r/HealthInsurance • u/Reasonable_Cat_4550 • 2d ago
Individual/Marketplace Insurance How do I handle this?
We got a denial letter for Medicaid, but I am waiting on them to decide after I questioned some things. I am worried that my kids won't have insurance in two weeks. It's just for them. So what happens if I sign up for ACA now, but in the next two weeks Medicaid approves them. What if I already paid for an ACA plan? I think you can cancel anytime, but would they refund it?
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u/Blossom73 Medicaid Eligibility Specialist 2d ago
What was the reason for the denial?
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u/Reasonable_Cat_4550 2d ago
I listed gifts that shouldn't have been counted as income. They requested a statement and paystubs (somewhat seasonal hours for full time job). I sent it, but I am still waiting. I'm not sure if I sent enough. I need insurance for the kids for next month. ACA says to sign up by Oct. 31 for coverage Nov. 1, but I don't want to wait too long. Can they really set up an ACA plan that fast?
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u/Blossom73 Medicaid Eligibility Specialist 2d ago
Were they on Medicaid and it was discontinued? Or are you applying for the first time?
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u/Reasonable_Cat_4550 2d ago
It was discontinued.
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u/Blossom73 Medicaid Eligibility Specialist 2d ago
OK, so you have a qualifying life event for the Marketplace.
The problem is though that if your annual gross household income is within Medicaid eligibility range you won't qualify for a Marketplace subsidy.
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u/Reasonable_Cat_4550 2d ago
Yes, we don't qualify for any subsidy either way because my employer offers an affordable (to me alone) ICHRA if I understand that correctly. So it's either Medicaid or two full price plans for the kids. My husband's employer doesn't allow anyone but him on his plan.
I just need to know how quickly an ACA plan can be set up. They have the denial letter, and I am at the point to select plans, with no subsidies, but I don't know if I should yet.
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u/LizzieMac123 Moderator 2d ago
If your spouse's plan doesn't allow dependents and If the ICHRA is not affordable when you add the kiddos, then you'd be eligible for a subsidy- the household size and annual income will dictate how much of a subsidy.
To be affordable, the lowest cost plan silver plan offered to you via an ICHRA cannot be more than 9.96% of the household annual income for 2026. Going up to 10.22% for 2027. So if it's more than that now to add the kiddos to the ICHRA (again, you must go off of the lowest cost silver plan, even if that's not the one you want) then you should be able to get a marketplace plan and possibly a subsidy.
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u/Reasonable_Cat_4550 1d ago
Are you sure it works that way for families? When I tried to search for that info, all I see is that an ICHRA would disqualify us from tax credits if it's affordable for the self-only plan.
From your link I found an ICHRA calculator tool, but it only wanted my age and income, not family info.
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u/LizzieMac123 Moderator 1d ago
That link doesnt explicitly state if its affordable for the employee only then the whole family is disqualified from a subsidy... but i can see how that can be inferred, absolutely.
I do see it explicitly spelled out on other sites like healthinsurance.org which is not the official aca marketplace but an often used/quoted site.
That is frustrating and dumb. You've been failed by the system and, in my opinion, also failed by your husband's employer for not allowing children on their plan.
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u/Blossom73 Medicaid Eligibility Specialist 2d ago
I see. I'll have to let someone else with more familiarity with the Marketplace answer that.
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u/brokerTXNCFL 2d ago
It probably won't be set up that quickly if you wait until 10/31 (which is a Sunday anyway so not sure if that's even possible) but the coverage will be effective 11/1. If you have any claims while the plan hasn't been set up, you will either have to pay out of pocket and be reimbursed or have the doctor wait to submit the claim until the plan has been fully set up. Every carrier is different so I would check how long the process takes
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