I have a love-hate relationship with the healthcare Marketplace. I love that it makes insurance available to anyone…and I hate everything else.
When my wife and I first applied for it back in 2015, there were a mind-numbing amount of plans to choose. And after all the fine-tuning and comparison shopping, your deciding factor was reduced to âOkay, how likely is it Iâm going to need major medical treatment this year?â and youâd select the least expensive.
Four years later, at least, this isnât a problem because the amount of plans have available my family for 2019 were a whopping three, with only one falling in the HMO category, taking our decision away from us.
I remember many years ago joking around with my sister-in-law about having an HMO plan is almost worse than having no insurance, and back in the nineties and before, that may have been the case. But now that there are networked health systems that only accept certain plans, thereâs absolutely no difference between a PPO and HMO, making the only deciding factor between the two how much money you have to spend.
In a way, the reduced options are a good thing. Too many options just confuses people, in my opinion. Whatâs not a good thing is what it takes to qualify your whole family without the interference of state aid for your child, which sounds like it shouldnât be considered âinterferenceâ but is when the review process is the complicate mess it is, holding up families from obtaining proper insurance for sometimes up to 150-plus days, as was the case with my son the first year he was born. The Marketplace kicked him off to Illinois All Kids in December and he wasnât disqualified (making him eligible…finally…for regular insurance) until late July of the following year, despite the review process is supposed to only take forty-five days to complete.
Last year, we went through something similar but were able to sidestep the review process because at the time of open enrollment, my son had been rejected by All Kids within a 180 day window, automatically disqualifying him from further consideration by the state, an action that resulted in an $.80 premium for my familyâs 2018 insurance. Yes, that figure is correct. We only paid $.80 each month for our 2018 insurance, which makes me very nervous for when my 2018 taxes are finally filed and the insurance equalizer kicks in after being weighed against my income. I donât make loads of money, but Iâm fairly certain someone, somewhere is going to look at my income, scratch his head, and say, âWait a minute,â then slap me with a hefty insurance bill.
This year, in an attempt to sidestep All Kids, I kept bumping up my annual income on the application until I was finally told all three of my family members qualified for regular coverage through Blue Cross Blue Shield. To keep my son out of the review process Iâd be willing to pay slightly more in insurance premiums throughout the year and let the government owe me money at the end for overpayments rather than the other way around. Oddly, it took raising my annual income to over $70k (for a family of three) to keep my son out of the All Kids review process. It gets more mindboggling when the Federal poverty level for a family of three is less than $22k annually. Thatâs nearly a $50k gap. Yes, within this gap there other factors are involved and there are different tiers based on what percentage you are away from the poverty line but itâs still a large gap.
Despite that everyone loves âfreeâ money and tax credits, this gap is so large families that truly need the help are swallowed whole during the review process because there are families who wonât qualify, clogging the system and preventing or holding up families who do need state aid from getting it in a timely fashion.
