The Medicaid Gap

Obamacare gives the Insurance companies carte blanche for EXTORTION (already a MAJOR problem–people would have insurance IF they could afford it.) Husband and I were both professionals, RN and Chemical Engineer. At age 60, due to military cutbacks he lost his job. You don’t get another job at 60 in this economy. So we were without insurance. As much as I fumed and screamed–we had to sign up for ObamaCare. The premiums for the govt. was 1425.00 per MONTH, of which we paid only 110.00 (Sounds good so far, right?)

Except—we RARELY go to doc, and it wouldn’t even pay for a 200.00 lab fee, and of course deductibles are through the roof. So ALL real medical care is out of pocket.

This year we were told we make too LITTLE (His unemployment, of course is gone for this year), that we qualified for Medicaid—except–we make too MUCH (818.00 per MONTH, my SS) for Medicaid. So without the “tax credit”–our premium jumped from 110 to 1425. REALLY AFFORDABLE HEALTH CARE —– YEAH!!!

Now we went without vacations and scrimped and saved for retirement—but at 1425.00 between the 5 years from lay off till Medicare we would go through $150,000.00 of our savings just in premiums alone, and it still would NOT PAY a dime unless it was catastrophic (we’re in good health).
So for the first time in our adult lives we are without insurance. SInce we would be paying ALL our expenses (never reaching the deductible) just WHOSE Medical Bill AM I PAYING?!! Not mine!

So Obamacare is NOT AFFORDABLE. It does NOT Help. It is just another way to make an already malevolent system (Insurance Companies) an extorting evil—so put me in jail and feed my fat tail–I can not AFFORD the AFFORDABLE HEALTH CARE ACT–and if I did pay the cost for my USELESS Insurance, I would be out in the cold, homeless–and you know what—Washington DC and all their minions are NOT WORTH what we have worked hard for.

So .. . like many others (MANY others! in our area where the median wage is 27,000/year)—I guess we’ll just have to break the law. Because we can not afford to let insurance break us! As an RN, I screamed then and now—GET GOVT. OUT OF MEDICINE, they only SCREW IT UP, like EVERYTHING else they touch!

– Vicki from Virgina

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I totally understand your plight. I had insurance until the Affordable Care Act came out and my insurance company cancelled my insurance. Yes… I was one of that lucky 1%.
So I went through the Marketplace and got my insurance as prescribed by law and dutifully paid my premiums. Here note, however, that no one in my area accepts this insurance. When I call I am told – “We do not accept that insurance.” And when I tell the insurance company they reply – “Oh, yes. That doctor does accept us.” Back and forth and the only one who is losing is me. I am losing money and time and patience. The Insurance Companies have become the crime lords and have taken control of the government… who shall be the first against the wall when the revolution comes?


Vicki, we are sorry to hear about your experience. The goal of the law is to decrease the uninsured rate, while at the same time making health insurance more affordable. You had two experiences connected to the ACA, one with getting cost assistance on a high deductible plan and the other with falling in the Medicaid gap because your state rejected a key ACA provision “Medicaid expansion.”

1. At first the high deductible plan you got through HealthCare.Gov didn’t provide coverage that you were accustomed too, abet it had a pretty low price tag after cost assistance. When shopping for plans it’s important to understand that high deductible plans often do little more than give you free essential preventive services, screenings, and a free annual wellness visit. They are meant mainly to protect you in an emergency. Health care is expensive and getting the right plan is all about balancing out-of-pocket costs and premiums. Pairing an HSA with a high deductible plan can make it more attractive, but a Silver plan with better cost sharing might have been a better deal for you and would have still provided lower costs.

2. Virginia decided not expand Medicaid, and due to this you fell in “the Medicaid gap” (the gap between Medicaid eligibility and ACA cost assistance). This gap only exists in state’s that rejected ObamaCare’s Medicaid expansion. You are directing your anger at ObamaCare, but it was actually a supreme court case spurred on by the anti-ObamaCare folks that allowed state’s like Virginia to keep narrow eligibility levels for Medicaid. Had you been in a state that allowed Medicaid expansion you would have been covered under the ACA as all adults are in that state. In state’s that expand Medicaid those making less than 138% of the Federal Poverty Level have access to Medicaid and in all states those making between 100% – 400% FPL have access to marketplace subsidies.

Lastly please understand that you should qualify for a hardship exemption. Simply present your Medicaid rejection letter to to qualify for the exemption. You’ll be able to buy a private catastrophic plan and won’t have to pay the fee. Also the fee is based on income, given this most folks who fall in the Medicaid gap are also exempt from the fee.

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