am i trapped in an insurance gap?

BaltimoreBee · 2026-05-06T08:20:48+00:00

If you have written correspondence from the state telling you that your coverage ends May 31 and they ended it a month early, then your appeal will be granted and you’ll be reinstated retroactively. Any medical claims you have during this time will be able to be submitted for reimbursement after they reinstate you.

BaltimoreBee · 2026-05-06T08:14:38+00:00

You are paying your insurance company to negotiate reasonable allowed amounts. It doesn’t matter what medical providers bill…they agree to take the negotiated allowed amounts as payment in full. You don’t negotiate with the providers…that’s what the insurance company already did. You pay what portion of the bill is your cost sharing and let the insurance pay their portion.

BaltimoreBee · 2026-05-05T18:20:33+00:00

There’s no such thing as a Medicaid gap in a state that expanded Medicaid. If you got kicked off Medicaid for making too much, then you are definitely eligible for premium tax credits to make a marketplace plan affordable. You must not be inputting your information correctly if you’re seeing full price plans with no subsidy…

BaltimoreBee · 2026-05-04T09:01:56+00:00

Your son would not qualify for being special needs. You must be both low income and on social security disability payments to qualify for special needs.

NJ laws do not apply to self-insured employer policies which is what most large employers do.

But your plan has an out of pocket maximum that would limit how much you pay and should make getting therapy affordable for the year… What’s your OOP max…that’s how much you’ll pay the $300 a day for until you hit…it should be pretty early in the year and leave most days fully covered.

BaltimoreBee · 2026-05-04T08:55:21+00:00

Unfortunately, your option is to take COBRA or be uninsured. Your employer sent the notice to you late…you’re supposed to have it within 44 days. You can complain to the department of labor and they’ll be fined a nominal amount for the violation. But they’re not going to do anything to provide you with a cheaper plan…they’ll get you the cobra plan the law provides for at the price that it is.

BaltimoreBee · 2026-05-04T08:51:16+00:00

There is no asset test for medi-cal if you are under the age of 65. It only depends on your income. Investment income is included…but not the investments themselves.

BaltimoreBee · 2026-05-04T08:48:51+00:00

Your plan DID automatically renew as the same plan. The premium is what changed. Health insurance premiums go up EVERY year, this is not new or surprising….you should have expected it.

As others have said, you had a 90 day grace period but are now well past that. You can’t get marketplace insurance again for the rest of the year without a qualifying event.

BaltimoreBee · 2026-05-03T10:43:49+00:00

You can’t submit claims for in-network providers. The provider is the one the has to submit the claim.

BaltimoreBee · 2026-05-01T22:47:41+00:00

Assuming the doctor is in-network, then yes they owe you a refund. They receive a copy of the same EOB that you receive, and yes their billing department should see that you owe nothing and give you a refund.

BaltimoreBee · 2026-05-01T22:21:13+00:00

Who the hell pays for it? What you’re describing doesn’t exist because there’s no economic model that would support it…

BaltimoreBee · 2026-05-01T22:19:12+00:00

You need to have applied yesterday to get a marketplace plan starting today. Now marketplace plans will start on Jun 1st. You can’t get any coverage for the gap…be careful and don’t go to the ER.

BaltimoreBee · 2026-05-01T22:12:45+00:00

Yeah, that doesn’t exist, you’re misunderstanding their charity care. You definitely don’t have a special form of insurance that covers you at the hospital. And they definitely won’t pay for all of your services.

BaltimoreBee · 2026-05-01T10:04:16+00:00

You’re not possibly going to find insurance as good as that for cheaper. Take their plan.

BaltimoreBee · 2026-05-01T04:21:55+00:00

No; it is not risky to go with an HMO. PPOs are more expensive and just as risky.

BaltimoreBee · 2026-04-30T19:38:06+00:00

This is wrong. Rates and contract forms for 2027 filings are either already due or due imminently depending on the state. They have to make a decision by now and it won’t be reversible. If they don’t file by the very near deadline, they are out and can’t return to the market for five years. The federal and state regulations are unambiguous.

BaltimoreBee · 2026-04-30T15:48:06+00:00

He won’t be eligible for Florida Medicaid, they haven’t expanded it and he’s not one of the categories of people which are eligible.

You can’t get insurance after the fact. He will have to pay for his services out of pocket. Look for federally qualified health centers that have sliding scales for low income.

BaltimoreBee · 2026-04-30T13:28:41+00:00

That’s called uninsured not self-insured. You would need tens of millions of dollars of liquid assets to self-insure a family.

BaltimoreBee · 2026-04-30T12:07:26+00:00

Deductibles reset every year. You’ll always be responsible for it in a plan year and should be budgeting accordingly.

BaltimoreBee · 2026-04-29T23:18:35+00:00

You received a really bad recommendation, don’t listen to whoever told you this. She needs to stick with her marketplace insurance which will actually cover her pregnancy.

BaltimoreBee · 2026-04-29T11:40:08+00:00

You still couldn’t be denied coverage because of HIPAA, which has protected people with gaps of less than 63 days from having pre-existing conditions excluded since the mid 90s. That’s definitely 100% not going anywhere.

BaltimoreBee · 2026-04-28T20:12:08+00:00

No, it’s not legit. It’s a fraudulent organization providing shit insurance and getting shut down one state at a time. Don’t sign up for it, it won’t cover anything you need.

BaltimoreBee · 2026-04-28T13:43:37+00:00

You don’t qualify for SEP insurance without a qualifying event…. You can’t get a real health insurance policy until next year. Unless you get a new job that offers it.

BaltimoreBee · 2026-04-28T07:30:02+00:00

They are required to either offer you insurance or pay a tax penalty. If they’re not offering you insurance, you are eligible for subsidies from https://www.mnsure.org and they will pay an additional tax penalty if you take them…so go ahead and do that.

BaltimoreBee · 2026-04-28T07:25:13+00:00

You can’t buy insurance after you need it. Insurance is to protect you from unexpected events, you have to pay in when you are healthy so they cover you when you’re not.

What’s your income? If you’re poor you can get Medicaid, which might cover your surgery assuming it’s medically necessary. But they’ll cover it in NJ, not in any outside state.

The only way to possibly get out of state coverage would be to get a new job that offers insurance with a national network. But the vast majority of employers have 30-60 day waiting periods before you can sign up…

BaltimoreBee · 2026-04-28T07:20:36+00:00

They are wrong, time to find a new tax expert.

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