Pennie health marketplace questions for new person

Submitted by Equivalent_Alps_8321 t3_11tdwl3 in pittsburgh

Hey guys my sister has had medical assistance coverage for a while (Medicaid). She's going to lose it soon I think, too many assets or something. So I guess she needs to buy a health plan from the Pennie marketplace. Is it legally required to have health insurance? Are there penalties if you don't have health coverage?

She doesn't have a job currently. How does Pennie work exactly? Do you need a job? Do you need tax returns to apply? How much are the plans for 1 person who is unemployed? The price range?

Also if she started working an under the table job and was making a small amount of cash would that effect Pennie?

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sr214 t1_jcivjk4 wrote

If her Medical Assistance ends, an automatic referral will be sent electronically to the Marketplace insurance. (Medical Assistance doesn't automatically close, it has to be purposely closed. Ride it out.)

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Aggravating_Foot_528 t1_jcjvv6h wrote

Agreed. The first call should be to the MA caseworker to see exactly when it expires and what happens for the renewal process. There is zero point in paying for a pennie plan while on MA.

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tricksterloki t1_jckkb2h wrote

I've talked with DHS about this before, and they said you would have at least 30 days' notice. Most likely, from other conversations and don't quote me on this, they're going to wait until your annual review before making a new decision. When in doubt, call the state helpline. They don't tend to have wait times, and my experience has always been friendly and helpful. Let them guide you. You don't have to do it on your own.

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[deleted] t1_jckkevy wrote

> I've talked with DHS about this before, and they said you would have at least 30 days' notice. Most likely, from other conversations and don't quote me on this, they're going to wait until your annual review before making a new decision. When in doubt, call the state helpline. They don't tend to have wait times, and NY experience has always been friendly and helpful. Let them guide you. You don't have to do it on your own.

I hope that info is right, because I just quoted you

^(I am a bot, please downvote to remove or contact me to remove it)

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Aggravating_Foot_528 t1_jcimpur wrote

All those questions are answered within the pennie website. It's easy to use.

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B0bb3r7 t1_jcino0v wrote

There used to be a penalty tax in certain circumstances if you did not carry health insurance. There were accommodations for those who could not afford coverage and it was goofy to figure out, something like if the premiums for the second most expensive silver plan on the marketplace was more than 9% of your income, you were not expected to carry coverage. Regardless, there is no longer a penalty assessed if you do not carry coverage.

You and she should take a look at Pennie's site for authoritative information. It is also the only place that you can purchase subsidized coverage. There are income limits for the subsidy. There are no work requirements.

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Aggravating_Foot_528 t1_jcjw0q2 wrote

We can thank SCOTUS and the GOP for this in one of their 600 attempts to scuttle ACA, which itself was based on a very popular Massachusetts GOP passed program.

The penality itself was repealed before it was even levied.

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Willow-girl t1_jcki9uq wrote

> We can thank SCOTUS and the GOP for this in one

Absolutely! When the individual mandate went away during the Trump administration, my then-boss and his wife were able to purchase an off-marketplace plan that saved them $800 a month. They used some of their savings to give me a raise. :-)

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Aggravating_Foot_528 t1_jckj04p wrote

They could have done this before the ACA was partially gutted. If anything getting rid of the individual mandate raised prices because it shrunk the size of the pool and increased risk for insurance companies. Insurance companies were always allowed to sell off exchange plans.

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Willow-girl t1_jcksv15 wrote

> because it shrunk the size of the pool

Which is another way of saying, "It allowed people to buy much less expensive policies that they preferred to the ACA-compliant ones."

The horror!

>Insurance companies were always allowed to sell off exchange plans.

Yes, but before Trump repealed the individual mandate, you would be fined if you didn't buy an ACA-compliant plan. The cost of the fine most likely erased any savings that could be achieved by buying a noncompliant plan.

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Aggravating_Foot_528 t1_jcl49n8 wrote

the issue, and this is far beyond the scope of r/pittsburgh, is that most aca compliant policies are trash and society was ending up paying for the results of underinsurance, no insurance, or filling in the gaps of terrible policies.

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Willow-girl t1_jclbeb5 wrote

I think the problem was that an ever-increasing number of people were going without health insurance, either because they couldn't afford it or because the cost-benefit analysis didn't seem to work in their favor. Therefore, the government had to step in and subsidize policies in order to preserve the insurance industry's profits. This also solved the problem of hospitals giving too much uncompensated ER care to the poor. Healthcare systems, like insurance companies, donate a lot of money to "our" politicians.

It's a pity this couldn't have been done in a way that would actually extend regular healthcare to the subsidized policyholders, but since that was a secondary concern, no one seems to have paid much attention to it. It really doesn't help a poor person to give them a free insurance policy with an $8,000 deductible; they still won't be able to afford doctor visits, or they'll have to pay for them out-of-pocket, same as they were doing while uninsured. They'll only benefit if they have a catastrophic expense, but then they most likely wouldn't have been paying for that anyway. (As the old saying goes, "Can't get blood out of a turnip.")

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Aggravating_Foot_528 t1_jcleb2r wrote

The ACA (the non Medicaid expansion part) was 100 percent a GOP developed plan until they decided that they could score political points by opposing anything Obama did.

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Willow-girl t1_jcnlymu wrote

The healthcare and insurance industries give lots of money to Republicans too, you know!

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tricksterloki t1_jckjgum wrote

They also have counselors you can contact to help navigate the system.

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[deleted] t1_jcj8oml wrote

[deleted]

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Willow-girl t1_jckj1zq wrote

> all that gets sorted out at year end

Which is terrifying ... never knowing how much you may owe until tax time! :-o

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Naa2016 t1_jcil9p5 wrote

It is not illegal to not have health insurance

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Willow-girl t1_jckifjy wrote

I believe it is still technically illegal, but the Trump administration removed the part of the individual mandate that fines you if you don't have it. So there's no penalty for being out of compliance!

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SWPenn t1_jcjvcqf wrote

I had Pennie for a couple years and it was great. I also found that the customer service is really helpful. When you call you talk to a real person who can answer all your questions. Made it easy, and the website gives you all the plan options and prices, including your subsidy. So glad we live in PA, because a lot of states don't offer this many plans.

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Willow-girl t1_jckiw5l wrote

It's great to have insurance .. maybe someday we'll get insurance with co-pays and deductibles low enough that we can actually afford some healthcare.

Luckily I got hurt at work this year as was able to see a doc for the first time in 5 years since it was covered by worker's comp! The doc was cool ... "Anything else you'd care to discuss while you're here?" Oh boy would I ever!

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Delicious-Breath8415 t1_jck05bd wrote

There are no resource (asset) limits for Medicaid in Pennsylvania. If she has zero income she can't buy off of Pennie. She will be referred back to Medicaid.

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sr214 t1_jckl2xc wrote

8773958930 State Wide Customer Service Center

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