Recently I had broke a back molar tooth- It was pretty bad and quite painful. Luckily included in my Obamacare health insurance plan is Dental Insurance. I went to an in-network dentist and he confirmed that I would need a root canal and new crown (My First EVER). The office of the dentist then informed me that OBAMACARE PLANS ONLY COVER CERTAIN TEETH and molars are not among them.
I could not believe it — how could a dental plan only cover certain teeth and not others .. so I called and complained to my insurance company. When I got on the phone with the benefits department of my insurance the woman said something that blew my mind
“Medicaid Dental Insurance only covers certain teeth and certain situations”
I told here “Wait I have Private ACA insurance not Medicaid” . She tried to backpedal and stated a different reason for my dental insurance denial but the cat was out of the bag .
This immediately reminded me of last year I had a medical issue and needed to see a specialist, Instead of using the Health Insurance Website Directory , I used ZocDoc.com and search for my insurance .. In one of the calls I received a similar answer The specialist office said do not take MEDICAID when I pointed out that I had Private insurance — they changed their wording and said the Health Insurance GOLD plan that I currently have.
I did some research on Medicaid — 75% of all Medicaid plans are actually administered by PRIVATE INSURANCE. They negotiate with States to set coverage and prices Currently in NY State Medicaid spends on average $8618 per enrollee. This is exactly what my health insurance cost per year EXCEPT I have a $1,200 Deductible and $8000 out of pocket.
My Point in all this is .
MY INSURANCE IS REALLY MEDICAID BUY-IN BUT PRIVATE INSURANCE COMPANIES ARE SETTING THE PRICES.
UPDATE My Point is the State is negotiating Medicaid with private insurance for a certain price and then Private Insurance is turning around and selling this SAME INSURANCE in Marketplace is for $9000 — $10,000 dollars more. (Medicaid is essentially a Platinum plan on the Marketplace which is insurance that has no Deductible)
I believe that everyone would immediately have better insurance if States got rid of marketplace and negotiated with private insurance companies as part of Medicaid and then the States gave Medicaid insurance plans to EVERYONE and charged people a sliding scale above a certain incomes.
If I had a Medicaid Buy-In (Which I already DO have). I would have insurance with no Deductible and limited out of pocket. It insane the scam that private insurance has hoisted on the American people.