My COBRA / ACA / Medicaid Story

[jyl]

Thought I'd post about my experience with health insurance - COBRA and ACA and Medicaid.

I quit my job in February. After checking out the options under the ACA (Obamacare) I decided to stick with my existing coverage under COBRA. Set up autopay from my bank account using the employer's website. The website seemed very clunky so I started taking screenshots of the "due/paid" screens just in case. In May, they terminated my COBRA for non-payment. I called, spoke to a puzzled person who said she couldn't see why I was cancelled but I'd have to appeal. Appeal was denied with no explanation. I wrote them a letter with all the screenshots showing payment of premiums (about $4,500) and pointing out Oregon's pandemic emergency order prohibiting termination of medical coverage even for non-payment. I also filed a complaint with the Oregon state insurance office, which was then referred to the US Dept of Labor office in Seattle.

Having no family medical coverage during the pandemic is not an option, so I went to the ACA (Exchange) and tried to get coverage. The plan I selected refused to use my COBRA termination as the effective date, so I had to pay three months' back premium (back to February) plus the current month's premium to get coverage, oh and I had one day to do so or miss the window for getting ACA coverage. Ouch (that's nearly $7,000), but no choice.

I also started getting notices about my family coverage under the Oregon Health Plan, which I didn't understand. After some calls, figured out that in March the state had enrolled us in Medicaid, probably because I'd stated zero current income when I was checking out ACA options back in February, which was a true statement at the time.

A month later, my former employer contacted me, conceded that my coverage had been wrongfully terminated, and offered to reinstate COBRA. I said I didn't want to be on COBRA medical anymore, but wanted a refund of all premiums I'd paid since February, and to be reinstated to some other parts of COBRA (term life, dental, etc). They agreed to that and refunded my prior COBRA premiums.

This week I called the Oregon Health Plan to sort out the Medicaid coverage. They agreed that I had been eligible for Medicaid in February, that I am now no longer eligible due to my current income, but that the pandemic order prohibited them from ending my Medicaid coverage despite my non-eligibility. I asked if I expressly instructed them to terminate my coverage, could they then do it; the answer was yes, so that's what I did. I'm supposed to get a letter confirming withdrawal of Medicaid coverage.

This has been a big PITA.

I'm lucky because I can splash out several thousand dollars on a minute's notice and to keep records and file appeals to get my money back, and because I can afford to pay for medical coverage without any employer benefit. But for a lot of families, especially those who've lost income during this economic crash, that's not possible.

We need a better healthcare system.

[Tobra]

It became exponentially worse in March of 2010

[LWJ]

Sorry. Sounds about right. I do this for a living. It is awful.

[jyl]

Tobra, you're referring to ACA (aka Obamacare), I guess?

From the point of view of a doctor, I can definitely see that.

From the point of view of a consumer, ACA has been very helpful. I left jobs in 2015 and 2020, and both times the ACA was a lifesaver - allowed me to keep self/family covered without being yoked to an employer.

I've talked with some doctors about the percent of operating expense that they spend on medical billing and insurance claims, they've told me it is ridiculously high. I think when we look at the healthcare system, we need to find a way to get rid of 90% of that expense.

Medical malpractice would be another expense we should be able to slash. There should be compensation for genuinely serious medical errors, but our current system goes too far (spoken as a former lawyer).

I'm a believer in strong drug company profits - that's a big part of my investing focus - but there's surely some way to shift some profits away from older and me-too drugs and toward new drugs that address unmet needs.

Finally, I know lots of people get their living from it, but I feel that some substantial portion of the medical insurance industry's revenues could be eliminated and directed to the doctors and others who actually provide patient care.

[Hugh R]

Are you 65? I went to SS and Medicare and a United Healthcare supplemental plan and while I think the gov't is mostly incompetent, this was really easy, and I have no complaints, the SS checks roll in and United Health care pays bills.

[jyl]

No, still most of a decade before I can go on Medicare.

I hear pretty good things from my friends on Medicare.

[Tobra]

It is fortunate you did not have to avail yourself of critical services using insurance bought on the ACA exchange.

[jyl]

Originally Posted by Tobra

It is fortunate you did not have to avail yourself of critical services using insurance bought on the ACA exchange.

What would have happened? Suppose I went to the E.D.?

[Bigtoe32067]

I have Medicare. Been on it for 10 years when I was 43 due to kidney failure. I also have VA which I dont use because of Medicare. I’d be screwed because my transplant failed and the last four years I’ve been dealing with congestive heart failure and dialysis. My life should suck but I have a great family and a very supportive wife who quit her job four years ago to take care of me.
If you can get Medicare then I highly recommend it. I think I pay about 200-300 per month for it and have had millions of dollars worth of medical bills but Medicare shaves them down to about $20k. I’m slowly trying to work through them on a fixed income but my hospitalizations occur faster than I can get them paid for. Shoot, just my dialysis is $600/month but it’d be many thousands without it.
Medicare has definitely been a lifesaver for me. My private insurance yearly increase went from $1700/month to $3500/month right before I was approved for Medicare.