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Now I get the joy of signing my wife up for insurance. And as usual I have to complicate things.
I guess I have till the 15th so I'm running out of time very quickly. She is not working at the moment and I'm on disability (SSDI) but intend to return to work this year. I have an idea this year will be a 25 - 30,000 income year for the both of us so it looks like she'll qualify for a subsidy. This will only be for her as even though I'm 46 I have medicare/medigap/ for me due to my disability.
She is a very healthy 39 so as far as affordability I'm thinking bronze which here in MD is around 75/month with subsidy for a cheaper plan. I guess the price is determined by expected income and not past income? Why I'm asking is last year I won a fishing tournament and that gets added as income but takes me above what would qualify for a subsidy if based on 2014 income. I would love to do that again this year but it's not something I can count on.
Now, as far as in network. Am I correct in that if she gets a plan here in MD it is only good for local in network Dr's? If we go to FL for the winter (if everything improves) and she needs to see a Dr it won't be covered unless we drive up to MD? Likewise I understand that if she needs to go to an emergency room (accident, broken bones, heart issues, etc..) that it is covered after deductible just as within network? however, what if she needed to be checked into a Hospital for those issues? Hospital is not covered out of network so i would have to drive/fly her to MD for the hospital stay?
I guess if our move would be permanent she could just switch to a FL based insurance plan. With subsidy's they are about the same but without subsidy's (if -no WHEN- everything improves for us) FL's insurance plans are double. Likewise so are the Medigap plans for me.
Or am I misunderstanding what they mean by in network providers? Any ideas?
Now I get the joy of signing my wife up for insurance. And as usual I have to complicate things.
I guess I have till the 15th so I'm running out of time very quickly. She is not working at the moment and I'm on disability (SSDI) but intend to return to work this year. I have an idea this year will be a 25 - 30,000 income year for the both of us so it looks like she'll qualify for a subsidy. This will only be for her as even though I'm 46 I have medicare/medigap/ for me due to my disability.
She is a very healthy 39 so as far as affordability I'm thinking bronze which here in MD is around 75/month with subsidy for a cheaper plan. I guess the price is determined by expected income and not past income? Why I'm asking is last year I won a fishing tournament and that gets added as income but takes me above what would qualify for a subsidy if based on 2014 income. I would love to do that again this year but it's not something I can count on.
Now, as far as in network. Am I correct in that if she gets a plan here in MD it is only good for local in network Dr's? If we go to FL for the winter (if everything improves) and she needs to see a Dr it won't be covered unless we drive up to MD? Likewise I understand that if she needs to go to an emergency room (accident, broken bones, heart issues, etc..) that it is covered after deductible just as within network? however, what if she needed to be checked into a Hospital for those issues? Hospital is not covered out of network so i would have to drive/fly her to MD for the hospital stay?
I guess if our move would be permanent she could just switch to a FL based insurance plan. With subsidy's they are about the same but without subsidy's (if -no WHEN- everything improves for us) FL's insurance plans are double. Likewise so are the Medigap plans for me.
Or am I misunderstanding what they mean by in network providers? Any ideas?
Your in network providers are those that the insurance company contracts with in your home state. If she goes to a doctor in Florida, it is most likely she will not be covered. If however, as you say, there is an emergency and she is brought to the hospital, then typically they will cover this until she is stabilized and able to be moved back to MD and be treated there with her in network doctors and hospital.
Every policy is somewhat different and to the extent she would be covered in another state should be discussed with the insurance carrier perhaps before you chose a policy. However, the above is the general rule.
Now I have another problem as I filled out the eligibility application now.
It asks if either of us are working and how much for this past month. At the moment the answer is none and only my SSDI payment. That is AT THE MOMENT. so now my wife would have to pay double for her policy or go on Medicaid. However, the minute she finds a job she will have to go off Medicaid. Likewise, I intend to try to get back to work but there is no guaranteed income. I have a company so for giggles I put that in and added what MIGHT be my income and now it shows she qualify's for a subsidy and the bronze plan is only 20/month. OK, sounds great but reality is that she will get a job (though probably only a seasonal minimum wage as that's all that is available here). So our income will take her up to what the pre application/qualification site shows as about 75ish/month. More like it.
Basically she doesn't have the funds now to pay more monthly but get some back next tax time and sure doesn't have the funds to have to repay Medicaid or any large subsidies.
I feel my estimation is correct based on previous years but since there is only SSDI income this month it directs her to Medicaid. AAARRRGGGHHH!!!
Now I have another problem as I filled out the eligibility application now.
It asks if either of us are working and how much for this past month. At the moment the answer is none and only my SSDI payment. That is AT THE MOMENT. so now my wife would have to pay double for her policy or go on Medicaid. However, the minute she finds a job she will have to go off Medicaid. Likewise, I intend to try to get back to work but there is no guaranteed income. I have a company so for giggles I put that in and added what MIGHT be my income and now it shows she qualify's for a subsidy and the bronze plan is only 20/month. OK, sounds great but reality is that she will get a job (though probably only a seasonal minimum wage as that's all that is available here). So our income will take her up to what the pre application/qualification site shows as about 75ish/month. More like it.
Basically she doesn't have the funds now to pay more monthly but get some back next tax time and sure doesn't have the funds to have to repay Medicaid or any large subsidies.
I feel my estimation is correct based on previous years but since there is only SSDI income this month it directs her to Medicaid. AAARRRGGGHHH!!!
Well worse case scenario, she goes on Medicaid and if either you or she gets a job and your income goes up, she can move to one of the Medicaid transition plans on the Exchange (though you will find Medicaid very generous, provided there are doctors in your area that take it.) It's a safety net and certainly better than no insurance. Actually if your income is low enough, a Silver plan is better for her, as all costs ,deductible etc. are reduced.
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