My son is starting the new year without a job. He’s generally a high income worker, but right now he’s unemployed and looking at health insurance until he gets a job that covers it. He could get Cobra for around $750 (which sounds really expensive), but it looks like he qualifies for Medi-Cal, since he has zero income. Is this decent insurance, or should he try to get something off the marketplace? Obviously the price is right (zero), but I’m wondering if there’s a good reason to look at other insurance options. I doubt he’ll be on this very long, though you never know.
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That COBRA price, if for one person, suggests a relatively high-end employer plan.
Medi-Cal is California’s Medicaid program. Provider acceptance of patients with fee-for-service Medi-Cal is lower than for patients with private insurance or traditional Medicare, probably due to low reimbursement rates. Medi-Cal also has the option to enroll in a managed care plan (see https://www.dhcs.ca.gov/individuals/Pages/MMCDHealthPlanDir.aspx ) instead of using it on a fee-for-service basis.
If he has ongoing medical needs, particularly specialty care, he may want to check with his current providers if they will accept fee-for-service Medi-Cal or a Medi-Cal managed care plan that is available to him. If they do not, he may want to check if there are other providers for his medical needs who accept Medi-Cal.
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Medi-cal has been great for those I know who have had it. Although the selection of PCPs might not be the best, appointments were easy to get. Referrals to specialists were quick, and at least in the greater L.A. area, some of the best, at leading hospitals.
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Thanks for info, you two. He’s very healthy and rarely sees a doctor, no medications or issues that we know of. Likely he could go uninsured and be fine, but that is not an option. You never know what life will bring you.
Also, if you go into the ACA marketplace, if you input that you expect to make 20K next year, you can get a Blue Cross PPO plan for $24 a month. I don’t know how you estimate your salary if you’re unemployed, for the next year. It could be anything. But I wonder if he should go for one of the highly subsidized ACA plans instead. He doesn’t have a specific provider.
@ucbalumnus Medi-Cal in our state is a very good option vs that insane COBRA payment - unless your son has serious pre-existing conditions requiring him to stay with specialist(s) that have been providing regular care. Every hospital, urgent care and walk in clinic accepts it.
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@ucbalumnus - an alternative is to apply for the Covered California program which provides a financial subsidy for low/no income individuals - have him put $12,000 annually (which he will need to update immediately upon making any $, getting a job, or he’ll pay a penalty) and he’ll know right away the subsidy and can then “shop” for health insurance knowing what the new monthly premium will be.
Covered California will provide a detailed list of plans available -
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Thank you for the information, @JustaMom, I’ll tell my son. Though I wonder which of your options is the better choice.
@busdriver11 - actually he can review both - my personal thought would be how likely is he to need specialized care in the next x months? Most young people I know do just fine with Medi-Cal.
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Medi-cal in CA is better than Medicaid in most states, particularly if he doesn’t have any current needs I.e. mental health support.
A note of caution, a few years ago I was laid off and went from a private plan to an exchange plan. Six months later we went under husbands employer plan. It took me almost SIX years of repeated attempts at disenrollment from the state’s plan for children which I never requested, qualified for, or enrolled in. It was a nightmare and I would get it resolved and then they would Re enroll the kids. I would hate to deal with that bureaucracy
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Ugh, sounds like a paperwork nightmare!
Problem is, when I look up information about Medi-Cal, it appears to have an assets limit (that they don’t have in 2024) that he wouldn’t qualify for Medicaid-Cal with. But the application doesn’t even ask about assets. It’s really confusing.
The asset limit for medicaid may only apply for those using it for assisted living. I know that’s the rule for Colorado, and since medicaid is 50% a federal program, the rules could be similar in California.
Currently, if you qualify for medicaid, you qualify until the feds change the covid extensions. They were supposed to go away last fall, but like most things are still extended. I’m not sure of the California rules,but I think he can pick a plan like Kaiser or another HMO, PPO, etc. Here, Kaiser limits its coverage to those who have had Kaiser before (at any time, not just the last insurer). So if he has doctors, see if they accept one of the plans.
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(oops, accidentally made this a reply to a post instead of the thread)
He should call and talk to counselors at Medi-Cal and Covered Calif to see what happens next year after he finds a job, asking if he will have to pay back anything when his income for the year exceeds what it was at the start.
I’m not an expert, but for ACA it says " Marketplace savings are based on your expected household income for the year you want coverage" at https://www.healthcare.gov/income-and-household-information/how-to-report/ So it seems possible that when he signs up for coverage he is eligible but in 2024 when he is filing taxes for 2023 he may have to repay the subsidy or an additional premium for Medi-cal coverage. Hopefully it doesn’t work this way, they examine month-by-month income and as long as you only have coverage for months with low income you’re ok.
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Actually @mikemac if he immediately reports a change in status (income) there may be a very small repayment but it wouldn’t be much - I qualify for Covered California (it doesn’t take much, thank you California!) and yearly when my work review/raise comes I update the income & it simply adjusts the subsidy effective the following month - I’ve never had a penalty.
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Can’t see why you wouldn’t go for the cost-free option, unless there is some kind of specialty care needed like someone else mentioned. But the no cost appeal would be hard for me not to consider in that situation.
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Actually, he talked to someone on the Covered Cal website a few hours ago and they advised him to stay away from Medi-Cal. I’m shocked and quite impressed that they actually called him back on Christmas. The guy told him not to go for Medi-Cal, because it takes forever to get approved. He said that if he applied for the Covered Cal, he could get that immediately, and it appears that he will get a high subsidy. If he has to pay some back when he gets a job, so be it, you gotta have health insurance, and I’ll tell him to make sure and immediately report a change in status as @JustaMom advises.
The agent also fixed his application by changing expected income, because online he had put zero income, which drove him to Medi-Cal, and wouldn’t allow him to apply for Covered Cal insurance. The site also won’t allow you to change your income. So hopefully it’s fixed now and he can get insurance very shortly. Thank you all for your help!
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Excellent!
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One other thing to pass on to your son. As part of the sign-up process or shortly after enrolling he’s going to be asked to verify his income to show that he qualifies for a subsidy. Usually what people submit is a paystub or their previous year tax return, but this won’t work for him since it will show an income that makes him ineligible for a subsidy.
What he wants to do is submit an “attestation of income” as found at Proof of Income | Covered California™ It does say “no documentation available” but it can also be used if the documents someone has don’t accurately reflect their income going forward.
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Thanks, he did submit a paystub for last year that gave him a partial subsidy, but not as much as we thought. It does look like you get a subsidy based upon what you expect to make, but that’s pretty much up in the air for him, as there’s a wide range depending upon when/who hires him. The main thing is to get healthcare at a decent price, and reimburse if needed. Gotta have coverage!
Hey, bus driver 11. Thanks for sharing your experience with the pay stub subsidy.
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