Benefits Buzz – October 2018
This month’s Benefits Buzz discusses the guidance on association health plans issued by the IRS and Department of Labor, provides a reminder that Medicare Part D notices are due Oct. 15 and explains the repeal of the individual mandate penalty.
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I’m Eligible for Medicaid, but is it good insurance?
A. My daughter, age 27, is a part-time student who will earn little or no income in 2014. She just applied for coverage through the state marketplace and learned she is going to be put on Medicaid. I’m concerned that she won’t be able to find a doctor or hospital that takes Medicaid, and that it’s not very good coverage. Can she opt out of Medicaid and get a subsidy to buy a private plan instead?
B. Now that people are insurance-shopping en masse on HealthCare.gov and the state-run health insurance marketplaces, I’m getting more and more questions like this, from middle-class people who never dreamed they or anyone in their family would qualify for Medicaid, the public health insurance program, which in 25 states plus the District of Columbia is expanding to cover everyone with a household income of less than 133 percent of the Federal Poverty Level.
They worry that it’s cut-rate coverage that will relegate them to overcrowded emergency rooms and overburdened public clinics in scary neighborhoods.
But first, an answer to the last part of the question. If upon completing a marketplace application you’re told that you’re eligible for Medicaid, you won’t qualify for a subsidy to buy a private plan. Your choice at that point will be either to enroll in the government plan or purchase a private plan at full price.
Our advice to you is, if you qualify for Medicaid, take it.
“It’s way better coverage than anything you’re going to buy in the marketplace,” says Judith Solomon, Vice President for Health Policy at the Center on Budget and policy Priorities, a Washington think tank. “First of all, it’s free. There’s little or no out-of-pocket cost. It’s at least as comprehensive as private insurance.” In most states, Medicaid even covers at least some dental and vision care for adults, benefits notably absent from private marketplace plans.
The thing that seems to be scaring off some new eligible’s is the fear that they won’t be able to find a doctor or hospital willing to take new Medicaid patients.
Here, the evidence is confusing, to put it mildly. In surveys, doctors are more likely to say they won’t take new Medicaid patients than new patients with Medicare or private insurance. But surveys of patients themselves find that people on Medicaid report the same degree of access to doctors as people with private insurance. Our guess is that your access will depend a lot on where you live, but in no location will you find zero Medicaid providers.
“Medicaid has pretty clear federal requirements that you have to ensure beneficiaries have access to provider’s equivalent to what the average person in the area might get,” says Matt Salo,executive director of the National Association of State Medicaid Directors. “It’s not like it’s this vast wasteland.”
As for where you’ll get your care, the answer is most likely through a private managed care plan at a private hospital or doctor’s office, says Robin Rudowitz, a Medicaid expert at the KaiserFamily Foundation. That is because the vast majority of states have contracted out their Medicaid plans to managed care companies, many of whose names you will recognize because they also sell private individual and group insurance. “Medicaid may be publicly financed, but it’s purchasing care on the private market,” Rudowitz explains.
So, what should you do if you find out you’re eligible for Medicaid?
1. Enroll! Although the original hope and dream was that state health insurance marketplaces could handle this process seamlessly and online, it turns out that a lot of them can’t. Save yourself the headache and sign up directly. Here are links to state Medicaid agencies.
2. If you are given a choice of Medicaid managed care plans to join, check out quality rankings of the plans from the National Committee on Quality Assurance. They’re available right here on our site, free of charge.
3. If you want to keep a doctor or hospital you have now, check directly with the provider or with
the managed care plan you’re considering.
Got a question for our health insurance expert? Ask it here; be sure to include the state you live in. And if you can’t get enough health insurance news here, follow me on Twitter @NancyMetcalf.
Michigan Governor Signs Medicaid Expansion Bill
Gov. Snyder signs bill that expands Medicaid to hundreds of
Thousands of Michigan residents
By Mike Householder, Associated Press | Associated Press
DEARBORN, Mich. (AP) — Gov. Rick Snyder checked off one of the major priorities of his first term
on Monday, signing into law a measure that will make hundreds of thousands of state residents
eligible for Medicaid.
Snyder’s signature at the ceremony at Oakwood Hospital in Dearborn makes Michigan the largest
state controlled by Republicans to support a key component of the new federal health care law.
It will expand the government health insurance program to almost a half-million Michigan residents
within a few years, nearly halving the state’s uninsured. An estimated 320,000 are expected to be
eligible in late March if the federal government approves the plan.
“This is something that’s really important. This is about the health of our fellow Michiganders,”
Snyder said to applause prior to the bill-signing, noting that “we didn’t do anything about it for many
Medicaid expansion is part of a strategy to ensure that nearly all Americans have health insurance
under the Affordable Care Act. It was designed to cover the neediest uninsured people yet became
optional for states because of a Supreme Court decision.
Many GOP-led states opposed to the law have declined the expansion, despite the U.S. government
promising to cover the entire cost for the first three years and 90 percent later. Michigan becomes
just the third state where the GOP also controls the Legislature to accept it — joining Arizona and
“(Signing the bill) is the easy part of the job,” Snyder said Monday. Now it needs to be implemented,
The program already covers one in five Michigan residents, mainly low-income children, pregnant
women, the disabled and some poorer working adults. The expansion will cover adults making up to
133 percent of the poverty level — $15,500 for an individual, $26,500 for a family of three.
Snyder and a coalition of backers ranging from the business and medical lobbies to advocates for the
poor say offering health insurance to more low-income residents will make them healthier and
minimize expensive trips to the emergency room, preventing cost-shifting to businesses and
individuals with health plans.