California Health Insurance Quotes and Blog

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.

Fred, living in Santa Monica, was unknowingly paying for maternity coverage. Being single and a guy mattered not due to a clerical error.

Fred, a confirmed bachelor and still single, upon receiving his monthly statement, was shocked to discover that his health insurance premium had nearly doubled one month. Upon further investigation when he called his agent to complain, he learned that for more than two years he’d been paying an extra $104.00 per month, and that this resulted from maternity coverage.

“That should be easy to fix,” he confidently told his agent, “I’m single and a 59-year-old male. When do I start getting the lowered rate, and maybe money returned to me retroactively?”

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“Not so fast,” Fred’s inadequate agent blithely replied, “You failed to correct it.”

“I failed to correct it?”

“That’s right. It’s your responsibility.”

“How is it my responsibility?”

“I can explain it to you.”

“Please do,” whimpered Fred, now shaken to the core of his being after realizing that for two years he’d been categorized by his trusted insurance carrier as having the potential to become a pregnant woman and never so much as eaten a pickle. Recovering a bit of his dignity, he started to become indignant, something that the agent could instinctively sense.

The agent now realized in the nick of time that explaining how the mistake had come to be was not only prudent but the right thing to do.

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“Here’s what happened,” he began blithely spouting, “When you first joined up with this health insurance plan, we sent you a booklet describing coverage in every particular. The maternity coverage clause was mentioned in that. You should have chosen a plan that excluded maternity coverage to begin with. The plan you picked had maternity coverage in case you became pregnant. ”

“But I’m a guy.”

The agent softened a bit hearing that. “You had ten days to examine the coverage. We never heard from you about maternity coverage.”

Fred won’t get his money back but it’s not too late to find a competent California Health Insurance Agent.

Get to know your health insurance agent. Don’t let this happen to you. There are plenty of reliable health insurance agents like Matt Lockard of MattsInsurance4CA.com who have the experience and knowledge to help you find a health plan that will cover what you need and only what you need.

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