Anyone use Molina with GroupHealth in WA State?

[lawman3966]

I'm currently with GroupHealth on an ACA Silver plan in Washington state, but expect to switch to Medicaid in the new year due to a decline in income. I would nevertheless still like to be able to use Grouphealth's facilities.

I've been told that one way to access GroupHealth facilities in WA state while on Medicaid is to select Molina as one's health insurance company within the Medicaid/Apple Health system.

I've found it hard to get much information on this option and am thus asking for input from anyone here who might have experience with this option.

Separately, feedback from anyone with experience being on Medicaid in Washington state either with Molina, or any other insurance company, would also be appreciated.

[Spokane2303]

We've been on Molina for 2 years and haven't had any problems.

Our primary care provider has been in constant flux as Molina uses SeaMar as their provider in Vancouver. Our referrals to and care by outside Specialists has been excellent! We've been seen by two of the best MD's we've ever experienced.

Sometimes it is a time hassle to get your meds pre-approved if they fall into that category; however, to be honest, we were experiencing the same issue with our former commercial provider from my previous employer.

Having been with Kaiser in the distant pass, we learned that you just have to be your own advocate and a little pushy to get good care. We find working with Molina similar. We also would be very happy is Kaiser (Group Health) becomes their provider in our region in the future.

One final thought, we have always reserved the option to income out of Molina/AppleCare/Medicaid by doing Roth IRA conversions if we feel our care isn't good. I also use the VA's medical care for an ongoing heart condition and am 100% pleased with their care in my region.

It was never our intention to use Medicaid coverage. When we first tried to purchase coverage on the WA exchange, we ran into endless issues trying to prove our projected income. By default the Medicaid coverage was much easier to get and we figured we'd be better able to document our income a year further out. The Medicaid coverage turned out to be so good that we've just continued to control and our taxable income and enjoy our early retirement.

[lawman3966]

Thanks very much for your reply.

I will have to see what the Medicaid coverage is like under the Molina/ Apple/Medicaid/ Kaiser regime. I asked a customer service rep at Group health about it, and she said that one would be able to answer any of these questions until open enrollment begins in November 2016.

[lawman3966]

Quote:

Originally Posted by Spokane2303 We've been on Molina for 2 years and haven't had any problems. One final thought, we have always reserved the option to income out of Molina/AppleCare/Medicaid by doing Roth IRA conversions if we feel our care isn't good. I also use the VA's medical care for an ongoing heart condition and am 100% pleased with their care in my region.

A follow-up question occurred to me. You mention that you could "income out" of Medicaid using Roth Conversions. However, outside of the open enrollment period, you would need a life event to enroll in the ACA, would you not? The only thing I can think of is that increasing your income might render you ineligible for Medicaid. Thereafter, you would tell the ACA that a loss of your former insurance plan qualifies as a life event enabling you to enroll in the ACA using Special Enrollment. Did I guess right?

[Spokane2303]

Yes, that is exactly how you can "income out" of Medicaid and meet the special rules to enroll in an ACA insurance plan outside of the open enrollment period.

I do wonder/worry that one might experience a 30 day gap in coverage. So timing would be very important.

[Brat]

You know that Kaiser is aquiring Group Health. Group Health approves acquisition by Kaiser Permanente | The Seattle Times https://www.ghc.org/static/pdf/publi...on-summary.pdf

[lawman3966]

Quote:

Originally Posted by Spokane2303 Yes, that is exactly how you can "income out" of Medicaid and meet the special rules to enroll in an ACA insurance plan outside of the open enrollment period. I do wonder/worry that one might experience a 30 day gap in coverage. So timing would be very important.

It seems timely to revive this thread since the Open Enrollment period is approaching.

I have had limited success in determining which providers will be available under Medicaid/Molina in the Tacoma area. In part, it's not clear whether Molina's provider search function has been updated to show its 2017 offerings.

Does anyone (Spokane2303 or other poster) know if Kaiser is a covered provider under Medicaid/Molina for 2017?

[Spokane2303]

Since your earlier thread, I've learned that Kaiser, in my region, will only accept Molina customers if you have other direct family members currently covered by Kaiser; or, if you yourself have been directly covered by Kaiser in the previous 12 months.

Since they are the new owners of Grouphealth, they might have the same rules for your region.

[Brat]

It seems to me the OP should consider enrolling in a Group Health plan as those members will be transitioned to Kaiser.

[lhamo]

For anyone with questions related to the healthcare exchange in WA, I highly recommend scheduling an in-person consultation with a Navigator. They are on staff at many of the local healthcare clinics (esp those that work with Medicaid/Apple Health). I was planning to add my DD to my Regence Silver HDHP (that I was already paying $500/month for for me and DS) when the Navigator explained that WA Medicaid ability is based on CURRENT MONTHLY INCOME. Since we will have no more taxable income until our apartment sale in Beijing finalizes in early 2017, the kids and I were eligible for Apple Health. And the Navigator was able to confirm DD's eligibility immediately (a process that took several weeks when I did it through the exchange online last year for me and DS, and ended up in a real mess that cost us hundreds of dolalrs), and get us signed up right away -- a day before my premium for the ACA Silver plan was scheduled to be charged to my cc!

This is comparatively a slow time for the Navigators, so if you have general questions I would try to schedule an appointment before Nov 1, when open enrollment starts. They will be very busy once people start looking at the new plans.

Also, this wasn't asked about but I will also note it as it is useful info for early retirees who plan domestic and international travel. In the 2016 plans I found that Regence Blue Cross Blue Shield was one of the only plans that would cover emergency medical care on an in-network basis at any Blue Cross Blue Shield affiliated hospital worldwide. For me this meant that our US based plan would cover DS and I if we needed emergency treatment at the hospital we used in Beijing. YOu can't use it for non-emergency issues, but it is a good alternative to paying extra for an international travel plan. And I found that Regence was actually cheaper than the Premera BCBS plan I had been on previously, which didn't have that same provision for global coverage. Can't guarantee the coverage will be the same for 2017, but worth having a look at if this is an issue for you.

[lawman3966]

Someone from Molina called me today, in response an internet query I submitted, and told me that Kaiser/Grouphealth would accept Molina/Medicaid coverage, and even said that I'd be able to keep my current Group healthcard and ID. I am therefore disappointed and surprised regarding the limits referred to above (by Spokane2303) have been imposed by Kaiser for Medicaid patients.

To Brat: Grouphealth (soon to be Kaiser) does not accept Medicaid patients directly. One has to sign up for them indirectly through Molina, if on Medicaid.

Regarding Ihamo: I will look into speaking with a navigator. I used a health insurance broker last year, but this appears to be something different. Thanks for this suggestion.

[Brat]

Ah, I didn't know that Molina is a Medicaid provider.

[lawman3966]

Since last posting in this thread, I've contacted a health insurance broker (which I think is the same as a Navigator); and spoken to an employee at GroupHealth regarding my prior question, but have not gotten an answer yet.

My prior question was whether insuring with Molina under Medicaid (Apple Health) in 2017 would enable the insured to access all of the facilities of Group Health/(Kaiser as of 2017) or whether each doctor would decide for him or herself whether to accept the insured as a patient.

I have checked online but haven't found an answer to this query there either.