Moms to be unable to afford California health insurance coverage may qualify for the Access for Infants and Mothers Program (AIM) or else the Medi-Cal Income Disregard Program, both administered by the State of California.

If the Terminator’s controversial budget cuts somehow spare them, two health insurance options that financially struggling pregnant moms to be might target is AIM – The Access for Infants and Mothers program, a health insurance program administered by the State of California that is not a Medi-Cal program, and one that is, the Medi-Cal Income Disregard Program.

AIM provides full coverage private health insurance at low cost to pregnant women during pregnancy as well as a full two months beyond into post-natal. To be eligible, the family’s income must fall between 200% and 300% of the Federal Poverty Level amount as configured by the size of the applicant’s family. Property limits do not apply. Applications are accepted at local Social Service Agency Intake offices where an appointment with an Information Supervisor is appropriate.

Although the Income Disregard Program has a lower income threshold for eligibility, it involves considerably more “red tape.” Pregnant women seeking “Income Disregard” coverage must apply in person by visiting one of the Social Service Agency Intake offices and filling it out an application or calling an Intake office and asking for a mail-in-Medi-Cal application. Again, the Information Supervisor is the key contact person. But to “disregard” your income, you first must prove that you don’t have any, more or less. Applicants must provide proof of identity, proof of pregnancy, proof of Social Security number, proof of immigration status, proof of California residency, and perhaps most crucially, proof of income. So expect to bring along a slew of documents to your interview.

Requirements are stringent because the Income Disregard Program is true to its name. To eligible pregnant women, this special Medi-Cal program provides prenatal and postnatal care to pregnant women at no cost. But pregnant women applying for this program must be fully evaluated by an Eligibility Worker (EW) at one of the Intake offices and determined to have a share of cost. A share of cost is roughly equivalent to a monthly deductible. It is the amount for medical expenses that a Medi-Cal beneficiary must pay or be obligated to pay prior to any reimbursement for medical expenses by Medi-Cal. Also, the net nonexempt family income must not exceed 200% of the Federal Poverty Level while eligibility can begin no earlier than the first day of the month the pregnancy is reported.

Dodger Stadium

Mickey Moosaka’s nephews and nieces were at their wit’s end. What activity would their cantankerous grand-uncle agree to participate in that the entire family might attend? He’d turned down bowling. “It reminds me of pinheads,” old Mickey said. He avoided restaurants. “Flies and their eggs on every plate,” he said, sickening anyone within earshot. Miniature golf emphasized the codger’s recently shrunken stature. “Don’t belittle me by taking me to a place like that,” he’d said to his thrifty niece Sappy in his rather squeaky Buster Brown voice. It was decided that “Uncle Mickey” would take in a Dodger game at the Stadium. Above all else, he enjoyed baseball, despite his consummate fears. He finally relented but warned, “I’ll probably get bonked by a foul ball off the bat of Manny Ramirez.” The geezer was a lifelong Dodger fan but had never been to a game in person.

The Moosakas got a nice row of boxes not far from home plate but well back in the upper deck. The seats seemed relatively safe. “These are great seats, huh Grumpa,” chirped twelve-year-old Matty to his beloved great-great-uncle. Matty was in his last year of Little League and played all-star caliber shortstop on a junior version of the resurgent Dodgers.

Fifty or sixty foul balls came and went, a few coming close, within a few rows, by the sixth inning, when the famous Dodger left fielder approached the batter’s box. “He’s going to conk me with a foul ball,” Mickey Moosaka predicted. The first pitch to Manny Ramirez was a fastball, which he took. The next two pitches were outside, so the count was 2-and-1 when the fateful pitch came. “This one hits me, I know it,” wailed old fearful Mickey. “No, it won’t,” said Sappy, fast becoming Mickey’s least favorite niece. “You worry too much.” But the next pitch, a curveball, was fouled back on an ominous trajectory. It seemed like the ball had eyes. Sure enough, it smacked old Mickey on the forehead with tremendous force, knocking him cold. Carried out of the ballgame on a stretcher, he was taken to the nearest hospital.

But Sappy was no sap. “Thank God we already had accidental coverage from a California Health Insurance agent,” she said. “It didn’t cost us a cent.”

“Thank God Grumpa Mickey didn’t die!” wailed Matty, placing priorities correctly.

“I guess,” Sappy was forced to agree.

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Johnny and Marissa had been an item long before they’d been married. They met at the Amalgamated Plastics factory in Merced and began dating almost immediately. She started as an assistant floor walker and he began his Amalgamated career as a trainee mold pourer. She’d learned to crawl before she walked, and he’d poured pudding as a boy, primarily butterscotch which had been his favorite. Sixteen years later, they both were in management; she as a chief floor walker and he as a mold taster. While both were still wage-earners instead of salaried personnel, their employer did pick up 90% of their health insurance premiums.

The layoffs caught the Klingers by surprise. “It’s the economy,” their boss Mr. Dykstra first told Marissa, and then her man. The withdrawal was painful from an emotional perspective as well as from a financial one. “I hate the taste of butterscotch now,” he opined. Marissa knew the plastic had had something to do with it, it only looked like butterscotch, but she kept quiet. Discretion is the better part of valor, she mused. Worse, besides the sudden lack of cash flow and the drain on their accumulated savings, there was something called COBRA to consider. It cost 102% of their policy at Amalgamated, but now they were laid off and …

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“I’m going to make some pudding. You can pour it dear,” Johnny said. She knew now that something was wrong. This was a crisis. He never lets me pour the pudding, she thought. “I’m going to make butterscotch,” he said. Those ominous words spurred her into action. “I’m calling Matt Lockard,” she said, “the California Health Insurance Agent who’s never been on TV.”

“Why?” Johnny queried. 

“Because,” and she wanted to break it to her husband gently, “our COBRA has grown fangs.” She added almost in a whisper, “Matt will know what to do.”

“It’s not like it used to be at Amalgamated,” he said in a genuine whisper.

She dialed. “Is this Matt Lockard, the California Health Insurance agent with the reputation for solving COBRA matters?”

“Yes, COBRA matters,” said Matt, simply being declarative. “I can help.” By the next week, Johnny and Marissa had health insurance again, and the price was reasonable.

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Chauncey McBride earned $75K per year as a top salesman for an Oxnard-based copy machine chain. His attractive fiancée Irene earned almost as much from the Thousand Oaks bagel shop she owned. Their friends Rick and Brianca each earned six figures as rising attorneys specializing in Elderly Law. On Tuesdays, Thursdays, Fridays, and Saturdays they’d dress to the max and “do lunch” at Diamond Jim’s, where a lamb chop swimming in mint gravy cost fifty bucks. Irene and Brianca liked to wear designer jewelry; earrings, broaches, even anklets if the truth be known. Chauncey and Rick looked liked the male models gracing the pages of GQ. One night, these four successful twenty-somethings chanced to meet an acquaintance of their parents, Matt Lockard – successful in his own right as a California health insurance agent. The restaurant’s owner was a sensible man, even if he catered to expensive tastes.

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“Howdy Jim,” Matt said, “I brought over that change in your policy you wanted.”

“Howdy Matt,” said Diamond Jim, “We’re still busy from the lunch crowd. Why don’t you take a seat next to those two couples waiting for a table? It’ll just be a few minutes.” 

“Okay,” Matt said, sitting down alongside Rick and Brianca. He sat still for a few seconds, until he was recognized.

“Hey,” said Brianca, “I know you. We all know you. You’re Matt Lockard.”

“Still shilling health insurance?” asked Chauncey, with his slightly abrasive tone.

“Yeah,” echoed the others, their voices merging in a kind of yuppie meld, “you’re that health insurance guy.”

Matt had been put off guard, but he soon recovered. “Do any of you have health insurance?” he said. It was then that he discovered their secret. None of them did. “Why don’t you?” Matt asked, nobly taking the offensive.

“We can’t afford it,” came the trill of a quartet harmonious only in their will to remain oblivious. Matt knew that a low cost policy would probably cost each of them less than the price of their lunch.  But he was tactful to the last. “Oh,” Matt said.

Diamond Jim intervened, ending an uncomfortable tension. “Come into my office Matt.”

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Stian had never been considered especially responsible by his parents – until he “popped the question” to a helpful California health insurance agent.

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 He was blonde, tall, handsome and invincible according to his peers, a group of fellow 24-year-olds considered equally invincible by each other. All of them were recent college graduates prone to taking incredible risks. Bryan, a heavy-set version of Stian, liked to hang glide off the steepest California cliff faces, catching the first thermal while shouting madly in his counterfeit Dylanesque twang, “You don’t need a weatherman to see which way the wind blows.” Angela, an emaciated version of Bryan, did roulette drugs by needle just “for the thrill of it.” Carrie, a Gothic version of Angela, enjoyed being buried alive and popping up unexpectedly in the manner of her cinematic namesake.

Stian would run barefoot through rattlesnake pits with one of his friends holding a stopwatch as he raced to and fro. “Do it again,” Angela would trill, “You’re so funny.” Carrie would pop up like a tart and sometimes Bryan would glide into view, usually with a beer in his left hand, the sinister one.

“Where did he come from?” they’d all ask, except for Stian, who was concentrating on the pit vipers.

But one day Stian’s parents Joe and Flo came by to bring their son a latte. “What do you think you’re doing?” asked a horrified Joe.

“He’s twenty-four and still doesn’t have the sense of a pet rock,” murmured Flo.

“You’d think he’d at least have health insurance when he pulls these stunts.” Joe told his wife, still in a state of shock for the moment instead of The Golden State, “But no-o, not our irresponsible son.”

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Stian gingerly stopped his antics with the snakes and stepped out of the pit as if he’d been bitten. He’d overheard what his parents had been saying about him. He was sobbing as he walked past an incredulous Angela, Carrie, and Bryan straight to his parents, also incredulous.  “Here’s your latte,” his mother said, attempting to hand it to him.

“Hold onto that,” Stian said, still teary-eyed, “just hand me your cell.” Flo’s cell phone was pink, with black crocodiles on the receiver.

“Who are you going to call?” Joe asked softly.

Through a drizzle of tears, came the answer, rather defiantly, “Your California health insurance agent. I’ll bet she has a low cost plan for people my age.”

“That’s my boy,” said Flo, her own tears forming.

“He’s a man, not a boy anymore,” Joe replied, choking up too. “Stian knows what he’s doing.”

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The Elberts, James, wife Jane, and the kids – Patrick, Jorel, and Wendy – at first glance epitomized the average American family living in La Puente. Dark-haired with pleasant, angular faces, they weren’t ugly; each was well-spoken and polite, although Wendy the youngest was only nine.  On second glance, one noticed that each of them possessed seven fingers on each hand, and if their bare feet were inspected, seven toes on each foot. When 17-year-old Jorel was in an accident at the factory, he proved to be less than a Superman; one of two left index fingers had been nearly severed at the second joint in a slicing machine. At the hospital, Jorel came in with his Dad. The first question asked by an on-duty intake woman seemed like a given, “Do you have insurance young man?” The teenager was lapsing into shock, but managed to look at his father who handled the visual cue appropriately. “No, he doesn’t,” the seven-fingered man admitted. “Why not?” the diligent hospital employee asked, musing about bills never paid when patients prove indigent. When James scratched his forehead in plain view, she considered if she wasn’t being given an extra finger or two. She finally smiled pleasantly when the man assumed responsibility then and there. “I’ll sign for the bills!”

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Jorel was admitted, and the hospital saved his finger.

But this incident gave way to serious soul-searching on the part of Mr. Elbert. “Why don’t we have a family plan?” he pondered. Deep down, he knew. During his otherwise uneventful childhood, James had been told by a wizened grandmother figure living in the home that because he had seven digits on each limb, that he was cursed, and if he ever married a woman with more digits than she was entitled to “by a just God,” then at the very least their family would someday be categorically denied family health insurance coverage. Still, he possessed extraordinary courage and picked up the phone, his fingers like a spider’s legs, and called the first California health insurance agent that came into view.

It was Matt Lockard. After hearing the story, he made his comment succinct. “Wizened grandmother figures always say that in situations like yours. That’s why they don’t sell family plans.”

To learn more please visit: http://www.mattsinsurance4ca.com

Mattsinsurance4ca.com is a licensed health insurance agent in California. They provide instant online quote for health insurance, Medicare Supplements, travel health insurance, and child only health insurance.

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I get asked this question daily at my Health Insurance Agency. Health Insurance can be expensive in California. If you have a preexisting medical condition an insurance company can give you a higher monthly rate or just flat out decline coverage. I’ve seen 50% and even rates 100% higher than the standard rate healthy people with no medical conditions get. The inconvenience of having to pay more than the normal rate will influence many people to get creative while filling out their health insurance application. “What if I forget to mention my pre-existing medical condition on the application, will they find out that I already have a medical condition or will it lead to any trouble, etc?” I get asked. People say “I cannot be without any medical insurance. And if I mention the medical condition I have my rates will be higher than what I want to pay.” A potentially higher insurance premium makes people consider all these options.

Health insurance companies help people enjoy good health by offering wellness and preventative programs. They actually want you to stay health so that there are no giant claims to be paid. You need to buy a policy early in life while you’re healthy and keep the policy forever. Health insurance is for the big “what if I get really sick” situation. Let me give you this analogy. Do you insure your car before or after an accident? Wouldn’t it be nice if we could not have to pay any premiums for car insurance, then if we get into an accident, we can race over the local insurance broker and say “I wrecked my car and I want your company to pay to get it fixed. And here’s one month’s premium. I want to take the car into the shop as soon as I leave here. And by the way, as soon as my car gets fixed I’ll be canceling the policy because don’t like that pesky monthly premium.” Wouldn’t that be great! We’d all save tons of money! But we all know it doesn’t work that way don’t we.

You cannot conceal a pre-existing ailment to the health insurance company because it will be a pure case of deception. When you deceive the health insurance company and later file claims including the legitimate ones, the insurance company can deny the request. If the insurance company finds out that you lied on your application they will rescind your policy. Rescind means they will give you back the premiums you paid and cancel/take away the policy like it never happened. When that happens, of course the person who lied on their application calls the local news crew and tells them how unfair the insurance company was. And that’s what you usually see on the news. A liar complaining that they can’t get something for free.

Having health insurance is important. You can reduce the cost of your premium by comparing a number of quotes using independent agents like Matt at www.mattsinsurance4ca.com . The competition is high in the California health insurance sector so many companies offer several different plan designs and premiums. Get insurance while you’re young and healthy and keep it forever. If you happen to have a medical condition and you need coverage, fill out an application with a reputable carrier and see what they say. If you get a higher rating by all means take it. You might be close to being flat out declined. Take the policy and then shop around to see if you can get another policy issued at a lower rate. If you do get declined, you will be offered a HIPPA plan. If that happens you need to talk to your agent ASAP for advice. There are other options.