My friend is stuck in a tough situation with her health insurance. She thought she had a Marketplace plan, but turns out she fell for a scam. Now that she’s pregnant, this plan doesn’t cover what she needs most. She’s a nanny and believes she should qualify for financial help from the Marketplace, but she missed the window to change plans. Besides marriage, are there any other ways she can get a new health insurance plan here in Ohio? She makes around 42k a year and is really stressed about handling all the medical costs ahead.
She could look for a job with health insurance since it’s a qualifying life event.
If she can manage a pay cut of around 3-5k, she could then qualify for Ohio pregnancy Medicaid. Since she’s pregnant, the unborn child counts as another household member, boosting her chances.
@Bao
Would the household size count as 2 for Medicaid calculations since it includes the baby, or just 1 since it’s only her and the unborn child?
Merrick said:
@Bao
Would the household size count as 2 for Medicaid calculations since it includes the baby, or just 1 since it’s only her and the unborn child?
It counts as two. The fetus is included for Medicaid purposes.
@Bao
Thanks a bunch for your help!
Merrick said:
@Bao
Would the household size count as 2 for Medicaid calculations since it includes the baby, or just 1 since it’s only her and the unborn child?
It counts as two unless she’s expecting multiple babies. Also, keep in mind that MAGI is used, meaning some deductions come into play for gross income. One helpful way to lower income for qualifying close to the limit is contributing to a pre-tax retirement plan.
@Bao
I mistakenly looked at the 2024 rates instead of 2025. Appreciate the link!
Eli said:
If she can manage a pay cut of around 3-5k, she could then qualify for Ohio pregnancy Medicaid. Since she’s pregnant, the unborn child counts as another household member, boosting her chances.
Does the father of the baby live with her? That would change their household size and income limits.
@Micah
If they’re not married, his income won’t count against her eligibility.
Bao said:
@Micah
If they’re not married, his income won’t count against her eligibility.
Interesting. I learned that while they’re considered a household under SNAP, they aren’t for Medicaid.
@Micah
For SNAP, they wouldn’t be counted until the baby is born, unless they’re already sharing food and living together.
Eli said:
If she can manage a pay cut of around 3-5k, she could then qualify for Ohio pregnancy Medicaid. Since she’s pregnant, the unborn child counts as another household member, boosting her chances.
In Ohio, they allow a spend down for medical bills so those expenses reduce her income. It’s also good to check whether they cover retroactive medical costs if she applies within 90 days.
If the insurance misrepresented itself as Marketplace insurance, has she reported it as a scam?
She might want to consult a marketplace assister to explore if she can cancel her current plan and see if they would consider it a qualifying loss.
@Ren
I keep seeing similar posts where people think they got valid Marketplace coverage but really, they ended up on a different site that looks similar. It’s frustrating! They really should only use “.gov” websites and ask for help before signing up for something so important.
@Hayes
Scammers know how to target people, especially those who are in tough spots.
@Hayes
This country has a real issue with misinformation.
Bao said:
Tell her to apply for pregnancy Medicaid. If she really makes $3500 a month, she would qualify. The cap is $3525 monthly for a household of 2 - the baby is counted as part of the household.
Reach out to a local pregnancy center; they usually offer support for up to two years.
Having the baby can be a qualifying event for retroactive coverage if she can’t get a health plan until after the birth.
She might have to explore other options.