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Son just had 2nd kid now being forced into CHIP
Old 09-19-2016, 04:03 PM   #1
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Son just had 2nd kid now being forced into CHIP

Anyone understand what is going on, what I know right now.
He lives in Pa,has own business so does not pay himself much.
He has Aetna through the market place, they call up to get new baby insured, well they tell him he does not make enough and kids must go on CHIP. The market place has now cancelled his insurance for the kids, and
I guess for some reason the wife. He still has insurance with subsidy I guess. Anyway he must now apply for medicade/chip in pa, will take two weeks I think, so kids are without insurance for at least two weeks.

He told them he will raise his income to over 138% of poverty level, but seems it is somehow automatic with computers, and the people have no good answers.

What the hell is going on. He does not want kids on Chip/medicade.
Wants everyone in family on the single silver plan.
Thanks to anyone who has knowledge of this mess.

Old Mike
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Old 09-19-2016, 04:26 PM   #2
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How about going directly to the company and not through the exchange. Having a second kid would qualify for a life event, I would think. Of course, no subsidies if you go direct, but you can't have it both ways.
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Old 09-19-2016, 04:42 PM   #3
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It sure is funny logic when you have someone that wants to be on ACA plan, but can't because they don't make enough to qualify. Yet they want to fine you if you don't have coverage and the concept is designed to provide more to those in need. Seems kind of insane to me.
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Old 09-19-2016, 05:01 PM   #4
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Originally Posted by mf15 View Post
What the hell is going on. He does not want kids on Chip/medicade.
Wants everyone in family on the single silver plan.
It's time for your son to purchase a non-subsidized plan on the open market. As mentioned, the new child is likely a qualifying event. Perhaps later he can manipulate his income vs. the business in a way that allows him to hit the sweet spot where his income is low enough for a subsidy on a silver family plan but high enough to not require the kids to be on Medicaid/CHIP.
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Old 09-19-2016, 05:11 PM   #5
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Originally Posted by mf15 View Post
He told them he will raise his income to over 138% of poverty level, but seems it is somehow automatic with computers, and the people have no good answers.

What the hell is going on. He does not want kids on Chip/medicade.
Wants everyone in family on the single silver plan.
Thanks to anyone who has knowledge of this mess.

Old Mike
CHiPs is a Federal Program that each state implements as they want, making sure to meet the federal guidelines. It looks like PA- CHiP has a different income threshold than the ACA / Medicaid, and if your son's household income is below that the state can require CHiP cover the children instead of obtaining subsidized coverage on the exchange. Here's a link to a table on the "PA CHiP" program that shows income levels. http://www.chipcoverspakids.com/Abou...chart_2016.pdf
Eyeballing the chart, to have the entire family on an ACA plan and not on CHiP, a family of 4 would need to have (MAGI) income greater than $63.7K. That's around 2.6x the federal poverty level, so he could still be eligible for some premium assistance, but it will be much less.

Your son would probably be better off discussing this with someone from the PA exchange. The insurance company will know the required income levels, but they are often more difficult to deal with outside the open enrollment period.
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Old 09-19-2016, 05:20 PM   #6
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Originally Posted by DFW_M5 View Post
It sure is funny logic when you have someone that wants to be on ACA plan, but can't because they don't make enough to qualify. Yet they want to fine you if you don't have coverage and the concept is designed to provide more to those in need. Seems kind of insane to me.
If you really make too little for purchasing an ACA plan, you should not get fined. If the least expensive plan on the ACA site is more than 8.x% of your income (I forget what the x is ... so a little over 8% of income), then you are exempt from the mandate if you file the exemption. You then don't get the fine/fair share payment.
My guess the OP is referring to someone who is trying to maximize the cost sharing. Likely the only way to do this is to file new income and request insurance for the new baby at the same time and in the same filing. That might work.
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Old 09-19-2016, 05:36 PM   #7
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Thanks for the replies.
That 63.7 income threshold is a decent income, looks like for some reason
they are trying to force the kids onto chip.
But with a threshold that high you are getting out of the decent subsidy range, if
you get one at all, I would have to look.
Something doesn't pass the smell test with this, and not sure I like what I see.
He keeps the income low since he has little to no debt, like many of the successful people here.
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Old 09-19-2016, 06:26 PM   #8
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PA doesn't have an exchange, it uses the federal exchange. I think the addition of the baby raised the income threshold so the family qualifies for Medicaid. This is a huge problem, as many pediatricians don't take Medicaid at all, at least in my part of PA. It isn't a very high threshold to Medicaid, depending on the number of kids. I also understand second hand from mothers that CHIP doesn't kick in for awhile so the newborn has to go on Medicaid initially. Older kids are covered quicker.

This is THE reason above all I would like to see single payor. It's a stupid system that kicks NEWBORNS off of insurance just because the family got larger, or because the baby was born to a 23 year old still using her parents' insurance.

Good luck to your son. The application can be daunting. The baby is covered for 30 days period, though.
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Old 09-19-2016, 06:48 PM   #9
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Thanks East West:
I just went to the ACA site and started an application, used an income of 4000/month
just for kicks, for a family of 4. Yep it kicked me right into medicade/chip and would
not let me go on.
Very strange/insanity.
Yes I am looking for pediatrics who accept these plans in their location, seems tricky
not all accept them,and the ones that do might not be too good.
Old Mike
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Old 09-20-2016, 04:19 AM   #10
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This is THE reason above all I would like to see single payor.
Just curious, since you are a physician. How do you know that a single-payer system won't end up being something akin to medicaid for all?
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Old 09-20-2016, 05:40 AM   #11
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Well to took me long enough to figure it out,this is the current
info on the govt site.
What a friggin mess.
The other option is to go without tax credit.
What they seem to be doing for some reason is raising eligible income so high that they are capturing
middle class families into the medicade/chip mess.
Old Mike

https://www.healthcare.gov/medicaid-...ketplace-plan/
Once you get a final determination that you're eligible for Medicaid or the Children’s Health
Insurance Program (CHIP) that counts as qualifying health coverage (or "minimum essential coverage"):

  • You’re no longer eligible for a Marketplace plan with advance payments of the premium tax credit and savings on out-of-pocket costs
  • You should IMMEDIATELY end Marketplace coverage with premium tax credits or other cost savings for anyone in your household who is determined eligible for or already enrolled in Medicaid or CHIP that counts as qualifying health coverage
  • If you still want a Marketplace plan after you’re found eligible for Medicaid or CHIP, you will have to pay full price for your share of the Marketplace plan without premium tax credits or other cost savings
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Old 09-20-2016, 07:17 AM   #12
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Ok just talked to my son.
Here are the key words in the law.
Once you get a final determination that you're eligible for Medicaid or the Children’s Health Insurance Program (CHIP).


So he calls PA medicade told then he was making over 138% of poverty level,
and got denied. Calls back the market place, told them he was denied, and now it is OK to get insurance. But he needs for some reason to get new insurance, Aetna is leaving PA anyway for 2017.


That old saying.
That we are from the government and we are here to help, really does apply here.


Old Mike
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Old 09-23-2016, 02:57 PM   #13
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I am sure many here are not interested in this problem, but your kids may run up against it.
Additional insanity by the ACA.
It seems that they have now retro actively changed my sons insurance to the new company on the date the baby was born. So now instead
of paying 100 bucks with Aetna, the new insurance charges are 800 to have a kid.

They should not have messed with any of his insurance in the first place.
Glad I have medicare and do not have to deal with this mess.

I think he has filed a formal complaint in an attempt to get this resolved.

Old Mike
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Old 09-23-2016, 03:00 PM   #14
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Just curious, since you are a physician. How do you know that a single-payer system won't end up being something akin to medicaid for all?
If you go single payer then those who don't like the payments can retire or leave the country, no other option exists.
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Old 09-23-2016, 03:15 PM   #15
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So now instead
of paying 100 bucks with Aetna, the new insurance charges are 800 to have a kid.

They should not have messed with any of his insurance in the first place.
Glad I have medicare and do not have to deal with this mess.

I think he as filed a formal complaint in an attempt to get this resolved.

Old Mike
I suspect you are comparing apples to oranges here if the $800 is a unsubsidized policy.

Do you realize that in many states Medicaid/CHIP is managed by private insurance companies such as Aetna?

Quote:
I am sure many here are not interested in this problem, but your kids may run up against it.
Actually I find this thread quite fascinating.

-gauss
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Old 09-23-2016, 03:22 PM   #16
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Just curious, since you are a physician. How do you know that a single-payer system won't end up being something akin to medicaid for all?
Or perhaps Medicare for all - OP seems quite happy with his Medicare. Just sayin'
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Old 09-23-2016, 05:15 PM   #17
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No not comparing apples to oranges. Both subsidized policies.
The system is very screwed up.
Aetna was what he had, ACA cancelled it, retroactive after second kid, to
another market place policy.
Yes of course I know that CHIP/Medicade are managed by insurance companies.
The only thing that happened was to have a second kid.
Crazy.
Yes, the OP, so far is very satisfied with medicare, I had better be, I paid
into the system since 1966, and the wife started about 1962

Old Mike
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Old 09-23-2016, 05:49 PM   #18
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Ok - Thanks Mike

-gauss
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Old 09-23-2016, 05:50 PM   #19
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Just curious, since you are a physician. How do you know that a single-payer system won't end up being something akin to medicaid for all?

Medicare for all could work. If everyone has the same system, the docs have to accept the insurance or they can't make a living. In my 28 year career, only my first job post residency was in a group that didn't take Medicaid.

Virtually all hospitals accept Medicaid, as do academic faculty clinics. Private practice is no guarantee of quality of care.

And single payer, though complex, is not impossible. Taiwan seems to have a very good system.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960712/


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