Ronnie Pudding in comments last night asked a good question:
Aren’t most of those young people covered by their parents’ plans?
The keeping a young adult on a parent’s group policy is a middle and upper middle class policy sweetner. It is not a comprehensive policy to actually address access to insurance among those who can’t afford it.
NBC News relays the numbers for 2012:
Last year, an estimated 7.8 million adults between the ages of 19 and 25 were able to either join or stay on their parents’ plans, according to the Commonwealth Fund’s 2013 annual tracking survey.
In 2011, the Census Bureau projected 21 million people between 20 and 25, and making some rough assumptions, there were probably 25 million people between 19 and 25 in 2011.
So there are roughly 17 million people between the ages of 19 and 25 who were not receiving health insurance coverage through their parents in 2012.
The most important thing to remember about the allowance of dependents to stay on parental group health insurance until the month of the 26th birthday is that it assumes a parent or parents is participating in group health insurance. Furthermore, it assumes that the parent is able to afford the additional premium to keep their kid(s) on their health insurance past the 19th birthday. I know at my company, the basic employee plan costs a low wage employee $17 a paycheck for self-coverage, but as soon as anyone is added, the per-paycheck amount increases to $102. For middle and high wage employees, the employee costs are higher.
If a parent is running naked and had the kids on CHIP or Medicaid until they aged out, the parent can’t help. If the parent was on Medicaid or Medicare or was dual eligible for Medicare and Medicaid, the parent can’t help. If a parent and a young adult don’t have a working relationship where health insurance is not a means of control, the young adult may not accept help even if the parent can provide it.
Not all of the 17 million young adults are running around without health insurance. Some get it through their jobs, some get it as they enlisted in the military, some get it through half decent college plans, some get it through the individual market, some qualify for Medicaid (depending on the state) and more will qualify for Medicaid in nine weeks. The sweetner of keeping a kid on a policy is as much a shifter of coverage instead of a provider of coverage as it keeps some people off of Medicaid or the individual market or away from really bad employer provided health care. There is a significant number of young adults who don’t have coverage today because they can’t get on their parent’s non-exisisting plan who will be looking to buy coverage over the next few months.
Maybe you have answered this already–in terms of numbers, what age bucket is the most sizable portion of the uninsured? Is it young adults? Or is it simply the ones that the insurance companies most wan to sign up?
My previous employer had cheap insurance for employees and their children. It was fairly decent, given the cost. Adding a spouse, however, added close to $1000 per month. The theory was that they wanted working spouses to use their own employer’s insurance. One friend of mine was the solo breadwinner, and had to pick up a bare-bones, catastrophe-only policy for his wife, and another friend quit and went to a different company in order to get affordable coverage for him and his wife.
Richard, Have you read this NY Times article about rural america and higher premiums? The market does not work to lower costs in the health care marketplace and I’m not sure why this isn’t mentioned.
Richard, if you ever get time, I’d love to see more on this. I haven’t seen it anywhere.
Many college students are required to purchase health insurance thru a college or university if they are uninsured upon enrollment in the college, are they not? I have a vague memory of this going in as state law in Ohio, and I know I had to “opt out” of my daughter’s college plan (we had insurance, so I sent documentation of that-she’s out of school now). I was surprised that she was going to be billed for a bare bones college plan UNLESS I affirmatively opted out.
Do I have this right? Were a lot of uninsured (so probably lower income) college students actually under a sort of “mandate” already?
@Kay: Depends on the state — but yes, quite a few college students have minimal coverage through their school as a requirement of attendance. Most of the time the coverage is just rolled into either the student loan or the grant aid.
@JPL: That is not surprising at all. As the article noted, most rural areas have a single dominant provider as there is insufficient population to support a wide variety of providers, so the providers have the ability to say no to insurers and the insurers are stuck at either not providing coverage in an area or paying the provider’s price. Throw in the fact that setting up a new insurance company/network is expensive as hell, rural areas with locally dominant provider monopolies and very few people eligible to buy the product that may be created aren’t attractice places for new entrants to the market.
@MrSnrub: When I went back to work I began coverage through my job. Before that I was on hubby’s family plan. I am paying about $60 a month for myself for medical/dental halfway decent coverage. His premium, once I was dropped, was cut in half. And that is with him keeping both kids on his plan (aged 10 & 12). I assume it is because women get gouged on premiums because of all our complicated lady parts.
@Valdivia: Most are under 35 (http://www.pfizer.com/files/products/Profile_of_uninsured_persons_in_the_United_States.pdf) Pfizer actually has a fairly friendly report on this concerning the pre-PPACA age distribution of the uninsured.
And here is a 2011 Health and Human Services Report:
@Richard Mayhew: If they had a single payer option nationwide, that would not be the situation. Our free market system doesn’t work because there is no competition for rural america. The republicans will use this as proof that ACA doesn’t work but they will not discuss the underlying reason.
My younger son went on mine, at a cost of $50 per month. The premium is similar to what my older son pays for his individual, but my coverage is much, much better.
For the record we pay $460 a month which includes dental (dental doesn’t cover my son, though.) My insurance is subsidized by my employer on top of what we pay.
I have a question i hope you can address. Medicaid Estate Recovery is evidently going to be in effect for anyone over 55 taking the expanded Medicaid option. I have read it can vary from state to state. Since the Federal government will be supplying 90% of the funds for the expansion, will the Federal Government be administering the Estate Recovery Program? And why is this such a little known part of the package? Especially since it could financially devastate a surviving spouse.
Seems to me that Medicaid in this instance is not functioning as insurance for those over 55.
@JPL: Mostly true, this is one spot where a public option at Medicare +5% would have been valuable, although be aware that rural hospitals get extremely good Medicare rates, so the savings of someone living in Middle of Nowheresville with one hospital within 25 miles versus someone living in Big City with 12 hospitals within 10 miles won’t be as good as it could be.
Thanks. I thought it was interesting within the context of “they don’t need health insurance!”
Somebody thought “they” needed it, or it wouldn’t have gotten thru a statehouse. I imagine someone was getting stuck with the bill.
Thanks for the info Richard. For all the talk in the last few years I didn’t really have a grasp of the numbers.
I’ve got friends who do not have health insurance due to job loss, money issues, etc. Their son who recently turned 18 got into some accident with his bike–typical young adult accident–and had to go to the ER to get sewn up. Also got x-rays. Of course they didn’t charge him right then, but those bills are coming. The kid is in his last year of high school and is going to start his life with medical bills that will most likely be in the multiple thousands.
I have no idea if he’ll be purchasing health insurance on his own. I doubt it. He doesn’t even have a job. How would he pay for it?
@Violet: Medicaid expansion should be able to help him. I recall reading where people who come to the ER uninsured are being temporarlly signed up to Medicaid while eligibility issues are being worked out.
@Kay: It makes sense that they would be. It would be ridiculous to be resident in a dorm, miles or even states away from your parents, and not be able to access a college health clinic or an ER for an emergency. But the colleges don’t want to take on the higher medical costs associated with serious health issues.
Not to get side tracked but my Sister In Law (the good one) is a professor of sociology and public policy and has worked extensively on the issues that arise as various kinds of special needs or chronic medical or mental health issue children age out of the child health and social services system and into college and the work force. There is a huge stressor placed on them and their families when they go off to college–which a whole lot of people do thinking their condition is well managed–and then fall off their parent’s health care and radar when the college is forced to treat them as adults. There were a couple of high profile suicides at MIT over just this issue.
@Mino: Is the idea that if you are over 55 and have assets you should be able to purchase regular health insurance over the exchanges, with subsidies? Isn’t this to prevent the children and spouse of a wealthy sick person from treating their assets as family property and looting medicaid to cover the health bills?
I’m a parent with a non-existing plan. I’m covered by COBRA until it runs out in March. I purchased my son, a healthy 17-year old, an individual PPO plan with Blue Shield. It started out 2 years ago at $118 per month. After one year it went to $132 per month. Blue Shield just informed me my policy will be rolled into the Obamacare exchange and the premium will be $138 per month. My co-pays will double, however, I will now have vision care for my son. It’s almost November and my son has had zero visits to the Dr. this year. He does, however, have very bad vision and needs an annual eye exam. So all in all, costs will probably be a wash for me under our new world order in healthcare. I will sign up for Obamacare in early March for an April 1 start date. That is if Ted Cruz hasn’t won the war by then. If Ted wins, I move to Switzerland. I love Lake Geneva.
@Kay: My son has applied to 8 colleges, some public, some private. All require proof of health insurance or purchase of a school plan.
@aimai: Why should those under 55 be provided insurance under the Medicaid expansion, but if you are over 55, it is treated as a superior type of credit card debt and is recoverable, even if it means your surviving spouse is forced to sell assets, even to the house in states where there is no homestead protection.
And if you are to be forced to sell your assets to pay for health insurance or be fined, I foresee a few court cases. As I understood it, subsidies were based on income, not assets.
Thanks. I remember thinking it was a little deceptively packaged, that if one didn’t read the contract closely one would miss it and be enrolled. I hope they’re better at making it clear.
I’m a little amused at the response to the mandate, because this “college student mandate” is the second health insurance mandate I’ve encountered at the state level.
There’s a health insurance mandate that comes along with child support for never-married and divorced parents (applies to children). It went in at the state level, in all 50 states, under Bush, relying on a federal rule change (states wrote ‘enabling legislation” but it was a federal rule change that created the mandate).
No one said a word in media when that mandate went in.
I know it’s different, state law, applies only to the children of unmarried parents, but it’s still a health insurance mandate. Only the Obama mandate is a HUGE over-reach. These limited, gradual mandates that apply to sections of the population got no push-back whatsoever.
Can you show me where you’re getting the surviving spouse info? That is not my understanding of Medicaid estate recovery. It is my understanding that recovery only takes place after the death of a surviving spouse, and won’t take place if there’s is a disabled adult child or child under 21.
Was this a change in federal law?
I was fine with it. I just think the idea that there is no health insurance mandate ever, and this is novel and new is not true. I’m aware of two: one for college students and one for the children of unmarried parents.
Has this changed?
@Kay: Every state is different. Here is Iowa heads-up….http://thegazette.com/2013/09/13/estates-could-owe-medicaid/
My question is why the difference in status for the over/under 55? For one it works as insurance, for the other as debt.
Going through this now. The “plans” offered by the colleges are terrible and really expensive. My son has signed up on the exchange.
@Kay: So the parent is legally mandated to purchase insurance for their children in the event of a divorce or an unmarried person siring a child? Am I understanding this correctly? I’m a single adult male with no kids so I’m trying to come up to speed.
They are! If they go thru a court or a child support agency. In Ohio, it can’t cost more than 5% of gross. If health insurance is not available thru the parent’s employer (and the parent is OVER 150% of poverty) the parent pays something called a “medical support order” which is intended to cover medical costs.
It went in in 2006, I believe. Maybe 2007.
@Kay: I have never heard of Estate Recovery of Medicaid charges incurred at ages 21-54. Does that ever occur?
No, I gave you the federal rule so that’s the “floor”. States can be more generous than the federal rule, but they can’t be less generous.
States can’t abrogate the federal rule, so states can’t recover if there’s a surviving spouse, etc. (exceptions listed in the rule). They would have to wait until the surviving spouse or disabled adult dies, or the surviving child reached 21.
No, because the original policy was enacted to recover nursing home costs.
People were changing title of assets to their adult children, relatives, etc. and then qualifying for long -term nursing home care under Medicaid. The program was getting killed because anyone could move assets, and simply not pay for nursing home care. Now they do a “look back” so if your mother has an asset and you move that over to your name and then immediately apply for Medicaid to cover her nursing home costs as “no asset” they find out.
@Kay: Well, it would seem that they have expanded collections from nursing home to any and all medical expenses. Gonna be a big shock to the over 55 crowd.
I think the author of that article has seriously misunderstood the rule. It’s not that all Medicaid for people over 55 is subject to estate recovery. It’s nursing home, home health, and long-term hospitalization that are subject to those rules.
IOW, if someone over 55 gets a flu shot or even a surgery that has an ordinary recovery, the government is not going to try and collect that from the person’s estate. It’s only for long-term care for the reasons Kay explained above.
@MomSense: they vary. My company offers several universities their plans and they range from fugly to pretty good (as in already PPACA Silver(ish) compliant with only minor tweaks) It depends on what the colleges want to offer
Also, as far as I can tell, that’s a letter to the editor, not a news article, so the usual caveats about opinion pieces apply.
It never just applied to nursing homes. It always applied to covered costs. I’ll give you an example because these are people I act as a guardian for.
Severely mentally ill people. If they have an asset when they die, Medicaid recovers that asset for costs incurred. This seems fair to me. The other way would leave family members inheriting the asset, but they didn’t cover the medical bills and they’re not on the hook for the medical bills. Shouldn’t the program get paid when the person dies if it’s possible to get paid? I don’t have any mentally ill people with assets, but if I did I would think that was fair. If we didn’t have the rule, and one had a very sick uninsured relative, one could simply transfer title to assets and have the feds pick up the cost of medical care.
Who is the Medicaid recipient we’re imaging here? They’re uninsured with virtually no income but they have an asset they want to pass down? So a house or other property?
@Mnemosyne (iPhone): From the NY state application form…. I understand that once I get Medicaid coverage, if I am over 55 or if I am in a medical institution and not expected to return home, the Medicaid program may do the following in order to pay for my medical care:
Take money I already have or that is owned to me.
Take money that was made from selling certain things I own
Take money from people who were legally responsible for me when I got benefits
It does not say 55 and/or. So this is an instance where estate recovery for an under 54 would apply, But it likewise seems to me that they are creating a class of over 55 that would include all medical care. This Estate Recovery has been expanded to other areas already in some states. NH Breast & Cervical Health Program is now an estate-recoverable item.
Sample for Washington state…3. Which medical services are subject to estate-recovery laws?
In discussing services subject to estate recovery, it is important to distinguish between Medicaid-funded services (paid for jointly by the federal government and Washington State) and state-funded services (paid for solely by Washington State).
A. Estate recovery for Medicaid-funded services
For estate recovery of Medicaid-funded services, it is important to know the age of the person at the time services were provided.
Estate recovery is allowed for all Medicaid-funded services provided after May 2004 to a person 55 or older.
Estate recovery recovery is allowed for certain Medicaid-funded services provided before June 2004. (See Appendix.)
Estate recovery is not allowed for Medicaid-funded services provided to a person under 55.
Exception: If a nursing home resident receiving Medicaid is “permanently” institutionalized, estate recovery is allowed regardless of the recipient’s age. For more information, see the answer to question 6.
@Kay: Well, a lot of people “think” they will be getting “insurance”, even if it is called Medicaid.
Maybe it needs to be clarified that they will be getting Welfare, not health insurance.
And there are quite a few folks out there nowadays with assets, but no income, thanks to job losses. The premium support portion of the program is based on salary, not assets.
And I haven’t seen any of the exceptions of wife/dependent spelled out in the forms.
It does, though, Miro.
NY can’t change the federal rule. If the federal rule is 55, that’s the rule.
The other thing is, if you are uninsured, a provider can attach assets to recover on medical debt. They can go to a court and get a judgment. Now, there are laws forbidding seizure of a residence, but those laws apply here too, re: surviving spouse, etc.
It’s not like if they didn’t have Medicaid and did have medical debt those assets were “safe” and they could hang onto them.
@Mino:This is what the official medicaid site has to say.
@Kay: Do you realize the states already have programs up to apply for any federal benefits that state charges might be eligible for? You would be surprised at how much reimbursement they are managing. And with the state budget constraints, I cannot fault them.
Yeah, I just think we’re going to disagree on this one, as far as unusual or egregious or unprecedented. Medicaid can recover assets. Providers can also attach assets if the person doesn’t have Medicaid and does have medical debt.
I think you have a good point that people over 55 should be aware that Medicaid can recover assets, but that was always true.
My problem here is that Medicaid behaves as insurance for the under 55 crowd, except in certain delineated circumstances.
But does not for the over 55 group. Am I wrong?
Do you have any actual links? This is from muddy’s link to the Medicaid.gov website:
It’s not a federal or Obamacare rule, it’s a state rule. Look at your dates again — 2004.
If you want to point out that this is a problem with Medicaid, I don’t disagree with you. But it’s not a new problem.
@Mnemosyne: I think it’s similar to the law that if you apply for public welfare benefits as a single parent, they want the info on the other parent. In case the other parent should be paying child support, and not leave it to the state to take care of.
If there isn’t a child support order in effect, they put one in. Then that parent either pays the child support (negating the need for benefits) or the state gets at least some of what they pay out from that parent.
@Mnemosyne: It actually dates back to 1993. That is when the Federal government started mandating that states implement a Medicaid Estate Recovery program instead of just having the option to do so if they wanted.
But look at it the other way. If they didn’t have the rule, one could retire at 55 with lots of assets but low income and have Medicaid cover medical costs. You could have a rule that favors assets over income. That wouldn’t be fair to the person over 55 who works, has no assets to speak of, but has slightly higher income so doesn’t qualify for Medicaid and could have to actually purchase insurance, with or without a subsidy.
I think we have thrashed out the status of 55 and over to be that all Medicare expenses are recoverable, subject to the stated exceptions..
My question is why are they being treated differently than the under 55’s? I might find it understandable if it were reserved for long term nursing care, but that no longer seems the case.
I think it’s so you can’t rack up assets, retire at 55, then declare very little income and get on Medicaid.
You could have some really ludicrous results, someone with substantial assets but very little income just getting a ten year free ride until they qualify for Medicare.
Doesn’t that encourage people in that bracket to forgo medical attention right when a lot of those problems can be minimized by early intervention? I could easily see that happen.
I work for the dental clinic of a small state university. Prior to this year, the mandated student health insurance was a self-insured program, so they rolled the costs of keeping the dental clinic open into that cost, but this year they had to buy a private health insurance plan because of ACA (or so I was told). This year we are running on reserve funds, and unless we find another funding source my job and the clinic are gone as of the next school year. This is my dream job and I love it even if it pays less than private practice, but if having ACA be successful means I have to find a new job, well, I’m OK with that. I’m hoping the plan to find other funding works out though and I won’t have to.
But you can still do that at 54, which I think is Mino’s point.
I have no idea why 55 is the cut off age. Given that they can’t go after the estate if you have a surviving spouse or a dependent child, it seems like an unnecessary line in the sand. But I haven’t given it enough thought so there may be unintended consequences I have not considered.
Right but that wouldn’t work because they’d just get you the following year. You could also retire with assets at 56, 57, etc. I know people would do it at 60, 61, 62, 63 etc.
I think they’re afraid we’ll stop working, if we have a house and a car and no real expenses but one big problem, which is health insurance :)
And quite a few states have capitation charges under managed care arrangements that states may recover whether the individual ever used medical services to that extent or even at all. If you are over 55.
There is a similar (but opposite direction) going on with private disability insurance as well. If you qualify for disability under your employer’s plan, the company *makes you* apply for SSDI. They don’t pay for the doctor visits it might take to do this, of course. Then if the private insurance ends up being more than the SSDI, the insurance company only has to pay the difference. A friend went through this with UNUM.
I thought it was a sweet deal for the insurance company. Take in all the payments and then shuffle off the payout to the government.
Continuity of care is one reason to keep the kids on your policy. If you have an HMO, the kids will still be able to see the same doctor, which may be important. There are people in SoCal who won’t have anything but Kaiser coverage for that reason. Different employer, different employee cost and different copays don’t matter so long as you are in the same network. Other health plans have brand loyalty for the same reason. It is one reason the choose your own doctor varieties are popular, even if they cost more. I didn’t switch plans until my family physician retired. Then I went to Kaiser because of the lower out of pocket cost. Been there ever since.