Accidentally Double insured??? How to unenroll from marketplace so that medicaid becomes primary coverage without delaying prescription [VA] [medicaid/marketplace/prescriptions]

Hi there! I have a bit of a situation and could use some guidance on what to do. I'm in VA.

the setup: I've had Optima thru marketplace with a tax credit for a couple of years, but this March I was approved for medicaid. I (stupidly) thought that by enrolling for medicaid, that it would cancel my enrollment for the marketplace insurance, but I found out the hard way at the doctor's office last week that I am still enrolled in Optima (double insured), with the marketplace being my primary insurance. Since I have the tax credit, there's apparently a three month grace period where they still cover you even if you haven't paid the premium (which I haven't since March), but will withhold any claims until that premium is paid.

This is where my problem starts: I need a medication that is a controlled substance and requires a previous authorization. The doctor's office is insisting they HAVE to go thru optima first to get it approved. Optima has denied the request due to lack of payment of the premium. They filed an expedited appeal, but I know that they'll still deny it, again, due to lack of payment. I asked the dr if they can go directly thru medicaid, which has this medication listed as a preferred medication, and they said no, that Optima is the primary insurance and that medicaid will only cover what optima will not. They also told me that if I cancel Optima now, they'll have to start the entire process over with medicaid, which according to them can take several weeks.

So my question is this: Should I cancel Optima right now and have them start over with medicaid? Or do I wait to cancel until the medication is denied again (ie does Optima denying the PA mean that medicaid will step in)? I didn't even know you could have double insurance, and even if I could afford to pay the last three months of premiums, I wouldn't want to considering the whole point of getting medicaid was to NOT pay premiums. I'm also wondering if I cancel now, if this past dr's appointment will be covered by medicaid if Optima doesn't pay, or will I be on the hook for the full appointment?

on another note, what's the process for cancelling? the doctor's office told me I need to call medicaid directly to make them my primary insurance once optima was cancelled but that doesn't seem to make sense to me – if it's the only insure I have on file, wouldn't it automatically be the primary insurance? Also Would I have to pay back the tax credit? Or is that something that's reimbursed when I file next year? Sorry for all the questions but as we all know this system is a fucking nightmare.

Thanks to anyone who's read all this and super grateful for any insight anyone might be able to provide!!!

submitted by /u/TheLittlestTiefling
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