scrubbedexpat099

On another forum there was a confused lady, and struck me as a dilemma.

Recently moved here, adjusting status, pregnant, sounds like she is due beginning of April.

Husband has no cover, sounds like they have little money.

She has Emergency Medi Cal Pregnancy.

She now gets that she is not eligible for Medi Cal, but can not afford even the cheapest Obamacare policy, that may not be quite true. Seems that what she has is OK and pays ground up, which presumably nothing through the Exchange would.

From what I can gather she can not buy cover and have Medi Cal? Seems that Medi Cal would still be needed to cover deductibles/copays. This seems to me to be the crux, is this right?

By the time the child comes she will of course passed the next window. So could not buy in until 2015.

Sounds wrong, is there a logical solution?

Pulaski

Doesn't the birth of a child create a "life event" that allows enrollment to ACA policies mid-year?

scrubbedexpat099

Possibly, you can see why it would be pertinent for the Child, begs the question as to what has changed for the mother, but that may be too logical.

Michael

If family income is low but above Medicaid requirements, the child may be eligible for the CHIP program.

Michael

She would lose her emergency MediCal pregnancy so that should also be considered an event. However ACA is for families and if the husband doesn't purchase health insurance for himself through the exchanges by March, that may possibly be cause problems.

scrubbedexpat099

I assumed you could sign up as an individual, you did not need the family to be signed up?

If having a child is a qualifying event, neither has to worry if the child is born in April and they miss the end of March sign up?

and is it right that you can not get Medi Cal Pregnancy if you have any other cover no matter how crap?

Michael

I suspect it would be difficult to sign up as an individual since ACA primarily bases the cost on family income, number of people in the family, and ages. I suspect someone would have to explain why others in the family are not enrolled and then someone would have to figure out whether they use 1 or 2 people to calculate the 133%-400% of the poverty level. It may be possible but I don't know how it would be done. Also if he doesn't sign up by March, there is a small penalty that he would have to pay this year. He may be able to explain that his wife does not currently need coverage since she's covered by emergency Medi-Cal pregnancy but if he didn't have an ACA policy by March, that may be more difficult to explain.

I couldn't find anything on the internet concerning whether having other health insurance will make a difference. I think the only way to determine would be for her to call to find out.

scrubbedexpat099

She said she could not have Medi Cal if she other insurance, I do not know how valid that is. She had been told it by somebody.

Sort of seems odd. Let us say the Husband has a minimum wage sort of job, he would qualify for Medicaid, the Baby would most likely as well. So how is she supposed to get cover?

Perhaps I should know the answer, but do Employers who provide cover have to also provide it for Spouses etc? I know most do but assumed it was voluntary. I seem to remember seeing that many only subsidise the cost for employees, so the Exchange should be a better bet, well for many.

That CHIP programme mentioned that it provided cover for children where Parents did not qualify for Medicaid, so many would be looking to the Exchanges.