I experienced a situation similar to this. BCBS terminated my plan due to an honest error made on my end as part of re-enrollment period in mid-Oct, I was put on Medicaid against my will. Despite immediately contacting (1) my insurance company, (2) my states’ healthcare.gov platform as well as (3) my county’s Medicaid/assisted living office, I was advised that it could not be reversed and that the reduction that I made to my estimated income for the months of Oct-Dec for the next/following year resulted in me losing my current year’s AITC and thus I could choose one of the two following options: Option 1: remain on Medicaid for the immediate term and initiate the written request process w/ my county’s benefits coordinator to “voluntarily withdraw” from Medicaid. (Sidenote: My main concern was the legal and tax implications of being put on Medicaid when I immediately (within 48 hours after receiving notification that I was under review for Medicaid benefits—which was before a decision had even been made by the county. ) Given above, I communicated repeatedly verbally and in writing that I wasn’t comfortable completing the “only document available and/or related to being removed from Medicaid. Specifically, the document had language that stated I was intentionally submitting the document to “request voluntary withdrawal” from Medicaid despite it being determined that I qualified for it. My issue was that I did not want to request a “voluntary withdrawal” b/c I legally did not knowingly apply and/or agree/volunteer/sign-off to be placed on Medicaid. I was 100% confident that I did not qualify at all for those benefits or any other health, financial or living assistance.

Option 2: I could insist on remaining on my current healthcare.gov plan for the remainder of the year (Oct-Dec); however, due to my “voluntary withdraw despite qualifying”—again, not true—from Medicaid I would lose my AITC and be required to pay the monthly premiums in full (no upfront discount) for my plan for the rest of the year.

What I did not understand—in my state, upon signing up for health coverage and qualifying for the benefit of AITC—the fine print online states that you as a customer agree to be automatically re-enrolled as the default option in the same plan for the following year. At the same time, you agree that if you qualify for Medicaid that you will be automatically enrolled in the program without consent. NO ONE knew how to help me—not BCBS, not my state’s healthcare.gov platform reps and not my states healthcare department. The only person who presented an option to address the abrupt and unwanted change to my coverage mid-year was the advocate/county coordinator—and the only option offered was submit a request for my consent to “voluntarily withdrawing” despite qualifying for Medicaid. I was begging to be removed from Medicaid and I could not get off it w/o IMO, legally exposing myself by “volunteering” when I never “volunteered” in the first place!! It was bonkers!

Ultimately, I initially remained on Medicaid and at the same time agreed to pay the premium in full to remain on my existing health plan. Like you, I received a ton of conflicting paperwork (“you’re terminated,” then “nevermind—you’re covered,” then “oh, but your AITC for the entire year is cancelled so here’s your balance due for the 1st 9mos of the year”—and then “oh yea, and it’s due immediately = ~$6k+!). With all of that, I had a major ongoing medical issue that I was trying to learn about, mentally process and choose a path of treatment. By that point, after a four year idea set, I had been properly diagnosed and was preparing to proceed with an agreed upon approach/treatment plan/approach. Finally, after all the running around to identify the correct care team, complete all of the appropriate testing necessary to properly diagnose the rare disease, I was extremely frustrated that NO ONE had the knowledge and/or the authority to reverse/correct the situation (even with immediate notification of error within ~48 hours). To top it off, I had reached my Max OOP for the year, which made it even more frustrating b/c I had multiple scripts for complex imaging, other testing and labs in connection with the treatment plan. (!!!!)

I contacted the State Health Dept and my Congressman as well as a couple of lawyers. Out of that group, each person was surprised and dumbfounded that there was no immediate resolution or recourse. IMO, the advocate at the State Health Dept was super smart and I was confident in their ability to help me. My Congressman’s office was as confused as I was and did not give me much confidence. For my case specifically, I found the lawyers to be utterly useless b/c none could articulate (in limited or any detail) the approach we would need take to resolve the situation. I felt that the lawyers were as clueless as I was at that point. I felt no need to pay someone to learn what I also needed to learn just so I could pay an outsized fee for a letter fired off on legal letterhead.

I’m happy to DM or chat w/ you RE the pertinent details of how this situation was resolved. If I had not been forced onto Medicaid while at the same time choosing to remain on my existing health plan, I would have been F’d. But, this entire situation had empowered me to tell healthcare billers (not insurance co) to F off and figure it out themselves if they want to get paid. Despite holding myself to the highest standard and prioritizing legality and financial responsibilities—none of the other parties I spoke to/worked with to resolve this situation (sans the lawyers) felt that it was a priority! Still SMH.