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I am flabbergasted.....Healthcare/ Insurance related (probably JAWM)


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This will be full of crass talk about money so look away if you must

Before getting pregnant my dd had 2.5 part time jobs.  One with the local public school as the reading specialist where she worked 1 hour less than they would be required to give her benefits, another job with the same public school running the after school program, again no benefits and the .5 being the  2 hours/ day from 4-6am she spends online teaching English to kids in other countries.

Her husband worked the maximum allowed 28 hours/ week on campus while finishing his Masters.

Because she is turning 26 in June and thus will be off our insurance which only offers her emergency services because she is in another state, she went to the exchange and got on a plan that costs her just over $400/ month.  Just her, as her husband pays $500/ semester at the school for his insurance.

Fast forward to today and she is pregnant with twins and in the hospital for the next 6 weeks until the babies are born.  The nice insurance person came in today and told them that the cost for her to stay in the hospital is $8K/ day (!) but her current plan has an OOP cap of $6K/ year......wait for it....per person, so when the babies arrive it will be an additional $6K/ baby.  The woman told her to apply for Medicaid and everything would be covered.....wait for it.....unless her husband got a job.  Even a part time job at the grocery store, if he makes more then some ridiculously low amount then they would lose the Medicaid and have to re-enroll in another insurance.   The woman told them if they qualify for Medicaid, then their best bet is for her husband to not get a job until the babies are born and out of the NICU.

But who is going to pay their rent?  Their bills?  They have some savings but not enough for months of no income.

aaarrrggghhh

OK,

I am better now

Amber in SJ

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Medicaid requirements aren't so restrictive that her DH can't have a part time job but there are income limits. This totally depends on where they live. Being the sole income-earner for a family of four is a different calculation than for a household of two.

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This must be very stressful for your daughter, her husband, and you. It is frustrating when you do everything "right" and you find yourself as a football between various agencies. 

Going past JAWM: Please have her contact Medicaid and see what happens if she applies; babies change a lot of how its calculated and depending on the state she could be ok. If she gets Medicaid, then they would probably qualify for WIC or SNAP (idk what is available in her state) so that would help out as well if her husband has to take a cut in hours. Also, at least in AZ, the children can qualify for Medicaid even if parents do not, so that may help even if not fully cover everything. 

Back to JAWM: Many hugs {{{{}}}}

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Yep, like others are saying...find out how much he can make on Medicaid and make sure they know she is PG with multiples. Some states have higher income limits for PG people. 

Another option (if he is not going to be working or in school this summer) is moving back to where you live, if they can live with you and drop the rent/housing expenses. 

My son is turning 26 this, year.....He is finding out that paying for insurance sucks!

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In our state, pregnant mom's and the babies for the first year have a lot higher income limits than 2 working parents with no children.  

I would research the options in your state and I come guidelines for various situations.

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On top of that she will have perinatology bills (not covered by the room fees), ekgs and other tests on the babies, plus the costs of their supplemental preemie formula and preemie vitamins until they hit age 1. Dd's preemie bills hit xxx,xxx.  Thankfully we had a max out-of-pocket amount that was xx,xxx. We did not get a charitable write-off.

Universal healthcare.  No one should have to be homeless or go without necessary medical care because they can't afford it. 

FWIW, in ye olden days, they used to have lifetime maximum payouts.  Some of those were as low as $100,000, which would've made preemies like this uninsurable. "Obamacare" ended that. For those wanting to end Obamacare, we could see the return of lifetime max payouts and pre-existing conditions (being preemie could limit your coverage of care).

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What state are they in? I'm assuming one that didn't expand Medicaid?

I think @Tap is right about seeing if they can move to NJ.

There's always gofundme, too, they might be able to raise enough to cover rent.

 

Edited by chiguirre
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2 minutes ago, prairiewindmomma said:

 

FWIW, in ye olden days, they used to have lifetime maximum payouts.  Some of those were as low as $100,000, which would've made preemies like this uninsurable. "Obamacare" ended that. For those wanting to end Obamacare, we could see the return of lifetime max payouts and pre-existing conditions (being preemie could limit your coverage of care).

Pre-existing conditions is a huge thing.  I had heart surgery as a 3 year old.....47 years ago.   Repair was made....but it was still considered a pre-existing condition until the Obama care took that away.  Health share miniatures would not touch that either.

We do need to do something to improve our health care.  We need more and better access across the country for primary care doctors and urgent care centers.   This would take a lot of pressure off the emergency rooms as so many people coming in there are NOT emergency level needs.   People need a family physician to build a relationship with and get regular access to health monitoring for chronic conditions.

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When I was on pg Medicaid (over a decade ago), they included the unborn baby in the household count.  With a household of four (counting baby), dh was able to work full time, at above minimum wage, and we were well under the income limits for pg Medicaid and also for under-5 Medicaid.  (We were too high for older kid and non-pg adult medicaid.)  We also were eligible for WIC, but not food stamps. 

Definitely research the limits - pg Medicaid limits were higher (at the time, anyway) than other Medicaid limits, and they counted the unborn babies in the household, too.

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Definitely research, research, research. It varies so much by state, and there are so many programs. 

My state has children's insurance if you make above medicaid but below a certain amount. I know the amount used to be quite generous. I'd see if you have such a program and if it could potentially cover the babies the moment they are born (if they can't get Medicaid). 

It might help to post on social media, asking if anyone in your/their social circle has experience dealing with insurance and/or the medicaid system. 

I just checked, and my state does have a program for pregnant women and babies that has a higher income cap. It can cover stuff up to 60 days after the baby is born. If you have insurance, your insurance will still pay and they pay the difference. 

Research for sure, but Medicaid is almost certainly the answer. I know they still have bills to cover, but scrambling to pay those now is better than crushing debt. They need to find out the guidelines ASAP. I can't imagine he makes too much in 28 hours/week at a campus job to qualify. 

  • Absolutely go to a local church and ask for help. The food pantry can lower grocery bills for her dh, and they often have have help for rent/utilities (occasional, not every month). At the two local churches I'm familiar with, anyone can go in and get food, no questions asked. If you want money, you need to talk to someone. In either case, you do not have to be a member of the congregation. 
  • His school might have resources as well. Sometimes they have discretionary funds for students in dire need, they may or may not be called a scholarship. He needs to go to his dean, go to his financial aid office, and lay it out. I'm desperate, what can you do for me?  
  • Maybe he can work for a bit of cash in odd jobs like lawn mowing, babysitting, tutoring, editing papers. 
  • It would be better to go into a small amount of debt for bills than a large amount of debt for medical, imo. As someone noted, they are going to be charges above and beyond the actual hospital stay. If she's already not been working, they should be able to pay the bills if they get Medicaid, yes? 

I hope you find some great solutions! 

 

 

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I received WIC benefits while I was pregnant with twins and got a huge amount of food.  It might be worth checking out.  I got overwhelmed with it after they were born and it was not very worthwhile for me with fortunately being able to nurse successfully, so didn’t need formula.  It was great while I was pregnant, though.  
 

If they need specialized formula after they are born, I have heard different things as far as WIC or insurance being able to cover it.  We didn’t but it is something I heard about at the time.  
 

Edit:  I heard about people who had major formula expenses for twins and needing special formula, and it was a reason I wanted to do WIC.  
 

Edited by Lecka
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She needs to apply for Medicaid and discuss everything with the people in the Medicaid because what the insurance person told her doesn't sound completely right.  I have ALWAYS qualified for Medicaid while pregnant and a year after, even before our state expanded Medicaid, with dh working full-time and it was above minimum wage.  What that insurance person told your dd may be accurate but it has not been my experience.

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3 minutes ago, hjffkj said:

She needs to apply for Medicaid and discuss everything with the people in the Medicaid because what the insurance person told her doesn't sound completely right.  I have ALWAYS qualified for Medicaid while pregnant and a year after, even before our state expanded Medicaid, with dh working full-time and it was above minimum wage.  What that insurance person told your dd may be accurate but it has not been my experience.

Agree totally.  APPLY NOW....as it can go back 30 days from date of application (at least in my state) and then get a local worker to help you figure it out.   

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Is it a state that didn’t expand Medicaid coverage?  That didn’t do the Medicaid expansion?

That has been the issue when I have heard of things seeming really different between two people in different states.

Just throwing it out there.

Then any state with Medicaid expansion might be better.  
 

Not that I know a lot about it!  It’s my impression though.  

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Is there someone in the hospital who can help with this?  It might be worth asking!

 

Edit:  like a social worker or something?  A patient liaison or something?

Edited by Lecka
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In my state it is $54,000 for a child 0-18, and $50,00 for a pregnant mom.  Other adult.is $35,00.....all numbers for a family of 4 as they count the babies.

If she is told no, ask for policy page, etc that explains why and appeal if needed.  Again though, the date of application is key.

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I just googled and Michigan participated in Medicaid expansion.  
 

If op is in a state that does not participate, the numbers will not be similar.  

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1 hour ago, prairiewindmomma said:

On top of that she will have perinatology bills (not covered by the room fees), ekgs and other tests on the babies, plus the costs of their supplemental preemie formula and preemie vitamins until they hit age 1. Dd's preemie bills hit xxx,xxx.  Thankfully we had a max out-of-pocket amount that was xx,xxx. We did not get a charitable write-off.

Universal healthcare.  No one should have to be homeless or go without necessary medical care because they can't afford it. 

FWIW, in ye olden days, they used to have lifetime maximum payouts.  Some of those were as low as $100,000, which would've made preemies like this uninsurable. "Obamacare" ended that. For those wanting to end Obamacare, we could see the return of lifetime max payouts and pre-existing conditions (being preemie could limit your coverage of care).

Yes to universal healthcare. And when people are benefiting from charitable write-offs it already is a form of universal healthcare, it just isn’t available to everyone. The hospitals charge more to those with adequate insurance, and more people have insurance since the ACA, so at least before the pandemic, many hospitals were flush with money. It got to the point in my state that the legislature considered some bills to require a certain amount of charitable giving by non-profit hospitals with very large profits.

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1) It may or may not be helpful, but your daughter *might* be able to change exchange plans because it might permit her a "special enrollment period." If that's the case, check her state's exchange and see if there's a better plan that would provide better coverage.

2) People, please remember health care when you're voting. Until we get single payer universal health coverage, these stories will just devastate more and more families. 

 

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1 hour ago, Ottakee said:

Pre-existing conditions is a huge thing.  I had heart surgery as a 3 year old.....47 years ago.   Repair was made....but it was still considered a pre-existing condition until the Obama care took that away.  Health share miniatures would not touch that either.

We do need to do something to improve our health care.  We need more and better access across the country for primary care doctors and urgent care centers.   This would take a lot of pressure off the emergency rooms as so many people coming in there are NOT emergency level needs.   People need a family physician to build a relationship with and get regular access to health monitoring for chronic conditions.

My state has one of the highest percentage of people covered in the country, even before the ACA. Our former governor was a doctor who led many of the reforms. Those on the state health plan do have a medical home that does exactly as you outline. And it does save on emergency room visits, in addition to improving health outcomes. In fact, the provider groups are incentivized to keep patients as health as possible through good preventive care. It also costs the state less per person. So win win.

Edited by Frances
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2 hours ago, Dotwithaperiod said:

Welcome to the world of privatized health care and a country that has no trouble allowing  employers to keep employees one hair below the allowance of offering benefits,  little babies!

It differs by state, but they need to take the time and research what income level allows him to work at, for a family of 2 right now, to qualify for Medicaid. And as awful as it is, it may make more sense for him to quit his job in order to be with her during the next 6 weeks in order for their hospital bills to be covered. Could you help pay their rent/utilities until then? The only other option is just knowing they’ll be $18,000 in debt once they’re born.

I’d have no trouble working the system. It’s screwed up. It’s shameful. And no one benefits more than the greedy, thieving insurance executives.

Since she is pregnant with twins, Medicaid counts the babies and considers them a family of four. That will allow them to have a much higher income and still be eligible.

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