One group of people that is treated entirely differently from everyone else as it relates to health insurance, are those people who are between 55 and 65 who qualify for Medicaid and own their own homes. This group is the ONLY group that is required to pay back their 'subsidy.' This is done through Estate Recovery. The monthly cost of the Medicaid premium is tracked, added to what is actually spent for medical and medication benefits and is due at the time of the beneficiary's death. The children of the person who received the subsidy do not get to inherit the family home without having to pay back the parent's 'subsidy'. Typically the home has to be sold.
To illustrate: My partner receives a subsidy of over $500.00 per month for a silver plan. He will never have to pay that back. But since I am eligible for Medicaid my home would be sold to pay off my subsidy. Additionally, if someone is eligible for Medicaid they are not allowed to buy subsidized insurance on the state exchanges not even the lowest priced plan. If someone has income that varies through the year and falls below the Medicaid threshold, they will automatically be enrolled in Medicaid without their knowledge or consent.
When people are signed up for Medicaid they are sort of told about Estate Recovery but it isn't explained adequately. When I spoke to the state exchange last year I was told that there is only Estate Recovery for "higher dollar amount cases." This is simply untrue.
So I am 60, haven't had insurance for over 5 years, and unless something changes will not be able get insurance for another 5 years when i am eligible for Medicare. And unbelievably i am subject to a fine for not having insurance!
I can't tell you how scary it is to be in this position.
Another thing: When I went to the federally subsidized rural clinic for a small health matter, i was unable to see my regular provider, instead saw the head of the clinic. He was very confrontational and wanted to know why I wasn't on Medicaid. (He was able to see my income because i get a discount for being low income) I had to inform this doctor and clinic head about Estate Recovery and how it discriminates against people 55 to 65. After being hardnosed about not having Medicaid, he had to say "I didn't know that."