ACA-you can switch plans any time?

[Fermion]

My current ACA fiasco where I thought I was changing my income for 2016 and it ended up changing 2015 has brought to light something interesting.

I am going to be forced to purchase a new health plan for just December of 2015 because I reported the income change. Evidently an income change of $150 triggers this.

I have not determined if I will go to a bronze plan from our current silver plan or go with a higher cost silver plan. Ours was a 2500/5000 deduct silver and the only plan now is 3000/6000 silver (they must have gotten rid of our old plan mid year)

This makes me wonder why someone wouldn't just go with a cheap bronze plan then if they need to change it, sell some stocks for a capital gain or loss, changing their income by at least $150 a month. They could then buy a gold plan with a $1000 deductible instead of $6000 and end up saving a few thousand dollars total.

I tried to explain that you are not supposed to be able to change plans at any time but the health plan agent said income change triggers a special enrollment.

 

[MichaelB]

Special enrollment, defined as outside the open enrollment period, requires a "life changing" event. Changes in income would not quality. Changes in employment might, if it meant losing coverage. Here's a link https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

 

[easysurfer]

Wow. Sounds like if someone is not happy with their current plan, they can just make a small income plan and then re-enroll as special. Or, if one doesn't want to go through the headache, to just not report the small change and let the reconcile happen at tax time.

I can't answer about the why not just get a bronze plan question as I'm just at the "Do I really want to enroll in the marketplace?" stage.

 

[Fermion]

Special enrollment, defined as outside the open enrollment period, requires a "life changing" event. Changes in income would not quality. Changes in employment might, if it meant losing coverage. Here's a link https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

I used to think the above was true.

 

[gauss]

A few thoughts/questions on this:


Are the insurance brokers suppose to be enforcing the same standards that the health care exchanges do, or is the individual suppose to be responsible for ensuring compliance when purchasing off-exchange?


On the other hand, do different rules apply when purchasing off-exchange (ie does guarantee-issue only apply to exchange purchased policies?)


-gauss

 

[mpeirce]

I've been wondering why there is an "open enrollment period" at all.

What other purchasing decision only comes around only once a year? Other insurance can be changed at any time. I certainly don't have to wait until, say, next June, to buy a car.

Anyone know why we have this weird system?

 

[ziggy29]

On the other hand, do different rules apply when purchasing off-exchange (ie does guarantee-issue only apply to exchange purchased policies?)

I believe the only significant difference is that when you buy outside the exchange there are no tax credits or cost sharing. But if you know your income is too high for any of those, you can just as easily go through a broker, and there may be other ACA-compliant policy offerings available to you outside of the Exchange.

 

[gauss]

I've been wondering why there is an "open enrollment period" at all.

What other purchasing decision only comes around only once a year? Other insurance can be changed at any time. I certainly don't have to wait until, say, next June, to buy a car.

Anyone know why we have this weird system?

Adverse Selection - ie only buying insurance when you have private knowledge that you will need it soon.

 

[jim584672]

I didn't think a change in income would trigger a special enrollment period (SEP). The only exception would be an increase of income that would result in loss of coverage, for example loosing Medicaid due to an income increase would trigger a SEP. Conversely a drop in income mid year can drop someone into Medicaid, since Medicaid has no open enrollment period requirement.

 

[MichaelB]

I used to think the above was true.

It still is. What information do you have that is different?

 

[Fermion]

It is possible the SEP was generated from the temporary, mistaken drop down into Medicaid and then back out again, but I am definitely in the position where I can pick a different plan for December (I don't want to do this and am fighting it now).

Whether ethical or not, it does seem to be legal in Washington state that if you report a current decline in income, perhaps enough to drop you into Apple care, then find out the next day that you don't have that decline, it triggers a SEP.

For example, you thought you were going to sell your Apple stock for a $20,000 gain, but the next day you decided not to sell the stock.

 

[gauss]

Fermion,

Was your insurance broker quoting you an ACA-compliant health plan?

Private Health Plans Outside the Marketplace
suggests that all private insurers use the open-enrollment period for off-exchange purchases to protect themselves from abuse of ACA compliant plans.

They also mention that "temporary" plans are available off-exchange year round, but they do not have any of the ACA protections (ie they can medically underwrite and drop you if you were misleading on your application) and do not count as MEC and thus will not protect you from the penalty for not having insurance.


If an insurance company is indeed offering an ACA-compliant plan without enforcing enrollment restrictions, then once the word gets out, this loophole will surely be closed. Ask the broker if the plan being offered counts as minimum essential coverage (MEC) under ACA.

-gauss

 

[jim584672]

The loophole is that Medicaid is monthly based, while the other plans are yearly based.

 

[gauss]

The loophole is that Medicaid is monthly based, while the other plans are yearly based.

So this would potentially be available in all 50 states? (although I realize we have 50 different flavors of Medicaid in the various states).

I guess it comes down to how close you can keep your income to the Medicaid level and how strict the Medicaid enrollment process is in your state. Interesting...

-gauss

 

[jim584672]

It should be available in all states, provided they expanded Medicaid.

 

[gauss]

I have always tentatively planned to get a Bronze plan if I ever found myself without group health insurance, so in my situation nothing would change. Pension income would keep us quite a distance from the Medicaid income level however.

 

[MichaelB]

Loss of coverage is a qualifying event for eligibility for special enrollment. In the case of Medicaid, (I would guess) that means losing Medicaid coverage. That is, being enrolled in Medicaid and then losing that coverage due to a change in income. The situation described by Fermion is different because there is never any enrollment in Medicaid, just an acknowledgement of eligibility.

 

[Fermion]

No, it seems for one day or at least a few hours I was actually enrolled in Medicaid. Washington may just be feeble minded.

 

[gauss]

Just being able to enroll in Medicaid is a financial hedge against serious illness costs possible under a bronze plan if one's income is nominally close to the Medicaid level.


I wonder how transparent the Medicaid application process/decision process is in the 50 states.

 

[jim584672]

I had a drop in income, reported it at my state exchange (NY). It automatically cancelled my old plan and enrolled me in Medicaid seamlessly.

 

[gauss]

Jim,


Was the drop in income reported by a third-party (ie employer) or was it self-reported/self-managed ie IRA transactions, Schedule C etc.

 

[Fermion]

Can you be on Medicaid if your MAGI is $50,000? It seems maybe so, if you current monthly income drops.

 

[gauss]

Can you be on Medicaid if your MAGI is $50,000? It seems maybe so, if you current monthly income drops.

Probably depends on what is the size of the family

 

[jim584672]

Jim,


Was the drop in income reported by a third-party (ie employer) or was it self-reported/self-managed ie IRA transactions, Schedule C etc.

My unemployment ran out in June, so I reported it at the web site.

 

[homestead]

Can you be on Medicaid if your MAGI is $50,000? It seems maybe so, if you current monthly income drops.

I thinks so, in jan 2014 I took a large distribution from ira to get my yearly income high enough to keep me out of medicaid. It didn't work they put me in medicaid anyway. Maybe if you took a monthly distribution it would work.