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Re: Suspending benefits to get Medicaid

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Message 1 of 18

Very good.  Thank you.

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Re: Suspending benefits to get Medicaid

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Here ya go - Robert

I want from here:  West Virginia Health Care Marketplace - Silver

 

To Here - which is the actual contract for 2018 Silver plans

West Virginia - Narketplace plans 2018 - Care Source - Evidence of Coverage And Health Insurance Con...

 

Appears to be very complete and detailed, seems easy to read too, long but well sectioned - the only thing that is missing is the specifics of the various CareSource plans (see page 131 - Section 14) which would be inserted once you know your plan pick.

 

There is a link provided within the document where hopefully you can check in-network providers and facilities.   I believe there is also a Questions phone contact.

 

Glad I could help but only you know all the details and logistics and the order in which you need to do all these things -Decisions, Decisions . . . . .

  • SS early benefit begin (yes or no),
  • drop Medicaid in 2018 or 2019 or not at all if you decide not to get your SS benefit early
  • get SS early benefit in 2018 - stay on Medicaid for 2018
  • get SS early benefit in 2019 - pick up a Marketplace plan ( choose in the fall of 2018) after checking the 2019 plan

Make sure the procedure is covered at an in-network facility and done by an in-network surgeon - make sure any other providers are also in-network like the MRI facility, radiologist who reads it, anesthesilogist for the procedure -

Good Luck


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Suspending benefits to get Medicaid

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Message 3 of 18

@RobertC767060 wrote:

Thank you.  Did you mean to post Kentucky?  I live in West Virginia.


Yes, I am sorry, Robert - let me see what I can find on West Virginia cause it does go by state.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Suspending benefits to get Medicaid

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Message 4 of 18

Thank you.  Did you mean to post Kentucky?  I live in West Virginia.

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Re: Suspending benefits to get Medicaid

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For people who make less than 400% of the federal poverty level, their premium cost are subsidized -'the less income, the higher the subsidy - so it is government that is making your premiums much lower.

 

Obamacare plans have to cover the Essential Health Benefits.

Healthcare.gov - Essential Health Benefits

 

Here is the 2018 CareSource Kentucky Health Care Marketplace - Silver Plans

Here is the summary of the Kentucky CareSource plans for 2018 - 

2018 Kentucky CareSource Marketplace Plan Comparison Brochure - pdf

 

Read it and review any footnotes, and any imbedded links - on the brochure there is a number listed for "Questions" - might be a good source for info and specifics.  The brochure for specific plan names and coverage might be available too online, I did not check.

 

in general, the higher the metal rating, the more extensive the network, maybe formulary too.

 

The "cost sharing reductions" are not applicable anymore - the government stopped funding them but the insurer might be providing some benefit - ask them..

 

For the comparison purposes, I think, the plan you are referring to in is on page 9 of the CareSource document.  

 

Since you have mentioned that for this special surgical procedure, there is only a limited number of providers and perhaps facilities which perform it - so it seems to me that making sure that they are "in network" is very important.

 

Making sure that everybody agrees that it is medically necessary and is a covered procedure is also important.

 

If those are your priorities for a plan - make sure of these 1st and then you can find the plan to see if you can afford the subsidized premiums, copays, coinsurance, deductible.

 

Deductibles may have to be met before the plan pays anything - 

Copays may not be counted towards deductible

all these things should be spelled out in the plans you pick for further scrutiny

Remeber plans change for 2019


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Suspending benefits to get Medicaid

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Message 6 of 18

Yes, I meant Medicaid.

 

The link is working.  Thank you. 

 

Somehow I got the idea that Obamacare is much more expensive that it apparently is. I don't know where I got that idea.  So, assuming I lose Medicaid, I go into healthcare.gov and enter my info and pull up the plans and I see Care Source Low Premium Silver 2 has a deductible of $950, maximum out-of-pocket of $1600 and a monthly premium of $69.99.  Much better than the higher-premium plans!  Am I missing something?  So I need to find out most importantly does it cover surgery?  Clicking on Quick View it says "Inpatient hospital services (like a hospital stay) - $350 copay per stay after deductible".  I don't see surgery.  ?

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Re: Suspending benefits to get Medicaid

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Message 7 of 18

OK, Robert, I fixed the link to the 2018 premium estimator -Sorry about that -

just click on it again in my same post - it will literally take you a minute to complete.  You can even fool around with it and put in different incomes to see what happens.  However, below 138% of the Federal Poverty Level, it will refer you to Medicaid.  

 

Or or here it is again -

 

https://www.kff.org/interactive/subsidy-calculator/

 

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Suspending benefits to get Medicaid

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Message 8 of 18

@RobertC767060 wrote:

Thank you.  Obviously there is a lot to consider and you're right I'll have to speak to some of these doctors about what insurance they take, the ongoing costs, and if I'm medically necessary (that part probably can't be determined over the phone) and I'll have to speak to W. Va. Medicare.  

 

The link you posted doesn't work.  


I'm pretty sure that you meant MEDICAID rather than Medicare - they are so similar sometimes auto correct picks one and it is the wrong one.

 

I will see what I did wron on the KFF - Obamacare plan estimator for 2018 and will repost it.

 

Yep - you have lots going on and it seems it will all affect your decision as to which way to go.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Suspending benefits to get Medicaid

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Message 9 of 18

Thank you.  Obviously there is a lot to consider and you're right I'll have to speak to some of these doctors about what insurance they take, the ongoing costs, and if I'm medically necessary (that part probably can't be determined over the phone) and I'll have to speak to W. Va. Medicare.  

 

The link you posted doesn't work.  

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Re: Suspending benefits to get Medicaid

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Message 10 of 18

@RobertC767060

Here is an easy way for you to estimate what your Obamacare insurance cost would have been for 2018 - if you were receiving your early SS benefit for all of 2018.

Kaiser Family Foundation - Obamacare Health Insurance Marketplace ESTIMATOR 2018

 

just fill in the blanks about your geographical area, use the income that you will get from Ss or any other place, answer the other questions about you - age, children, smoker, etc. and hit submit - it will tell you how much it would have costed in 2018 and what type of subsidy you would have gotten.

2019 will be different but comparable.  This estimate will be based on a silver rated plan.

 

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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