Forums » Smalltalk » AMA: Medicare and Healthcare Marketplace

I have worked with Medicare and the Health Marketplace for a few years. I will answer what ever questions that are with in my ability about:

1. How they work
2. Qualifications
3. Coverage
4. General Questions
5. My position and responsibilities

lmao i don't got any questions, but i did have to come here and say you a real g. i got my degree in HIT and bounced right out of the field as soon as i realized how hard it is. anyone who can stick with it is pretty hardcore in my book. i never got on my hands on medicare, so i'm not sure if coding claims for it is more or less of a nightmare, but i worked with medicaid for a couple months and my eyeballs went

👁👄👁

I dunno if "Medicare" specifically applies to disability/welfare here, but did you do anything with Medicaid as well?

I've got some questions I'd love to toss at someone with experience in working with disability insurances, just want to know if this is the right place to toss them.

In what ways do you work with these services?

I'm self-employed and get my health insurance through the healthcare marketplace every year. I have to do this in November/December, but don't actually know what my income was until I do my taxes the following January (Or sometimes I am forced to wait until April depending on when people send me the paperwork they owe me), and am never at all sure what my income will be the following year. I always estimate as best I can, which is what the input says to do, but fear terribly that I'm getting it wrong and am going to get audited or something over it. Do you have any advice for self-employed folks trying to navigate the marketplace when they only have the ballparkiest of ideas what their income is going to be?

Medicaid is state based and varies. Income limits apply. Some states Medicaid only cover children and the elderly. Some have expanded Medicaid and cover more people. Because it varies so much I would suggest checking out the website. Sorry that I don't have more for you.

But also Medicare is available for those under (65) who recieve social security disability for 24 months (2 years). Coverage can begins the 25th month. But for for certain illnesses the 24 month wait is waived.

My suggestion is go ahead and renew your coverage. You can give a estimate of what you expect your income to be for 2023 and can update your application to match the income you find it to be later. Even if it's a bit off it's fine. You can update you application as many times as you like the entire year (anytime updates are needed or changes have occured). This can be helpful when your income fluctuates monthly.

But sometimes you don't need to do anything unless the marketplace has informed you that to keep you tax credit you need to update your application. In those cases it does need to be updated. Also for this year open enrollment ends January 15th so there's more time.

In the cases where no information is needed a letter about being being auto reenrolled would be sent (or in your healthcare website account.), nothing needs to be done right away. You can still update the application later if needed.

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I work for a federal contractor and assist people in every state\territory with Medicare enrollment questions, enrollment status, coverage information, premium info, steps to getting additional assistance with Medicare costs and prescriptions, claims\appeals, assist with Medicare website navigation, plan enrollment (prescription drug and Medicare advantage plans), finding care and much more.

For the healthcare marketplace I assist with filling out applications and enrollment into available plans, changing plans, update applications, complaints, review general information of plans available, provide information about current coverage, how the market place plans work with other coverage, cost of coverage including what they will save, what documents to send if proof of information provided on application needs verification, and more.

And in some cases we navigate callers to the right number to reach out for for assistance outside of them if they aren't eligible.

I actually receive both (Disability). I know a lot about it.

What I wanted to know is why some doctors refuse to take it, even when they specialize in fields related to the disabled such as low vision or hearing, and especially why dentists are so hostile toward it to the point where their websites will state upfront they don't take it just to avoid people calling in and asking.

Well the main reason is money. Medicaid has a total medicaid allowed amount, which is the maximum they will pay. It is not the same amount that the provider submitted for the claim. Say the claim was for $500 but the medicaid allowed amount is $150 for that specific service. Then that is what they will get paid. Providers who accept medicaid will be paid a lower amount than if the claim went through a private insurance or if the person paid out of pocket. I don't know much more. I really only know this part because medicare has a medicare approved amount and it works the same way.

Some doctors/specialist/suppliers etc don't like like the way medicaid works and don't want to deal with in.

They may have other reasons but those two are the ones I'm sure of.

Thank you very much for your help!

Thank you for your answers and helping people navigate the rough waters of Medicare and Medicaid and private insurance! Paperwork navigation and deductible gaps for various procedure codes is nothing short of a pain for both patients and healthcare providers.

What are your thoughts on:
A. Medical Savings Acounts? A place I worked had payroll deduction for group insurance, and they gave you X amount of funds to use through the year for everything. there was a 'gap' though between how much they give the first year and the threshold where the 'major medical' insurance picked up. it worked for me as I had more than half my allotment after the first year and it rolled over into the next year, filling in the gap. One lady I worked with wasn't so fiortunate. he son got really sick and was hospitalized, and she used up the whole allotment the first two months of the year and had to pay the 'gap' bills before the major medical insurance poicked up, and had to pay for all further doctor bills because her account was drained by one major medical expense.

B. Single-payer universal healthcare like what is provided in a lot of different countries?

Sorry if these questions are outside your work, but I am curious about what your thoughts are if you wish to answer.

No worries.

a: I have a love\hate relationship with MSA. They can be helpful. But many are connected to plans that have very high deductibles and\or out of pocket maximums which can be a strain on families. Anyone can get hit by a huge medical bill and those plans just don't seem to cover enough in those situations. And because of that new insurances like critical illness and hospital stay insurance are becoming more and more available. They call it covering coverage gaps, but those companies are the ones gutting their coverage and widening them.

b: That would only work if government officials worked to make sure that it was implemented effectively and efficiently with out allowing outside influence control or sway its purpose or use.