TWIN FALLS • Micki Grubb had health insurance for three months earlier this spring, when she was able to get a defibrillator put in to help with a heart problem.
She lost her coverage a couple of weeks ago, because her income as reported to the state was too little to qualify for subsidized insurance on the state exchange. This leaves her on her own for any followup she might need.
“I just don’t know what to do,” she said Tuesday at her home in Twin Falls. “I’m just screwed. And I can’t qualify for Medicare.”
You need to make between 100 percent and 400 percent of the poverty level to qualify for the Advance Payment of Premium Tax Credit, which worked out to a minimum of $925 a month in Grubb’s case. People below that line often qualify for Medicaid in states that have expanded the program under the Affordable Care Act. Idaho isn’t one of them — Medicaid eligibility is limited to poor pregnant women and children, people who are blind or disabled according to Social Security Administration criteria, and some extremely poor parents. An estimated 78,000 Idahoans, many of them employed but poor, fall into the “Medicaid gap” where they don’t qualify either for Medicaid or for tax credits to buy insurance through Your Health Idaho.
Grubb signed up for insurance on the state exchange, through SelectHealth, earlier this year, after getting divorced. She said she and her ex-husband had been separated for several years, but she hadn’t been able to afford to file for divorce. Because she was still legally married, she was unqualified for the exchange since her husband could claim her as a dependent. Her coverage kicked in in March.
Grubb said her actual income earlier this year was a bit more than the minimum to qualify. However, she works at a bar, and her hours fluctuate week to week. When her employer filled out her work verification form for the state Department of Health and Welfare, her boss estimated her hours at a little less, putting Grubb’s estimated income at $125 a month less than she needed to make to get the tax credit.
Grubb’s coverage lapsed at the end of May, as she was unable to pay the $1,763.82 bill to keep her insurance.
“You don’t make enough money,” she said. “Boom. That was it.”
Grubb went to St. Luke’s Boise Medical Center at the end of April to get an angiogram and then to get the defibrillator put in. Grubb went in for one followup appointment, but wasn’t able to go in for an electrocardiogram she was supposed to get since she no longer has insurance. Now, she worries she might get penalized on her taxes because she can’t afford insurance. And, she is waiting to see if her defibrillator shocks her. If that happens, you’re supposed to go to the doctor.
“Of course, I won’t have insurance to go to the doctor when it does it,” she said. “But I guess I’ll be alive.”