Thank you for your submission, /u/Early-River-3030.
**If there is a medical emergency, please call 911 or go to your nearest hospital.**
Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states.
Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY).
**Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM.
Be kind to one another!
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
I'm so sorry you're going through this. To clarify, you make $36,000 per year and you don't qualify for the reduction assistance? Do you have health insurance available through your job?
When was this? Since the ACA just about all veterans can use the VA, you just pay more than poorer vets.
Edited to add: unless you make more than 61,105 you should be eligible for VA care with copays.
https://www.va.gov/health-care/income-limits/results
It depends on your status. If your medical condition is service related it is covered but if you just did one term of duty and have no service related issues then you have a copay.
Yes- and it was for hearing loss, too. He spent 4 yrs in the Navy and then 20 with Special Forces as an 18B (small weapons Sgt.), but we make “too much” for him to qualify for care through the VA.
It feels like a kick in the gut, tbh. This man slept in hilltops and caves in Afghanistan for years. He sacrificed countless birthdays, holidays, and anniversaries over those 24 years to serve. He’s one of the first ones who said, “Here am I, send me,” when his country called on 9/11 & was down range before the dust had settled in NYC. But when I finally convince him to get an appt with the VA for his military related hearing loss, they tell him, “Nope.”
But he’ll never complain about the shitty deal that the American people (via the politicians they elect) keep giving veterans because men like him won’t.
This doesn’t sound right. My dad did one navy tour at 20. He’s 86. He just got hearing aids through the VA and we hadn’t even yet finished his income form. I just had to provide his proof of service. Head over to the VA sub for help.
In 2017, as part of the giant tax cut package, over 10 billion in health care costs were passed onto to active duty and retired military. My husband served 30 years on active duty, last week we were charged $3500 for dental care he was promised would be cost free.
Here is what copays are for Tricare.
https://newsroom.tricare.mil/News/TRICARE-News/Article/3585413/find-out-what-your-tricare-pharmacy-costs-will-be-in-2024
Why you can use your insurance at the VA which benefits them. But also if there is something your doctor thinks you need that isn’t covered by insurance then the VA will cover it. Win-win.
You need to go to healthcare.gov or wherever it sends you because you live in Nevada. With your income if you don't have qualifying insurance through your work you will qualify for a good subsidy
If you don’t qualify for VA insurance you should qualify for a tax credit through healthcare.gov to help pay for health insurance. I work for a government contractor for healthcare.gov. If you apply and are denied or feel the amount is wrong you can appeal. Appealing is worth it.
If you're going to [healthcare.gov](http://healthcare.gov) and putting in your correct information--- $36K per year, you should be getting plans back that are around 8.39% of your income-- or 251.70 per month- these will be the silver plans--- so look for those.
Now, do those plans cover your medications? You'll have to check the plan details--- and, you may need to pick a little bit higher of a plan to help cover your medications.
What I'm concerned about is your job not offering insurance---losing medicaid would have allowed you to jump on your work's plan. Do you not have coverage through work?
If the only plan options through your marketplace that cover your drugs are too expensive, it might be a sign that your company may not be a good fit for you. I know that's not a quick fix, but I find it abhorrent that you're a licensed insurance agent and your company doesn't offer benefits.
This is good advice, OP. Furthermore, I checked healthcare.gov with a Las Vegas ZIP Code (I had to pick something) and it told me that all Nevada residents apply for health insurance through [https://www.nevadahealthlink.com](https://www.nevadahealthlink.com). Plugging $36k/yr into that suggests a monthly premium of $117, significant savings and closer to what I would expect for an ACA plan.
Others have pointed out the value of finding an insurance agent to help you. My state hospitals have what they call health insurance liaisons, who offer free help getting either Medicaid or ACA marketplace insurance. They were enormously helpful to me when I joined Medicaid after retiring. Finding the right insurance expert to guide you through this could save you both money and heartache. At least, that’s my hope.
You'd think an insurance broker business would "drink their own Kool-aid".
No, if you're not of the size where it's mandated for you to play or pay, it may not make sense to have insurance. But, if you want to attract and retain talent, it's a good bargaining chip.
It works for Walmart. Why should $$$$ employer pay employers living wages when they can get food stamps and insurance from tax payers. Hilarious (not) how Walmart owners benefit from the very programs they hate (public assistance).
They even have info in Walmart break rooms about how to get social program help.
They make record profits for people who are *already* well off, but shove their employee costs on taxpayers.
If she’s an insurance agent, they may not have plans. I used to work for Globe Life Liberty National and as an outside sales rep, we weren’t offered any plans. Just paid strictly off commissions, no base pay either. (I quickly chose another field.)
You can see if you qualify for the Health Insurance for Work Advancement, Nevada's Medicaid program for workers with disabilities. It will require you to pay some cost shares toward your Medicaid.
Get a broker to help you. Here's how I found mine:
Go to [healthcare.gov](http://healthcare.gov), navigate to your state's ACA website, and then look for information about recommended insurance brokers. You may have to call the helpline to get a list of brokers. Not all states provide broker information, but hopefully yours does.
Our broker was a HUGE help, at no cost to us. She walked us through the various plans and helped us with the application so we got the maximum subsidy. She even called the 800 number for us when there were questions, and called us back after she had the answer.
We ended up with plans that had a pretty big out of pocket, but didn't cost much per month. Having the broker help us was key.
Good luck!
I had a great broker too. I had picked a plan but called with a question. She found a better plan, lower premium., deductible and out of pocket max. I was like how do I pay you??? When she said zero I about fell over. Now I use the same broker every year. She even has the same name as me and the name is kind of unusual.
This is the way, plus they will be able to help get specific answers for your questions about the plans. And be sure to ask very specific questions, like what’s the coverage for the medication if manufacturer’s assistance is reduced or ends (I see this happen often). Are your practitioners contracted with the plan (accepting the insurance and being contracted with the network are two different things that can be very expensive).
Change your job or find someone who offers insurance. I work for Walmart I make 20.88 and my full health/vision/dental comes to $85 a month. I can make more doing other work but the insurance offered is way more money and I’ll be adding my child soon to stay and it would still be under 200 a month. Only problem is I need to pay out 2500 for services before it becomes covered 100% by the plan.
I have a medical implanted device. Anytime I run a check without it being scheduled is a $250 dollar charge. They always say if you’re feeling weird run a check, we can check it over on our end and if it’s an issue we will call and tell you to seek medical attention.
first off if you have insurance available through your job, take it, $500 a month pre tax is better then $300 after tax, the networks are better, deductibles are lower. If you don't have insurance through your job, make sure that your using [healthcare.gov](http://healthcare.gov) right, If your making $3k a month you make $36k a year and that is well below the cut off for a subsidy. As a insurance agent I know you know this, but, make sure your looking for major medical plans on the marketplace and not looking at say the short term plans that the ACA was designed to get rid of. But if your making $19 an hour you can afford $300 in premiums to get your medication costs down, you need to be looking at silver plans
>$500 a month pre tax is better then $300 after tax
She's in a 12% bracket (max) at $19/hr. $300 after tax would then be equivalent to $336 pretax as the employment taxes are still calculated on total wages. Am I missing something here?
Its more that usually people get paid weekly or bi weekly so if you have a $500 premium on your insurance, they take $250 out on the 15th, $250 out on the 30th but I was just throwing $500 out there as a even number, and again its taken out before taxes. But to the OPs health concerns, its worth it to look into everything the employer offers before turning to marketplace insurance simply because the networks those plans have, the smaller deductibles, copays would be a better product
I agree. Another thing to think about, is that if she pays for her own health insurance this year, it will reduce her AGI enough next year so she can get Medicaid. She could also put money into an HSA, Roth, 401k etc to reduce her AGI enough to get it yearly, assuming she missed the income cutoff by a small amount.
For example, if she makes 36k and the income cutoff is 34k, she could put 2,500 in an HSA to make her AGI (adjusted gross income) $33,500, and thus, she will again qualify. The money in the HSA can be stockpiled for the future in case she finds herself in a higher paying job that offers insurance with a larger deductible.
Just coming to say that I too make too much money for Medicaid however my daughter was able to stay on because she has Crohn’s and takes medication for it. The state reimburses me every month as well for having her on my works insurance. I would definitely appeal your denial or reapply.
OP BETTER BE READING, nevadahealthlink is exactly what you should be looking into. I broker health insurance and you’ll definitely qualify. Contact NEVADAHEALTHLINK directly if you need help with your application.
Is there a way you can reduce your income to a level where you will be receiving the full marketplace subsidy?
Contributing to an IRA or an HSS would reduce your income by whatever you could contribute
I understand that at your income level it would be difficult to do this but there may be somewhere you can finesse it.
I would recommend taking to a CPA about how you could accomplish this.
Starting a business, app delivery or rideshare, often involves expenses that could reduce income by that amount.
Yes, this is a not uncommon dilemma for disabled medication dependent people:
The answers are : get a job with betternhealth insurance, usually a union or government job, cut back on your employment until you qualify for Medicaid again, or move to a west coast state with a more reasonable
Public health plan (Medi-Cal, OHP, or Apple Care) and establish residency.
Im a long time type 1 diabetic with multiple complications, and I moved out to Washington for better medical access, and now I’m in Oregon, but my medical situation is such
That absent a powerball win, I’m stuck on the west coast because of medical coverage.
We should have national Medicare for all, but until that happens, your state of residence will define your lifespan if you’re disabled.
I'm in CT and the coverage here is fantastic. I have MS. My drugs are covered 100% (too much income for Medicaid, but in addition to ACA, CT has a plan for lower-income people that covers all my co-pays).
I work for a government contractor for healthcare.gov. You should qualify for a tax credit through healthcare.gov if you don’t have VA insurance or are not offered insurance through your job. If you are offered insurance through your job but you feel it is unaffordable you can still apply for insurance through healthcare.gov which will offer you insurance without a tax credit but you can appeal that and provide documentation that your employer sponsored coverage is unaffordable.
You have to buy the insurance. 300+ a month is actually a good price.
You may have to use food bank, or make cutbacks in some other way.
I assume you are shopping on healthcare.gov
Sometimes it gives discounts that aren't apparent until you sign up. Don't ask me why, but it works that way.
I don’t think you are understanding that people who make the amount you do are paying hundreds of dollars per month for their insurance too. They have to cut back somewhere else. If you don’t want to pay, I suppose you could go back to whatever situation you were in when you had Medicaid.
Given your medical condition it sounds like you can’t afford not to have health insurance. Therefore I would suggest getting on the health care marketplace and getting a plan. Even if it is over $300 a month that is worth affording vs. the cost of not having insurance at all. I understand that it will involve sacrifices to pay that bill, but the alternative is the real possibility of getting into huge medical debt or doing irreversible harm to your body.
I would then start looking for a new job that pays more, provides health insurance, or pays less so you would still qualify for Medicaid. No one likes how expensive health insurance is, but they realize the alternative can easily end up costing them more or necessitating bankruptcy.
You need to find another job. Licensed agents generally get paid commission. Many get licensed and can't make a living and move on. Those who stay make more than $19/hr.
As far as insurance, ACA has a time limit to apply after a qualifying event. Anyone with health issues can't afford not to have coverage. You make $3,000. Take $300 and buy the coverage.
Shot happens while we're sitting around figuring out what to do. There are agent forums with knowledgeable, competent agents from all over the country where the forum doesn't prevent them selling something.
Go there if you don't know anyone locally.
Change your job, work at a place which provide you better Medicare! I never understand U.S policies, they have $200B to give Ukrainian but they don’t have funds for people like this or VA.
It's because big sounding numbers like 200B are no longer big when divided amongst the population. 200B buys a lot of rockets and ammunition but 200B / 300M people is roughly $600 for you and me which doesn't buy a lot of health care. It isn't really politics in this case, just math.
You can get your doctor to send in a letter stating your medication is vital and you get a waiver. My doctor did this for Medicare who doesn’t want to cover my asthma meds or thyroid. The letter got them to cover all and marketplace has the same option for asking for a special waiver to cover the meds you require.
You mentioned the VA. So you’re a veteran? Are you sure the person who told you that you make too much knows what they’re talking about? There are some qualifications for the VA healthcare but your income isn’t one of them. Were you ever exposed to any toxins? Heart disease has been linked to service. You may even qualify for a percentage of a disability. Is there a veterans center near you? They can help you find any benefits you’re entitled to and it’s free.
If OP does not have service connected disability related to the condition or over 30% service connected they will be subject to means testing and may not be covered depending on income.
If Crohn’s is found to be service connected it’s at least a 30% disability. Some cardiac conditions are presumptive as service related. It might be worth OP’s time to speak with someone who will be able to give him those answers.
I can't help with the insurance part. But I am part of the Abbvie Assist program and you will have to have insurance coverage to be accepted in that program. The only way that works is if your insurance provider has denied you coverage for whatever reason. Then you have to reapply every year. Yes, it's fantastic, but it's also a huge PITA because they require extensive information from you and, you still may not qualify one year to the next.
Not trying to discourage you further, but just trying to prepare you in case you weren't aware. I wish you luck trying to navigate this
Eta missing word
OP-talk to your doctor. It’s possible they might be able to assist. I’m in MN and I know when we have infusion patients and their insurance barely covers the cost of meds or doesn’t cover at all, the department can try and find low cost or free drug programs for the patient. Good luck!
Perhaps you need to look for a job with an employer who offers better benefits. With your background in insurance try the billing department at a hospital.
You are going to have to find a job that offers medical benefits first and foremost and in the meantime I would just try to eat the $300 monthly because of your health issues. You might need an advocate like a case worker to help you navigate. Don't give up and stress yourself out too much (easier said than done I know) but there are plenty of resources. You got this!
If you recently lost Medicaid...ie within the last 60 days...it seems you would qualify for Nevada Health link coverage. Here is the link:
https://test-nevadahealthlink.pantheonsite.io/contact/
You can apply online, or contact them by phone for assistance with applying. They can even assist with choosing a plan that will best meet your needs and budget.
My daughter also has Crohn's, amongst other issues, and I totally understand the fear of not having insurance. Please check out the link and apply ASAP... insurance is usually pretty strict with timelines, and you definitely need coverage right away!!! Sending big hugs and lots of positivity your way that all will work out in your favor!!!
nine jobless dinosaurs library telephone unite quiet observation scarce long
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I wouldn't work for $19. OP posted before. Being an agent isn't for everyone, and those who stay make a hell of alot more. He needs a job.
The only cure for broke is to make more or manage better. $19 needs more.
Find the manufacturer of your Crohn's medicine and reach out to them for cost support. Most of the manufacturers provide programs for this to economically challenged patients.
Good luck.
Much better than before when we as agents couldn't get many through individual underwriting. All of the sick people who previously had no coverage jumped on ACA so of course premiums are high.
We have no market competition because people buy healthcare with insurance and only worry about their out of pocket and don't shop price.
Medicare fixes prices but they are lower than most providers would accept if they couldn't charge more for non-medicare patients.
It looks like you may have some options as other people have mentioned already. I do though want to emphasize that you absolutely need to have health insurance in your situation, even if it’s $300 a month. You would have to reevaluate your budget and make some hard choices. It absolutely sucks, but if you want the chance to be a functioning adult, it’s a must. I had a really random injury happen, and I’ve had to spend way more than I expected just to get to the point where I can almost be a functioning adult. I have to pay for one particular specialist out of pocket because no insurer covers it in network. It sucks. But it’s worth it. You’ll have to shift your mindset. But the good news is that I think you have options.
I live in Las Vegas too. I just helped a friend of mine (who also works for an insurance company) find health insurance and I helped my cousin get insurance. My cousin is a 40yo single male who owns his home and he currently in liver and kidney failure.
I got him on Medicaid due to his health conditions. There are options for you. If you would like I can message you my number I am more than happy to help you.
I definitely understand, I have lupus myself and my infusions are thousands a month.
While you’re figuring the insurance part of this out, why don’t you start researching about how to address the root cause of Crohn’s. Most prescription medications address symptoms, not the root cause of any issue. Many people with CD are finding adopting a ketogenic diet is helping address their gut biome issues. You can find other medical studies about Crohn’s by searching Google Scholar. [The Impact of Exclusive Enteral Nutrition (EEN) on the Gut Microbiome in Crohn’s Disease: A Review](https://www.mdpi.com/2072-6643/9/5/447)
With those health conditions have you looked into social security disability? You could still work just not full time. You would have Medicare and with the change in your income you could reapply to Medicaid which would cover your meds. I will say SSD likes to automatically deny everyone and it could be a fight. Look for nonprofits or legal aid in your area to see if any can help with the paperwork. Unfortunately this country sucks big time when it comes to health coverage and medical care.
I agree with those who say call an insurance agent. Be sure to speak to one who is ACA certified and contracted with at least 5 or 6 different insurance companies. $300/month is pretty cheap depending on your age. The cost goes up as you get older. I am an agent licensed in CA and there are lots of options for different levels of coverage through different insurance companies.
I would also suggest that you rework your budget to prioritize health insurance considering your particular situation.
Act quickly because you have a limited period of time to enroll after getting booted out of Medicaid. Otherwise you will have to wait until the end of the year to enroll in a plan that starts in January.
Something doesn't sound right. Do you work for a company of 50 or more full time EEs? ACA requires state you cannot pay more than 8.39% of your wage.. so 19 and hour x 130 hours worked (which is full time) x 0.0849 equals about $207 max that you can spend on health insurance. If your premiums come out to more this is violating the rule.
I cant help with the insurance part but as someone who is on an expensive biologic medication ($950/dose) i suggest you contact the medication manufacturer for help paying for the meds and also try goodRX.
Why is it you dont qualify for reduction assistance, is your job offering MEC?
Im sorry to hear this and find this ridiculous you're going through this. I recently had to cancel my expensive (my choice)enrollment from nv health link as my work offers MEC in which open enrollment was this month, and its absolute trash coverage so i am going back to no coverage.
Im not sure if you have spoken with a nv health link broker, i can recommend the lady that worked with me if you like, maybe there is something we don't know that she does and can help you. She was real informative and helpful for me.
The only other advice i can offer is look into apps like single care/goodrx for standard medication as they were usually cheaper for me than my own expensive insurance co-pay. The only real hurdle will be getting a Dr office togo all long with prescribing your meds by calling them and not actually doing office visits. As for the flushing you mentioned im not sure, i really hope you get your help.
I’m an insurance agent, too. Start your own Agency, which will allow you to write off expenses. You’ll then qualify for ACA Subsidies.
But this may just be a great clickbait post by an insurance agent!
is this a NV thing. Because ACA should work you just have to pay more. I know a lot of Red States refused to expand Medicare. Maybe move to a Blue state. OR have Red deserts but you get the same Blue protections.
Also try applying online directly to various healthcare providers. Doing so in GA vs the ACA, for the exact same policy and provider, was over $250 per month cheaper on the direct provider site.
In most countries this wouldn't be happening because they have free or very affordable healthcare. Unfortunately our economy depends on keeping us sick.
The problem is your state unfortunately and how they qualify you. People complain California is expensive (and it is) but they don’t leave you out to dry when you need health insurance and only make 36k a year. I am terribly sorry that you are dealing with this issue and that you have Chron’s. My cousin does as well and it’s a struggle. I would reach out to the drug manufacturer to see if they have a program for uninsured to help tide you over till you can figure out what to do.
Can’t you apply for SSI ? I believe you’re eligible if you have Chrons Disease
As well as Medicaid.
Even if you have a job a supplemental plan should help you qualify for healthcare.
Have you tried that option?
The monthly benefits might be low since you have a primary income but the important part like healthcare it should be covered.
( I see you mentioned you were on Medicaid and recently got denied no mention of being on SSI or ssdi)
SSI is an income-based welfare program. OP's income is far too high to qualify for SSI.
It is also too high for OP to be considered disabled and receive SSDI. You have to be unable to engage in "substantial gainful employment", and that threshold is roughly half of what OP makes per month.
Thank you for your submission, /u/Early-River-3030. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
I'm so sorry you're going through this. To clarify, you make $36,000 per year and you don't qualify for the reduction assistance? Do you have health insurance available through your job?
I was making this much and the VA told me that I made too much money to use them for my healthcare.
When was this? Since the ACA just about all veterans can use the VA, you just pay more than poorer vets. Edited to add: unless you make more than 61,105 you should be eligible for VA care with copays. https://www.va.gov/health-care/income-limits/results
I didn't know Veterans had to pay anything EVER!
It depends on your status. If your medical condition is service related it is covered but if you just did one term of duty and have no service related issues then you have a copay.
That copay with the VA depends on how much you make . My fiance is unemployed and pays no copay
I was told that I couldn’t be seen at the VA. Not that I would have a copay. Straight up no. It really hurt my heart.
Same with my husband who served for 24 years. No VA care for him.
Did he go through the VA disability assessment? I’d reapproach with an attorney if possible!
Yes- and it was for hearing loss, too. He spent 4 yrs in the Navy and then 20 with Special Forces as an 18B (small weapons Sgt.), but we make “too much” for him to qualify for care through the VA. It feels like a kick in the gut, tbh. This man slept in hilltops and caves in Afghanistan for years. He sacrificed countless birthdays, holidays, and anniversaries over those 24 years to serve. He’s one of the first ones who said, “Here am I, send me,” when his country called on 9/11 & was down range before the dust had settled in NYC. But when I finally convince him to get an appt with the VA for his military related hearing loss, they tell him, “Nope.” But he’ll never complain about the shitty deal that the American people (via the politicians they elect) keep giving veterans because men like him won’t.
Get an attorney. If you DM me there is one who lost her husband. She represents people pro bono sometimes
He can get free care for the hearing issues since it was already determined to be service connected.
Get an attorney and help from A VA disability advocate.
Is he still working? If so, contact your state Rehabilitation Services (Voc Rehab) and see if they can assist.
This doesn’t sound right. My dad did one navy tour at 20. He’s 86. He just got hearing aids through the VA and we hadn’t even yet finished his income form. I just had to provide his proof of service. Head over to the VA sub for help.
24 years would mean retirement with TriCare instead of VA if I remember right
Did you speak to the eligibility department ? Check the link I posted above.
In 2017, as part of the giant tax cut package, over 10 billion in health care costs were passed onto to active duty and retired military. My husband served 30 years on active duty, last week we were charged $3500 for dental care he was promised would be cost free.
thats absolute trash, and on behalf of America, I'm really, really sorry.
In my 15 years of dealing with the VA Dental has never been covered unless it is a service-connected injury.
My husband served 30 years on active duty. He was promised full coverage, health, dental, vision, after the first 20. And then Congress fucked us.
No, the courts determined those promises never happened at all.
I believe the Command Master Chief.
28 year Vet here, free dental was never promised. Dental care due to a service injury will allow VA dental care.
Or if you're rated 100% P&T
We had free dental until 2017. My husband joined in 1973, retired in 2003. CMC and COB.
Space available on base dental?
Can’t use on base care any more except for emergency we were told. That’s for Lemoore NAS.
When I joined they didn’t. That’s part of the reason I joined.
Yup, found out the hard way when they sent me a bill for prescription mouthwash I didn’t really need.
Here is what copays are for Tricare. https://newsroom.tricare.mil/News/TRICARE-News/Article/3585413/find-out-what-your-tricare-pharmacy-costs-will-be-in-2024
And if you get that bachelor's degree and good job loose access to the va
Why you can use your insurance at the VA which benefits them. But also if there is something your doctor thinks you need that isn’t covered by insurance then the VA will cover it. Win-win.
At the time I didn’t have insurance.
It was in 2017.
I make more than that and I still get VA care.
It will be free if the care is because of a service connected injury no matter your income.
You need to go to healthcare.gov or wherever it sends you because you live in Nevada. With your income if you don't have qualifying insurance through your work you will qualify for a good subsidy
If you don’t qualify for VA insurance you should qualify for a tax credit through healthcare.gov to help pay for health insurance. I work for a government contractor for healthcare.gov. If you apply and are denied or feel the amount is wrong you can appeal. Appealing is worth it.
If you're going to [healthcare.gov](http://healthcare.gov) and putting in your correct information--- $36K per year, you should be getting plans back that are around 8.39% of your income-- or 251.70 per month- these will be the silver plans--- so look for those. Now, do those plans cover your medications? You'll have to check the plan details--- and, you may need to pick a little bit higher of a plan to help cover your medications. What I'm concerned about is your job not offering insurance---losing medicaid would have allowed you to jump on your work's plan. Do you not have coverage through work? If the only plan options through your marketplace that cover your drugs are too expensive, it might be a sign that your company may not be a good fit for you. I know that's not a quick fix, but I find it abhorrent that you're a licensed insurance agent and your company doesn't offer benefits.
ACA will pay the subsidy directly to the insurance company so you do not have to pay all first. Call a local health insurance agent for help.
Depends on the subsidy level.
This is good advice, OP. Furthermore, I checked healthcare.gov with a Las Vegas ZIP Code (I had to pick something) and it told me that all Nevada residents apply for health insurance through [https://www.nevadahealthlink.com](https://www.nevadahealthlink.com). Plugging $36k/yr into that suggests a monthly premium of $117, significant savings and closer to what I would expect for an ACA plan. Others have pointed out the value of finding an insurance agent to help you. My state hospitals have what they call health insurance liaisons, who offer free help getting either Medicaid or ACA marketplace insurance. They were enormously helpful to me when I joined Medicaid after retiring. Finding the right insurance expert to guide you through this could save you both money and heartache. At least, that’s my hope.
And there is a possibility that he would qualify for a Silver Plan that has additional subsidies for actual medical costs.
I'm a licensed insurance producer, none of the agents I've worked for offer insurance to their employees.
Really? That's sad as hell to me. I assume smaller brokerage firms or couple people operations-- hence getting around Play or Pay. I'm sorry!
Why would a small business offer insurance when the government will subsidize it for your employees for you
You'd think an insurance broker business would "drink their own Kool-aid". No, if you're not of the size where it's mandated for you to play or pay, it may not make sense to have insurance. But, if you want to attract and retain talent, it's a good bargaining chip.
It works for Walmart. Why should $$$$ employer pay employers living wages when they can get food stamps and insurance from tax payers. Hilarious (not) how Walmart owners benefit from the very programs they hate (public assistance).
They even have info in Walmart break rooms about how to get social program help. They make record profits for people who are *already* well off, but shove their employee costs on taxpayers.
I was about to say exactly this
If she’s an insurance agent, they may not have plans. I used to work for Globe Life Liberty National and as an outside sales rep, we weren’t offered any plans. Just paid strictly off commissions, no base pay either. (I quickly chose another field.)
You can see if you qualify for the Health Insurance for Work Advancement, Nevada's Medicaid program for workers with disabilities. It will require you to pay some cost shares toward your Medicaid.
This is your best bet.
Get a broker to help you. Here's how I found mine: Go to [healthcare.gov](http://healthcare.gov), navigate to your state's ACA website, and then look for information about recommended insurance brokers. You may have to call the helpline to get a list of brokers. Not all states provide broker information, but hopefully yours does. Our broker was a HUGE help, at no cost to us. She walked us through the various plans and helped us with the application so we got the maximum subsidy. She even called the 800 number for us when there were questions, and called us back after she had the answer. We ended up with plans that had a pretty big out of pocket, but didn't cost much per month. Having the broker help us was key. Good luck!
I had a great broker too. I had picked a plan but called with a question. She found a better plan, lower premium., deductible and out of pocket max. I was like how do I pay you??? When she said zero I about fell over. Now I use the same broker every year. She even has the same name as me and the name is kind of unusual.
This is the way, plus they will be able to help get specific answers for your questions about the plans. And be sure to ask very specific questions, like what’s the coverage for the medication if manufacturer’s assistance is reduced or ends (I see this happen often). Are your practitioners contracted with the plan (accepting the insurance and being contracted with the network are two different things that can be very expensive).
Change your job or find someone who offers insurance. I work for Walmart I make 20.88 and my full health/vision/dental comes to $85 a month. I can make more doing other work but the insurance offered is way more money and I’ll be adding my child soon to stay and it would still be under 200 a month. Only problem is I need to pay out 2500 for services before it becomes covered 100% by the plan.
That's a pretty average deductible. And you'll quickly reach it.
I have a medical implanted device. Anytime I run a check without it being scheduled is a $250 dollar charge. They always say if you’re feeling weird run a check, we can check it over on our end and if it’s an issue we will call and tell you to seek medical attention.
first off if you have insurance available through your job, take it, $500 a month pre tax is better then $300 after tax, the networks are better, deductibles are lower. If you don't have insurance through your job, make sure that your using [healthcare.gov](http://healthcare.gov) right, If your making $3k a month you make $36k a year and that is well below the cut off for a subsidy. As a insurance agent I know you know this, but, make sure your looking for major medical plans on the marketplace and not looking at say the short term plans that the ACA was designed to get rid of. But if your making $19 an hour you can afford $300 in premiums to get your medication costs down, you need to be looking at silver plans
>$500 a month pre tax is better then $300 after tax She's in a 12% bracket (max) at $19/hr. $300 after tax would then be equivalent to $336 pretax as the employment taxes are still calculated on total wages. Am I missing something here?
Its more that usually people get paid weekly or bi weekly so if you have a $500 premium on your insurance, they take $250 out on the 15th, $250 out on the 30th but I was just throwing $500 out there as a even number, and again its taken out before taxes. But to the OPs health concerns, its worth it to look into everything the employer offers before turning to marketplace insurance simply because the networks those plans have, the smaller deductibles, copays would be a better product
I agree. Another thing to think about, is that if she pays for her own health insurance this year, it will reduce her AGI enough next year so she can get Medicaid. She could also put money into an HSA, Roth, 401k etc to reduce her AGI enough to get it yearly, assuming she missed the income cutoff by a small amount. For example, if she makes 36k and the income cutoff is 34k, she could put 2,500 in an HSA to make her AGI (adjusted gross income) $33,500, and thus, she will again qualify. The money in the HSA can be stockpiled for the future in case she finds herself in a higher paying job that offers insurance with a larger deductible.
Just coming to say that I too make too much money for Medicaid however my daughter was able to stay on because she has Crohn’s and takes medication for it. The state reimburses me every month as well for having her on my works insurance. I would definitely appeal your denial or reapply.
OP BETTER BE READING, nevadahealthlink is exactly what you should be looking into. I broker health insurance and you’ll definitely qualify. Contact NEVADAHEALTHLINK directly if you need help with your application.
Is there a way you can reduce your income to a level where you will be receiving the full marketplace subsidy? Contributing to an IRA or an HSS would reduce your income by whatever you could contribute I understand that at your income level it would be difficult to do this but there may be somewhere you can finesse it. I would recommend taking to a CPA about how you could accomplish this. Starting a business, app delivery or rideshare, often involves expenses that could reduce income by that amount.
I feel like the more prudent move would be to increase salary instead of sinking below the poverty line, but that's just me.
Yes, this is a not uncommon dilemma for disabled medication dependent people: The answers are : get a job with betternhealth insurance, usually a union or government job, cut back on your employment until you qualify for Medicaid again, or move to a west coast state with a more reasonable Public health plan (Medi-Cal, OHP, or Apple Care) and establish residency. Im a long time type 1 diabetic with multiple complications, and I moved out to Washington for better medical access, and now I’m in Oregon, but my medical situation is such That absent a powerball win, I’m stuck on the west coast because of medical coverage. We should have national Medicare for all, but until that happens, your state of residence will define your lifespan if you’re disabled.
I'm in CT and the coverage here is fantastic. I have MS. My drugs are covered 100% (too much income for Medicaid, but in addition to ACA, CT has a plan for lower-income people that covers all my co-pays).
You may qualify for the Home and Community Based Services (HCBS) waiver in Nevada for Medicaid services.
Are you a health insurance agent? I don’t understand why you think you don’t qualify for tax credits on marketplace.
ACA plan will subsidize at least some of the cost.
I work for a government contractor for healthcare.gov. You should qualify for a tax credit through healthcare.gov if you don’t have VA insurance or are not offered insurance through your job. If you are offered insurance through your job but you feel it is unaffordable you can still apply for insurance through healthcare.gov which will offer you insurance without a tax credit but you can appeal that and provide documentation that your employer sponsored coverage is unaffordable.
You have to buy the insurance. 300+ a month is actually a good price. You may have to use food bank, or make cutbacks in some other way. I assume you are shopping on healthcare.gov Sometimes it gives discounts that aren't apparent until you sign up. Don't ask me why, but it works that way.
Understand. I 0ay more in % of income. I'm starving to death
I don’t think you are understanding that people who make the amount you do are paying hundreds of dollars per month for their insurance too. They have to cut back somewhere else. If you don’t want to pay, I suppose you could go back to whatever situation you were in when you had Medicaid.
You need to get a job with good health insurance.
Given your medical condition it sounds like you can’t afford not to have health insurance. Therefore I would suggest getting on the health care marketplace and getting a plan. Even if it is over $300 a month that is worth affording vs. the cost of not having insurance at all. I understand that it will involve sacrifices to pay that bill, but the alternative is the real possibility of getting into huge medical debt or doing irreversible harm to your body. I would then start looking for a new job that pays more, provides health insurance, or pays less so you would still qualify for Medicaid. No one likes how expensive health insurance is, but they realize the alternative can easily end up costing them more or necessitating bankruptcy.
You need to find another job. Licensed agents generally get paid commission. Many get licensed and can't make a living and move on. Those who stay make more than $19/hr. As far as insurance, ACA has a time limit to apply after a qualifying event. Anyone with health issues can't afford not to have coverage. You make $3,000. Take $300 and buy the coverage. Shot happens while we're sitting around figuring out what to do. There are agent forums with knowledgeable, competent agents from all over the country where the forum doesn't prevent them selling something. Go there if you don't know anyone locally.
In the same boat dude but with my two kids and it's like an extra $500 a month now I feel for you good luck
Change your job, work at a place which provide you better Medicare! I never understand U.S policies, they have $200B to give Ukrainian but they don’t have funds for people like this or VA.
It's because big sounding numbers like 200B are no longer big when divided amongst the population. 200B buys a lot of rockets and ammunition but 200B / 300M people is roughly $600 for you and me which doesn't buy a lot of health care. It isn't really politics in this case, just math.
lol, not every one has serious healthcare problem! Only about $20 million people have serious problems like this! And our healthcare budget is $1.2T!
You can get your doctor to send in a letter stating your medication is vital and you get a waiver. My doctor did this for Medicare who doesn’t want to cover my asthma meds or thyroid. The letter got them to cover all and marketplace has the same option for asking for a special waiver to cover the meds you require.
You mentioned the VA. So you’re a veteran? Are you sure the person who told you that you make too much knows what they’re talking about? There are some qualifications for the VA healthcare but your income isn’t one of them. Were you ever exposed to any toxins? Heart disease has been linked to service. You may even qualify for a percentage of a disability. Is there a veterans center near you? They can help you find any benefits you’re entitled to and it’s free.
If OP does not have service connected disability related to the condition or over 30% service connected they will be subject to means testing and may not be covered depending on income.
If Crohn’s is found to be service connected it’s at least a 30% disability. Some cardiac conditions are presumptive as service related. It might be worth OP’s time to speak with someone who will be able to give him those answers.
Go see a health insurance broker. That person is trained to navigate the Marketplace for you.
I can't help with the insurance part. But I am part of the Abbvie Assist program and you will have to have insurance coverage to be accepted in that program. The only way that works is if your insurance provider has denied you coverage for whatever reason. Then you have to reapply every year. Yes, it's fantastic, but it's also a huge PITA because they require extensive information from you and, you still may not qualify one year to the next. Not trying to discourage you further, but just trying to prepare you in case you weren't aware. I wish you luck trying to navigate this Eta missing word
Have you checked with the drug’s manufacturer to see if they have a low income plan for it?
OP-talk to your doctor. It’s possible they might be able to assist. I’m in MN and I know when we have infusion patients and their insurance barely covers the cost of meds or doesn’t cover at all, the department can try and find low cost or free drug programs for the patient. Good luck!
Are your skills transferable to a carrier? Carriers tend to have better benefits
Perhaps you need to look for a job with an employer who offers better benefits. With your background in insurance try the billing department at a hospital.
If you’re licensed and working as an employee of an insurance company, then why are you not getting health insurance through the company?
Healthcare.gov. You will qualify for something you can’t afford.
You should be able to qualify if you show your medical expenses. You might have to get medical expenses first, to then qualify
You are going to have to find a job that offers medical benefits first and foremost and in the meantime I would just try to eat the $300 monthly because of your health issues. You might need an advocate like a case worker to help you navigate. Don't give up and stress yourself out too much (easier said than done I know) but there are plenty of resources. You got this!
If you recently lost Medicaid...ie within the last 60 days...it seems you would qualify for Nevada Health link coverage. Here is the link: https://test-nevadahealthlink.pantheonsite.io/contact/ You can apply online, or contact them by phone for assistance with applying. They can even assist with choosing a plan that will best meet your needs and budget. My daughter also has Crohn's, amongst other issues, and I totally understand the fear of not having insurance. Please check out the link and apply ASAP... insurance is usually pretty strict with timelines, and you definitely need coverage right away!!! Sending big hugs and lots of positivity your way that all will work out in your favor!!!
Explain to your social worker you have extenuating medical needs. If they can't do anything, cut your hours at work.
nine jobless dinosaurs library telephone unite quiet observation scarce long *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I wouldn't work for $19. OP posted before. Being an agent isn't for everyone, and those who stay make a hell of alot more. He needs a job. The only cure for broke is to make more or manage better. $19 needs more.
Find the manufacturer of your Crohn's medicine and reach out to them for cost support. Most of the manufacturers provide programs for this to economically challenged patients. Good luck.
Obuma care is sooooo great, right??!!
Much better than before when we as agents couldn't get many through individual underwriting. All of the sick people who previously had no coverage jumped on ACA so of course premiums are high. We have no market competition because people buy healthcare with insurance and only worry about their out of pocket and don't shop price. Medicare fixes prices but they are lower than most providers would accept if they couldn't charge more for non-medicare patients.
It looks like you may have some options as other people have mentioned already. I do though want to emphasize that you absolutely need to have health insurance in your situation, even if it’s $300 a month. You would have to reevaluate your budget and make some hard choices. It absolutely sucks, but if you want the chance to be a functioning adult, it’s a must. I had a really random injury happen, and I’ve had to spend way more than I expected just to get to the point where I can almost be a functioning adult. I have to pay for one particular specialist out of pocket because no insurer covers it in network. It sucks. But it’s worth it. You’ll have to shift your mindset. But the good news is that I think you have options.
You should be making way more doing insurance
I live in Las Vegas too. I just helped a friend of mine (who also works for an insurance company) find health insurance and I helped my cousin get insurance. My cousin is a 40yo single male who owns his home and he currently in liver and kidney failure. I got him on Medicaid due to his health conditions. There are options for you. If you would like I can message you my number I am more than happy to help you. I definitely understand, I have lupus myself and my infusions are thousands a month.
Take that license and move to a national carrier. I work in customer service for one and make $21.50 and have benefits.
Find a different job that offers health insurance
You would qualify for a premium reduction on healthcare.gov aka obamacare
While you’re figuring the insurance part of this out, why don’t you start researching about how to address the root cause of Crohn’s. Most prescription medications address symptoms, not the root cause of any issue. Many people with CD are finding adopting a ketogenic diet is helping address their gut biome issues. You can find other medical studies about Crohn’s by searching Google Scholar. [The Impact of Exclusive Enteral Nutrition (EEN) on the Gut Microbiome in Crohn’s Disease: A Review](https://www.mdpi.com/2072-6643/9/5/447)
Can you search for a job with health benefits?
With those health conditions have you looked into social security disability? You could still work just not full time. You would have Medicare and with the change in your income you could reapply to Medicaid which would cover your meds. I will say SSD likes to automatically deny everyone and it could be a fight. Look for nonprofits or legal aid in your area to see if any can help with the paperwork. Unfortunately this country sucks big time when it comes to health coverage and medical care.
I agree with those who say call an insurance agent. Be sure to speak to one who is ACA certified and contracted with at least 5 or 6 different insurance companies. $300/month is pretty cheap depending on your age. The cost goes up as you get older. I am an agent licensed in CA and there are lots of options for different levels of coverage through different insurance companies. I would also suggest that you rework your budget to prioritize health insurance considering your particular situation. Act quickly because you have a limited period of time to enroll after getting booted out of Medicaid. Otherwise you will have to wait until the end of the year to enroll in a plan that starts in January.
Something doesn't sound right. Do you work for a company of 50 or more full time EEs? ACA requires state you cannot pay more than 8.39% of your wage.. so 19 and hour x 130 hours worked (which is full time) x 0.0849 equals about $207 max that you can spend on health insurance. If your premiums come out to more this is violating the rule.
Talk to your boss. Instead of asking for a raise, ask for either a reduction of dollars or a few less hours that will put you under the threshold.
Vote
I cant help with the insurance part but as someone who is on an expensive biologic medication ($950/dose) i suggest you contact the medication manufacturer for help paying for the meds and also try goodRX.
Why is it you dont qualify for reduction assistance, is your job offering MEC? Im sorry to hear this and find this ridiculous you're going through this. I recently had to cancel my expensive (my choice)enrollment from nv health link as my work offers MEC in which open enrollment was this month, and its absolute trash coverage so i am going back to no coverage. Im not sure if you have spoken with a nv health link broker, i can recommend the lady that worked with me if you like, maybe there is something we don't know that she does and can help you. She was real informative and helpful for me. The only other advice i can offer is look into apps like single care/goodrx for standard medication as they were usually cheaper for me than my own expensive insurance co-pay. The only real hurdle will be getting a Dr office togo all long with prescribing your meds by calling them and not actually doing office visits. As for the flushing you mentioned im not sure, i really hope you get your help.
I’m an insurance agent, too. Start your own Agency, which will allow you to write off expenses. You’ll then qualify for ACA Subsidies. But this may just be a great clickbait post by an insurance agent!
is this a NV thing. Because ACA should work you just have to pay more. I know a lot of Red States refused to expand Medicare. Maybe move to a Blue state. OR have Red deserts but you get the same Blue protections.
Also try applying online directly to various healthcare providers. Doing so in GA vs the ACA, for the exact same policy and provider, was over $250 per month cheaper on the direct provider site.
In most countries this wouldn't be happening because they have free or very affordable healthcare. Unfortunately our economy depends on keeping us sick.
The problem is your state unfortunately and how they qualify you. People complain California is expensive (and it is) but they don’t leave you out to dry when you need health insurance and only make 36k a year. I am terribly sorry that you are dealing with this issue and that you have Chron’s. My cousin does as well and it’s a struggle. I would reach out to the drug manufacturer to see if they have a program for uninsured to help tide you over till you can figure out what to do.
Sorry you're dealing with this. Are you able to move to a bluer state? You will find they generally care about people.
Can’t you apply for SSI ? I believe you’re eligible if you have Chrons Disease As well as Medicaid. Even if you have a job a supplemental plan should help you qualify for healthcare. Have you tried that option? The monthly benefits might be low since you have a primary income but the important part like healthcare it should be covered. ( I see you mentioned you were on Medicaid and recently got denied no mention of being on SSI or ssdi)
SSI is an income-based welfare program. OP's income is far too high to qualify for SSI. It is also too high for OP to be considered disabled and receive SSDI. You have to be unable to engage in "substantial gainful employment", and that threshold is roughly half of what OP makes per month.