We had to learn this the hard way and it may seem counter-intuitive, but remember this: If you are poor - and most PCVs are - you will not get help with your healthcare premiums! If your income falls below the poverty line, you will not be eligible for a tax credit on your income tax bill.
While Julie and I were serving our second PC tour in Zambia, the ACA system came into force and we had to learn about it in-country during the uncommon times we had good internet access. We didn’t do well enough.
We tried to do the right thing and get signed up for health insurance before we got home. We went online to sign-up through the Healthcare Marketplace (Exchange) and the system locked us out saying we could not sign up 60 days within the date of needing insurance. We were later told by a healthcare rep that this was a system glitch, but this glitch forced us to wait until we got home to get insured in time before our 30 days of PC insurance expired. (BTW: after our first tour in Mongolia, PC offered affordable healthcare insurance for up to 18 months. No longer!) So, next piece of advice: skip the online system. Get a rep from the Exchange on the phone and walk through every aspect of the process with them.
So, when we got home, we raced to learn which of the over-priced insurance policies to buy and apply to make a purchase through the Exchange before our month was up. After we applied online, we were instructed to wait (up to a month!) to learn if we were eligible to receive Medicaid coverage from our state because of our PC-poverty. (Warning: some states don’t offer Medicaid for the poor). It seemed we couldn’t wait a month because our PC insurance would end and we’d be uncovered if we didn’t buy a policy. We naively bought a policy to cover us until we heard our fate believing that we’d get a refund when/if we canceled.
So the days tick by, we don’t hear from the state, the first of the month arrives and we are forced to pay the $850 premium for the first month. We responded to all the reminder emails about paying our premium by paying on-time.
Another week passes and we call our state’s Medicaid office to ask what’s going on. We were told we’d been qualified, but the representative couldn’t explain why we weren’t informed in a timely way. So great.We’re covered by the state until we can find jobs and we can get our premium back. Well, not so fast. We called the Marketplace immediately to cancel our for-profit insurance policy and were told it would take two weeks(!) for this phone call to have any effect. We questioned the delay and rather than an explanation, we heard a snicker.
For every day that ticked by without notification, we lost money. In all, the experience cost us over $600 for coverage we didn’t need in a system that’s overly confusing. The normal insurance premium for just one month can be 1/5 of your annual PCV income. Don’t let this happen to you.
1) Talk to a Healthcare Marketplace representative before you leave country. Don’t first rely on the online system to get signed up.
2) Talk to a second representative to confirm/deny what the first rep tells you.
3) Like every PCV who earns poverty wages, know that you are NOT eligible for any premium tax credits. Despite being PCV-poor, you will not get tax credit assistance for anything you fork over to an insurance company.
4) Know/recall that, regardless, a tax credit only reduces your tax bill. Most PCV’s don’t owe income taxes so there’d be no taxes to reduce. A tax credit is not a benefit in this case.
4) If you’re 26 or younger, you can likely qualify to continue or get on your parents policy. Check on that.
5) Knowing what we now know, we would have called our state Medicaid agency daily to get the important eligibility question answered. If you're forced to pay the first monthly premium, remember that you won’t get your money back in a timely way and you will kiss those funds you desperately need to re-settle goodbye.
6) Treat insurance coverage responsibly and understand that despite your good intentions, the current for-profit insurance system is neither efficient nor sympathetic.
Thanks for your service and good luck in your re-settlement.
RPCV Mongolia, 2007-09
RPCV Zambia, 2013-15