By MATTHEW HOLT
Strap in for a dramatic story wherein our hero battles paperwork and logic to attempt to get his medical health insurance again.
About 20 years in the past numerous Individuals, particularly Californians who purchased medical health insurance from Blue Defend of California, discovered that their coverage was cancelled without them knowing about it. That observe referred to as “recission” acquired numerous consideration through the run as much as the ACA, and was banned by it. Now if you wish to purchase insurance coverage and also you pay for it, the insurance coverage firm has to promote it to you and may’t cancel it after the very fact.
Or so I believed.
Submit ACA most individuals who don’t get their insurance coverage by way of an employer, or Medicare or Medicaid, now purchase it by way of a really regulated “particular person market” on a state-based or Federal change. Typically, the insurance coverage they purchase is closely standardized (with bronze, silver or gold ranges) and what they pay for insurance coverage is closely backed based mostly on revenue. It’s these subsidies that had been elevated within the pandemic and prolonged within the Inflation Discount Act (IRA) through the Biden administration. The subsidies had been the subject–nonetheless unresolved–of the most recent authorities shutdown. (Sure, sure, I do know the shutdown is over—for now).
It’s just about unimaginable to purchase particular person insurance coverage outdoors the change, though in case you have Scott Galloway levels of wealth you can avoid buying insurance altogether and pay money and also you may be higher off, or you possibly can be a part of some quasi-religious health share organization and take your chance. However for most individuals you might be manner higher off shopping for on the change as a result of that’s the one manner you may get these subsidies.
I reside in California and stay an under-employed blogger, and some instances in my current life I’ve not been married to somebody with medical health insurance offered by their employer. It occurred in 2016-17 and once more two years in the past. No, not what you’re considering. I didn’t get kicked to the curb by my spouse, however in 2022 she acquired laid off by her employer and determined to not get one other job. For the primary 12 months of that interval (2023) we didn’t purchase by way of the change, however used COBRA. Meaning we purchased into her earlier firm’s insurance coverage utilizing our personal cash as a result of it was cheaper than shopping for on the change. Two causes for this. First, she acquired a severance package deal that made our mixed incomes too excessive to get a subsidy and secondly, the ACA plans cost by age, whereas employers pay a flat charge for all staff. That made the change plan costlier than the employer plan. (No prizes for guessing who in our household is previous and costly!)
However COBRA solely lasts a 12 months, after which it was time to go again to Lined California.
This begins a course of the place you attempt to determine which plan provided is the most cost effective, but contains your and your loved ones’s medical doctors, and which one has the bottom related charges for the stuff you employ essentially the most (normally pediatric visits in our case). Seems that in our case is the Blue Defend Trio 73 HMO. My incapability to know why it’s referred to as Trio 73 reveals why nobody calls me a advertising and marketing genius.
The opposite factor you need to determine is what stage of subsidy you get. As talked about, the IRA handed in 2022 prolonged the pandemic emergency improve in subsidies for folks with greater incomes. However then once more, you need to determine what your revenue can be whenever you join. Just like the viewers laughing at an apparent punch line a comic hasn’t gotten to but, these of you working forward of me could have labored out a slight downside right here.
I used to be signing up for a 2024 well being plan in 2023. However I needed to guess what my 2024 taxable revenue could be. Like many self-employed folks with extraordinarily variable revenue I had no concept what that ultimate revenue could be till I filed my 2024 taxes in October 2025 (given I take the IRS extension). In different phrases, virtually two years after I selected the plan. It seems that in California, the individuals who observe your revenue usually are not your well being plan, nor the change however as an alternative your native county well being division. So in November 2023 I guessed my 2024 revenue and needed to inform the native county what that guess is by way of some affidavit. The county well being division truly referred to as me to examine that my estimate was appropriate. Or no less than was what I informed them it was. Keep in mind this for later.
In the meantime I join on what I regard to be a really complicated website online run by Lined California, and choose the aforementioned Blue Defend HMO. It covers One Medical and UCSF theoretically by way of the Brown & Toland IPA, and results in numerous enjoyable and video games in phrases producing much content for me on this weblog and Linkedin.
Because it seems, I used to be despatched for an echocardiogram by my major care physician this previous summer season to examine if I had a coronary heart. Whereas a lot of you had been shocked on the reply (sure, I do), apparently it’s acquired a congenital dysfunction that wants a little bit assist.
This will get us to November 2025 (final month!) along with your courageous hero going again onto the Lined California change making an attempt to determine whether or not the heart specialist advisable by my major care doc is roofed by the 2026 model of the Blue Defend plan I’m on, or whether or not I want to modify. I might now digress and let you know the late Ian Morrison’s formulation for selecting a well being plan however I’ll maintain that for the following telenovela article as after all that course of is a fricking mess too!
To be able to attempt to try this I login to the Lined California website and see I’ve a discover that I’m not eligible for medical health insurance. I’m confused.
The following day my spouse will get a letter from Blue Defend telling her that she and my youngsters have a brand new insurance coverage member quantity and a brand new major care physician. And on the youngsters’ subsequent go to to One Medical (additionally in November) they inform her that they’re not their major care physician and the go to is probably not lined. By the best way, I believe I’ve been informed my major care physician has modified 3 instances whereas I’ve been on this HMO previously 23 months and at no time do I recall my precise major care physician’s identify or One Medical being on the shiny new ID card they ship me. However they nonetheless pay for my annual wellness go to with my One Medical PCP. So I assume it doesn’t a lot matter.
Whereas my spouse is getting a brand new card and new membership quantity, I get a letter from Blue Defend saying I’m not eligible for insurance coverage, and my plan is cancelled as of November 30th.
You would possibly surmise I’m a little bit puzzled. In spite of everything they will’t cancel insurance coverage any extra, and I’d already paid for November.
So I head to the Lined California web site to attempt to determine what occurred. After plenty of digging, I get into the primary of many lengthy message chats with their human brokers. To be sincere they’re all making an attempt arduous and despite the fact that you begin off 27th or so within the queue you get somebody fairly shortly. (They don’t although have a ChatGPT-like clever AI help agent although which a number of corporations now use).
It seems that Lined California has determined I’m not a US citizen.
I am going into my standing, dig by way of all of the questions I answered and there it’s. Citizenship field checked as “no”. To be honest, I’ll have made that mistake once I signed up 2 years in the past. But it surely’s value declaring that I had insurance coverage in 2016 & 2017 by way of Lined California, and had it from January 2024 to November 2025 earlier than anybody determined something was unsuitable. So far as I’m conscious nobody cared sufficient to inform me earlier than telling me my insurance coverage was cancelled.
Nonetheless presumably simple sufficient to repair. I am going into my utility and examine the field saying citizen. It then asks me if I used to be naturalized. Foolishly (and honestly) I examine the field for “sure”. It then asks me for my naturalization quantity. Nicely that 25 12 months previous certificates is in a secure someplace, so I ignore that request and head again to the net chat. Seems there’s a manner I can add paperwork, and one of many ones allowed is a passport, so I try this.
I assume all is nicely and that I’ll be reinstated. A bit of too optimistic.
I even have a suspicion that I do know what has triggered all this.
Do not forget that situation of making an attempt to guess your revenue for the longer term from two years in the past? Nicely In mid-October 2025 I (nicely, my accountant) lastly acquired my 2024 taxes into the IRS. Sadly my 2024 revenue was reasonably decrease than my optimistic estimate, and on my tax kind I truly acquired a rebate as a result of I had overpaid my premium. In different phrases I acquired some tax again from the IRS as a result of I had not acquired as large a subsidy from Lined Califonia in 2024 as I used to be entitled to. (How that switch works between Trump and Newsome I have no idea!)
Within the flurry of letters and notices from Lined California in November 2025, a few of them elevated my subsidy for 2025 which meant that for the remaining month of 2025 my household’s premium went down. However, on the identical time my insurance coverage was cancelled, and I acquired a discover that my kids may be eligible for Medicaid (Medi-Cal in California). Was this due to my decrease than anticipated 2024 revenue or was it as a result of I had put that my spouse had $0 revenue in 2025 on the shape? I’m nonetheless uncertain of that reply.
Nevertheless, I then acquired a letter from the County Well being Division asking me to show my citizenship and to once more put in an affidavit for my revenue. I headed again to the Lined California on-line chat to attempt to type it out. Regardless of being logged into the positioning, and giving them the reference variety of my final 3 chats, I nonetheless have to inform them my identify, date of start, handle, inside leg measurement and what number of video games the SF Giants gained in 1993 to get them to confirm me. Their recommendation was to name the County.
I name the Marin County Well being Division. Their telephone line is simply open at very particular instances like 2-4 on Tuesdays when the moon is in retrograde. While you name again throughout these instances, they play you about 4 minutes value of messages, then put you thru an extended telephone tree. On the finish of the telephone tree they let you know the common maintain time is, I child you not, 2 hours. If you actually need the County’s assist, I’m unsure that’s the best way a mean low revenue Medi-cal recipient goes to get it.
Now, nobody informed me this, however finally after a little bit googling I discovered that there’s a website online referred to as BenefitsCal. You may register for this web site for County companies, and one of many issues you are able to do is add proof of citizenship. So like I had accomplished with Lined California, I uploaded my passport.
Just a few days later, I am going again to the Lined California website, and see a message/letter dated November 18 than I’m briefly reinstated on my plan. Throughout my subsequent lengthy on-line chat with Lined California—you knew I used to be going to have one—they inform me that I’m formally acknowledged as a citizen and subsequently eligible for the insurance coverage I’ve had from them for practically 4 years!
Because it occurs I’ve an extended standing appointment with Andrew Diamond at One Medical on December 1 to debate that coronary heart situation. I arrive on the desk and so they inform me that Blue Defend says I don’t have insurance coverage. Sitting within the ready room, I name Blue Defend who verify I don’t. I inform the Blue Defend rep that not solely was I reinstated on November 18 however that their web site confirms in my profile that I’m lined. The rep tells me properly that it might probably take 10 enterprise days to indicate. Why the web site and their rep’s system present various things I don’t know. I inform One Medical to not put within the declare for every week or so
In the meantime whereas I’ve her on, I ask the rep if she will change my PCP of file again to One Medical and do the identical for my spouse and youngsters. She seems up Andrew Diamond and the identify of each One Medical physician I can discover on their website that my youngsters have seen. (One Medical does a pleasant go to historical past listing).
None of them are in her system.
The One Medical receptionist means that I name again and get another person “as a result of if seems to be completely random with them”.
The tip of this a part of the telenovela is that I name Blue Defend 3 days later. I used to be principally asking about which of their plans that heart specialist was lined on, and naturally they couldn’t inform me that and referred me again to Lined California’s web site! (extra on that subsequent episode!). However they’ve now discovered me of their system, and I discover that my subscriber quantity has modified.
However whereas I had the rep on, I requested who my major care doc was. It was nonetheless somebody I had by no means heard of. May I modify it to One Medical, I requested? Give me a reputation and I’ll attempt, the rep mentioned. Andrew Diamond, I puzzled? Sure, after all was the reply. So now my PCP is my precise appropriate PCP.
So being actually daring, I requested can I modify my spouse’s and my youngsters PCP to One Medical too? Sure however I want their permission? I perceive needing my spouse’s permission however why do I want my youngsters? Nicely they’re over 10 years previous! I took the telephone to my spouse who was within the subsequent room and so they acquired her permission to vary her PCP additionally to Andrew Diamond (who isn’t her PCP however is no less than in One Medical).
Later within the day, my spouse is driving the children to swimming, She calls Blue Defend and asks to vary their PCP. The rep makes the change with out asking for my youngsters’ permission! Because the One Medical receptionist mentioned, “it seems to be completely random with them”.
***
In order of December 4, 2025 we as a household are signed up for the proper well being plan with the proper PCP, and we hope it really works retroactively for any November visits.
In fact, who the hell—apart from an under-employed well being care blogger producing content material—has the time to take care of this entire mess? In each different nation on the planet you get the equal of a social safety card and present up at any physician or hospital and get handled. Individuals are rats in a well being care maze wanting desperately for cheese that retains getting moved.
Oh, and I nonetheless have to determine the best plan for January 2026….three weeks from now.
Matthew Holt is the founder/writer and someday writer of THCB
