Health insurance sticker shock!

amother

Floralwhite

Wed, Mar 15 2017, 5:12 pm

Formerly my kids were on medicaid and I was on NY State of Health with some government subsidy paying less than $50 a month for myself. DH gets insurance free from his employer.

Recently I had to reapply my kids and the application somehow seems to have gotten messed up, and in the process of trying to sort it out I kept getting different letters with conflicting information. I talked to navigators and phone helpline people and it seemed that they might or might not qualify for medicaid but if not they would get something on the lower cost end. Somehow even though I wasn't reapplying for myself they seemed to include me in the process. I thought I was settled already.

Anyway today I got yet ANOTHER notice in the mail and it says the kids now have Child Health Plus and I have NOTHING. I'm "eligible to purchase a health plan through NY State of Health with no assistance."

In the past my kids were on CHP and all it meant was that we had copays instead of paying nothing as with medicaid. So I felt chilled about that until I went onto the NY State of Health website to choose their CHP plan and they are all over $200 per child!!! So I'm not even sure what makes this CHP as opposed to just pay-through-the-nose insurance - are you telling me regular insurance would be even more?

And then for myself the plans START at close to $400.

In total that means that I'll need to pay about $1000 a month for health insurance. That's not much less than my income changed in the first place. I'm hyperventilating. I waited SOOOO long to finally get a little more income after living on what seemed like air and water for such a long time. I was totally cool with graduating out of medicaid, thinking I would still get some subsidy to help with the transition. I started thinking about getting a cleaning lady to help with Pesach since I now have more working hours for the more income. POOF!

Please help calm me down and figure out how to make this work! Do you think there could be some mistake that I could appeal for? We earn about $5000 a month for a family of 4. I am extremely frugal and have an extremely tight budget that ends up being about $4000 a month. Previously we were not really meeting our expenses. We added an additional part-time job to my existing part time job (which makes my schedule extremely tight and entails additional childcare for one child) and DH got a raise from temp to salary, and the result is that after all that added time and work, we end up with still nothing to put away or spend on anything extra. And "extra" for me doesn't mean much - I live extremely frugally. There go my hopes of ever having any quality of life Sad

amother

Apricot

Wed, Mar 15 2017, 5:35 pm

amother wrote:

Where do u live? If u live in Brooklyn I highly recommend nachas healthcare to help u figure out your options if it was a mistake or not etc
And daven!
Hatzlacha rabba!

amother

Floralwhite

Wed, Mar 15 2017, 5:38 pm

I also want to clarify that my $5000 a month does not translate into $60k a year. I only get paid Sept-June (even if I work during the summer I only break even because childcare and work expenses ends up being more) and DH's job is also temporary/seasonal. So part of my hope was that for these months we could put something away for the "dry season." When I talked to NY State of Health they said they could do that, calculate my yearly income instead of monthly. Somehow it seems that even with that we qualify for.... nothing? And isn't CHP supposed to be more affordable?

amother

Floralwhite

Wed, Mar 15 2017, 5:50 pm

DH's work plan is similar in cost, definitely not lower, not sure if it's a better plan.

Neither of us is on an upward trajectory that will make it "worth it" to push through working harder for zero net gain (let's not discuss that problem here. It's a separate topic. DH is in school for a better career but that has nothing to do with working harder at his current job. My pay rate goes by an industry standard that does not change if I work harder.) If we were gaining even just a few hundred extra a month it would be worth all the extra work because that's how tight our budget was before, but this makes it seem that we are really literally coming away with no benefit after doubling our work efforts!

amother

Floralwhite

Wed, Mar 15 2017, 5:52 pm

amother wrote:

The numbers you looked up online are full premium prices or the amount that you as a family of 4 making $50k a year have to pay?
We pay full premium of $250 per child for CHP's most expensive plan for same size family making significantly more than that but that's because we're not eligible for any help. There are no copays.

I think it's full price, no idea, that's just what it showed me when I clicked "choose a health plan" for each of us.
Since when does Child Health Plus = not eligible for help? Did something change? I thought by definition CHP always was the "help" version!
My letter said the kids are eligible for CHP and I am not eligible for any help. AUGH!

amother

Burgundy

Wed, Mar 15 2017, 5:59 pm

amother wrote:

Every child is eligable for CHP. They want all children to have access to health insurance. But price is income dependant. Some get it for free, some for $30 per child, some have to pay the full premium without any help from NY. You're likely to have to pay $15 per child with no copays. Sit down with someone at nachas health net so you don't rip your hair out. It's a complicated system. And they can have you up and running by the end of the appointment. I went for an appointment to utilize their know how even though we don't get any subsidies from NY for my kid's CHP and pay the full sticker price.

amother

Wheat

Wed, Mar 15 2017, 6:06 pm

I'm not in NY so this is probably not extremely helpful, but I'm going through something similar. I joined dh plan which is pretty good and manageable. Our monthly income, like yours, varies over the course of the year, with the summers being very dry. Of course our renewal month was a higher earning one 🙄 They refused to consider our yearly income since we are self employed, and stuck to the monthly number. It's very close to yours (a bit over 5k). Anyway, my kids were also eligible only for the highest premium state plan, also 200/month. I'm putting them on my dh plan instead, which is $200 less per month total. The state plan is really bad for full premium members in my state. Sucks.

amother

Floralwhite

Thu, Mar 16 2017, 4:54 pm

amother wrote:

Where do u live? If u live in Brooklyn I highly recommend nachas healthcare to help u figure out your options if it was a mistake or not etc
And daven!
Hatzlacha rabba!

I'm not in Bkln but hoping they can help anyway because I'm desperate, can you please share contact info? I tried google but the number I got hung up on me as if it was a wrong number. Did not sound like a business.

Got the info about joining DH's business plan and it's even more expensive than state of health. Only thing is maybe it covers more. But I think the additional things it covers are the ones with the biggest copays. Maybe - it's hard to tell because it's easier to see the list that the company insurance covers than it is to see the lists of state of health insurances. It's a neat outline easy to read. I should look more closely but I don't have the head for this, it's too complicated and my brain goes into a spin just from seeing the premium costs!

There's also stuff I just don't understand or don't know anything about. There's a HDHP which is cheaper but I think that means you pay a lot more out of pocket for each thing. Hard to tell because the details are written in a foreign language. Then the other choices are EPO and POS which I don't even know what they stand for let alone what all the gibberish under them means. And I have just a few days to figure this out in time to stay covered. Help!

brooklyn11211

Thu, Mar 16 2017, 4:59 pm

amother wrote:

if you don't mind,

How much is your total income for the year and how many kids do you have, I just navigated all this mess and I might be able to help out a bit

amother

Floralwhite

Thu, Mar 16 2017, 5:05 pm

2 kids.

Monthly income:
me - about $2000 sometimes more sometimes less because I get paid by the hour. BUT may be going up soon because I took on more hours.
DH - a little over $3000
So about 5000 per month

Year:
DH will probably (not definitely but I predict) only have this job until July or August for a total of one year but only about half of THIS year 2017. So figure 7 or so x3000 = 21k
My income usually averages out about 25k over a year, sometimes less sometimes more but that's my working estimate. BUT may be more by the end of this year because of the added work I took on. Hard to predict because my work is fickle.
So about 46k give or take for the year BUT hard to predict for sure.

brooklyn11211

Thu, Mar 16 2017, 5:13 pm

amother wrote:

PERFECT!!

You qualify for the New York essential Plan, for a family of 4 you can make up to $48,000 a year and qualify, it will cost you $20 per adult without dental and vision and $40 a month with dental and vision included, it covers everything Medicaid would,

Where do you live? I live in Brooklyn and there are many social organizations that help out,

Please check out this link and share your thoughts

https://info.nystateofhealth.n.....7.pdf

brooklyn11211

Thu, Mar 16 2017, 5:21 pm

amother wrote:

Also, some months we might make combined over $6000 but then after July DH will be making nothing (he has to do an unpaid internship type of thing). So it's like Jan-March about $4000-5000 a month, March-June about $5000-6500 a month, then July-Dec about $3000 a month (my dry season followed by DH's dry season)
So I'm revising my year estimate to about 50-54k but again this is almost like a wild guess because of all the changes we're going through.

You can always go by last year and worry next year when the next certification comes up, assuming last year you made less then the threshold that should be good enough

amother

Floralwhite

Thu, Mar 16 2017, 5:22 pm

brooklyn11211 wrote:

Is there anything between the essential plan and the full price so you don't have to jump from paying $20 to paying $500?!!! Because that seems to be where I'm stuck now! Suppose we go with my estimate of $50-53k a year, that means I'm making 2000-5000 over the limit but I'll need to pay more than that for the insurance and that's just for me, forget the rest of the family!

Also wondering what is up with the family size calculation because we are in the process of divorce so the family size is going to shrink without much change in income because it was always mostly me earning - but our expenses are going to be just as much because it costs a lot more to raise kids alone than to house and feed one more adult. Mad