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Giving up Insurance in favor of Medicaid
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et27




 
 
 
 

Post  Tue, Jan 21 2020, 2:34 pm
Hi, I'm considering cutting my work hours, which would mean giving up my good private health insurance and going on Medicaid for the first time in my life. I am concerned that if I go on Medicaid I will not have access to the right Doctors in case of a crisis. Does anyone have experience (both good and bad) of having a severe medical crisis on medicaid? Would you advise me to avoid Medicaid at all costs if I can keep my current job with good insurance benefits?
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mha3484




 
 
 
 

Post  Tue, Jan 21 2020, 3:06 pm
This really depends on where you live.
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amother




Peach
 

Post  Tue, Jan 21 2020, 3:11 pm
I suggest you look at the local hospitals and see what they take. My local children's hospital takes medicaid. They dont' take all other insurances so when we were looking for a "Regualr" insurance that was one of the things we took in to account because we have a child who is recieving treatment there.
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Amarante




 
 
 
 

Post  Tue, Jan 21 2020, 3:16 pm
As posted, it really depends on where you live.

Where I am located, there are almost no providers who accept Medicaid and I would want to avoid those who do accept it. However, it appears from reading threads on imamother that there are locations where many medical providers do accept Medicaid.

Your choice of hospitals - except in a true medical emergency - would be governed by where your doctor has privileges.
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amother




Linen
 

Post  Tue, Jan 21 2020, 3:17 pm
I wish I can get back my Medicaid! All hospitals in NY take Medicaid as well as many many great doctors. I think Medicaid is the best insurance. And there are no co pays or deductibles.
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tryinghard




 
 
 
 

Post  Tue, Jan 21 2020, 3:18 pm
As others have said, depends where you live. I know that when I lived in NYC, I didn’t have access to good doctors. In the county where I currently live, the way that the insurance companies negotiated their contracts means that virtually all doctors accept it, including mental health practitioners.
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amother




Goldenrod
 

Post  Tue, Jan 21 2020, 3:18 pm
amother [ Linen ] wrote:
I wish I can get back my Medicaid! All hospitals in NY take Medicaid as well as many many great doctors. I think Medicaid is the best insurance. And there are no co pays or deductibles.


And Medicaid covers a lot of things private insurance doesn't cover.
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et27




 
 
 
 

Post  Tue, Jan 21 2020, 3:24 pm
OP here.
I live in NY. I'm hearing that in the case of a medical crisis even if the local hospitals take Medicaid, the best Dr or hospital may be out of state or not accept it. Has anyone had an experience where they felt limited in NY or wished they access to Drs that don't take Medicaid?
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amother




Teal
 

Post  Tue, Jan 21 2020, 3:29 pm
I have had great experiences on Medicaid in NY (Five towns/LI specifically).
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Ffff




 
 
 
 

Post  Tue, Jan 21 2020, 3:30 pm
You still always have the option of paying for 1 or 2 visits to a special dr. With cash. You are still saving tooons of money on premiums and copays.
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et27




 
 
 
 

Post  Tue, Jan 21 2020, 3:33 pm
That's not the case with a real illness or injury, which is what insurance is really for. Of course I'd love free co-pays for strep tests but that's not why I want health insurance .
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et27




 
 
 
 

Post  Tue, Jan 21 2020, 3:34 pm
Has anyone experienced a serious illness or injury while on Medicaid?
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amother




Linen
 

Post  Tue, Jan 21 2020, 3:37 pm
et27 wrote:
OP here.
I live in NY. I'm hearing that in the case of a medical crisis even if the local hospitals take Medicaid, the best Dr or hospital may be out of state or not accept it. Has anyone had an experience where they felt limited in NY or wished they access to Drs that don't take Medicaid?


If the hospital takes Medicaid, then whoever is hospitalized can be seen by any doctor. The doctor doesn't bill insurance, the hospital does.
When we had Medicaid, DD was hospitalized in Columbia, they have amazing doctors. Her surgeon was a top top doctor, people come to him from all over the world. She needed emergency surgery, he was on call then. With my current insurance, I'd have to pay thousands in co pays for the same hospital stay. There are some tests and treatments that Medicaid doesn't pay for, but most other insurance don't pay for them either.
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amother




Floralwhite
 

Post  Tue, Jan 21 2020, 3:41 pm
et27 wrote:
Has anyone experienced a serious illness or injury while on Medicaid?


I know many people and they got great care. High risk OB you can’t really get in Medicaid unless you use Columbia clinic verses a private doctor. But in NY almost all specialist you can get good ones on Medicaid
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amother




Slateblue
 

Post  Tue, Jan 21 2020, 3:46 pm
Do you mean out of network or out of state. With very few exceptions, most insurance plans have some kind of preferred providers which are limited to in one state. This is because it is almost impossible for insurance companies to negotiate fees with an unlimited number of doctors.

Comparing Medicaid to private insurance is impossible since it really depends on where you are located and how "good" your private insurance is. However, unless you are signed up to an HMO most plans have the option to go out of network. It might cost you a bit more but you can pay for a specialist of your choice who is out of network. My experience is that the co-pay might be higher (e.g. 50%) and less goes towards meeting your deductible.

If seeing the "top" doctor and freedom of choice is critical to you, I would advise against Medicaid. Medicaid compensation is below rates that private insurers pay doctors so most doctors would not take it if they had any choice.

It is only after joining imamother that I realized there were actually places where a substantial number of doctors did take Medicaid. Presumably this is limited to certain areas of Brooklyn, Lakewood and Monsey with substantial numbers of from people on Medicaid. In every other area, Medicaid doctors are few and far between because it is so low paying. Presumably in Brooklyn, Lakewood and Monsey a doctor is almost forced to take Medicaid or else he or she would have difficult getting sufficient patients.

The lack of Medicaid doctors in most doctors is well substantiated.
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amother




Apricot
 

Post  Tue, Jan 21 2020, 3:48 pm
et27 wrote:
Has anyone experienced a serious illness or injury while on Medicaid?


My son was severely ill (short term bH) and hospitalized in Westchester hospital. We got good care and all costs were covered.

I don’t know if that’s what you’re looking for, not that you can really predict what you’ll need.
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amother




Slateblue
 

Post  Tue, Jan 21 2020, 3:51 pm
amother [ Linen ] wrote:
If the hospital takes Medicaid, then whoever is hospitalized can be seen by any doctor. The doctor doesn't bill insurance, the hospital does.
When we had Medicaid, DD was hospitalized in Columbia, they have amazing doctors. Her surgeon was a top top doctor, people come to him from all over the world. She needed emergency surgery, he was on call then. With my current insurance, I'd have to pay thousands in co pays for the same hospital stay. There are some tests and treatments that Medicaid doesn't pay for, but most other insurance don't pay for them either.


This isn't entirely true. There are doctors who work for the hospital but many doctors aren't employed by hospitals but have "privileges" at specific hospitals. Therefore, if one is getting surgery or has cancer, one selects a doctor with privileges at a hospital. That doctor and other specialists you choose are billed separately. But that is different from the staff attending physicians who do work for the hospital.

For example, when my father was hospitalized for a heart condition, his urologist, cardiologist and surgeon were all selected by him and were not employed by the hospital. They would make rounds periodically and those visits were billed separately to his insurance. However, the staff doctors who were available 24/7 for an emergency were employed by the hospital.
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amother




Linen
 

Post  Tue, Jan 21 2020, 3:59 pm
amother [ Slateblue ] wrote:
This isn't entirely true. There are doctors who work for the hospital but many doctors aren't employed by hospitals but have "privileges" at specific hospitals. Therefore, if one is getting surgery or has cancer, one selects a doctor with privileges at a hospital. That doctor and other specialists you choose are billed separately. But that is different from the staff attending physicians who do work for the hospital.

For example, when my father was hospitalized for a heart condition, his urologist, cardiologist and surgeon were all selected by him and were not employed by the hospital. They would make rounds periodically and those visits were billed separately to his insurance. However, the staff doctors who were available 24/7 for an emergency were employed by the hospital.


If the doctor doesn't work at the hospital & just has privileges there, he's not on call. I'm talking about the doctors that do work at the hospital are all covered by Medicaid. In the big NY hospitals, most doctors are great doctors.
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amother




Rose
 

Post  Tue, Jan 21 2020, 4:10 pm
Quote:
It is only after joining imamother that I realized there were actually places where a substantial number of doctors did take Medicaid.

I live in Texas near one of the best medical centers in the world. Many top doctors and hospitals here accept Medicaid. In my 10 yrs of living here I have encountered one dr who did not.
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Just One




 
 
 
 

Post  Tue, Jan 21 2020, 4:26 pm
We are currently going through a serious health crisis with a young child. I thank Hashem for Medicaid which totally takes the financial burden off our head. All hospitals in NY accept Medicaid. No worrying about deductibles for long hospital stays. We had a world class surgeon. Totally covered. No worrying about surprise bills when seen by an out of network provider in the hospital (as a Medicaid patient it's illegal to bill you for anything except it you signed that you will pay prior to being seen)
In general pretty much all providers accept Medicaid. The only areas where you'll be limited are mental health (most therapists ask for cash anyways though private insurance might reimburse you afterwards) and high risk obgyn. Columbia clinic is a good option on Medicaid as someone noted before me
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