Desperately Need Some Guidance/advice Re: Health Insurance (Kinda Long) - Dallas,TX

Updated on December 10, 2013
J.J. asks from Dallas, TX
15 answers

hi mamas, i have a real problem here and need some help.
health in the heck is everybody else in the world affording this? i don't even know where to start, please forgive me. i'm worried about this & this is admittedly a topic/problem that i do lose sleep over. :(
i'm about to release some private info, lol, but maybe some of you smart mamas can help me crunch numbers w/the actual amounts. I make $15/hr and support myself and my son. Under the affordable health care act i certaintly qualify for lower premiums, but because my employer offers insurance, I'm not eligible for the lower rate, at least that's my understanding...(is that correct as far as you know?) My son and I were previously w/the county hospital for lower medical costs, but they changed their rules in the summer & they don't provide help if employer offers it. To qualify for CHIP, a family of two has to make $29,000. I make approx $33K/yr. My employer's rate to cover my family is $665/month. That's approximately 27% of my income/month. I do have a pre-existing condition, so ONE good thing about aff healthcare act is that you can't be denied for that's a plus, but in researching & calling, etc, the cheapest i can find for "full" coverage (lack of a better word) is around $400-$450/month.
Okay, well, that's still SO MUCH out of my bring home pay, which is approx $2400.
my expenses: d. ramsey suggests my rent to be 25% of my income, which is $600, my rent is currently $720/month. i'm aware this is where i should cut back. it's a very small house (880 sq ft), but it's a HOUSE, has a backyard and i'm trying my best to stay here & afford health insurance. i could get an apartment, for no less than $675 or $700 but cost of moving financially, and having to move my son, that just sucks. :(
utilities - approx $325/month for gas, lights, phone, t.v., and water. so far that's $1045 for utilities & rent.
daycare's $360/month = $1405/month so far for what i mentioned.
car insurance - $131/month (i've compared, full coverage, this is what i found, with progressive) = $1536
health insurance, we'll just say $500 (avg of what i've seen) = $2036/month.
So w/all necessary expenses paid, I have $364 remaining for food, gas (i fill up 2-3x/wk b/c of my job), savings, and xmas & bday presents for my son. i GUESS i could make it work w/o drowning, but all the ancillary expenses (car reg/insp, vet stuff, etc...) how will i be able to afford that? or doctor copays or meds? right now i put back $80/check to have for extra expenses, there when i need it, but w/this budget above i won't have the money to do that. also, right now, i'm able to save approx $75/month. it's not much, and i certaintly don't have 3 months worth saved up, but i'm doing the best i can. i'm very budgeted, live on cash/envelope system when i get paid. bills are paid on time, etc.
i have a bachelor's degree, it's just the field i'm in is notoriously known for being a lower paid field, social services. i've thought about asking for a raise to $18/hr to make it better or ask for a decrease to $13/hr so i can get CHIP. i'm sooo j/k, but my mind's been reeling over this for a minute. :)
i have strong faith in God, i know this will work out somehow someway, i just can't see it. do y'all have any ideas, suggestions, etc?
i'm being very forthright and vulnerable in saying all this info, so PLEASE don't say anything yucky. i've mentioned before my mom's passed away already, and I say that b/c she would help me through this. I do have one lady that's "adopted" me and my boy that i can ask for guidance and her suggestion was to get the insurance and stay in this house b/c i really wouldn't be able to get much cheaper. i just can't see having $364/month remaining to cover everything that we'll need. kinder starts next year, daycare should be cheaper (HOPEFULLY) but then i have school uniforms, supplies, fundraisers, etc. As a single mother in this income bracket, i don't fit into the indigent category but i'm barely able to make it. it's frustrating. thankfully, i am able to support us w/o any help from anybody, family or government, but DANG, it's so frustrating. all single mom's are in different places. I'm not a 'young' mom, per se, out of my 20's, mid 30's. My friend makes a little less than me, has two children, has medicaid, food stamps, child care help, and housing. her fiancee lives w/her though and makes $40K+/yr, she has just never reported he lives there. Now, I would much rather be self sufficient than reliant on welfare, but situation's like that really get to me....sigh.
i digress, it's not about her, it's about us.
do y'all have any thoughts....suggestions....??? at present, neither of us are insured. and soon, i will be made to pay a fine for not being insured. what the heck should i do?
also re: child support, i do have a case w/the OAG, but until he works and they can "pull" up his SSN w/their system, his wages won't be garnished to be sent to me. per court order, he's also responsible for health insurance, but again, same situation w/the regular child support.
thanks for reading, sorry it's so terribly long.

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So What Happened?

thanks to everyone for responding, seriously. :)
my employer is at 9.5% of my income for myself, approx $220 so it's "affordable", disqualifying me fr marketplace, which is fine, just saying.. what i hadn't considered was doing mine through my employer (which i've now missed the window for darn it - but can do next year!) and then getting my son's elsewhere if i can.
makes me sad b/c i LOVE my job & coworkers & couldn't see workng anywhere else.....but perhaps i should consider doing something else..... :(

thanks again everyone, if nothing else, i feel heard, supported, and got a couple of ideas.

More Answers



answers from Seattle on

Ok, so I didn't read your entire post... BUT I can tell you that I just purchased insurance for me and my DD for about $450 a month without any tax breaks on it. That is still $200 more than I pay now (my current insurance plan is discontinued thanks to ACA) but we can work that out.

Our income (fortunately) puts us where any tax credits we'd get by going through our state exchange are only minor and since I just couldn't get the website to work properly I stated looking at just purchasing insurance directly. Turns out I could buy a plan for only $20 more and much better benefits than going through the exchange.
The cheapest plans that I was offered were about $350 (these are "bronze" plans, I decided to go with higher benefit levels on a "silver" plan) - which is still a hell of a lot less than you would pay through your employer. Again, this does NOT factor in any tax benefits!
I would suggest that you try two things:

Talk to a "navigator" and get help navigating the application process if you go through a state or national insurance exchange. The websites tend to be shoddy and work improperly. It is my impression that you can still buy through the exchange if your employer's plan is to expensive for your income.

Look around online or talk to an insurance agent. I found my plan by taking the plan I would have bought through the exchange and going to the website of the insurance company directly. I just wanted to check out the benefits on the plan when I realized that they offer similar and other plans for direct purchase that are way better than what I would have gotten.

I feel that I got lucky. I'm the type of person that shops around and I feel that I would have been cheated by going through the exchange my state set up. I can only recommend to everyone that they shop around.

Good luck.

Not sure if you will be reading this, but after your SWH I wanted to add: you CAN buy insurance for a dependent only. It does not have to cover both of you. In your case since your employer offers affordable insurance that may be the way to go. You really need to speak to a professional about it... it's impossible for the average person to navigate the system.

4 moms found this helpful


answers from Tyler on

I can't add any good advice, I only wanted to commend you on doing your best to provide a safe home and loving environment for your son. I'm so glad you addressed the child support issue, his bio dad is legally obligated to support his son, it is amazing you are doing so much alone.

Just know that you came to a safe place to disclose these details, I applaud you and will pray for you to find some rest and comfort in knowing that you are doing right by your son.

3 moms found this helpful


answers from Washington DC on

I would start with finding out what your options are RE: healthcare.

ETA: As a single parent, you should also check what responsibility your ex has to your child. I covered my stepkids on my dental insurance for years.

Companies horse trade insurance all the time, not just with the current law. Sometimes it's better and sometimes it's not. My old job swapped dental plans on us mid-year. Friend of mine had/has low cost insurance...with insane deductibles. It's almost no better than no insurance at all.

3 moms found this helpful


answers from Pittsburgh on

What does your employer charge for individual healthcare (just for you)?

My very quick understanding is that you lose your ability to qualify for lower premiums only if the healthcare offered by your employer for just you (not family) is more than 9.5% of your income.

So, at $33K/year, if your employer-sponsored individual healthcare premium is more than $3135/year ($261/month), then you still qualify for discounts through the federal exchange.

I'm not on the exchange, so I'm no expert. But don't give up on this option too quickly...

Also, if your child is under age 5, I believe you qualify for help under the WIC program. From what I see online, income limits are (pretax) about $4400/month for a family of 2. I think if I were you, I'd stop by the WIC office ASAP. In addition to their benefits, they probably have a good handle on what else you qualify for - eg, help with daycare costs?

3 moms found this helpful


answers from Boston on

Yes what MyNewNickname said - your eligibility for lower costs on the marketplace is based on the cost of your employer's plan for a single person. So find out what that is - if it's more than 9.5% of your income, you can get a reduced rate on a marketplace plan. That might provide enough of a cushion for you to be able to afford a plan.

It might be time to consider transitioning your career to something that pays more. When I was a single mom, I opted out of the career I went to school for because it was not enough to support myself and my son. I've been working in the corporate world for 15 years now and make a good living with excellent benefits. It's not a career that I'm super-passionate about but it pays the bills and gives me the flexibility I need, and it's nice to not live paycheck to paycheck. Like you, I also never got child support despite court orders.

Anyway...check out whether or not your employer's plan meets the 9.5% threshold before panicking. You might be able to get a plan for less than you think. Good luck!

ETA: After your SWH - the price difference between the individual and "family" plan with your employer is crazy! Is there a "self + 1" option available? I was able to use that instead of the "family" plan when it was just my son and me. If that's not an option, maybe you can suggest it to your employer. Most have 3 tiers of coverage - employee only, employee +1 (usually a spouse or domestic partner but can also work for a single parent and child) and then "family," which is everyone under the sun. Family makes sense for me now because I'm insuring 6 people - you shouldn't have to pay the same as someone insuring him or herself, a spouse and any number of children.

3 moms found this helpful


answers from Williamsport on

You have more options now, not less. Yes, health care in America is a horrible expensive racket, but hopefully it's improving and will continue to do so.

I've been uninsured my entire adult working life until now. Health insurance for me s a healthy, young, single 20-something in NYC would have been over $1200 per month so of course I never had it. Prices dropped where I live now about a year ago to brace for Obamacare competition, so I was finally able to buy some. I haven't checked exchanges yet, but we have Blue Cross for $200 per month for my 3 kids and I. Yes, it's catastrophic and we still pay for all of our appointments because our deductible is so high, but at least in case of cancer or car crash we won't go bankrupt. If all else fails you can opt to be uninsured and pay the low penalty at tax time-equal to about a speeding ticket where we live.

People complain they are losing their rip off scam plans (many insurers are dropping people because now they actually have to PAY for illnesses and take people with pre-existing conditions), and people complain because they no longer qualify for charity programs, but people shouldn't have to be on charity when they work, and the plans in this country have been criminal for decades. So the change is awkward but needs to happen.

If we had socialized medicine, you wouldn't have this problem-no one would-but the GOP put the kabash on anything resembling a single payer system or even a public option, so you can thank them for the very limited savings, and price hikes in some cases, by the same old private insurers of yore. At least there are SOME improvements being made-like the discount you now have.

In the end, millions have to reduce expenses to afford coverage, but that's what the GOP wants instead of universal health care. It's still better than depending on county programs and other subsidies or paying into the corrupt insurers who were turning everyone away and refusing to pay for life threatening illnesses just so they could make billions in profit every year. And you can still choose to be "totally free of coverage" (as some people are ranting they don't WANT health insurance) for a very minimal penalty, but then as you know you're at risk for ruin at all times if you get sick.

3 moms found this helpful


answers from New York on

I'm probably missing something basic, but if your employer offers health care, why are you trying to purchase it on a state/federal exchange?

2 moms found this helpful


answers from Salinas on

Call a broker. You are WAY over the percentage of household income that should be applied to insurance costs. As I understand it you can buy from the exchange if the insurance offered by your employer costs more than 9.5% of your income AND get the tax credit which in lkhhiujyour case may cover almost the entire cost of monthly premiums.

In California you get the tax credit even if your earning a solid middle class income (55K-65K). If you call a major insurance broker they will not only educate you but do all the paperwork for you. They're being paid by the insurance companies to sign up people. Honestly, you sound like the perfect candidate for some real savings, look into it today.

2 moms found this helpful


answers from Raleigh on

Ask for a raise and explain why you need the raise. The worst they can tell you is "no".

1 mom found this helpful


answers from Dallas on

I would suggest talking to a broker. You need someone who will objectively look out for you.

We own our own company and run our insurance through the company. Like MANY small business owners, we opted to stay with our current plan at no increase though 12/30/14 and at that time, IF the crappy plan the government is trying to ram down our throats is still in effect, we at least have been able to hold off a year and have our own plan continue.

On a personal note, I refuse to answer some of the very personal questions they are asking. I refuse not because I am some risk but because it is my personal information that is no one's business but my own. The government does not own me.

We pay $620 a month for medical which includes a $10,000 deductible for our family total. We will never hit that deductible. We also pay $460 a month for disability, catastrophic care, etc and this plan will not change.

IF we have to sign up on BO's plan, we are required to take out more coverage that we don't need... maternity, pediatrics and pay $1500 a month... CRAZY. I found it interesting that my husband's coverage under BO will provide lactating supplies for him... I laughed when he showed me that provision and asked... "So does that mean I get boner pills on my plan?"

I am sorry I am not better help for you but we went out of our way to stay away from this plan as long as we possibly can.

1 mom found this helpful


answers from Oklahoma City on

Your home should be about 1/3 of your income. I believe that HUD says that should include your utilities and insurance too. I do believe that is gross income too not adjusted.

As for the rest you need to just sit down and make a budget you can live with and cut the rest.



answers from New York on

You say that you work in social services. Have you fully vetted/ explored social services which you and your son might be eligible for? There might be some sort of lower income fresh produce supplement, police athletic league free or low cost before/ after school program, uniform exchange (for school uniforms), adopt a family christmas gift programs etc.

If you can gain a bit or margin elsewhere in your overall budget, the insurance need not be as prohibitive.

One more idea-
See if you can use some of those couponing sites to help you reduce your out of pocket food costs, or gain fringe perks faster, like gas points at your supermarket. (again, a bit more margin).

F. B.



answers from New York on

Does your employer contribute to premiums? You have a lot of variables here. You need an expert, certainly not these people on the 800 number.
Go to HR and see if someone there can help. You might be able to get your son on state insurance for kids. Then your premiums at work,should drop a lot. Once you add "family" prices sore. Just a thought. I thought I was really good at this insurance stuff having worked in the medical,field and have a good understanding of the entire mess, but I must admit you got me.



answers from Washington DC on

1. I would explain things to your superior and ask for a raise. Or will they pay for your schooling to better your position with them to get a wage increase?

2 In my state we have inexpensive coverage for all children under 18. I would check into that. added: sorry, I missed the chip part

3. See if you can work off some of your monthly rent. Maybe the owner has multiple properties and could find you a way to decrease your rent. Lawn care, etc.

4. As far as school uniforms--our school has used, but very nice uniforms for nothing or close to nothing. Maybe yours does, too.

5. You are doing an awesome job, Mom!!



answers from Sacramento on

i know exactly what your going through right now. in the same situation living in california. Here is my situation:

i make 14hr. work f/t and raise a 5yr old all on my own. I have a 2br/1ba duplex. huge front yard and back yard. hot tub, dog, cat and i drive a truck and make car payments. Rent is $825, utilities $40, $13 sons health insurance, Cell $45, ATT $40, $50-$169 childcare, Gas $250 budget, $250 food, cc $100 and have $8500 in debt. Plus i have NO health insurance.

I am lucky if i have $100 left over each month. Now because of my income i do not qualify for free health insurance. Through obama care i would have to pay $50-$150 a month with outrageous out of pocket limits ($5000). then pay 30% for x-rays, $60 co-pay for doctors. And due to my high blood pressure, i go every month to my doctors. So i would be paying my monthly fee plus my 60co pay. Ya i cant afford that! I can't even afford the medical insurance through work, as i would loose $140 a month. Oh forgot to mention...i claim 7 on federal and 4 on state. Which means i get VERY little taxes take out, so i maximize my income anyway i can now. If i didn't, i would be screwed financially, as i would be loosing $200+ a month due to taxes.

My ex husband is ordered to pay child support. $348. No i do not go after him for it. I have my reasons. He doesn't pay childcare expenses or medical for my son. I do it all on my own. I struggle, yet my son is in the best school, has medical insurance, a roof over his head, food on the table and great friends.

Now my problem health...i have medi-cal shared costs. Basically i have to pay out EACH MONTH $1300 before medi-cal will cover anything. I am in need of x-rays and a MRI, stress test. Expenses I have no way in affording. If my truck breaks down, i have no money to fix it. If i get sick again, as i did last year, and end up in the ER, my medical bills will only be $1300...which sadly, i don't have till tax time.

Welfare and food stamps, out of the question...we make too much money. At least you can get your child on state funded health insurance. I pay $13.00 a month for my sons health insurance.

Me personally....i will and can give up everything i have. Live in a trailer rent free and move place to place to avoid paying a "space" fee to put the trailer some where so i can have health insurance and afford those unknowns when they happen. However, i have a child. Life like that is socially unacceptable and i know my son's father would put an end to that and contact CPS or social services and get my son taken away. Yet he refuses to pay child support, childcare or anything for our son. Go figure!

This is sucks. Yet we need to make the best of it.

I would get on a cost shared medi-cal plan. No co pay. just a large deductable you have to pay each month. YET its there if you have a major medical issue and land in the ER. At least you only need to pay the deductable. You are not out each month in copays and out of pocket expenses each time you go to the doctor. That is what i am doing currently. Keeping medi-cal for my emergencies. Then paying out of pocket at a clinic as a cash paying customer. Services are only $40 a visit and anything extra is discounted for me. I had needed xrays and it only cost me $70 plus the $40 office fee. Had it been through insurance, it be more! go figure!

Sometimes having no insurance saves you in the long run. As most medical places charge based on a sliding scale or as a cash paying, which in turn you get the benefit of having services for less then someone who has insurance, as they charge you WAY more, almost 50% more. Even the hospitals, as they get paid sooner then waiting for the insurance companies to pay them. Doctors prefer cash paying patients.

Look for a low cost clinic in your area. Tell them your a cash paying customer and see if they bill on a sliding scale. Do a search through google. I was lucky to find one and been on track in getting healthy. Now i just need to figure out my next move to spend less so i can afford the xray, MRI and stress test i need to rule out other health issues and hopefully catch things now instead of too late!!!

Look at all your options. Yes moving sucks. down sizing sucks. but knowing you can afford things without worry...priceless. I am willing to down size, sell all my things and live almost rent free if it means knowing my debt will b paid off sooner, insurance and the ability to do more with my son. Right now i can't cause money is very very tight. My son does have a lot for me being a single parent. But i went into debt to give him what he has. Its not all that as its just material things. I rather have the quality time doing things with him then the hot tub, dog, cat, huge play structure in our yard and awesome neighbors w two girls who are his bff's. I give all that up in a heart beat, knowing i can get 90% back when i am debt free. It will give me $500 more a month when i become debt free. THen i can work back at getting everything back and have insurance. Then be smart about how i spend my $. No more CC' spending on things i want, instead on things i "need". It takes a lot of discipline to get yourself financially on track.

I would toss away expenses of what is not needed. Especially now that insurance is so expensive, even with obamacare. Have what is necessity. The other stuff u can get again. It will always be there. Priority first over selfish unnecessary want. Internet/tv can be replaced with being outdoors more. Utilities are less in apartments. Spend time at a pool to eliminate the ac cost. Use blankets and wear layering to keep the heater from running all the time. Water is paid for in an apartment. Same as garage in most places here in CA. Cut where you can. SAVE SAVE SAVE order to plan for those must have's that are unfortunately an expense we must incur to be healthy.

Hope that helps a bit...good i need it too :)

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