Living in the 'gray area': How gaps in health insurance coverage haunt vulnerable patients

[Northeast Agent]

Living in the 'gray area': How gaps in health insurance coverage haunt vulnerable patients

Unable to afford their old health insurance, the Marshes' modest income is too much to qualify for an indigent program but not enough to afford premiums through the Affordable Care Act. And because Marsh lives in Georgia, one of 12 states that have refused to expand a less-than-generous Medicaid program, she and an estimated 678,000 residents fall into a coverage gap that leaves them with no relief from hefty medical bills.

Susan has qualified for Social Security Disability Insurance, but she won't get Medicare coverage until she has been on it for two years, a rule that baffles her husband, Gene, a retired welder.

 

[Newby]

Living in the 'gray area': How gaps in health insurance coverage haunt vulnerable patients

Unable to afford their old health insurance, the Marshes' modest income is too much to qualify for an indigent program but not enough to afford premiums through the Affordable Care Act. And because Marsh lives in Georgia, one of 12 states that have refused to expand a less-than-generous Medicaid program, she and an estimated 678,000 residents fall into a coverage gap that leaves them with no relief from hefty medical bills.

Susan has qualified for Social Security Disability Insurance, but she won't get Medicare coverage until she has been on it for two years, a rule that baffles her husband, Gene, a retired welder.

That 2-year rule was invented by lawyers so you have to hire them to backdate your dsability 2-years.
It makes perfect sense to lawyers.

 

[Truce]

The USA Today story says the couple is 55 and has about $1800 mo income.

I plug those numbers into a Georgia zip code on healthcare.gov and it says they get a silver plan with $0 premium and a $900 max out of pocket per person.

What am I missing here? What is the gray area between people who make a little too much to qualify for Medicaid and still can't afford the premium/out of pocket for an ACA plan after tax credits?

Now if they had $40K income and were stuck with a $6500 out of pocket max for multiple years of cancer claims, I'd say they have a gripe and I'd help them write the USA today story of how our crazy ACA system forces insured people go file bankruptcy from covered medical claims.

But these people in the story are EXACTLY what the ACA protects by virtually eliminating premiums and OOP costs for people just above Medicaid floor. Maybe that letter they wrote to congressional rep should have been returned with that message about ACA.