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A Case Study in Grandchild Health Insurance

One issue we face as relatives raising someone else’s child is health insurance.  In many cases, you won’t be able to add the child to your insurance if you work.  If you are retired, it is even harder to figure out how to cover the child.  In short, grandchild health insurance can be hard to figure out.

Even a healthy child needs well-child care.  If the child has issues, you are looking at more expense.  My grandson has speech therapy, occupational therapy, and sees a behavioral specialist MD who prescribes his ADD medication.   I am not wealthy, so he would lack some care he needs if I had to pay out of pocket.

I would like to share one person’s story.  It was posted online in a group and I asked permission to anonymously repost here.

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REPOST
“SORRY LONG POST about insurance, and a LITTLE BIT TECHNICAL:

This info about medical insurance might help someone here. Our 21 yr old son has a permanent disability. He gets SSI and Medicaid, as do many of the children those in this group are raising, including our 4 yr old grandson.

Grandson has had GREAT medical care on Medicaid, and we have found a urology specialist that he needed as well as a pediatric dentist nearby and with great skills/reputation. However, for our 21 yr old son, we found few specialists that HE needed – our pediatrician that he had for years doesn’t take Medicaid, his psychiatrist doesn’t. The hospital group we use that is all around our area doesn’t. Medicaid primary doc assigned to him was 15 miles away, and we have a good doctor just about every block around here, that is with the large local hospital system.

So, we have been paying for private insurance in addition to the free Medicaid, for our son, since he began Medicaid at age 18. At age 21 his premium went from $250 to $450 a month and his social security will NOT stretch that far, yet I fear him having to switch to only Medicaid doctors / far away / sub par care/hospitals and mental health providers that are NOT as good as the ones we have for him. Grandson’s pediatric specialists are super. I am assuming it’s age related, and after age 18 it’s a lot harder to find Medicaid docs and hospitals?

So I looked into a program I couldn’t get figured out when son was 18 and got it approved. It’s called HIPP (not HIPAA). It stands for Health Insurance Provider Payment or something like that. It’s Federally mandated but run by each state. We own our own business and pay (exorbitantly) for our medical insurance. The HIPP office evaluates the cost of Medicaid compared to the private, employer provided/subsidized insurance cost, and if cost effective, HIPP pays the employer for the cost of the private insurance coverage to replace Medicaid. HIPP found this to be cost effective in our case, and will start next month paying son’s premium back to our company! And he will get the best specialists and the hospitals we want him to be able to use.

His Medicaid medical insurance card will not work but his ACCESS card will still cover co-pays IF we use Medicaid providers. His private insurance was primary, and we were paying is co-pays since they were non-Medicaid anyway. The co-pays will be less than $40 a month, barring a crisis……well under the $450 we are saving him a month. IF he ends up in the hospital as an inpatient we do risk $100 a night x 5 night co-pay, but that is well under what we are saving, so we are very happy about finding this program. If he needs physical occupational therapy several times a week, the co-pays could get close what we are saving but we can choose the therapy location best for us and for him, OR, if necessary, find a Medicaid provider and use his ACCESS card for the copays. He is still considered a Medicaid recipient, technically.

Another part of this is that we had to show HIPP that MY insurance was paid in full by my employer. I am the employer so I can do that but I had to take a chance that I was “leaving money on the table” so to speak… , because HIPP has to consider all the cost of MINE and my son’s insurance and possibly pay BOTH premiums, since son would not be eligible without my participation in company insurance. So, for example if my employer paid 40% of my coverage and none of my son’s, the HIPP program would evaluate the cost of HIPP paying 40% of MY insurance plus all of my son’s and then IF that amount was less than the cost of his Medicaid, they would pay both my portion AND son’s portion. But if the cost of my employer’s (or maybe it’s my portion??? confused at the moment..) was more than the cost of his Medicaid, then HIPP would pay NOTHING, and son would stay on Medicaid card with no HIPP reimbursement. Once your employer tells HIPP the portion they will pay, they cannot say, Oh, never mind, we will pay or less to qualify… that’s considered price fixing.

In the case of dental insurance, our plan is one price for the whole family ($125 ish a month) and is not age related / age tiered, so HIPP would have to pay ALL of that premium to pay son’s dental, so that was deemed “not cost effective” and they will not pay for his dental. Even so, that is only $35 or so from son each month, and we are saving $450 a month for his medical.

Perhaps those of you with young kids are satisfied with Medicaid providers as we have been with our grandson, but for our older son, it just was not the best care. And also, with us owning our business, we had some flexibility that others might not have with employer provided insurance. But there are a large number of people on this HIPP program and it should be available in all 50 states, I believe.

Lastly, it appears that since we have legal custody of GS we COULD also add him to our company/family plan and use HIPP to pay for it, but since Medicaid is working well for him, we are holding off on that. But, we don’t think we need private insurance for grandson right now. We have several excellent children’s hospitals in nearby cities, and their many doctors have offices in our area, and they all take Medicaid.

Hope this makes sense to those that might benefit from it.”

CONSIDERATIONS

This will only apply to caregivers who are employed.  Also, the HIPP program has different names in different states.

If you are retired, the child may be eligible for Medicaid.  Eligibility rules are different for each state, so check your state for income limit and how to apply.

 

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