HOLY SHIT. I’m losing my ACA Marketplace Insurance Plan in 30 days.
I am one of 200,000 New Yorkers who recently discovered my Health Republic plan is going under in 2016. I’ve been scrambling to find a new plan that covers my doctors.
About Me: I am a disability advocate. My advocacy aims to ease the stigma of products used by people with disabilities. I believe a reduction in stigma will save countless lives. I am also a trained Navigator and will be spending a better part of November volunteering for Community Health Advocates helping my fellow New Yorkers understand their marketplace options… yet I cannot seem to navigate my own healthcare situation.
Here is a recent post about my health insurance experience:
But HOLY SHIT.
This was just released by New York State (on Friday, October 29th):
However, a subsequent NYDFS and CMS-led review of Health Republic’s finances has found that the company’s financial condition is substantially worse than the company previously reported in its filings to NYDFS. In light of these developments, NYDFS and the NYSOH Marketplace have determined that it is in the best interest of consumers to end all Health Republic policies — both individual and small group — on November 30, 2015 so that customers can transition to new coverage after that date.
I’m losing my health insurance in 30 days and I don’t know what to do.
I only have 15 days to select a new plan.
I live with chronic illness and disability. I see my doctors at least weekly. There is no other plan that carries my entire medical team (3 doctors). This honestly could kill me. I can’t be any more clear. I need help. Somebody needs to step in to ensure those who require continuity of care get it. How could this have happened?
Update: I just received the following (and incredibly warm) message from my contact at Health Republic. Remember this is someone who is in the process of losing her job.
They’re shutting us down… We will no longer provide or have insurance after November.
On Monday, I will send over any information I can gather. I am almost positive the NY exchange will have additional assistance available as well as support from DFS… Remain optimistic. You may be able to keep the providers you’re currently visiting for a bit of time after our “doors have closed”.
This may be insanity, and it certainly seems… Unjust… But keep in mind, everything happens for a reason. This door may be closing just as another will be opening.
11/1/15 UPDATE: Knowing I only have 15 days to select a new plan, I logged into NY State of Health as soon as the new marketplace plans went up this morning and discovered I’m locked out. Due to a glitch from 2013, I have two separate accounts. I was assured this was fixed, it’s not.
The account I use says this:
The other account says this:
NYState of Health offices are closed on Sundays. Guess I only have 14 days.
11/2/15 UPDATE: There was a series of Marketplace outages today meaning New Yorkers struggled to get logged on and start shopping. It is also becoming increasingly evident that most Health Republic insurees have yet to be notified they need to sign up for new coverage in just 13 days.
11/3/15 UPDATE: I am now logged onto the New York Marketplace. I found a plan that could work, it’s an Oscar plan as I assumed would be the case. Unfortunately while both of my doctors assure me they accept Oscar, I was unable to locate either of them in Oscar’s doctor search.
Furthermore, I still have not received official notification from Health Republic, which means the majority of Health Republic insurees remain unaware they need to select a new plan in 12 days. I thought the Marketplace would have a warning, but this was the best I got:
11/3/15 Another UPDATE: This is a fiasco. I just spoke with my contact at New York State of Health. She informed me I was no longer eligible for subsidies on any marketplace plans (I receive $285 a month in subsidies because I am on SSD). I became Medicare eligible on 6/1 and turned down Medicare Part B. At the time I was happy with my Health Republic plan and didn’t want to lose my medical team. There were (and are) no Medicare plans that cover all my doctors.
In order for me to receive my subsidies, I need to get rid of Medicare Part A. I was forced onto Medicare Part A. And to get rid of Part A means I will need to also come off of Social Security Disability, which is my source of income and how I pay for my healthcare.
To get back onto Medicare part B, I will need to pay a steep penalty every month for the rest of my life because I declined it in the first place. But none of my doctors accept the same Medicare plan.
I need help.
11/4/14 UPDATE: I received an unexpected and incredibly warm call from a nurse at Oscar Health. She understood the importance of continuity of care regarding mental health physicians. She knew how strong and influential a psychologist and patient bond can be, especially in patients with chronic conditions. So she said Oscar would be more than happy to cover my out of network psychologist. I had chosen Oscar because they covered my two other doctors (my Neurologist and General Practitioner).
Unfortunately the nurse told me Oscar and New York Presbyterian are parting ways. This means my GP and Neurologist will no longer be covered by Oscar in 2016. New York Presbyterian is renowned for being one of the top ten best hospitals in the world, the best in NYC and yet it won’t be covered by an NYC health insurance plan. There are no other Marketplace plans that cover both my GP and my Neurologist. So even had I been an Oscar insuree from day one, I still would be losing continuity of care come 2016.
I also learned I am not eligible for New York’s new and affordable Essential Plan because I am Medicare eligible. And lastly, I am not eligible for Medicaid, though a Medicaid SpendDown plan might be an option (that is, if it doesn’t cost me more than a Marketplace plan without the subsidies).
11/6/15 UPDATE: First, it just came to my attention that the shuttering of Health Republic means there are now no Marketplace plans that cover Memorial Sloane Kettering, which is the best cancer hospital in the world.
In regards to my personal story. I just had a conversation with a Medicare expert. Apparently there have not been any data matches between Medicare and Marketplace plans because a system was in place to notify Health Republic that I (unwillingly) became eligible for Medicare Part A. Having Medicare Part A means I have the minimal required coverage, and come tax time I am S.O.L. How this is my fault that the system wasn’t properly set up? Not entirely sure… but I think I’m about to get a lot broker.
Because I’m already in this precarious tax situation, my new Medicare expert friend urged me not to re-run my Marketplace application, as re-running it might cause the system to match data and take away the subsidies that I currently am shown that I’m eligible for. Taking advantage of this systemic flaw will mean I can receive coverage for the month of December from Oscar (even if it will make my tax situation even worse).
As I was emailing with my new Medicare expert friend, I received a call from my (incredibly kind) contact at New York State of Health asking me to reach out before the end of the day so we can re-run my application and start looking into Medicaid Spend Down options. I’m not sure what I am going to do yet. But I am so grateful to see there may be an enrollment extension in the works.
I’m also thrilled to announce that I got a call from Senator Carlucci’s office. David Carlucci is my favorite Senator in New York because he brought the Accessible Icon to New York State. He is passionate both about People with Disabilities and easing Mental Health stigma. It relieves me to no end knowing this is now on his radar.
Please check out my list of #AffordableCareAsks (and please feel free to get in touch and submit your own).
11/7/15 UPDATE: The New York Times is covering my story!
11/7/15 Another UPDATE: If you can make sense of this Tweet, you will discover you have until November 30th to select a new plan for December.
Click here for the entire Twitter conversation. Took me a while to understand, but basically it would be difficult to notify users, via the New York State of Health website that they would need to indicate they were applying through a Special Enrollment Period (SEP) instead of an Open Enrollment period (OEP). And to have users facing an SEP alongside an OEP might be confusing. So, instead New York state is telling all Health Republic insurees they have until the November 15th (taking 15 enrollment days away from consumers) to avoid confusion.
11/7/15 UPDATE: New York state is stepping in. The official November 15th deadline has been moved back to November 30th. There will be an application hotline for those applying after the 15th. There will be steps put in place that allow Health Republic consumers to continue coverage at New York Presbyterian and Memorial Sloane Kettering for up to a year, since no other marketplace plan covers NYP or MSK.
But it still doesn’t resolve the Medicare issues that came to light through this ordeal. I am still virtually uninsurable as of 2016 and will have to ‘trick the system’ to maintain coverage for the month of December.
My focus for the week of 11/9/15 will be dis-enrollment from Medicare Part A without losing my SSD benefits so I can maintain continuity of care.
Update 11/9/2015: I received the below message from my friend Barry. Barry has a condition a lot like mine, though his actually has a name. CIDP. In reading this, you will notice two things. First, Barry is a tried and true Texas Republican (I am neither). Second, the desire to opt out of Medicare Part A crosses partisan lines.
I saw this in the Times today and I share your frustration. I’m facing similar problems. Since I’ve been granted SSDI (which I was contractually required to apply for under my contract with my private disability insurer), I’m required to enroll in Medicare. Never mind that I don’t want Medicare because it provides worse coverage of my IVIG therapy (at a greater cost to me, out of pocket) than I could get from a private insurer. It amazes me that the government forces me to accept its “benefit,” even when I’d be much better off (as would the taxpayers) without it.
Meanwhile, since it’s illegal for me to buy group health insurance through the Texas bar, I also can’t insure my wife and kids that way. So they’re stuck with the ACA exchange policies, none of which is accepted by their doctors. So now we’re scrambling to find a new pediatrician and a new endocrinologist for my son, who’s a type 1 diabetic and sees his doctor very frequently. If we can’t manage that by January — and we’ve been trying for over a month, now — our only option will be to take him to the ER for his routine diabetes care, which happens, on average, twice a month. He’ll miss a full day of school, my wife will miss a day of work, and the cost will be many times what it would be under a rational system.
It’s hard to argue that the pre-Obamacare system made much sense, but it’s also hard to argue this is much better. At least the old system didn’t come with a trillion dollar price tag.
Note, BTW, that I’ve been practicing law for 11 years and I nonetheless find the Medicare rules as opaque as if they were written in ancient Sumerian. How an average senior can be expected to navigate them is beyond me.
11/11/15 UPDATE: I am speaking with a wonderful representative at The Medicare Rights Center who is helping me figure out the best Part B plan to enroll in. Our agreed upon first step was something I was not comfortable doing, but I had to ask my Psychologist to become a Medicare provider. The rep at MRC suggested I provide this form to my Psychologist and she is currently reviewing and considering it.
In speaking with my psychologist about this, I listed off a variety of reasons I thought she may not be comfortable becoming a Medicare provider. As she is good at her job, she doesn’t let on her thinking, but I can’t imagine I’m far off. The main reason was, I never see elderly people come and go from her office. It is probably not her specialty. Most of her patients are my age. How does a psychologist attract clientele within one’s specialty? This is something this whole experience has made me feel very curious about.
Another thing I’ve become curious about? Why, when you Google ‘Medicare’ and click on images are the only people you see elderly? What about me? Young Medicare recipients? I don’t feel like this system is made for me.
11/13/15 UPDATE: My psychologist reviewed the materials and decided not to become a Medicare provider. I feel both scared shitless and more dedicated than ever to maintaining my medical team and advocating for a Medicare opt out for SSD recipients. But currently, things feel very dire and I’m I worry it’s going to make me sick.
11/14/15 UPDATE: During tonight’s Democratic Debate, Hillary Clinton said we need to find ways to improve the ACA.
Dear Brian Fallon, Stephanie Hannon, Jennifer Palmieri, Hillary for Iowa,Christina Reynolds, Ginger Lew, Karen Finney, Jess Morales Rocketto, Ann O’Leary, and David Plouffe I could not agree more and would love her support in making changes so Medicare/Marketplace plans work for me.
11/17/15 UPDATE: I still haven’t resolved anything and have started to fall into a depression caused by my inability to secure a plan that covers my psychologist. Is this a Catch-22 or just hell?
11/18/15 UPDATE: My psychologist will not be eligible for any Medicare PPO plans because she is not a contracted provider. Isn’t a PPO, by nature, supposed to cover doctors that aren’t contracted? So frustrated. I had gotten my hopes up about this plan.
12/3/15 UPDATE: Things just took a really bad turn. I just heard from the Medicare Rights Center and Senator Gillibrand’s Office, and the SSA denied my equitable relief request that they submitted on my behalf. They were shocked and I’m floored. I am now ineligible both for Medicare and for Marketplace Subsidies.
12/7/15 UPDATE: Today is the Medicare enrollment deadline. It will pass without me.
12/22/15 UPDATE: I just received a letter from Health Republic stating I owe $608.48. They will not pay my provider’s final claim until I pay this amount. I wrote a post in May detailing a billing issue that I believed had been resolved. It had not been resolved. When I try to call the provided number, it’s incredibly difficult to get through to customer service. And when I do get through to customer service, they immediately transfer me to The New York State Department of Financial Services. It’s mind boggling. I canNOT figure out how to resolve this issue to get my doctor paid. I worry this could hurt my credit.
12/29/15 UPDATE: Grandma’s Advice came in the mail:
1/19/16 UPDATE: It’s been a little while since my last update. I’m so grateful that Oscar and my psychologist came to an out of network coverage agreement, so I get to keep my doctor. I still am not receiving subsidies. This means that even though my neurologist is covered (until April when Oscar drops New York Presbyterian) I can’t afford to go. In other random news, I was invited to The White House to speak about my advocacy (unrelated to insurance woes) and brought my letter from Nonie were I to perchance run into the President. I didn’t run into the President. But here’s the video of my speech (my first ever public talk) at The White House: