and had already made 80 or 100k before he lost his job).

 

It was certainly an unpalatable option as it had a 10K deductible, but one good car wreck can cost that.

 

 

HEALTH SHERPA is an exceptionally easy to use website which helps people navigate the ACA plans available to them and has been widely used and publicised. Look into it if you need info and share it, bc its so helpful.

 

https://www.healthsherpa.com/

I would not assume that there were cheaper plans available to the OP than what she referenced, available plans vary widely from state to state and region to region and $1000/ month for 2 people as the cheapest option is not at all surprising.

 

FWIW entering one Texas zipcode into the site you linked brought up $946 as the lowest premium for two adults, other zip codes will produce different options but it doesn't sound like OP is in a big city (which would have the most options).

Edited December 29, 2016 by maize