My personal experience with Obamacare enrollment

As an uninsured individual, I’ve been following the Affordable Care Act (Obamacare) pretty closely since its inception.  Even though I’m probably more knowledgeable of the law than most people, it became evident during the enrollment process that I still had much to learn.  Without doubt, the ACA is complicated and it will take time for the public to become familiar with it.  But when they do, I think most people will be as pleasantly surprised with it as I am now.

First off, I had assumed that I wouldn’t be eligible for the ACA’s Medicaid expansion provision due to my financial assets (I’m close to retirement age living off savings and investment earnings).  So, I was anticipating purchasing a low cost private insurance plan through the new health care exchanges.  However, that assumption proved incorrect.  The ACA removed the existing asset limitation, and Medicaid eligibility is now based on the following requirements:

  • Age must be 19-65.
  • Income must be below 138% of the federal poverty level ($1322/month or $15864/year).
  • Must not be entitled to Medicare.
  • Must not be incarcerated.
  • Must meet citizenship requirements.
  • Must be a resident of the state you’re applying in.

I had this experience with the online application process:

Day 1 – I couldn’t access the website because the shear volume of users had crashed their servers.

Day 2 – I filled out the reasonably-sized questionnaire in short order, but couldn’t submit the application due to a software glitch.

Day 3 – I submitted the application, and it was approved later that same day.

One of the many faces of Obamacare

One of the many faces of Obamacare

The Medicaid expansion plan I’m enrolled in is called Washington Apple Health – No Cost Adult Coverage.  There are no monthly premiums associated with this plan, although I’m not sure yet about co-pays and other potential costs.  Also, I won’t know the exact spectrum of benefits until I receive the official documentation in the mail.

In any event, this is a huge load off my shoulders.  No longer will I have to worry about an illness or injury wiping out my financial resources.  In 2009, I supported Congressman Alan Grayson’s (D-FL) Medicare Buy-In plan and the widely debated Public Option.  Both of those legislative options failed to pass Congress, but the now enacted ACA still appears to be a very beneficial law for millions of Americans.  And, I’m one of them.

19 thoughts on “My personal experience with Obamacare enrollment

  1. Ever heard that Medicaid benefits received on or after age 55 are subject to estate recovery?

    Key words to research are “Medicaid estate recovery” +your favorite of the 50 states.

    • This is definitely a consideration for Medicaid beneficiaries particularly if they have heirs. However, people with large estates would have incomes over 138% of the federal poverty level and therefore ineligible for Medicaid.

      From: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Estate-Recovery.html

      State Medicaid programs must recover certain Medicaid benefits paid on behalf of a Medicaid enrollee. For individuals age 55 or older, states are required to seek recovery of payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States have the option to recover payments for all other Medicaid services provided to these individuals, except Medicare cost-sharing paid on behalf of Medicare Savings Program beneficiaries.

      Under certain conditions, money remaining in a trust after a Medicaid enrollee has passed away may be used to reimburse Medicaid. States may not recover from the estate of a deceased Medicaid enrollee who is survived by a spouse, child under age 21, or blind or disabled child of any age. States are also required to establish procedures for waiving estate recovery when recovery would cause an undue hardship.

      States may impose liens for Medicaid benefits incorrectly paid pursuant to a court judgment. States may also impose liens on real property during the lifetime of a Medicaid enrollee who is permanently institutionalized, except when one of the following individuals resides in the home: the spouse, child under age 21, blind or disabled child of any age, or sibling who has an equity interest in the home. The states must remove the lien when the Medicaid enrollee is discharged from the facility and returns home.

      For Washington state, see also: http://www.dshs.wa.gov/pdf/ms/forms/14_454.pdf

      and: http://www.dshs.wa.gov/manuals/eaz/sections/EstateRecovery.shtml

  2. I’m so glad the Affordable Care Act is working out for you so far! Hearing from someone who has signed up for ACA is so much more valuable than some Fox News anchor telling us how horrible it will be. The true test of whether this will work will be whether or not the people who try it find it beneficial, not what some rich Tea Partyer or Republican who doesn’t need health care anyway says.

    Definitely keep us up-to-date on how its going 🙂

    BTW, I feel so sorry for people who live in states that chose to allow many people to still go without healthcare by not expanding Medicaid. Apparently, ACA won’t work for them. Why do you think those states did this? Do those people have any other options?

    • Thanks, Tanya. I’m pretty sure the ACA will work out in time, but much depends on uninsured younger folks. If they don’t sign up, premiums could rise across the board.

      The states that refused to expand Medicaid did so for purely partisan reasons. As you know, Obamacare is an anathema to the Tea Party. However, they will probably join in eventually because the pressure from hospitals, doctors, etc. will only increase. Uninsured people in states that haven’t yet expanded Medicaid can still enroll in private plans through the new exchanges.

  3. Pingback: I was however, NOT a proud ACA (aka Obamacare) website fan yet: | Sunset Daily

  4. I am also a WA state resident looking forward to affordable coverage for 2014. Unfortunately for some lower income people ages 55-65, “estate recovery” will be a shocker to the “you might qualify for “FREE” healthcare” mantra. Many people this age have worked hard to own a house, and now with the newly expanded Medicaid, some people (but only in some states) will have to eventually pay back all of their “free” medical costs when they die, from their estate assets.

    The federal law requires Estate Recovery for ALL states for long term care/nursing home expenses, but it is OPTIONAL for states to write laws to recover for all other medical costs.
    Unfortunately, WA state is one of the few (along with NY, CO, MA, OR, MN, RI) that I can find that include Estate Recovery in their new Healthcare applications (Note that the Federal application on the Healthcare.gov does NOT include Estate Recovery).

    What I don’t understand- why is it equitable for this kind of age discrimination for older people with lower incomes (and only in a few states), when higher income people who qualify for the subsidized premiums/tax credits which don’t have to be paid back, as well as all the younger, lower income people who will get the real free healthcare.
    This state based law must be changed!

  5. From what I have been able to find; Washington and Oregon are the only states to remove the Estate Recovery Program from their Medicaid. So it seems you are among the lucky. My husband and I are not. (This is what I have found. I will look up the links if asked.)

    This is the first thing I have found addressing the issue of of the Estate Recovery Program. My husband and I signed up in California and started every conversation we had with, “Will our estate be attached for our medical services?”
    We were told 5 times that they “assumed” that the ERP would no longer be enforced since we are required by law to register. I took us two weeks and the 6th person we talked to finally admitted that is was still in effect. We have been lied to every step of the way.
    Right now we are looking for ways to protect our property and our children. These options include burying ourselves in debt after working 42 years to be debt free by retirement so we could live on SS and a very small IRA.
    We are reaching out anywhere that we can find support hoping to get the message out to unsuspecting seniors.
    Ruth

    • Ruth,
      I am surprised to hear that you are told in CA that Estate Recovery for the expanded Medicaid applies- It does apply (as it always has) for long term care and Medicaid, but my understanding is that estate recovery does not apply for your premiums, medical bills etc. that are paid through the new expanded Medicaid in CA. As I recall, it is not included on the online application through the state’s exchange website.
      You might contact NSCLC.org (Nat’l. Senior Citizen’s Law Center), at their L.A. office. I spoke with them this fall and they told me that Estate Recovery did NOT apply in CA to the expanded Medicaid. I also spoke with NHelp (Nat’l. Health Law Program) which has an office in the same building as NSCLC about this- they were working on a national level with CMS about this issue, but assured me that it did not apply in CA.
      Good luck!

      Robert- The recent changes in WA & OR are just for no estate recovery with medical costs related to the new expanded Medicaid (but long term care costs will still be recovered for traditional Medicaid coverage). Google- Estate Recovery- Seattle Times articles in December.

  6. Okay, I have dial-up and am not very computer savy. So rather than post a couple of links that may not work; google estate recovery program. It is full of links to explanations and lawyers offering to help people hide their assets.

    This is what I found on the Medi-cal site. See how carefull they word it?

    13. If I sign up for Medi-Cal, will anything happen to my assets?
    Medi-Cal only tries to recover its costs for medical assistance when a recipient is over 55, or when a member of any age is cared for at an institution, such as a nursing home. If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized. For those over 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care. It would be paid from your estate at the time of your death, and would not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son, or daughter, or while your child is under 21 years of age.

    Here is a real OMG explanation I found:
    Although the idea of Medicaid taking money that otherwise would have gone to your heirs is distasteful, it becomes more palatable when you look at the reasons behind the MERP program. Since Medicaid is funded by federal and state taxpayers, the goal of MERP is to lower Medicaid costs. If it can recover part or all of the money it spent on your healthcare, it saves taxpayers money.
    If Medicaid is paying for your long-term nursing home care, it’s likely thanks to Medicaid that there will be any estate left to recover funds from. Without Medicaid coverage, you may have had to sell your house and other valuables to pay for your care, in effect liquidating your estate while you’re alive to pay for your long-term care.

    This is what we got when our application was approved and it was hidden on the back page.

    “The state of California must seek repayment of Medi-Cal benefits from the estate of a deceased Medi-Cal beneficiary for services received on or after the beneficiary’s 55th birthday. For Medi-Cal beneficiatries enrolled (either voluntarily or mandatorily) in a managed care organization, the State must seek recovery of the total premium/capitation payments for the period of time they were enrolled in the managed care organization. Additionally, any other payments made for services provided by non-managed care providers will also be recovered from the estate. For further information regarding the Estate Recover program only, call (916) 650-0494, or seek legal advice.
    PLEASE DO NOT CALL YOUR ELEGIBILITY WORKER. He or she does not have this information, so they cannot help you.”

    Nowhere on any application was it mentioned though the law states that we must be informed.

    Thanks 48 north, we need all the info we can get.

    This only applies to medicaid. But if you need medicaid to suppliment your medicare they come after it. (Or at least they did for my mom’s friend. This may have changed under the ACA.)
    Recovery is mandatory for long term care but optional for regular medical expences. And can vary state to state and even county to county.

    • That’s awesome, thank you! From the link:

      “OLYMPIA – Washington State’s Health Care Authority is reassuring new Washington Apple Health (Medicaid) applicants that the state will amend its estate recovery policy to avoid unintended consequences for enrollees under the Medicaid expansion.

      This change will align state policy with federal requirements and limit recoveries to enrollees 55 and over who are in long-term care and have related prescription drug and hospital costs.”

  7. Thank you all. It was so scarey to feel like we were all alone in this. So many people we have complained to just don’t see anything at all wrong with this. “Well the state has to recoup somehow.”
    I do know that it was discussed early on as my sister’s niece was one of the Californians working on our Covered California program. She thought it was going to go away and that is why we signed up. So I know it was discussed and *they* decided to keep it. (“I do repeat that we asked every worker we talked to about this and were obviously lied to.”) So folks who do not even know to ask are getting sucked in.
    I love how it is assumed that people who qualify for Medicaid can afford legal advice since everything (including our notice from the state) says to talk to a lawyer.

    I am grateful to know that there is some work going on as I would rather join a fight than have to start my own. We just have to get this to the press like they did in WA.
    My husband needs care now. We put it off waiting for Medicaid and are still waiting; worrying that expenses incurred now may not be made retroactive if they change the law.
    Sorry for the rant but we have felt so alone and are looking anywhere to vent a bit.
    I am very happy that Robert is in a good state.

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