I recently lost my job and don't have an income. I plan to have an income within a few months. What should I do? Sign up to medicaid? But then what happens when I start working again?

Correct - you should enroll in Medicaid. You can submit an eligibility application on healthsherpa.com and we pass that onto your state's Medicaid Program. When you start working again, if your job does not offer you coverage, you should report that income change to your state Medicaid office. Here's a handy guide with info here: https://www.healthsherpa.com/blog/qualify-for-medicaid/

and what if your state doesnt have expanded medicaid?

From a practical perspective, I would first check to make absolutely sure you aren't subsidy- or Medicaid- eligible on HealthSherpa.com (there are other ways to get Medicaid, e.g. if you are pregnant or have certain conditions - the specifics vary by state).

If you are in the so-called Medicaid Gap (non-expansion state, income below 100% of FPL, no other Medicaid eligibility), check if your county has a program - e.g. Harris County in TX which includes Houston covers people in the Medicaid Gap through a separate program. You can also read this article on low cost / no cost health care: https://www.healthsherpa.com/blog/free-or-low-cost-medical-care/.

Big picture the Medicaid Gap is a big problem, was never supposed to happen, and is something we hope will be addressed in a bipartisan evolution/improvement/revision to the ACA.

Great thank you for this info. Would you be able to tell me what happens if I am on medicaid, and then I start working again?

What is the process there, what would happen?

(I didn't find this info on your website)

Thanks.

You'd have to report this change to your state Medicaid office immediately. Based on what that new income is, it may impact your eligibility for Medicaid. You can always run a quick quote on HealthSherpa.com to see how income impacts your overall eligibility (Medicaid or Marketplace with subsidies). The key is reporting this immediately 😉!

By immediate, do you mean the day you get hired or the day you get your first paycheck?

Unfortunately this varies by state so there's no single answer we can provide. The reason we emphasize quick reporting of income changes is to avoid having to pay back subsidies later when you file your taxes. Your best bet is to check with your state Medicaid office about what their reporting deadlines are.

Even after my reduced payment I still can't afford the cheapest plan available to me. I make too much for medicaid but between rent, student loans, credit card debt and bills I just can't afford it. In the last two years I have only been to my therapist once a month. I feel like I have no choice but to be uninsured. Are there other options I am not aware of?

First off, here's a resource that may be useful: https://www.healthsherpa.com/blog/free-or-low-cost-medical-care/

With respect to other options, IMHO there are no other options that are worth your money. People will try to sell you a lot of things (e.g. short term insurance, hospital indemnity, health care sharing ministries, critical illness aka "cash cancer", etc) but all of that is inadequate coverage designed to make the insurer / broker money that doesn't cover you when you need it most. The two most popular you may hear about are short term and Christian Health Care Sharing Ministries, so here's some more detail on that.

Big disclaimer: We are biased here because we only sell what we consider to be real health insurance - ACA plans that have to cover pre-existing conditions, hospitalization, prescription, doctor visits, etc. We're also biased because when people have bad experiences with this other stuff we end up having to try to clean up the mess and get them real coverage.

SHORT TERM

Short term doesn't cover prescriptions, pre-existing conditions, or pregnancy/maternity. They do something called, “underwriting at the time of claim” where they wait until you try to use the insurance to find a reason to deny you. Like when you're sitting in the hospital. California has banned them completely. Probably better than nothing if you can’t afford real health insurance, but caveat emptor. Some insurance agents love them and will recommend them because they pay 25-30% commissions (vs ~2% for ACA plans, if they pay commissions at all).

CHRISTIAN HEALTH CARE SHARING MINISTRIES

Christian health care sharing ministries are big business masquerading as religion. They are basically unregulated - aren’t required to cover everything, aren’t audited to make sure they have enough money to pay claims, and there are a LOT of loopholes that can result in coverage being denied. Here’s an example from the actual T&C of one of these organizations:

F. Pregnancies of Unwed Mothers

Members agree that sex should be exclusively within Biblical Christian Marriage. Thus, maternity medical expenses for newborns conceived outside of marriage are ineligible for sharing.

That's just an example, God forbid you get sick doing something immoral, they can basically deny your claim at their discretion. Interestingly, also pay 25-30% commissions to the broker.

Can you explain why my California Anthem policies' (no requested policy changes) prices have skyrocketed?

Wife in 2011: 45 years old, $205/mo.

Wife in 2018: 53 years old, $623/mo.

Daughter in 2011: 6 years old, $86/mo.

Daughter in 2018: 13 years old, $187/mo.

Eye-watering. I'm a self-employed, disabled vet consulting in Health Care IT. My take is that the insurance companies are using those of us who can pay to cover those who can't, plus to keep their profits high, using Obamacare's required coverages as their excuse when the state regulators come knocking. I figure if I am going to get taxed to help the underinsured, I'd prefer a private entity not take a cut.

Do you have a better explanation than normal aging tables and a few extra minimum coverages that are well below the actual price of those services (doesn't even cover the HPV vac)?

In short, the plans now cover more, and they are covering more sick people, with no cap on lifetime payouts and no premium adjustments based on health status (underwriting). Insurer profits aren’t the culprit here because the ACA actually caps them by law (we're not saying insurer profits are good thing, just not to blame for this particular increase). The fundamental issue is that healthcare in the US is insanely expensive - healthcare costs more than 17% of GDP, which is nearly double the percentage spent by the rest of the world. Most people don’t have to directly pay for it, because it’s either covered by their employer or the government (Medicare, Medicaid, Tricare/VA). Those who bear the full brunt of healthcare costs (buy their own insurance, don’t qualify for a subsidy) see eye-wateringly high premiums - like “buy a new economy car every year” high.

I guess I see the opposite, my health insurance covers less and costs more. Every single person I talk to has the same problem where it is actually a thought of us 20 year old's drop all healthcare entirely.

You are probably seeing higher copays and deductibles which has definitely happened. By "covers more" I mean covers ALL pre-existing conditions, no lifetime limits on payouts (used to be a huge problem for NICU babies who would cost $1-$2m at birth and basically be capped out for life with that insurer), has to cover medically necessary prescriptions, has to provide free preventative care, etc etc.

To your point about young people though - the ACA capped the ratio of how much a 64 yr old pays to what a 21 yr old pays at 3 to 1 (so 64 yr old can pay max 3x what a 21 yr old does). Pre ACA that ratio was anywhere from 5 to 1 to 11 to 1, so its true that young people are being asked to pay disproportionately more to cover old people than they used to.

The issue is that the law doesn't require hospitals to offer fair prices and insurance companies are doing very little to negotiate lower prices.

It could be fixed, but when the controlling party is only interested in full repeal of the law, this is what we are left with. The only chance anyone has currently is if the state passes price controls.

Such as in New York, they passed a bill that stops hospitals from charging out of network prices for individuals working in the hospital for any kind of emergency service. https://www.dfs.ny.gov/consumer/hprotection.htm A start, but even in new york, more is needed.

Agree. Part of the reason insurance companies are not incentivized to negotiate lower rates is because under the ACA their overhead is capped at a percentage of premiums received - but the bigger the pie, the bigger their slice, so why fight to keep the pie small? There's obviously a lot more going on (see answer to why healthcare is so expensive) but the reasons you mention are definitely part of it.

To your second point re emergency services, a certain private equity company bought some failing hospitals and "turned them around" by canceling all their insurance contracts and charging full price for emergency services. This is a great example of where mixing healthcare and profits gets messy and expensive.

So the government allowed them a percentage? No wonder why the insurance has risen nearly 400 dollars per month for near poverty level people after ACA subsidy.

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To clarify: After all subsidy used.

Price in 2016: 150/month

Price in 2018: 450/month

Yes - insurers have to spend at least 80 cents on the dollar on actual treatment for insureds. If they spend less they have to refund the money to members. Put another way, insurers can use 20 cents on the dollar for operating and administrative expenses, marketing, and profits. The more dollars overall, the more they get to keep.

To your second point, there are a lot of factors at play there, including which insurers are in the market, what plans they are offering, etc. Of note - there's a built in protection in the ACA. If you qualify for a subsidy, the second cheapest silver plan available to you has to cost less than 10% of your income, and the APTC has to make up the rest. 10% is a big chunk, but without that cap it would be even worse.

Why is it so expensive?

That is a very complicated question, and one we're not particularly qualified to answer. At a high level, there are a number of factors - here's a partial list in no particular order:

- defensive medicine

- lack of rationing

- lots of choice/options

- pharmaceutical prices

- malpractice lawsuits

- most people don't pay for healthcare directly

- complex, convoluted, broken billing system

- massive waste in the system

- the American diet

- private companies wanting to make profit

- US doctors get paid a lot relative to other countries

The list goes on and on. Much of the debate about why US healthcare is so expensive is centered around what should be on this list, and how much each item on this list matters relative to the others. This is one of the biggest problems this country faces right now - nearly $1 of every $5 of GDP goes to health care and that share is growing faster than the economy. Sorry we can't provide a better answer.

Also, age rating. The older you get, the potential for more costly health incidences go up. Working in healthcare/med communications for 20 years. Pharma, insurance co, associations.

ACA actually capped the age rating at 64 yr old pays max 3x what a 21 yr old pays. Before ACA that was anywhere from 5 times more to 11 times more depending on state.

Why should I use HealthSherpa instead of going through HealthCare.gov?

We show all the same plans, at the same prices, and don’t bias our sorting or recommendations in any way. We focus on providing better customer service, and expert assistance year round if you have questions, need to make changes, or would like help using your coverage. So you get everything you get on Healthcare.gov, plus these people ready to help: https://www.youtube.com/watch?v=xB7HrDusl8E (that's our actual team, not paid actors). Basically whenever you need help, we're here for you.

Can you try to convince other people in your industry to stop using robocalls? 2 months at the end of every year getting unsolicited phone calls about somthing that doesnt apply to me is a huge waste of time and really puts a bad taste in my mouth regarding the whole industry.

We would if we could, believe me - we get those too and hate them. Also, they make everyone in the industry look bad. They are already technically not allowed, but the problem is that they are basically untraceable. The good news is there might actually be legislation in the works that can fix this, which would require calls to be authenticated by phone carriers and could address this issue. We feel your pain.

Do you support moving to a single payer system, why or why not? Thank you for your time here today.

That question is about 100 levels over our pay grade, but on the face of it, yes. Single payer, properly done, has a decent track record in other developed countries and could fix a lot of the cost & access issues with the US healthcare system today. Whether it's politically feasible we don't know. Also, trick question: what country has the largest single payer system in the world? It's the US, with Medicare.

Also, trick question: what country has the largest single payer system in the world? It's the US, with Medicare.

Largest using what? Cost? Coverage? Impact?

Genuinely curious

Cost (dollars spent). Should have been clearer about that!

When my employer offered health insurance I paid thousands of dollars per year and never used it. Now that my employer doesn't offer it, why bother?

Aren't plans still expensive? Is there still a fine for not having it, and if so, is the fine less than if I had to pay for coverage?

Yes, plans are expensive - health insurance is expensive because health care in the US is insanely expensive. That is also the reason to have health insurance - if you don't, and you end up getting sick or in an accident, there's a decent chance the bills will bankrupt you. If you are below 400% of the so-called federal poverty level (about $50k for a single person, $100k for a family of four), you may qualify for assistance paying for coverage if you aren't offered coverage through your job any more. There's a quick anonymous calculator on our site www.healthsherpa.com that should help you figure out if you qualify. If you don't qualify for assistance, the cost of real health insurance can be eye-wateringly high, and unfortunately, there's no easy fix or quick workaround, whatever people tell you.

How much you pay for a plan through the ACA Marketplace depends on your income - if you're under a certain threshold, plans can be very affordable, so it's always worth checking. (Half the people we've enrolled this year have gotten a comprehensive plan for $31/month or less!)

There is no fine on the national level, but certain states (MA, NJ, DC) have passed state-level penalties, so you may pay a fine for going without coverage in those states. The fine varies state-to-state and based on criteria like income and household size.

Half the people we've enrolled this year have gotten a comprehensive plan for $31/month or less

This percentage is high because most of the people that sign up get subsidies (that's why they sign up). It's almost $500/month just for me for a crappy plan.

This is definitely true. People who qualify for the subsidies are getting really affordable coverage as stated above. But individual coverage is very expensive for those who don't qualify for subsidies. This is a function of the underlying cost of health care and not something to do with the ACA per se. Big picture, affordability for the middle class is one of the major things that could be addressed through a moderate, bipartisan update to the ACA. Medicare is pretty affordable, even though seniors incur a lot more health care costs than people under 65, generally speaking. Medicare also needed several rounds of legislative revision to get to where it is, and it's reasonable for ACA to undergo the same evolution. Unfortunately that doesn't provide much relief to people like you looking at high premiums now. One word of advice - don't fall for the scammy stuff out there that bills itself as "alternatives" to ACA coverage - it won't cover you when you actually need it.

What happens if I don't enroll by December 15th?

If you miss the Open Enrollment deadline for your state* you may have to wait until next fall to sign up, unless you have a qualifying life event (for example your income changes and makes you eligible for financial assistance - full list here https://www.healthsherpa.com/qualifying-life-events/)

Depending on your state, if your income is below a certain threshold OR you meet certain criteria (e.g. low-income and pregnant/have a disability) you may be eligible for Medicaid, which you can enroll in year-round.

• Some states have extended deadlines; you can check here: https://www.healthsherpa.com/blog/your-quick-guide-to-the-2019-open-enrollment-period/

What's the reasoning behind these hard dates?

Under the ACA, insurers have to cover pre-existing conditions. If you could sign up any time during the year, people would just wait until they get sick to buy health insurance, which would wipe out the insurance companies. That's the logic behind open enrollment/those dates.

My bronze plan for family (me and my 21 y/o son) will be $725/mo ($8700) for 2019.

I pay this in all after tax dollars.

Will I get any tax breaks when I file my income taxes?

The subsidy is actually paid out monthly directly to the insurance company, reducing your monthly bill IF you qualify. For a household of two, basic criteria are total household income below $66k (both you and your son), and no eligibility for job-based health insurance or Tricare/VA. There's a quick anonymous calculator on our site https://www.healthsherpa.com you can use on our site to check what you may qualify for - happy to answer followups.

$200 was the most I could afford, that used to get me Silver with Kaiser and I was getting something like $75 in assistance. Now the minimum is $300 for Bronze and I don't qualify for assistance. What do you do when the min. is more than you can afford? My current goals are either a new higher paying job with benefits of some sort of program/career that takes me to a country with healthcare.

That's tough - I think it's wise to look for a job with benefits, which may or may not be possible depending on your circumstances (not everyone is that fortunate!). Most employer coverage is at least equivalent to a silver plan, and you aren't taxed on the employer health insurance, so when you do the math getting health insurance through your job is a really good deal and can be worth $5k or more in salary. Note that other countries with universal healthcare typically have some qualifications you have to meet to access that care - some of our team members are dual citizens and pointed this out.

I use to pay $150 a month until last year when the same coverage jumped up to $600 a month (Which is way out of my means.) with no change in my yearly income. So first I'm wondering why, and if there is an alternative?

Was this for on-exchange/ACA coverage? It could be that you were right near an income cutoff, or that the insurers in your area changed dramatically in which case there may be other cheaper plans now available. That big a jump doesn't make sense except in a few limited cases, we suggest you run through the wizard on www.healthsherpa.com and if you are still seeing that big a difference either PM us or give us a call at (855) 772-2663 and we'll try to get to the bottom of it.

If I am on the cusp of making too much money to qualify for subsidies, will anything be considered or will they just say I don’t qualify if I’m over by a couple hundred dollarS?

Tax credits are reconciled when you file your taxes, so anything that goes on your taxes counts. If you end up over the limit you'll be asked to repay the subsidy. Being right on the threshold can be a little tricky, give us a call if you'd like to discuss the specifics of your situation at (855) 772-2663.

Maybe this is more of an ELI5 question, but why are there even deadlines? What if someone lost their job the day after the deadline closed and they were previously on insurance with their job they lost? Would they be fucked?

And finally my choir-preaching question: why don’t we just have fucking universal healthcare?

Why deadlines exist: Under the ACA, insurers can't deny you coverage or charge you more based on pre-existing conditions. That means that if you could sign up any time, folks would only sign up when they got sick, which would lead to insurance companies going under. That's why we have a set "open enrollment" period.

If you lose your job and therefore health insurance, you get a "special enrollment" period - a special window to enroll outside the regular window. Complicated, we know.

To your final question: because, reasons.

I just finished an engineering degree and live with my parents while job searching. Otherwise not employed. How do I guess my income? Should I go for Medicaid until I find a job with insurance? 30 in Texas. I've been uninsured the last 5 years.

Tricky because TX didn't expand Medicaid to lower income adults. If you are in Harris County check out Harris Health: https://www.harrishealth.org/access-care/patient-eligibility

Can also apply using when you think you'll get a job and estimate partial-year income that way. Just remember to update that information when you do get a job / cancel the coverage if your new employer has health insurance. You may also be asked for proof of income which is tricky if you don't have recent pay stubs. If you can work part-time while job-searching that will help.

Can you please tell the robot lady to stop calling me? I already have work provided insurance.

Clear /s

We'll let her know but she still hasn't processed our request to get off the list

Me and my wife will be out of the country for 3 to 4 months starting in january so i stopped my insurance for now. Will i be able to reapply once we are back in us soil? Thanks

If you are able to supply documentation showing that you moved back to the US from outside the country you'll qualify for a 60-day window to enroll when you get back - see here for details: https://www.healthsherpa.com/blog/what-is-special-enrollment-period-sep/ and let us know if you have followup questions.

I know someone who is 16 and their father won't sign them up for health insurance on account of being too lazy. Seriously. Is there anything they can do?

Sorry to hear that - unfortunately this person will need an adult to apply on behalf of the tax household.

I’ve been debating if I should keep my bronze level plan or to go silver, since I qualify for a CSR. It doesn’t seem like my health care costs would justify paying so high of a premium, however. So seeing you here was a happy accident! The low-medium-high use chart always confused me, but your website tells me that low use includes zero doctor visits... zero prescriptions... zero all the way. Is that really what you use to do the math, zero doctor visits? With medium being one and high two?

We strongly recommend people who qualify for CSR choose silver, because it basically is a second subsidy that covers your copays. More than 70% of the enrollments we do are silver because of CSR eligibility. There are three tiers of CSR eligibility, and at the two higher tiers (CSR 94/CSR 87), you are basically getting a platinum plan for the cost of a silver plan. Can explain how that works if of interest, it gets a little technical.

Low usage typically means zero doctor visits outside of preventative care (e.g. annual checkup, or mammograms) which are covered by all plans with no cost sharing (its an ACA requirement).

Just turned 20, college student working a part time job. Parents are currently unemployed, and in Wisconsin we fall off parents healthcare at 19. Currently at my job I make about $30 more than the Medicaid requirement. Checked out aca plans but are unaffordable with current expenses, any suggestions?

Not sure where in Wisconsin you are but if you make less than $20k a year you should have ACA plan options that are $0 a month after the government subsidy, meaning no monthly premium, though deductibles may be high. You may have to file taxes separately from your parents, though if they have no income they should be Medicaid eligible, and your whole household might be Medicaid eligible if you are the only income. You can test out scenarios (filing with them / separately) using the anonymous calculator on our site www.healthsherpa.com.

I have a history of cancer, heart issues, and I’m in the process of being diagnosed with PTSD from childhood trauma (so lots and lots and lots of therapy). I make 46,000 a year, own a home, and have about 1600$ a month in bills (including the mortgage) and I have no idea what plan would be best for me.

What should I be looking for to ensure I get the best quality of care?

It sounds like you have fairly high health care utilization, which is not a problem because the ACA is designed to protect people in your situation. So-called QHPs (qualified health plans) - what is sold on the exchange - have to cover all of the Essential Health Benefits, which include everything you've listed and then some. The big differences between the plans will be:

- what doctors and hospitals are covered

- monthly premium cost

- deductibles/copays

We have an anonymous recommendation engine on our site www.healthsherpa.com which you can use to specify your expected level of utilization and see what doctors are covered by each plan and what the various copays and deductibles are - if you want to see that just visit the site and follow the steps.

Thank you. I used the search for my providers on the WAhealthplanfinder site and none of them are covered under available plans ):

Hoping your engine tells me different news

Unfortunately we're going to have the same information as WAhealthplanfinder - that's the official state exchange and generally the go-to place for WA residents. What you can do is call your doctors and ask them which on-exchange plans they accept - the website isn't always accurate because doctors are constantly moving in and out of plan networks.

Should I look into CoveredCA if I live in California for health insurance?

Yes! If you don't get insurance from your job, parents or a program like Tricare covered CA is the way to go

Your website says that you are based in San Francisco but in /r/sacramento you say you are a Sacramento startup. Did you relocate? Also, do you have any open positions that are remote or in SF?

We have offices in both SF and Sac. ~80% of us are in Sacramento, but we have openings in both offices and yes, plenty of folks who work remote too. Drop us a line at [[email protected]](mailto:[email protected]) with your info/interests and we'll folllow up.

We are using the Cobra bridge strategy. The 2 months will end on Jan 31. Can we apply for insurance then?

If I understand your question correctly, the answer is no. If by COBRA bridge strategy you mean waiting to see if you need it and then retroactively signing up for COBRA during the window when you're allowed to do that, if you wait until Jan 31 then COBRA will be your only option as you won't have a so-called "Qualifying Life Event" (see here: https://www.healthsherpa.com/blog/what-is-considered-a-qualifying-life-event/) that would enable you to sign up for individual health insurance coverage through us or Healthcare.gov.

Thanks.

More...

New job in Jan. Company insurance doesn't kick in until March. So we'll have that 1 month gap.

What to do?

ACA coverage with subsidy (if eligible) from January through March. Make sure to cancel ACA coverage when employer insurance kicks in because a) you don't want to keep paying for it, and b) you can't get a subsidy while having access to employer insurance. ACA coverage you can get through us (www.healthsherpa.com) or Healthcare.gov, same plans, same prices only difference is we aim for better customer experience & support.

I am a minimally employed part timer who wants to avoid any kind of communication or fines with the government. What is the bare minimum I can pay for the minimal amount of effort while maintaining my distance and any interaction with the vulturous agents of capitalism?
I'm just trying to avoid fines and/or bill collecting leaches.

There's no federal fine any more for not having insurance. The states of NJ, MA & DC have penalties for not having insurance if you happen to live in one of those three states.

If you decide that you do want to have some level of health insurance coverage, you can see what plans are available using the anonymous shopping tool on our site (www.healthsherpa.com) and if you sort by price that will put the cheapest plans up top. Hope that helps.

How does household income work? There are four people that live in my house:

My grandfather who is on social security. My brother who is unemployed. Myself with a full time job and a full time student. My girlfriend with a part time job and a half time student.

When I apply do I claim everyone in the households income even though we don’t share money with each other?

This is determined by how you file taxes. If each of you files your own taxes, you are separate "tax households" and each tax household applies separately. If any of you claim the others as dependents on your taxes, then those people would be in the same tax household and apply together.

Where can I find the best information about Dental and Vision coverage in my state(Georgia)?

We focus on ACA health insurance so don't offer dental and vision on our site but you can either call us at (855) 772-2663 for help or check out plans directly from the insurers on the following sites:

Blue Cross Blue Shield of Georgia (Dental, Vision) https://www.bcbsga.com/

Humana (Dental) www.humana.com

VSP (Vision) www.vsp.com

​

What will you guys do if I refuse to get health insurance?

We will do nothing except wish you health and happiness!

Kind of an odd question but will I have to pay back any amount of my subsidy that was used for health insurance (when it's time to file taxes) if I fell below the federal poverty line yet still received the tax credit?

Not an odd question, this comes up a lot. There are limits to how much you have to pay back based on your income, see the table at the bottom of this page: https://www.irs.gov/affordable-care-act/individuals-and-families/premium-tax-credit-claiming-the-credit-and-reconciling-advance-credit-payments.

Note that when you apply, you may be asked for proof of income if your anticipated income is substantially different from what the IRS has on file for you.

Thanks so much for the speedy reply!

Sadly I forgot to ask another question that came to mind slightly similar to the one posted before.

Here's my situation:

My partner filled out an application with Healthcare.gov for both of us (I'm listed as their dependent), we paid our premiums, all is good!

But here's where I'm left a bit worried. If I start working to where I'm no longer deemed a dependent due to acquiring income, what will happen to my coverage?

Will my plan be terminated? Will I have to pay full price for my premium? Etc. I really don't want employment to be a hindrance in keeping my plan.

See "Losing Coverage Through a Family Member" here (I know you may not be related, but this applies to all dependents): https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

You may qualify for a Special Enrollment Period if you lose qualifying health coverage you had through a parent, spouse, or other family member. This might happen if:

- You lose health coverage through a parent or guardian because you’re no longer a dependent.

So when you lose dependent status you will have a Special Enrollment Period to enroll yourself. Your partner will also have to update their application to remove you at that time. If you are in a state that expanded Medicaid, you may qualify for Medicaid. If you are in a state that did not expand Medicaid, if your income is below $12,000 or so, the scenario I responded too earlier applies where you may be asked for proof of income when applying.

I make too much money to get health insurance for free, but as I live in California, all my money goes to rent. The maximum fine for not having health insurance is not even half what having the worst health insurance costs which only helps me if I am saved from death and will be in debt for my whole life.

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Why would I go into debt so I can avoid going into debt when I need a doctor maybe once every 5 years? Even when I was in a motorcycle accident the whole thing was just retarded and I am still in pain so it feels like I should have just died.

There is no fine for not having health insurance anymore - Congress got rid of it. I would double check with CoveredCA (https://www.coveredca.com/) to see if you qualify for either Medi-Cal or a subsidy, and if a subsidy, exactly what your options are this year.

EDIT: NJ, MA and DC have passed state-level penalties, so if you live in those states, you may have to pay a fine for going without coverage - but you're fine in CA.

I am lost on what to do. When I got a letter stating that Medicaid was changing to medallion I called and updated my info and still have not received new insurance cards. Nor has my information truly been updated. Do I make changes through the health place market? Through kaiser? Through Medicaid? Can you point me in a better direction? I’m afraid my son will lose coverage because I don’t know who to contact.

Based on you mentioning Medallion I think you are in Virginia. You should be contacting the state Medicaid/CHIP office. For Virginia, here's their contact info: https://www.insurekidsnow.gov/coverage/va/index.html

What's the fee like this year if you don't have insurance?

There's no penalty any more for not having insurance unless you are in MA, NJ or DC

I have health coverage at work but I can’t afford to cover my husband. I can afford me and the kids barely. Can he buy insurance on the marketplace and qualify for a subsidy based on what he can afford on his income?

Unfortunately no because the IRS has a bad rule that says that if the cheapest plan for just you is "affordable" then all of you have access to "affordable" insurance (obviously not true) and don't qualify for subsidies. Sorry to be the bearer of bad news, more detail here: https://www.healthcare.gov/glossary/affordable-coverage/

I’m worried about using the subsidy because I got screwed on it the first year it was available. (Only took part of the subsidy and ended up having to pay everything back. Also the only year we used the HC marketplace because of circumstances.)

Right now it’s saying we’d get $X amount off and it would actually be affordable and I think I’ve overestimated the taxable income for this next year, but I don’t want a huge tax bill. Biggest thing that’s changed since the first year is added a dependent.

Any help on how these subsidies work so I don’t get screwed?

Edit: we also moved states so I am wondering if that changes things.

Why did you have to pay it back? Did your income come back too high/too low that year? Did someone in the household have insurance available through their job, or another program like Medicare, Medicaid, or Tricare? Were you married but didn't file taxes jointly? Those three are the major disqualifiers I can think of right now though there are some others. Note that adding a dependent will likely increase your subsidy all else equal, and depending on household income the dependent may be eligible for CHIP. The anonymous tool on our site www.healthsherpa.com is designed to automatically calculate all that based on where you live and your general household info, and the application itself on the site is government-approved and screens for all the disqualifiers that could get you in trouble. Happy to answer any followups.

I've been thinking to leave my current job, would I still be able to sign up post-deadline due to a significant life event? Do I have better options than private insurance? (relocating to nyc, even catastrophic insurance is ~$2k/month)

Yes, if you leave your job and lose coverage as a result, you will have a special enrollment period during which you can sign up outside the normal window. If your new job doesn't provide health insurance, you can check for eligibility for other programs by visiting the NY State of Health website (https://nystateofhealth.ny.gov/). Eligibility is typically based off income and household composition, so if you are young and relatively well paid you likely won't qualify for assistance.

NYC is an expensive place to buy your own health insurance because of the triple whammy of:

1. subsidies being based off the uniform federal poverty level (making $50k a year means very different things in different parts of the country).

2. The presence of very good but also very expensive hospitals

3. The flat age curve (meaning a 21yr old pays the same for private insurance as a 64 yr old - good for 64 yr olds, not so good if under ~45).

My dad still claims me on his taxes from last year but im uninsured because my CHIP expired, if I'm claimed can i still apply for medicaid? Im a college student btw with no steady source of income

What matters is whether he claims you on his taxes next year (2019). If he does, then total household income (including his) will factor into your eligibility determination. If he does not, and your state has expanded Medicaid, then you may qualify for Medicaid. You can review your options under both scenarios (claimed / not claimed) using the anonymous screener on our site at www.healthsherpa.com. Note that if he has job insurance that you are eligible for it will affect your eligibility for certain programs.

Thank you very much. He does have job insurance but said he wont put me on it unless i can pay my own copays and I cant since they're expensive. He claims me as a dependent even though he doesn't support me in any way financially it makes all of this very stressful. I appreciate the quick response!

If you are an adult, under 21, and live in a state that has expanded Medicaid to cover low income adults, you may be financially better off filing your own taxes if he does not provide any financial support. If you are over 21, it is possible that he can claim you as a dependent and not affect your Medicaid eligibility: https://ttlc.intuit.com/questions/2581508-claiming-parent-who-receives-medicaid-as-dependant

How are monthly prices determined? I went to determine which plan was best suited for me, and it asked for an estimate of my 2019 salary. So the cost of my plan doesn't get based on the already filed (2017) tax year or the almost over (2018) tax year, but on the not already begun (2019) tax year?

That is correct, it is based on your anticipated income next year - this is a major source of confusion for people. Next year, as your income changes, you should come back and "report a life change" (really easy to do on the site) which will adjust your subsidy accordingly. This ensures that you do not owe subsidies back at the end of the year.

Thanks for answering so many questions! Here’s mine:

My mother has Medicare early because she’s disabled with COPD. She’s terminal with ~6-10 months. We live in Washington state and I can’t find any kind of medigap coverage for her since she’s under 65.... is there any other way I can help support her?

Thanks again!

First of all, I'm sorry to hear that. If her income is low, you may wish to contact Apple Health (the state of WA's Medicaid program) to see if she is a dual eligible (eligible for both Medicaid and Medicare). See https://www.hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage/aged-blind-or-disabled

If I turn 26 sometime next year, do I need to get insurance now, at my birthday, or starting 2020?

See this response to another person turning 26: https://www.reddit.com/r/IAmA/comments/a5ke83/this_saturday_is_the_deadline_to_get_health/ebob57p. Happy to answer any followups

My family was on Medicaid this past year. My wife was listed as disabled May 2018. Social Security says she can't get Medicaid until May 2020. I am 57 yr old male who had prostrate cancer a couple of years ago. Wife 56 yr old (still has with undiagnosed neurological problems) Youngest child is a senior at college who plays on a sports team. The college has offered to pay her health insurance till the end of the school year. She has a job with great benefits when she graduates. But, given my projected (hopefully low) self-employed income and wife's benefits, the state will subsidize our three person family coverage to about $1,500 for the upcoming year. Two-person $0.

I don't think it will be a problem if I make a little more on my projected income, but will we lose the subsidy if my daughter graduates and joins her new company's health plan? The company is on the opposite coast if that makes a difference. Any other advice is greatly appreciated.

Generally speaking, this depends on what state you are in, as it sounds like you will be Medicaid eligible and Medicaid is primarily a state program with some federal funding. If your wife is receiving Social Security Disability Insurance (SSDI) benefits, after 24 months she will be Medicare eligible, though she may also be Medicaid eligible (confusing I know).

If your daughter graduates and gets a job, she should definitely get on the employer coverage if it is comprehensive (meaning ACA compliant) and may wish to file her own taxes separately as a different household, in which case her income should not be factored into your eligibility, though the fact that your household will be smaller (2 people instead of 3) will have an effect. It's hard to provide specific guidance in this instance and I would recommend getting in touch with your state's Medicaid office to make sure that you are getting access to all the programs you are eligible for.

Hey HealthSherpa, Are you seriously comparing the quest to get health insurance to climbing the most storied mountain on earth? My Sherpa friends are skeptical, but they don’t have to deal with US healthcare. Thanks!

No we definitely are not. To be honest, we don’t like our name very much at all, as it is cultural appropriation. It was never meant to be the name of a company - we dreamt it up for what started out as a side project late one night by plugging the word “navigator” into a thesaurus. We’ve looked at changing it repeatedly over the years and each time we’ve concluded that the loss of customers and name recognition could wipe us out. We do donate to ethnic Sherpa organizations on a regular basis, however - if you or your friends know of any worthy organizations, please let us know.

My COBRA runs out this summer, do I have to enroll and pay for private coverage starting in January or can I enroll now and have private coverage kick in when my COBRA ends?

Hi! You will qualify for a Special Enrollment Period when your COBRA runs out and can enroll in Marketplace coverage then. However, Marketplace plans are often more affordable than COBRA (especially if you qualify for a subsidy!) so it's worth checking out your options - you could save a lot by switching to Marketplace now rather than waiting.

More information on special enrollment periods here: https://www.healthsherpa.com/blog/what-is-special-enrollment-period-sep/

Cool! Thanks for the info, this is all super confusing but this helps a lot. Ive re-enrolled in my COBRA just for simplicity sake, but now I am finding plans on your site that are cheaper and have similar coverage, can I just quit my COBRA enrollment?

You certainly can cancel COBRA and enroll in Marketplace coverage before Saturday. A couple things to keep in mind:

1. Make sure the Marketplace coverage covers all your doctors (or if it doesn't whether the price makes up for it).
2. Any progress on deductibles will be lost (not an issue right now because typically since most deductibles reset annually in January).
3. Switching from COBRA to Marketplace makes the most sense since if you qualify for a subsidy, and/or are looking for a lower level (cheaper) of coverage than your employer plan.

Feel free to follow up here or give us a call at (855) 772-2663 with any further questions.

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It depends on the insurer, but many of them wait to run all the payments after open enrollment ends (so between Dec 15 and Dec 31). If they haven't charged you by early next week you can give us a call and we can log in to the system, check your payment status, and confirm everything is good to go. We're at (855) 772-2663. Generally speaking, the deadline is January 1, which is when the coverage takes effect, but various insurance companies will give people up to 30 days grace period after that.

My company offers health insurance and i pay ~$700/month pre tax for a HSA. According to HealthSherpa i could be paying closer to $200/month for an EPO. Should i make the switch or am i ultimately better off with the employer provided insurance? No health concerns or prescriptions at the moment.

If your employer offers health insurance then unfortunately you don't qualify for a subsidy, meaning you'll have to pay full price for that EPO. Generally speaking, if you have employer insurance, you should be on that, not individual coverage through us / the Marketplace.

I recently found out that I can't recieve health insurance at my job unless you work an average of 30 hours a week for a 6 month period. I will be falling off my parents insurance in January. I have been working 30 hours a week or more but dont qualify for insurance as of yet. My income right now is about 1300 a month. What insurance is available to me until I can get health insurance through my workplace?

SenpaiShane

Hi! This is a really common situation - what state are you in? In certain states, you may be eligible for Medicaid; in others, you'll likely qualify for subsidized coverage through the ACA Marketplace. We have an anonymous calculator on our site www.healthsherpa.com which can help you determine which scenario applies to you!

Thanks for the quick reply! I'm in Oklahoma.

Ah, OK. Oklahoma has not expanded Medicaid, but you may qualify for subsidized coverage through the Marketplace! (This will depend on your total household income - i.e. anyone you're filing taxes with, even if they're not getting coverage.)

The deadline for Oklahoma is Dec 15, this Saturday, so I'd advise you to check this out ASAP! If you need help: (855) 772-2663

I appreciate all your help, it really is stressful thinking about all of this. I took the anonymous calculator and it said a Blue Cross and Blue Shield plan that had a monthly premium price of 0 dollars. How does that work? Does it mean I dont pay anything a month? I know that is unlikely. Also I wasnt sure about the average amount of care that I thought I needed. I dont plan on going to the doctor or any of that I havent been to the doctor at all in 2018 but if it happens I would still like the coverage. I included a imgur link to the screenshot of the plan it offered me. https://imgur.com/U9OVXwL

You should definitely sign up for that plan or another like it on our site or on Healthcare.gov. You are right in the sweet spot and qualify for both the subsidy (so you pay $0 a month) and something called Cost Sharing Reduction which reduces your copays and deductibles. That right there is the best case scenario.

Since your screenshot includes a specific plan from a specific insurer for compliance reasons here's a link to my OK license: https://www.healthsherpa.com/insurance_licenses. Feel free to PM or call (855) 772-2663 with questions.

How do I, living in America, and not making anywhere near enough to pay for health insurance, hope to ever not have to go into crippling debt for say, breaking a bone?

Use the anonymous calculator on our site www.healthsherpa.com to see if you qualify for either:

1. Medicaid - basically free.
2. A subsidy - this is where the govt pays some or all of your monthly bill. This can actually cover the full cost - according to the nonprofit KFF, "Over half (52%) of the 4.2M uninsured people in the U.S. could get a free ACA bronze plan after tax credits" (source: https://www.kff.org/health-reform/issue-brief/how-many-of-the-uninsured-can-purchase-a-marketplace-plan-for-free/).

Worth checking for those two. If you don't qualify for either, here is some info on finding low-cost / no-cost healthcare: https://www.healthsherpa.com/blog/free-or-low-cost-medical-care/. Hope that helps.

u/cat_supports_the_ACA I enrolled and the site says my state’s health department will contact me. Am I done with the healthcare website side?

As long as you have the official "eligibility result" letter saying that (it's a PDF that says "Health Insurance Marketplace" in the top left) you are in good shape for now. You should hear from the state in 2-6 weeks (states can be slow), but if you don't hear from them by mid-January give them a call (or call us if you need help figuring out where to call - we're at 855-772-2663).

What does Vlade Divac has do to with this?

Says the guy who averaged like 2ppg

For real though you had us all cracking up no idea how that profile pic got there

I think I missed the boat here, but I’ll ask anyways. I am still under the 60 day period after losing my employers health coverage until the 13th, but would I still be able to get coverage under the open enrollment period until the 15th?

Yes you can enroll during open enrollment (through the 15th) for coverage effective Jan 1 regardless of when your other coverage expired.

My wife does not have health insurance provided through her employer(starting to be a substitute teacher). She attended university full time this year and will most likely be claiming only a few hundred for income this year...likely less than 10k next.

I will make approximately 75k next year. We live in Louisiana. If we file taxes separately can she get better rates? Does she have to claim any or all of my income? All the plans that wouldn't be ridiculously financially stressful are pretty terrible compared to any health insurance offered by any of my past employers. Getting her insurance through my current employer would cost roughly $550 to $600 a month(I only pay $30 roughly). It's an excellent plan with a max $500 deductible, low copays on all of the typical stuff, and max out of pocket of $1500 I believe. Would we better off just biting the bullet and getting it?

To qualify for the subsidy (formally called the APTC), married couples have to file jointly. You can use the anonymous calculator on our site www.healthsherpa.com to check if there's a full price individual market plan that is cheaper based on her age / where you live, but honestly sounds like your best bet is to bite the bullet and enroll her in your employer coverage.

I make too much to qualify for state insurance for my 18 month old daughter but not enough to easily offset the 88 dollars a WEEK, insurance through my employer would cost me. Are there any more affordable options out there or is that a fairly standard rate?

If I'm understanding your situation correctly you have employer insurance, but your daughter doesn't qualify for CHIP based on your income, and the cost of adding your daughter to your employer insurance is $88 per week. Depending on where you live you may be able to find a child-only plan for less than ~$350 a month, which seems really high unless you are some place like NYC. For child-only plans, there's a technical limitation that requires you to enroll through Healthcare.gov or your state exchange, though you can still see what plans would cost using the anonymous calculator on our site (www.healthsherpa.com). Happy to answer follow up questions.

What do I need to know if I turn 26 next year and will be moving off my parents' insurance?

Do I lose coverage on my birthday? Do I need to be signed up for coverage in advance? If so, do I need to do that by this deadline?

Reorganized your questions a bit:

Do I lose coverage on my birthday?

When exactly you lose coverage depends on your parents' insurance. Have them check with the Human Resources department at their work to determine when you lose coverage - common dates will be the day of your birthday, or the last day of the month of your birthday.

Do I need to be signed up for coverage in advance?

Technically you have a window after that but better to sign up before it ends so you don't have a lapse in coverage - so your new health insurance starts right after your old insurance ends.

If so, do I need to do that by this deadline?

No - losing that coverage is a Qualifying Life Event (QLE acronym alert!) which gives you a special window to enroll in coverage. More here: https://www.healthsherpa.com/blog/what-is-considered-a-qualifying-life-event/

What do I need to know if I turn 26 next year and will be moving off my parents' insurance?

About a month before your birthday, go to www.healthsherpa.com and sign up for health insurance that starts right after your old coverage ends. Note that if you've gotten a job that offers health insurance, you should just go with that instead.

Thanks for the info! I've been nervously putting finding out this info for a while.

Are there other options beyond those listed on the website that'll be worth looking into, assuming I can afford it? Or is this website more or less the resource to go to?

We show exactly the same plans at exactly the same prices as Healthcare.gov and the state exchanges, so honestly, you can go to either and get the exact same coverage. If you go through us you get the added benefit of free customer support from us.

I'd be careful going anywhere else - see https://www.reddit.com/r/IAmA/comments/a5ke83/this_saturday_is_the_deadline_to_get_health/ebnhazp for some of the tactics / products to watch out for.

You have to estimate 2019 income, what if you estimate you will make decent amount but in fact make less to the point you would qualify for medicaid?

I have read somewhere that in that case healthcare gov would charge you full price for insurance.

So if you predict to make 50k and only make 12 the obamacare will want all their tax credits back.

Is this true? If so isnt that insanely punishing?

The sense is that tax credits are given from your income taxes so if you make too little to pay taxes then tough luck and we want all money back.

Actually the amount you have to repay is limited by your income - see this publication: https://www.irs.gov/affordable-care-act/individuals-and-families/four-things-to-know-about-advance-payments-of-the-premium-tax-credit

I sent my application but haven't heard back. If I don't get approved by the 15th am I out of luck?

If you applied through HealthSherpa.com you should have an enrollment confirmation email verifying your enrollment. If you applied through Healthcare.gov then you should expect to get confirmation from the insurer of your enrollment. Either way, no need to worry - ACA plans are "guaranteed issue" meaning that they can't deny you as long as the application is submitted on time (which it sounds like it was). If you give us a call we can look up your application on either system to confirm - we're at (855) 772-2663.

I am going to be without insurance in a week. I am moving from Texas to Utah in two months, should I get Texas or Utah insurance?

Texas insurance for first two months then when you move reapply and get Utah insurance as the move qualifies you to enroll outside open enrollment (special enrollment period). Note that you must get the Texas coverage for first two months, they changed the rules about moving and now you can only get coverage after move if you had coverage before move. Obviously when you reapply tx insurance will get cancelled and you won't be paying for both. Can do all this easily on our site HealthSherpa.com or govt site healthcare.gov (same plans same prices)

I'm a young person (26F) working at a non profit making about 26K/year.

I make too much for Medicaid in Oregon, but a similar silver plan to one I used to have is available at a MUCH higher price out of pocket after subsidies (then: $57, now: $90) .

I'm in relatively good health but have recently diagnosed dietary issues, mental health needs, etc.

I see a less expensive bronze plan ($30) covers most of those appointments with no copay but needs "prior approval".

I'm wondering if this less expensive plan will prohibit me from seeing the folks I need to (on top of higher deductibles) while paying the higher monthly rate PLUS copay would really put me in a bad place for "standard" fare but better in case of an emergency ($1800 vs $6700 deductible).

Any advice?

As a general rule of thumb if you plan to use the coverage as more than just protection for a bad accident + basic preventive care get the silver plan, it will end up a lot cheaper.

My Mother died and I had to quit my job to take care of her estate, I've been unemployed since April and don't have insurance. COBRA was about 1k a month, which I opted out. I applied for assistance online but my monthly rate was about $600 for what I needed so I decided against it. I've had to relocate and will be moving soon, I'm in uni What can I do in regards to this? I dont have a steady income, but what I made in the first quarter of the year made me ineligible for any assistance, it seems.

Your options really depend on what state you are in and how much you think you'll make next year, I would run your updated general info through the anonymous screener on our site www.healthsherpa.com to see what you may qualify for this year. You can also check with your university to see if they have any affordable coverage options available.

I recently moved into an apartment with 3 other roommates and my job tells me I'm not 3ligible for their health insurance until after 10 months, what can I do when I barely make enough for rent on a minimum wage job?

Run your general information through the anonymous screener on our site www.healthsherpa.com based on making minimum wage and not having employer insurance there's a decent chance you either qualify for Medicaid or a plan with a $0 monthly premium.

I make the same money but my credit went from over 600 per month last year to under 400 this year. Any idea why? I live in TN.

Three possibilities I can think of:

1. Any changes to your household size eg divorce or a kid going off your taxes?

2. Was your income last year significantly higher than you had estimated meaning you had to pay back tax credit?

3. Tax credit is designed to make second cheapest silver plan affordable, if new insurance companies came in to market with cheap silver plans it would reduce tax credit for all plans.

I am a full time grad student. I work a few hours a week as a house cleaner. I was denied by healthcare.gov for making too little, denied by Medicaid bc my school offers insurance, but my school insurance costs $1000 per semester. I need insurance because I’m in a health related field and work with patients. Federal loans don’t cover the full cost of tuition, let alone cost of living.

TLDR: Grad student disqualified from both Medicaid and Obamacare due to income. Taking out private loans to afford shitty student health insurance @ $250 per month with a yearly income of 2K. What do I do?

Two suggestions, neither is a silver bullet: 1. Appeal Medicaid decision based on either affordability of student coverage or if the student coverage doesn't meet minimum value standard. 2. Plan to work enough next year to get a full subsidy (expected income of $12k-$16k). This will qualify you for a free (after subsidy) Obamacare plan. If for some reason you fail to reach that income level the max subsidy you would have to pay back is $300 for the year. Only do this if you are confident you can actually attain that income.

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Access Denied

You don't have permission to access "http://nystateofhealth.ny.gov/" on this server.

Reference #18.5957c817.1544653715.bc2b4a49

Ah that's not us, that's the New York ACA exchange, which we send people in NY to. They may well limit access based on IP address to people located in the US. Note that this type of filtering is only about 95% accurate, which is why we don't do it on our site. Thanks for the follow up.

I turn 26 in March, but I'm currently a student. I live in Arizona, should I just apply for AHCCCS after my birthday?

Yes, though maybe apply a little before your birthday and tell them you are losing coverage because you're turning 26. If they tell you that you make too much come to us or healthcare.gov to get a subsidized plan.