That’s the secret. State reps love going to bat for their constituents and it’s a small enough population that helping or ignoring one person can move the needle give all the praise/badmouth one person can do. I’ve worked for a few MCO’s in the area and nothing moves Heaven and earth like a state rep harassing a regulator who then leans on the MCO.
Whoever your state rep is - tell them they need to help everyone, including the health insurance industry and themselves, to understand that the world of digital automated customer service that is not aligned with the consumer is fraud.
The department of Justice is going after Adobe software right now for their online only software subscription model and bullshit cancellation fees.
This is the kind of non-sense we'll see for years now that we've "switched" online communication post pandemic.
I hope OP gets that bill redacted. Good luck.
If I ever get laid off I don’t even bother filing for unemployment because it’s a fucking nightmare, I just call my local rep and I have the check within 3 days and it’s smooth sailing. He’s actually a decent dude just trying to help people
Well, some state reps do. The one for the my area helped me a lot when there was a delay in getting my RN. I literally had a call from Harrisburg within 20 minutes of emailing them, and they had the situation resolved in less than two days.
One of my fellow students in Beaver County took a week to hear back from hers, and was given some weird right speech about how the government shouldn’t be in the business of licensing medical professionals.
This. I don't always agree with her politics, but I will forever vote for her because she and her office are so incredibly helpful with things like this. They go out of their way to let her constituents know that she is there for this type of thing and how to contact her to get the help you need. She seems to be one of the unicorns who is in it to help people.
Pennie messed me up too. I reported zero income and they said i did not qualify for medicaid and my bill went uo 200 dollars to be 500 a month. I was unable to change it despite calling them.
Pennie and their reps have been helpful to me, and I have some info on this based on several calls to them. Pennie is a subsidy and has income limits high and low for assistance, if income is below their threshold then they can't provide a subsidy (and you pay full insurance price to the insurance company) and then an application for Medicaid can be made, which is a completely separate program and department. The Pennie rep can get your request sent to Medicaid, then Medicaid will by mail request info from you. There might be other ways to work with Medicaid.
I've been unsuccessful in actually getting Medicaid due to denials, requests for income information already provided, and extremely slow mail on their end. For example, mailed requests for information arriving one day before or days after the due date. Getting Medicaid is a bureaucratic mess, and you have to fight for it. Someone else in my family was able to get it eventually.
All that said, Pennie is still a great program, their reps are very helpful, and Pennie can heavily subsidize normal insurance plans if you're within their income range. I suspect a lot of people don't know this program exists. Ultimately just call Pennie and see what is available to you.
The system was designed this way, it’s intended to funnel cash to politicians’ buddies and not to actual people in need.
https://www.npr.org/templates/story/story.php?storyId=476015630
All government programs work this way. Do you think wealthy politicians care if we starve? Of course not. SNAP, WIC, etc., are intended to channel billions to grocery chains and food conglomerates.
I’m sorry that you’re dealing with this. I worked in customer service for an insurance company for a few years and Pennie was a headache to deal with 75% of the time.
My advice is to keep calling. As annoying as it is to have to do, sometimes if you speak to the right person they may be willing to help out where someone else wouldn’t be, or if you call them enough times they may just want to make the problem go away.
If you’re making less income your rate should not be increasing, bottom line. Best of luck.
Yeah the entire system is F'd. I tried to sign up for Pennie but was told I qualified for Medicaid because my wife was unemployed and we have 3 kids. I make enough to provide for us but it was a nightmare and we had to submit multiple applications and sending them any documentation was a nightmare, they got some, didn't get others even though we sent it altogether. The entire system is literally just duct taped together, it's a joke. It took us over a month just to get everything set up and then they sent us so many duplicate access cards it was almost comical if it wasn't tax payer money paying for all the wasted cards and postage.
The monthly bill is just an estimate and you reconcile it with your annual income when you file taxes.
> When you apply for Marketplace coverage, you’ll find out if you qualify for the "premium tax credit" that lowers your premium — the amount you pay each month for your insurance plan.
The amount of your premium tax credit depends on the estimated household income for the year you want coverage that you put on your Marketplace application.
> You can apply some or all of this tax credit to your monthly insurance premium payment. The Marketplace will send your tax credit directly to your insurance company, so you’ll pay less each month. This is called taking an "advance payment of the premium tax credit."
https://www.healthcare.gov/lower-costs/save-on-monthly-premiums/
I understand that you're providing this information to hopefully help OP recover some money later. And I hope it's helpful to someone. But I just want to remind everyone that this does not help when OP does not have the money to pay the bill now.
Our US Healthcare system is well and truly broken.
I mean, I don't disagree with you.
But this isn't an indictment of our healthcare system, so much as a bureaucratic screw up. That's just something that happens. Even universal, single payer systems will have bureaucratic screw ups. OP will get it sorted out, it'll be a headache but it'll happen.
The existence of Pennie and ACA markets has helped us reduce the number of uninsured Americans. I think it would be unbalanced to paint with such a broad brush when Pennie is a step in the right direction.
> The existence of Pennie and ACA markets has helped us reduce the number of uninsured Americans
Maybe in the next round we will get actual healthcare, not just insurance with co-pays and deductibles so high that we still can't afford to see a doctor?
If it hadn't have been for the ACA, which allowed me to think I was at least insured even if I still couldn't afford healthcare, I probably would have gotten a REAL job sooner, and wouldn't have ended up with a hand permanently crippled from untreated CTS.
I fucked around and found out.
I'm sorry this happened to you. I've had mostly positive experiences with Pennie reps. Try getting someone else on the line.
For the amount you paid, I'm not an accountant, but I think it will get squared up when you file your taxes. I think we had a month or two we overpaid because our income wasn't adjusted for how much we were taking out for retirement contributions. At tax time our MAGI was accurate and the overpayment was refunded.
After that, I learned to self-attest my income because going from paystubs wasn't working.
Pennie can be a puzzle and if you make one little mistake or don’t update info correctly, it can cause some major headaches. I always recommend using a broker… if you have electric problems, you call the electrician, right? So call the insurance guy for your insurance problems, lol.
I’ve had similar situations happen to some of my clients, and while Pennie can be a pain, stuff like this can sometimes be fixed. Feel free to shoot me a DM if you have questions, I’m local to Pittsburgh and fully licensed, happy to help if able!
Edit: that Medicaid denial letter might come in handy. Keep any paperwork like that, that you receive
Almost exact same thing happened to me and also another friend I have. Just remember, health insurance companies don’t provide access to health care, they gatekeep it.
Just a note to let people who haven't used Pennie know that this seems to be about Medicaid. I used Pennie to buy a plan when I was working and it was just fine.
It was still complicated choosing between plans, because health insurance in the US is a dystopia. I took at look directly at the UPMC and Highmark website, and OMIGOD, they were so much worse to figure out than the Pennie website!
When I had questions, I called the Pennie number. I never had to wait on hold, and the reps were very helpful.
Pennie tried doing that with my son, too. I called and cussed them out, asked for a supervisor, and basically told them I wasn't paying. My son was a landscaper and needed insurance for the winter months due to no work. Needless to say, nothing exchanged hands. I told Pennie they're a rip off company...
This Medicare is a joke. When I retired I wasn’t on any medication so I never enrolled in a prescription plan. After nine years I wanted to sign up for a prescription plan and I’m being penalized $42. a month because I didn’t have a plan for the previous 9 years.
Similar thing happened to me a few months ago, and I’m still trying to figure out how to get back on my original plan. It’s screwed up all kinds of things, and according to their customer support, they can’t do anything about it.
I am sorry for you. We have to pay (I bet we get it back over taxes) 2 months for my mother. Dad retired in the fall and turned 65(so he’s Medicare) in Feb she’s 59 never worked. So we applied and they cancelled insurance for both and we had to reapply and that’s taken 2 weeks I think we owed high mark $1300 for these months plus her monthly health insurance should be $146.
I’ll pay the remaining $300 today and be done with it. But it’s been a mess since march
Hi 👋
I'm an insurance agent and I've been doing this for a while . I'll keep it a buck with you and tell you the government is not your friend and you should only tell the government the information they ask of you. Do until told not do, don't speak unless asked to.
The Medicaid system is distopian you need to be borderline homeless to qualify and as an adult medicaid has very limited options in terms of who will take you (children medicaid pays more on claims than adult medicaid so not many doctors like it). With the exception of medicaid due to disability and Medicare the ACA or how it is here in PA pennie is one of the best things since sliced bread. (I've been here a year) I've been doing ACA since it started and the issue is that the rules are very complex and doing alone through a state exchange the way Pennsylvania wants it to be done leaves a lot of people misinformed.
There are thresholds to reporting increases and decreases in income and most of the times unless you pass or fall below a particular threshold your subsidy is not adjusted and your premiums stay the same.
I'm sorry to hear about what happened to you but I suggest waiting a week and calling pennie back and report that your income didn't change. Or go through and agent or agency and they submit everything directly. All applications have to follow CMS guidelines even if it's a state exchange. Applications submitted through agencies are processed at a priority que and are under less scrutiny than a direct application.
There is no legal or financial penalty for over reporting income the only time you get in trouble is if you underreport income (like you make 60k and say you only make 20k).
I'm not contracted with any companies in PA so can't directly help but I'm more than happy to answer questions or just guide you in the right direction.
Ya Pennie isn't always your friend. We are middle class-ish and neither job offers health insurance. They also said we might be Medicaid eligible. Ha! We are middle aged with chronic conditions. I needed surgery so we didn't have much choice and our premium? $1,000/mo. I got the surgery done, but now I'm off work for 6 weeks so after next month we will be dropped, but the rent will get paid
If they are middle class-ish, they don't qualify for Medicaid. Pennie premiums are high if you want insurance that doesn't come with a $10,000 deductible before it covers so much as an office call. It's basically very expensive catastrophic insurance. (And I had it since its inception up until I finally got a job with good healthcare, thank ghod! It had been years since I had been able to afford seeing a doc.)
Call again and report the income again to get your subsidy back. Take their advice and call.
And if that doesn't work, contact your state representative's office.
That’s the secret. State reps love going to bat for their constituents and it’s a small enough population that helping or ignoring one person can move the needle give all the praise/badmouth one person can do. I’ve worked for a few MCO’s in the area and nothing moves Heaven and earth like a state rep harassing a regulator who then leans on the MCO.
Whoever your state rep is - tell them they need to help everyone, including the health insurance industry and themselves, to understand that the world of digital automated customer service that is not aligned with the consumer is fraud. The department of Justice is going after Adobe software right now for their online only software subscription model and bullshit cancellation fees. This is the kind of non-sense we'll see for years now that we've "switched" online communication post pandemic. I hope OP gets that bill redacted. Good luck.
If I ever get laid off I don’t even bother filing for unemployment because it’s a fucking nightmare, I just call my local rep and I have the check within 3 days and it’s smooth sailing. He’s actually a decent dude just trying to help people
Well, some state reps do. The one for the my area helped me a lot when there was a delay in getting my RN. I literally had a call from Harrisburg within 20 minutes of emailing them, and they had the situation resolved in less than two days. One of my fellow students in Beaver County took a week to hear back from hers, and was given some weird right speech about how the government shouldn’t be in the business of licensing medical professionals.
This. I don't always agree with her politics, but I will forever vote for her because she and her office are so incredibly helpful with things like this. They go out of their way to let her constituents know that she is there for this type of thing and how to contact her to get the help you need. She seems to be one of the unicorns who is in it to help people.
Reapply for Medicaid, ask for retroactive coverage if you have unpaid bills for June. Provide your income proof.
Pennie messed me up too. I reported zero income and they said i did not qualify for medicaid and my bill went uo 200 dollars to be 500 a month. I was unable to change it despite calling them.
Pennie and their reps have been helpful to me, and I have some info on this based on several calls to them. Pennie is a subsidy and has income limits high and low for assistance, if income is below their threshold then they can't provide a subsidy (and you pay full insurance price to the insurance company) and then an application for Medicaid can be made, which is a completely separate program and department. The Pennie rep can get your request sent to Medicaid, then Medicaid will by mail request info from you. There might be other ways to work with Medicaid. I've been unsuccessful in actually getting Medicaid due to denials, requests for income information already provided, and extremely slow mail on their end. For example, mailed requests for information arriving one day before or days after the due date. Getting Medicaid is a bureaucratic mess, and you have to fight for it. Someone else in my family was able to get it eventually. All that said, Pennie is still a great program, their reps are very helpful, and Pennie can heavily subsidize normal insurance plans if you're within their income range. I suspect a lot of people don't know this program exists. Ultimately just call Pennie and see what is available to you.
The system was designed this way, it’s intended to funnel cash to politicians’ buddies and not to actual people in need. https://www.npr.org/templates/story/story.php?storyId=476015630
All government programs work this way. Do you think wealthy politicians care if we starve? Of course not. SNAP, WIC, etc., are intended to channel billions to grocery chains and food conglomerates.
If you have zero income you definitely qualify for Medicaid.
Appeal
I’m sorry that you’re dealing with this. I worked in customer service for an insurance company for a few years and Pennie was a headache to deal with 75% of the time. My advice is to keep calling. As annoying as it is to have to do, sometimes if you speak to the right person they may be willing to help out where someone else wouldn’t be, or if you call them enough times they may just want to make the problem go away. If you’re making less income your rate should not be increasing, bottom line. Best of luck.
Yeah the entire system is F'd. I tried to sign up for Pennie but was told I qualified for Medicaid because my wife was unemployed and we have 3 kids. I make enough to provide for us but it was a nightmare and we had to submit multiple applications and sending them any documentation was a nightmare, they got some, didn't get others even though we sent it altogether. The entire system is literally just duct taped together, it's a joke. It took us over a month just to get everything set up and then they sent us so many duplicate access cards it was almost comical if it wasn't tax payer money paying for all the wasted cards and postage.
The monthly bill is just an estimate and you reconcile it with your annual income when you file taxes. > When you apply for Marketplace coverage, you’ll find out if you qualify for the "premium tax credit" that lowers your premium — the amount you pay each month for your insurance plan. The amount of your premium tax credit depends on the estimated household income for the year you want coverage that you put on your Marketplace application. > You can apply some or all of this tax credit to your monthly insurance premium payment. The Marketplace will send your tax credit directly to your insurance company, so you’ll pay less each month. This is called taking an "advance payment of the premium tax credit." https://www.healthcare.gov/lower-costs/save-on-monthly-premiums/
I understand that you're providing this information to hopefully help OP recover some money later. And I hope it's helpful to someone. But I just want to remind everyone that this does not help when OP does not have the money to pay the bill now. Our US Healthcare system is well and truly broken.
I mean, I don't disagree with you. But this isn't an indictment of our healthcare system, so much as a bureaucratic screw up. That's just something that happens. Even universal, single payer systems will have bureaucratic screw ups. OP will get it sorted out, it'll be a headache but it'll happen. The existence of Pennie and ACA markets has helped us reduce the number of uninsured Americans. I think it would be unbalanced to paint with such a broad brush when Pennie is a step in the right direction.
> The existence of Pennie and ACA markets has helped us reduce the number of uninsured Americans Maybe in the next round we will get actual healthcare, not just insurance with co-pays and deductibles so high that we still can't afford to see a doctor? If it hadn't have been for the ACA, which allowed me to think I was at least insured even if I still couldn't afford healthcare, I probably would have gotten a REAL job sooner, and wouldn't have ended up with a hand permanently crippled from untreated CTS. I fucked around and found out.
I'm sorry this happened to you. I've had mostly positive experiences with Pennie reps. Try getting someone else on the line. For the amount you paid, I'm not an accountant, but I think it will get squared up when you file your taxes. I think we had a month or two we overpaid because our income wasn't adjusted for how much we were taking out for retirement contributions. At tax time our MAGI was accurate and the overpayment was refunded. After that, I learned to self-attest my income because going from paystubs wasn't working.
Pennie can be a puzzle and if you make one little mistake or don’t update info correctly, it can cause some major headaches. I always recommend using a broker… if you have electric problems, you call the electrician, right? So call the insurance guy for your insurance problems, lol. I’ve had similar situations happen to some of my clients, and while Pennie can be a pain, stuff like this can sometimes be fixed. Feel free to shoot me a DM if you have questions, I’m local to Pittsburgh and fully licensed, happy to help if able! Edit: that Medicaid denial letter might come in handy. Keep any paperwork like that, that you receive
https://agency.pennie.com/wp-content/uploads/Appeals-Form-Interactive-1.pdf
With Pennie, you ALWAYS pay your premium in advance, so I’m not sure how you could owe a premium for a past month? There is no auto-renewal.
I’ve started free lance reporting where I call these companies and ask for their opinion on allegations on social medias. Been great
Almost exact same thing happened to me and also another friend I have. Just remember, health insurance companies don’t provide access to health care, they gatekeep it.
Honestly, I’m never doing Obamacare again. I have owed so much in back taxes from them
Just a note to let people who haven't used Pennie know that this seems to be about Medicaid. I used Pennie to buy a plan when I was working and it was just fine. It was still complicated choosing between plans, because health insurance in the US is a dystopia. I took at look directly at the UPMC and Highmark website, and OMIGOD, they were so much worse to figure out than the Pennie website! When I had questions, I called the Pennie number. I never had to wait on hold, and the reps were very helpful.
Reapply, call back advise the incoming was not correctly reported and needs reviewed, and state rep
Pennie tried doing that with my son, too. I called and cussed them out, asked for a supervisor, and basically told them I wasn't paying. My son was a landscaper and needed insurance for the winter months due to no work. Needless to say, nothing exchanged hands. I told Pennie they're a rip off company...
Same thing happened to me. I was out a few hundred bucks.
This Medicare is a joke. When I retired I wasn’t on any medication so I never enrolled in a prescription plan. After nine years I wanted to sign up for a prescription plan and I’m being penalized $42. a month because I didn’t have a plan for the previous 9 years.
Similar thing happened to me a few months ago, and I’m still trying to figure out how to get back on my original plan. It’s screwed up all kinds of things, and according to their customer support, they can’t do anything about it.
I am sorry for you. We have to pay (I bet we get it back over taxes) 2 months for my mother. Dad retired in the fall and turned 65(so he’s Medicare) in Feb she’s 59 never worked. So we applied and they cancelled insurance for both and we had to reapply and that’s taken 2 weeks I think we owed high mark $1300 for these months plus her monthly health insurance should be $146. I’ll pay the remaining $300 today and be done with it. But it’s been a mess since march
Hi 👋 I'm an insurance agent and I've been doing this for a while . I'll keep it a buck with you and tell you the government is not your friend and you should only tell the government the information they ask of you. Do until told not do, don't speak unless asked to. The Medicaid system is distopian you need to be borderline homeless to qualify and as an adult medicaid has very limited options in terms of who will take you (children medicaid pays more on claims than adult medicaid so not many doctors like it). With the exception of medicaid due to disability and Medicare the ACA or how it is here in PA pennie is one of the best things since sliced bread. (I've been here a year) I've been doing ACA since it started and the issue is that the rules are very complex and doing alone through a state exchange the way Pennsylvania wants it to be done leaves a lot of people misinformed. There are thresholds to reporting increases and decreases in income and most of the times unless you pass or fall below a particular threshold your subsidy is not adjusted and your premiums stay the same. I'm sorry to hear about what happened to you but I suggest waiting a week and calling pennie back and report that your income didn't change. Or go through and agent or agency and they submit everything directly. All applications have to follow CMS guidelines even if it's a state exchange. Applications submitted through agencies are processed at a priority que and are under less scrutiny than a direct application. There is no legal or financial penalty for over reporting income the only time you get in trouble is if you underreport income (like you make 60k and say you only make 20k). I'm not contracted with any companies in PA so can't directly help but I'm more than happy to answer questions or just guide you in the right direction.
Ya Pennie isn't always your friend. We are middle class-ish and neither job offers health insurance. They also said we might be Medicaid eligible. Ha! We are middle aged with chronic conditions. I needed surgery so we didn't have much choice and our premium? $1,000/mo. I got the surgery done, but now I'm off work for 6 weeks so after next month we will be dropped, but the rent will get paid
Your premium is $1000/mo. because you qualify for Medicaid. Apply for that.
If they are middle class-ish, they don't qualify for Medicaid. Pennie premiums are high if you want insurance that doesn't come with a $10,000 deductible before it covers so much as an office call. It's basically very expensive catastrophic insurance. (And I had it since its inception up until I finally got a job with good healthcare, thank ghod! It had been years since I had been able to afford seeing a doc.)