Health insurance for my kid - Part 2

[M A V I C]

Part 1: http://forums.macresource.com/read.php?1...20,1060561

(Again, I would prefer this thread not turn political. I've got my own feels on that but for this thread I hope to stay focused on the task at hand.)

My wife and I have been in communication with the state, researching on the web, asked a bunch of other people, and spoke to one insurance company this far.

One thing is for certain: As individuals health insurance is not available for purchase because we have a kid under 19 years old. According to the state, they do not know when it will be available again, and according to one insurance company the next enrollment period is December 1st, 2011. There are a couple of exceptions to that, including if I were to divorce my wife or if one of us were to die. I'm not willing to divorce or kill my wife to become eligible for health insurance, so there are no exemptions for us.

There are a few other options. Group policies allow you to add a kid.

- Costco - I don't like costco, but they do offer health insurance. Their cheapest plan is about $740/mo, and that's about $300-400/mo more than individual plans with better coverage. We were paying about $300/mo earlier in the year (catastrophic for myself, full coverage for my wife and son.)

- Group (my own) - the state changed the law in Oct to allow for groups of 1 if you meet what are essentially self-employment qualifications. Unfortunately, the insurance companies and even the Feds don't know/recognize/realize this yet so online systems deny us. We've received some referrals to brokers, but haven't heard back yet (not surprised, it's the holidays.)

- Group (third-party) - There are technical groups, associations... that offer health insurance. One of the biggest ones, unfortunately, uses a carrier that stopped accepting new providers many years ago so their selection is very slim. They've also greatly cutback coverage and jacked up prices. They typically don't cover (what in my book I consider "true" ) preventive medicine. Disagreements aside, they haven't got onboard yet with this "group of 1" law change and thus we're having a hard time making inroads with them anyway.

- CHIP - We're going to try for this anyway but I don't know if it's going to work. Last time we tried a government program they went off gross income. If one is self employed, they go off of the business's gross income. In my case, that poses a problem because I pay people so their income gets counted against me. That's actually not that big of an issue because the last year has sucked. Until about a month ago. Which brings up issue #2, they only go off of the last 30 days of income. So even if, using theoretical numbers, 11 out of 12 previous months I only made $20k, if in the last month I made $10k that's all they're going to look at, and make the false assumption I make that every month.

- Employer - I actually talked to a client today about what it would take for me to get insurance through them but it's not going to work. I'm going to try with a few others, and I know enough people I'm hoping I can pick up some project where the company would be willing to put me on their group, even if I have to foot the full cost of it.

And this actually makes me wonder if it is possible to get health insurance from another state. I have a client in another state that would likely work something out for me, but I wonder if it'd work.

[Mike Johnson]

Insurance companies aren't allowed to sell policies out of state. It becomes an issue of who would regulate them.

It may sound like a tangent, but I'd advise speaking to an accountant. Can you incorporate so that your corporation pays you a salary? That's what my wife does. She's a contractor for the county, and since we want the county health care plan, they let us purchase it at cost. We pay $950/month for the three of us.

[Acer]

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[Post self-redacted for waxing potentially political]

[michaelb]

M A V I C wrote:
- CHIP - We're going to try for this anyway but I don't know if it's going to work. Last time we tried a government program they went off gross income. If one is self employed, they go off of the business's gross income. In my case, that poses a problem because I pay people so their income gets counted against me. That's actually not that big of an issue because the last year has sucked. Until about a month ago. Which brings up issue #2, they only go off of the last 30 days of income. So even if, using theoretical numbers, 11 out of 12 previous months I only made $20k, if in the last month I made $10k that's all they're going to look at, and make the false assumption I make that every month.

I assume you are referring to California's SCHIP program. I don't think that is how they should determine countable income, and there could very well be good arguments to 1) count income for the self employed properly, net of expenses, and 2) pro rate income over a longer period of time, up to a year, if there is a valid basis for doing so. If you are denied, you will have a right to a "fair hearing" and there are several health care advocacy organizations in CA that should be able to give you legal advice about your specific situation. Good luck sorting this out.

edit: you are in WA, which I would take to refer to Washington, which then the SCHIP program is called Apple Health for Kids?

http://hrsa.dshs.wa.gov/applehealth/am_i_eligible.shtml

But the same basic rules will apply to any SCHIP program in any state (with significant variation on the income levels that apply). Plus, a state cannot have changed eligibility or made it more restrictive since July 2008 under the what are called the maintenance of effort requirements of the stimulus bill.

[rjmacs]

I'm so bummed/pissed to hear that you're having so much trouble with this. I went through a similar debacle (but just for myself) a couple years ago, and got lucky because my state still had a decent "insurer-of-last-resort" plan. Who knows how long it will last in this economy, but fingers remain crossed.

The trouble, generally, with coverage purchased in another state is networks. If you're buying a plan that involves any sort of managed care or provider networks, those groups of doctors and facilities tend to be geographically bounded. There was a question earlier in the year from someone on the forum who had moved because of disability, was covered under COBRA, but couldn't find a doctor in the new location. This can be a totalizing problem, so take care to be certain that any 'network issues' would be manageable from your location.

Best wishes with this. It's a crappy thing to be dealing with at any time, but Xmas week seems even crueller to me, somehow.

[M A V I C]

Mike Johnson wrote: It may sound like a tangent, but I'd advise speaking to an accountant. Can you incorporate so that your corporation pays you a salary? That's what my wife does. She's a contractor for the county, and since we want the county health care plan, they let us purchase it at cost. We pay $950/month for the three of us.

I have a corp that I get a W2 from. I guess I don't see how that helps. Yes, health insurance is deductible, but if it's not for sale, it's not for sale.

michaelb wrote: I assume you are referring to California's SCHIP program. I don't think that is how they should determine countable income, and there could very well be good arguments to 1) count income for the self employed properly, net of expenses, and 2) pro rate income over a longer period of time, up to a year, if there is a valid basis for doing so. If you are denied, you will have a right to a "fair hearing" and there are several health care advocacy organizations in CA that should be able to give you legal advice about your specific situation. Good luck sorting this out.

edit: you are in WA, which I would take to refer to Washington, which then the SCHIP program is called Apple Health for Kids?

Yep. The Federal name for it is just CHIP, but it goes by different names in different states. http://www.insurekidsnow.gov/ We've already talked to them and have the paperwork. That's where I found out they go by the last 30 days of income. They may or may not go by gross, I'm not sure yet. Before the county plan was eliminated, they went by gross.

[vicrock]

Have you checked with your local Chamber of Commerce? They usually have group policies for Chamber members. YMMV.

[Mike Johnson]

M A V I C wrote: I have a corp that I get a W2 from. I guess I don't see how that helps.

I was hoping you could use it to separate your business's gross income from your salary when applying for CHIP. My wife's corporation makes $x/month, but pays her $y/month, which is what we report on our personal tax forms. That's our income, not what the county pays her corporation.

The way things are going, everybody should incorporate. [rant] Like how you can go to jail for sharing a dozen mp3s, while banks are breaking into people's homes and literally stealing their stuff, and getting away with it because they're corporations. [/rant]

Anyhow, my dad worked as a commercial fisherman, and barely broke even, but on paper it looked like we were rolling in dough because programs would ignore the huge operating expenses in his business. It was the same thing you're going through. I wish I could travel back in time and help him incorporate. It would've paid for itself in no time.

[michaelb]

The program was originally called SCHIP or S-CHIP and is still referred to that way in most states and discussions about funding, but you are right that they also just call it CHIP (Children's Health Insurance Program) now.

I don't practice law in WA and am confused by the Medicaid regs, but I think this may be the one that governs the computation of self employment income. I don't see anything that requires only looking at 30 days or would count gross earnings and not be net of business expenses (I don't do any advocacy in SCHIP either, and so this is a bit out of my area, but my guess is that may violate the federal regulations). Here this looks at your taxes for the relevant period for example.

http://apps.leg.wa.gov/wac/default.aspx?...8-450-0085

I think if you are plausibly eligible for CHIP you should definitely apply, and seek advocacy assistance if denied. I don't see any obvious organization that provides health care advocacy to individuals, like what would be called a health care ombudsman. But there is the:

Northwest Health Law Advocates
http://nohla.org/resources.php#legal

Childrens Alliance
http://www.childrensalliance.org/our-cur...r-all-kids

Both of those groups seem to do statewide policy more than individual advocacy, but they try to help or could refer you. The general free legal help site (WashingtonLawHelp.org) doesn't seem to offer anything specific.

[Speedy]

No help for you but for comparison purposes, my state (MN) has an insurer of last resort that my daughter has had for the last 20 years (she will be 21 in July.) She is the policy holder. I wistfully remember at one time paying $86 a month with a $300 deductible. She has had two kidney transplants paid by this plan. Now the rate is $208.15/month/$2k deductible. Here is a pdf of the current rates:

http://www.mchamn.com/docs/10_std_rates.pdf

There is a six month pre-existing exclusion and no one who cannot get insurance elsewhere can be turned down. Her plan has a $2000 deductible. You can get a $500 deductible plan but it costs $1584 more per year than the $2000 deductible plan so even if you use a lot of medical services it is $84 cheaper to buy the $2k plan. Strange rate structure.

Note that thanks to the new Federal law this insurer goes out of business in 2014 when my daughter will be able to buy in the private sector and can't be turned down. I believe rates will be regulated at the state level through our insurance commissioner who will hopefully be pro-consumer and not pro-insurance company. The governor appoints the commissioner and the governor's seat is up in 2014 so we know which party we want to win the governor's seat.