By MATTHEW HOLT
Strap in for a dramatic story by which our hero battles forms and logic to attempt to get his medical health insurance again.
About 20 years in the past a lot of People, particularly Californians who purchased medical health insurance from Blue Defend of California, discovered that their protection was cancelled with out them understanding about it. That follow known as “recission” obtained a lot of consideration in the course of the run as much as the ACA, and was banned by it. Now if you wish to purchase insurance coverage and also you pay for it, the insurance coverage firm has to promote it to you and might’t cancel it after the very fact.
Or so I assumed.
Submit ACA most individuals who don’t get their insurance coverage by means of an employer, or Medicare or Medicaid, now purchase it through a really regulated “particular person market” on a state-based or Federal alternate. Usually, the insurance coverage they purchase is closely standardized (with bronze, silver or gold ranges) and what they pay for insurance coverage is closely backed primarily based on earnings. It’s these subsidies that had been elevated within the pandemic and prolonged within the Inflation Discount Act (IRA) in the course of the Biden administration. The subsidies had been the subject–nonetheless unresolved–of the most recent authorities shutdown. (Sure, sure, I do know the shutdown is over—for now).
It’s just about unimaginable to purchase particular person insurance coverage exterior the alternate, though when you have Scott Galloway ranges of wealth you may keep away from shopping for insurance coverage altogether and pay money and also you is perhaps higher off, or you may be part of some quasi-religious well being share group and take your probability. However for most individuals you’re manner higher off shopping for on the alternate as a result of that’s the one manner you will get these subsidies.
I reside in California and stay an under-employed blogger, and some instances in my latest life I’ve not been married to somebody with medical health insurance supplied by their employer. It occurred in 2016-17 and once more two years in the past. No, not what you’re considering. I didn’t get kicked to the curb by my spouse, however in 2022 she obtained laid off by her employer and determined to not get one other job. For the primary yr of that interval (2023) we didn’t purchase through the alternate, however used COBRA. Which means we purchased into her earlier firm’s insurance coverage utilizing our personal cash as a result of it was cheaper than shopping for on the alternate. Two causes for this. First, she obtained a severance package deal that made our mixed incomes too excessive to get a subsidy and secondly, the ACA plans cost by age, whereas employers pay a flat payment for all workers. That made the alternate plan dearer than the employer plan. (No prizes for guessing who in our household is outdated and costly!)
However COBRA solely lasts a yr, after which it was time to go again to Coated California.
This begins a course of the place you strive to determine which plan supplied is the most affordable, but consists of your and your loved ones’s docs, and which one has the bottom related charges for the stuff you employ probably the most (normally pediatric visits in our case). Seems that in our case is the Blue Defend Trio 73 HMO. My lack of ability to grasp why it’s known as Trio 73 reveals why nobody calls me a advertising and marketing genius.
The opposite factor you must determine is what stage of subsidy you get. As talked about, the IRA handed in 2022 prolonged the pandemic emergency improve in subsidies for folks with increased incomes. However then once more, you must determine what your earnings will probably be while you enroll. Just like the viewers laughing at an apparent punch line a comic hasn’t gotten to but, these of you operating forward of me may have labored out a slight downside right here.
I used to be signing up for a 2024 well being plan in 2023. However I needed to guess what my 2024 taxable earnings can be. Like many self-employed folks with extraordinarily variable earnings I had no concept what that remaining earnings can be till I filed my 2024 taxes in October 2025 (given I take the IRS extension). In different phrases, virtually two years after I selected the plan. It seems that in California, the individuals who monitor your earnings aren’t your well being plan, nor the alternate however as an alternative your native county well being division. So in November 2023 I guessed my 2024 earnings and needed to inform the native county what that guess is through some affidavit. The county well being division truly known as me to test that my estimate was right. Or a minimum of was what I instructed them it was. Bear in mind this for later.
In the meantime I enroll on what I regard to be a really complicated web page run by Coated California, and choose the aforementioned Blue Defend HMO. It covers One Medical and UCSF theoretically through the Brown & Toland IPA, and results in a lot of enjoyable and video games in phrases producing a lot content material for me on this weblog and Linkedin.
Because it seems, I used to be despatched for an echocardiogram by my major care physician this previous summer season to test if I had a coronary heart. Whereas a lot of you had been stunned on the reply (sure, I do), apparently it’s obtained a congenital dysfunction that wants somewhat assist.
This will get us to November 2025 (final month!) together with your courageous hero going again onto the Coated California alternate attempting to determine whether or not the heart specialist really useful by my major care doc is roofed by the 2026 model of the Blue Defend plan I’m on, or whether or not I want to change. I might now digress and inform you the late Ian Morrison’s system for selecting a well being plan however I’ll maintain that for the subsequent telenovela article as in fact that course of is a fricking mess too!
With a view to strive to do this I login to the Coated California web site and see I’ve a discover that I’m not eligible for medical health insurance. I’m confused.
The following day my spouse will get a letter from Blue Defend telling her that she and my youngsters have a brand new insurance coverage member quantity and a brand new major care physician. And on the youngsters’ subsequent go to to One Medical (additionally in November) they inform her that they’re now not their major care physician and the go to is probably not coated. By the way in which, I feel I’ve been instructed my major care physician has modified 3 instances whereas I’ve been on this HMO previously 23 months and at no time do I recall my precise major care physician’s identify or One Medical being on the shiny new ID card they ship me. However they nonetheless pay for my annual wellness go to with my One Medical PCP. So I assume it doesn’t a lot matter.
Whereas my spouse is getting a brand new card and new membership quantity, I get a letter from Blue Defend saying I’m not eligible for insurance coverage, and my plan is cancelled as of November 30th.
You would possibly surmise I’m somewhat puzzled. In any case they’ll’t cancel insurance coverage any extra, and I’d already paid for November.
So I head to the Coated California web site to strive to determine what occurred. After numerous digging, I get into the primary of many lengthy message chats with their human brokers. To be trustworthy they’re all attempting arduous and though you begin off 27th or so within the queue you get somebody fairly shortly. (They don’t although have a ChatGPT-like clever AI help agent although which a number of firms now use).
It seems that Coated California has determined I’m not a US citizen.
I am going into my standing, dig by means of all of the questions I answered and there it’s. Citizenship field checked as “no”. To be honest, I could have made that mistake after I signed up 2 years in the past. However it’s price stating that I had insurance coverage in 2016 & 2017 through Coated California, and had it from January 2024 to November 2025 earlier than anybody determined something was unsuitable. So far as I’m conscious nobody cared sufficient to inform me earlier than telling me my insurance coverage was cancelled.
Nonetheless presumably simple sufficient to repair. I am going into my utility and test the field saying citizen. It then asks me if I used to be naturalized. Foolishly (and in truth) I test the field for “sure”. It then asks me for my naturalization quantity. Effectively that 25 yr outdated certificates is in a protected someplace, so I ignore that request and head again to the net chat. Seems there’s a manner I can add paperwork, and one of many ones allowed is a passport, so I do this.
I assume all is effectively and that I’ll be reinstated. Somewhat too optimistic.
I even have a suspicion that I do know what has triggered all this.
Keep in mind that problem of attempting to guess your earnings for the longer term from two years in the past? Effectively In mid-October 2025 I (effectively, my accountant) lastly obtained my 2024 taxes into the IRS. Sadly my 2024 earnings was quite decrease than my optimistic estimate, and on my tax type I truly obtained a rebate as a result of I had overpaid my premium. In different phrases I obtained some tax again from the IRS as a result of I had not acquired as large a subsidy from Coated California in 2024 as I used to be entitled to. (How that switch works between Trump and Newsom I have no idea!)
Within the flurry of letters and notices from Coated California in November 2025, a few of them elevated my subsidy for 2025 which meant that for the remaining month of 2025 my household’s premium went down. However, on the similar time my insurance coverage was cancelled, and I obtained a discover that my youngsters is perhaps eligible for Medicaid (Medi-Cal in California). Was this due to my decrease than anticipated 2024 earnings or was it as a result of I had put that my spouse had $0 earnings in 2025 on the shape? I’m nonetheless uncertain of that reply.
Nonetheless, I then obtained a letter from the County Well being Division asking me to show my citizenship and to once more put in an affidavit for my earnings. I headed again to the Coated California on-line chat to attempt to type it out. Regardless of being logged into the positioning, and giving them the reference variety of my final 3 chats, I nonetheless have to inform them my identify, date of start, deal with, inside leg measurement and what number of video games the SF Giants received in 1993 to get them to confirm me. Their recommendation was to name the County.
I name the Marin County Well being Division. Their telephone line is simply open at very particular instances like 2-4 on Tuesdays when the moon is in retrograde. If you name again throughout these instances, they play you about 4 minutes price of messages, then put you thru a protracted telephone tree. On the finish of the telephone tree they inform you the typical maintain time is, I child you not, 2 hours. If you really want the County’s assist, I’m unsure that’s the way in which a median low earnings Medi-cal recipient goes to get it.
Now, nobody instructed me this, however finally after somewhat googling I discovered that there’s a web page known as BenefitsCal. You’ll be able to register for this web site for County companies, and one of many issues you are able to do is add proof of citizenship. So like I had executed with Coated California, I uploaded my passport.
A couple of days later, I am going again to the Coated California web site, and see a message/letter dated November 18 than I’m briefly reinstated on my plan. Throughout my subsequent lengthy on-line chat with Coated California—you knew I used to be going to have one—they inform me that I’m formally acknowledged as a citizen and subsequently eligible for the insurance coverage I’ve had from them for practically 4 years!
Because it occurs I’ve a protracted standing appointment with Andrew Diamond at One Medical on December 1 to debate that coronary heart situation. I arrive on the desk they usually inform me that Blue Defend says I don’t have insurance coverage. Sitting within the ready room, I name Blue Defend who verify I don’t. I inform the Blue Defend rep that not solely was I reinstated on November 18 however that their web site confirms in my profile that I’m coated. The rep tells me properly that it could actually take 10 enterprise days to point out. Why the web site and their rep’s system present various things I don’t know. I inform One Medical to not put within the declare for per week or so
In the meantime whereas I’ve her on, I ask the rep if she will be able to change my PCP of document again to One Medical and do the identical for my spouse and children. She seems to be up Andrew Diamond and the identify of each One Medical physician I can discover on their web site that my youngsters have seen. (One Medical does a pleasant go to historical past record).
None of them are in her system.
The One Medical receptionist means that I name again and get another person “as a result of if seems to be completely random with them”.
The top of this a part of the telenovela is that I name Blue Defend 3 days later. I used to be largely asking about which of their plans that heart specialist was coated on, and naturally they couldn’t inform me that and referred me again to Coated California’s web site! (extra on that subsequent episode!). However they’ve now discovered me of their system, and I discover that my subscriber quantity has modified.
However whereas I had the rep on, I requested who my major care doc was. It was nonetheless somebody I had by no means heard of. Might I alter it to One Medical, I requested? Give me a reputation and I’ll strive, the rep stated. Andrew Diamond, I questioned? Sure, in fact was the reply. So now my PCP is my precise right PCP.
So being actually daring, I requested can I alter my spouse’s and my youngsters PCP to One Medical too? Sure however I want their permission? I perceive needing my spouse’s permission however why do I want my youngsters? Effectively they’re over 10 years outdated! I took the telephone to my spouse who was within the subsequent room they usually obtained her permission to vary her PCP additionally to Andrew Diamond (who isn’t her PCP however is a minimum of in One Medical).
Later within the day, my spouse is driving the children to swimming, She calls Blue Defend and asks to vary their PCP. The rep makes the change with out asking for my youngsters’ permission! Because the One Medical receptionist stated, “it seems to be completely random with them”.
***
In order of December 4, 2025 we as a household are signed up for the proper well being plan with the proper PCP, and we hope it really works retroactively for any November visits.
In fact, who the hell—apart from an under-employed well being care blogger producing content material—has the time to take care of this entire mess? In each different nation on this planet you get the equal of a social safety card and present up at any physician or hospital and get handled. People are rats in a well being care maze trying desperately for cheese that retains getting moved.
Oh, and I nonetheless have to determine the suitable plan for January 2026….three weeks from now.
Matthew Holt is the founder/writer and someday creator of THCB
