qualify

Definition of Predicament: People Who Don’t Have Access to Employer Coverage, Aren’t Medicare Eligible, and Don’t Qualify for Subsidies

Yes, this is a bit anecdotal. Nevertheless, I think it’s  worth reporting and some may find it interesting.

First, recently our team managed the annual open enrollment process for the group health plan of one of our employer clients. After a quick but thoughtful evaluation of options, one employee who was previously covered by an individual market policy opted to enroll on the employer’s group plan (family coverage) and terminate coverage under the individual market plan. Both the individual plan and the group plan were Qualified Health Plans (QHP) under ACA. The plans had similar benefits. And, they were underwritten by the same large insurance carrier.

Savings?

$600 a month in gross premium. That’s quite a spread.  Add in the employer contribution and the savings to the employee were even greater.

A week-long series of Obamacare…Did you know?

Believe it or not, you can expect the second year of Obamacare to be even more chaotic than the first. Last week we attended a market update meeting related to this year’s open enrollment which begins November 15. The meeting was sponsored by one of the major insurance companies. Any notions we had for a smoother rollout and less disrupted market this year were quickly dispelled. With little more than 6 weeks to the start of open enrollment, it was pretty clear to those of us in attendance that there were still many more questions than answers.

HealthcaredotgovSo, over the next few days, I’m going to provide you with some important “Did you know?” points that I think you need to be aware of. Here’s the first installment:

Did you know…Additional complexities are expected in the enrollment process. Specifically, re-enrollment for those who signed on in the first year, i.e. those who qualified for subsidies in year one must re-qualify. And, more computer glitches are expected. Just yesterday the Wall Street Journal reports that in order to participate in any systems testing, insurance carriers must first agree to confidentiality of the testing process.  Disclosure of testing results is strictly prohibited. There’s essentially a gag order for those carriers. Hmmmm. Color me skeptical but it sure doesn’t foster confidence that things will be improved this year. Also, makes one wonder if keeping it all hush-hush has anything to do with the upcoming mid-term elections.

Read 5 things we need to know before Obamacare enrollment starts again from The Washington Post.

Your employees. Are they medicaid eligible?

There are many opinions about Medicaid expansion and my post is opinion free.

Employers across all sectors of the economy are likely to have Medicaid eligible employees/dependents in their population. Many do not know they are Medicaid eligible and some may be on the employer plan.

What does this mean?

Like anything, researching it may be the best first step. Simply finding out if this exists in an employer population may make sense.

Then what?

Some employees will be delighted to know they qualify, some may be upset. Some employers will take advantage of Medicaid expansion to reduce the rolls on the employer-sponsored plan while others may hate the idea and avoid it all together.

We respect all opinions but we also are developing a tool to determine eligibility and — if the employer would like — assist in the enrollment process. We will be launching it next month.

We want to help any employer that wants to know who in their population is eligible for Medicaid and then listen to find out if there is anything the employer would like to do about it.

What is Medicaid?

  • Medicaid is funded largely by the federal government but run by the states
  • Unlike Medicare, Medicaid eligibility is based on income.  The Affordable Care Act expanded medicaid to reach well beyond prior eligibility pools (it will now 133% of poverty level).
  • Medicaid operates as nearly 100% coverage for all medical expenses.
  • Medicaid networks are more restrictive than Medicare or commercial policy networks
Medicaid used to be accessible only to children and low (really low) income parents with dependent children. Single people did not qualify. Parents with eligible children did not qualify often. Eligibility now is much much wider.
In the next few weeks we will be rolling out a tool to assist any employer/employee evaluate Medicaid eligibility.
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