Medicaid Approves Coverage Providers Then Refuse to Accept
Individuals relying on Medicaid face significant hurdles in accessing essential healthcare services. Approved coverage often proves unusable due to provider discrepancies and a lack of acceptance, leading to frustration and financial strain. This highlights a systemic issue of inaccurate provider networks and a disconnect between promised coverage and actual service availability.
SOURCES (60)
“Can she/you guys qualify for Medicaid? Is insurance offered at your job(s)? Is there a sliding scale or low income clinic in your area?”
“When your Monthly income (not Annual) drops to zero, you are now eligible for Medicaid - starting the MBA and leaving your old job is a valid 'change of life status'. Best insurance ever - the closest thing we have to national healthcare. No arguing over bills - basically everything is covered. Had a big bill covered completely as it was within 3 months of starting Medicaid. Awesome people work there - they want to get you covered. Check healthcare.gov to confirm in your state. Universit”
“To add to the above, ask your insurance company up front how much your share is going to be. Don’t take the word of the medical practice as to what your insurance will cover.”
“Well, yes, and initially this was the case. The OoP max was like 2k on an old plan and so it was worth it, but changes in covered services meant I no longer hit the maximum with prescriptions. This was the most affordable I could find with all medications and without changing providers (which is a time cost and perhaps out of the scope of this forum) I had to address that because I did not need "get a better job" or moving advice. It is sometimes suggested and it is not valuable. I'”
“my dad had purchased insurance in phonepe back in 2022 thinking it will be as an extra security, after renewing for 4 years and not clamming even once we get to know from any insurance agent that the “Group arogya sanjeevini policy “ by STAR HEALTH cannot be ported to a different insurance because it was purchased online through a third party (phonepe) and nor you can seek any physical help from any star health offices here in Bangalore. when i approached the department manager of malleshwaram o”
“Xpo non union $36hr no OT home daily have to do some dock work. Family health plan 120$ a week and company match 401k ABF union and its .73 cents a mile or $29hr for probation period. Then .86 and $34hr plus you get $9hr towards retirement up to 2k hrs a year. And family health plan is 80$ a month. Based on these which one would you pick. submitted by /u/chrisp_ape [link] [comments]”
“So we went from a household income of $85,000 to $45,000-59,000. So the gross will be $4,000, minimum. My question is health insurance worth it? Since we’re a family of four we’re going to be 185% above the federal poverty line, which puts us able to have 100% of our health expenses waived at the county hospital. I simply have to apply for the help. I’m already applying for WIC. I’ve looked into all kinds of solutions but this seems to make financial sense to me? Please help. I’m trying to save”
“The school-offered health insurance is pricy, so I was wondering if I would be eligible for Medicaid given that I am a full-time MBA student with no income. Has anyone ever gone this route and successfully qualified for Medicaid as an MBA? I would be applying in Pennsylvania submitted by /u/StrawberriesandPimm [link] [comments]”
“25M, no health conditions thankfully, first year anesthesia resident. I’ve been quoted for 5k premiums with true own-occupation, future rider increase, COLA, guaranteed premium to be 120/month in IL. Was wondering if this is typical. Thanks! submitted by /u/Relaxe247 [link] [comments]”
“I'm almost 40, female, may become pregnant in next year or so, live in California, and have a husband with ulcerative colitis (auto-immune, but currently manageable with medicine and routine visits to doctor). The policy summarized below does not include my husband, and I'm paying about $60/month for it. I ran my policy through A.I. to provide a quick summary. I qualify as "Class 1" in this policy since the entire thing is probably too much to ask anyone to consider. Hopefully”
“I just hit 5 years at my company. The longest I've stayed at a company to be honest. I usually job hop, but given the job market it's been hard. I haven't had a pay raise or cost of living raise in 2 years. This year, we are changing health insurance and it will cost me so much based on my medical conditions, doctors, and prescriptions I take. I'm looking at an increase of about $5,000 to $7,000 in my out of pocket expenses over the year. Happy 5 years to me I guess? submit”
“Hi all, An older patient asked if I could take his insurance. It's Aetna medicare PPO. I have an NPI, but am currently out of network for all providers. Is there a way for me to submit a claim to aetna for him or do I need to provide him with a super bill he files himself? I'm not sure he knows how to submit a superbill. Also, do I need to provide insurance coding on the superbill? Where do I find the correct codes? Thanks! I only just started trying to figure out insurance and google ha”
“Hi I have a serious issue at work, there’s a number of law breaks employment, mental health and personal injury. I’d like to really go forward but I’m scared, and can’t afford the legal fees. Is there any insurance I can take such as ATE and how would that work, and how to obtain is possible. I have house insurance but it won’t cover existing issues. submitted by /u/Nice_day_835 [link] [comments]”
“Yes, this is normal. It it horribly normal. And the sad part is if and when you get a raise that entire raise will disappear into healthcare.”
“I also work in SoCal. Districts can vary wildly, but in mine we all get a set amount of money the district covers for benefits. If you go over, you pay. Double check that you don’t have the expensive version of other insurances or other stuff. I opted out of vision insurance in my district which freed up a lot of that set cost because my insurance didn’t cover very much and I pay the same out of pocket to go to Costco without insurance. You should have multiple options for your health/dental as”
“I just got hired for my first teaching job with a local district after graduation. Upon getting the new hire paperwork, I saw that all of the health insurance plans offered are very expensive, and we’re not allowed to opt out. The lowest tier plan is $429 a month that will be deducted out of my paycheck — and I’ll only be making about 50k annually. I’m a young, single individual with no dependents. This seems absurd — is this normal? Located in rural Southern California by the way. Edit: Sorry,”
“My husband is just at the point of considering it now. We’ve been concerned that the income will push us off of Medicaid, while not being enough for Marketplace insurance. But elsewhere in the comments I learned about Medicare eligibility after 6 months of SSDI. This is huge news for us. For me, I do advocacy work with an extremely vulnerable population, and it feels important to keep working until I really no longer can. I’ve cut my caseload way down, and I won’t be taking on new clients. So, o”
“I’m getting excited, hoping to start trying to conceive later this year, so I am looking at the financial aspect of it to try to plan ahead. My state/employer does not offer a paid maternity program. Instead, I have two options: 1) take leave of up to 6 weeks using my accrued sick leave (this would basically be me paying myself) 2) take up to a year of extended leave without pay I have short-term disability through my employer and I also have a separate Accident/Illness supplemental policy. From”
“My school allows us to waive the university health insurance if we have a qualifying plan. For those of you who successfully waived your school’s plan, what insurance did you use? I’m looking for something that: - Meets university waiver requirements - Provides decent coverage in the US - Is reasonably priced If you could also share roughly how much you paid and whether the waiver process was straightforward, I’d really appreciate it. Thanks in advance! submitted by /u/dajupopu [link”
“My spouse forgot (or something) to pay their private health insurance premiums. They are self employed. They won’t qualify for any of the ACA plans outside of open enrollment in our state. Has anyone found anything else that works until we can get them re enrolled for 2027? I have found one possible option for short term insurance by googling but I know Reddit is better. Thanks in advance for any thoughts. submitted by /u/ebot2023 [link] [comments]”
“At that income level you should receive a pretty substantial subsidy for an ACA marketplace plan. You can browse Healthcare.gov to get an idea.”
“Curious to hear from all, how have you accessed mental health resources through insurance after acquiring disability insurance? How (if at all) does it affect your disability insurance rate, premium, etc? Currently a fellow and the cash pay rates of 150-200 (especially for something like EMDR, which was previously recommended to me) makes my wallet hurt a little bit. submitted by /u/premed4 [link] [comments]”
“If I add the estimated monthly income from both jobs, it should be $29,280 annually before taxes and expenses and whatnot. If the IRA stuff is an actual option, and I worked 15 hours instead of 20 at the new job paying $12.50/hr, it would bring the gross monthly income to $2190, and if the income limit is $1836, it looks like I'd have to put $354 into the account every month. I am terrible at math and barely understand finances so these numbers could be total BS but those are the numbers I c”
“Hi. I've been on Medicaid for most of my life because I grew up really poor. Nowadays, I am a 21 year old paying $400/month to live in my parents' house. I currently work part time at a college for $18/hr, 20hrs/week. My new second job will pay $13/hr, plus tips, with 15-20hrs/week. This will roughly add up to $2440/month before taxes, pushing me over the poverty line for single adults in my state, Ohio. I am planning to move out into my own apartment soon, where I will likely be paying”
“My brain is still mush with an 8 week old but I have to make a decision by July 22nd for my benefits. I only make about 45k a year (they are not rehiring after my direct only coworker retired so all of her job duties officially fall on me now so i am hoping/planning to get a raise), my husband however makes roughly double that. He claims our (now) 2 girls on his income since it works best that way tax wise. Ive never used a dependant care account and I cant seem to get someone on the phone. I ha”
“OP's income is way too high for medicaid in any state unless there's some special condition such as pregnancy. If they don't have coverage, looking for plans on the ACA marketplace would be a really good idea. If their employer doesn't offer affordable insurance (less than about 9% of income) then OP would qualify for a marketplace plan.”
“Hey Peeps. I have a new job, yay! It offers health insurance, yay? I am in need of some advice though. The insurance is through Aetna. (I'm not familiar with them.) Can y'all give me the low-downs on what to expect? Are they a PITA to work with? What's the difference between the PPO and PPO buy-up? Any major changes that would benefit certain individuals? Info: I have chronic issues. Migraines. Future Back Surgery. Cancer scares. And Mental Health things. So I unfortunately see a lot”
“So i applied for reimbursement via Loop app which is an employer app. And medi assist is showing it as approved on the link they shared earlier but the Loop person is telling that "The claim has been referred for verification by the TPA, which is an in-person verification process. TPA representative may contact you for more information regarding the claim. Kindly cooperate with the required details, this process takes 15 working days to complete." What does that mean, does it mean that”
“Got a better job. Myself (F38), wife (F36) and baby (6 months old) are all on my health insurance. We’ll be covered for the rest of July by current job, and by my new job in September. What do we do in August?? COBRA, if I understand it, would mean paying the full premium out of pocket (about $4k). Not sure if we can afford that. Gap insurance doesn’t seem to cover pre-existing conditions? Is there some other option I don’t know about? I would have cared far less about this if it was just the gr”
“You're definitely not alone. One thing I'd look into is using an independent broker they're usually not tied to a single carrier and can compare level-funded plans, ICHRAs, and other options. Sometimes they can find better rates or negotiate benefits that you'd never find on your own Funny thing is you don't have to pay them a fees. They usually charged it to the insurance company. I'm not sure how that works though but I met a broker a few months ago and that is their ex”
“Hey, so I’m looking for advice on health insurance. I used to have health insurance until I became a LPN and switched jobs. I have been working since May and my job may offer me insurance in September if I can meet the minimum requirement of 30 work hours a week however I just got accepted into RN school and one of the requirements they have his health insurance. I would need health insurance proof by August, however every private health insurance that I’ve tried says the same thing that I need”
“She will be 63 before retirement and will be shopping for insurance plans either marketplace or private. We do want to keep our income low enough to get the supplements if we can. I used 1600 in this scenario after looking at various aca plans available. I have VA Healthcare which will be my primary source at least until Medicare. I will be 62 at retirement.”
“$2000/month for family BCBS is incredibly inexpensive. I’m doing family BCBS Cobra and it costs about $3000/month with low $500 deductible and $3000 max out of pocket.”
“Curious of feedback on my plans for the next few years. Retired last month at 56 but will work about 10 hours a week thru 2027. Currently using COBRA for the rest of 2026 and may do it thru 2027 because the few hours a week push us out of considerations for ACA subsidies and the COBRA is cheaper. We have a brokerage account with a cost basis about 40% of the value that we are planning on using to pay for living expenses. Currently those investments are solid and I want to keep them in the stocks”
“Is there any remote opportunities for personal lines only insurance producer? Should I get my L&H ? My current pay structure is 40k base. Let me know if it's low or just right. 0-30k premium a month i get 6% 30k-40k goes to 7% 40-50k goes to 8% 50-60k goes to 9% 60-70k goes to 10% 70-99k goes to 11% 100k+ goes to 12% I am interested in learning the business and possibly going indy ? Should I do all or just L&H or both PC and L&H? submitted by /u/Such-Insect36 [link] &”
“Hi everyone, I recently quit my W-2 job and started my mobile PT practice. I am the only employee and do not have contractors. To my understanding, individual malpractice insurance no longer applies, and I need a business/group policy. I got quotes from HPSO ($1370/yr) and Proliability ($766/yr) with the same 1M occurence/3M aggregate coverage. The price difference is confusing. Can anyone share what to look for when buying a policy for a solo practice, especially home health or mobile PT?”
“I have a smaller nut, the monthly payments for Medicare and Blue Cross (for prescriptions) are what kill my budget. I could live (frugally) on just SS even though it is not much, if it weren’t for those two bills.”
“i would suggest getting one more medicare plan for your wife cuz it's valid till your wife working there”
“I’m pretty sure only enterprise plan has the protection you need but I could be wrong - definitely double check”
“can someone explain insurance to me? specifically medical insurance. because why would i pay monthly to a service who might cover fuck all of a medical cost when i can instead put money into a high yeild savings account and have that cover all of my medical costs? submitted by /u/Fit_Ant_6550 [link] [comments]”
“I applied for short-term disability yesterday through my employer's STD provider, Lincoln Financial. I am still working as of today, but my job of 3.5 years is incredibly stressful and I'm very burnt out. This has led to exacerbation of my anxiety and depression to the point where I can't stand it anymore. I've had panic attacks, cried at my desk, etc and I need to get away for a while. I am planning to seek IOP treatment as well. My psychiatrist of 15 years has agreed to sign of”
“The new job is in a hospital A , the salary is 25% more than my current job. I'm hesitant to take it because I started having a new rare health condition 2 years ago and lots of doctors dismissed me except this one doctor in a hospital B. hospital A and B are rivals so if I work for hospital A they won't cover providers on hospital B and instead they will want me to use their own doctors, I might not find a doctor in their hospital who specializes in my condition. I'm in a dilemma es”
“I'm trying to decide between a PPO and an HDHP for next year, and my wife and I are expecting our first child in May. Currently on PPO Plan for 2026 and have no saving for HSA. I know pregnancy, delivery, and pediatric visits can make healthcare costs much higher than normal, so I'm trying to choose the plan that will likely cost the least overall. I'd really appreciate hearing about your experiences or any advice. Thanks! PPO: In Network Deductible: $500 Individual / $1,000 Family O”
“I am currently retired from NYPD and DHS and Retired DHS 10 years ago and have FHEB Retired NYPD and UMR united Currently age 62 and will be mandatory to have Medicare at 65. How does coordinations of benefits work? Do I need to get rid of one of just keep them all? submitted by /u/Watermelonbuttt [link] [comments]”
“Help- I just qualified for health insurance through a new employer but am worried it actually hurts my finances. If you read this or comment at all THANK YOU!!! Any advice is appreciated. Current Plan: currently on a Cigna Silver tier plan through my state (Colorado) health insurance marketplace. At my previous income I qualified for a fair amount of financial assistance/tax credit and pay $182/mo. I have a deductible of $2850 (as of July I’ve met $0). Out of pocket max is $8000. Specialist and”
“Hello! I just moved to LA from overseas at 28w, and I’ve been stressing out over enrolling in the healthcare system. Thankfully my husband has private insurance with Blue Shield (HMO), but I’m struggling to navigate the process as no one has been able to clearly outline what needs to come first or advise what is urgent and what isn’t. If anyone is in California with Blue Shield I would love some advice on the process of finding a gynae and getting appointments scheduled. So far, I’ve: 1. Gotten”
“Why would you take COBRA over the ACA HDHP through 2027? Is your employer’s health plan that much better?”
“We've budgeted for premiums plus max family out-of-pocket every year. Now through 2027, we'll use COBRA at ~$25k/yr. In 2028, we'll move to a bronze ACA HDHP with no subsidies. Today in our state that's ~$18k for premiums and $18k max out-of-pocket per year. We expect the premiums to rise substantially as we reach 50, 55, and 60 age brackets. It's a lot, but this is fatFIRE. We aren't worried about ACA disappearing before we reach Medicare age. (I'm eligible for Canad”
“The value of insurance, especially DI, is in its coverage. Not just $$, but the triggers, exclusions, and riders. A company provided group DI policy is going to be different than a private procured single policy. In general the group policy will have worst non-$ coverage. You need to look beyond just $ coverage. Outside this a company provided group policy does not travel with you terminate employment with the business; the private policy will travel with you. Premiums get more expensive as you”
“Be sure any policy that you have is an own occupation policy. It’s a pretty high threshold for a family physician versus a surgeon but you want be sure you can be considered disabled if you cannot practice your speciality. My husband just made a claim under his disability policy for a three month recovery from a hand injury. He performed surgery as part of his specialty, and he could no longer do that while recovering. He was still seeing patients in the office, but because his policy was own oc”
“Hi guys I’ve been a PT for close to 14 yrs but it looks like I’ll be taking about a yr off soon. I’ve always carried HPSO malpractice insurance for myself in addition to what my employer offers. Does anyone know if I stop it for a yr am I likely to have a huge hike in my yearly rate when I come back? I don’t want to spend the unnecessary money if I won’t be working for a yr but also if they are going to make it twice the price when I come back because I’ll be considered a new customer again then”
“I retired last spring at 62. My wife had already stepped back from her job the year before. We had saved, we had a plan, but the number that kept me awake was $1,280. That was the monthly quote for a benchmark plan for us both on the Marketplace, unsubsidized, in the gap before Medicare at 65. Three years of that felt like a hole we might fall into. So I did what felt like the responsible thing. I filed for Social Security at 62. The checks would start in July. I had run the comparison a dozen t”