Another COBRA/ACA question.

[Murf2]

Well, I got my ACA account set up with no problems. A big thank you to all! It was far easier than some other people made it sound. I'm glad I posted here. It is a very helpful forum.

I do have another question, mostly out of curiosity. How does the enrollment and payment phase of this work? Are the payments set up on the site or do you go to the insurer for that?

Thanks again, Murf

 

[big-papa]

My insurance company billed me.


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[Murf2]

Thanks bp, So at they time you enrolled online there was no real transaction and the insurance co. sent a bill directly to you? Was your tax break already figured into the insurance co. bill? I guess I'm having a hard time believing it go so well after all the negative talk I've heard.

Thanks, Murf

 

[Texas Proud]

Thanks bp, So at they time you enrolled online there was no real transaction and the insurance co. sent a bill directly to you? Was your tax break already figured into the insurance co. bill? I guess I'm having a hard time believing it go so well after all the negative talk I've heard.

Thanks, Murf

It makes a difference how you signed up.... I did not put in any income info so got a full cost of insurance and I have to pay the full amount... will get my money when I file tax return....

If you put in income, they should have told you your credit amount and quoted your net amount which you will pay... any difference to that you pay at tax time...

 

[EastWest Gal]

Thanks bp, So at they time you enrolled online there was no real transaction and the insurance co. sent a bill directly to you? Was your tax break already figured into the insurance co. bill? I guess I'm having a hard time believing it go so well after all the negative talk I've heard.

Thanks, Murf

I found it easy too. I made a mistake with initial enrollment stating my coverage ended 2/1/15 when I should have stated 1/31/15, so my insurance start date was 3/1/15. I worked the very nice and helpful folks at the ACA help center and they helped me fix it.

I think you need to pay your first premium in November to insure your coverage starting December 1st. I paid my first premium through the ACA website and afterward set up autopay directly with the insurance company. It was a very smooth process. And even my bronze plan is costing us less out of pocket than our old insurance coverage, even though it is with the same insurance company as my old employer used!

I've been convinced from Day 1 that the negative talk is political rather than real life experience, unfortunately.


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[MBSC]

My enrollment process was also smooth. When I submitted the application on the federal exchange, I got a screen asking if I wanted to make the first month's payment. I chose 'yes' but the next screen said my insurer had not set up that option and they would contact me. I received a welcome package about a week later. I receive a bill around the 20th of each month, due by the 1st of the following month.

Premium: $300
Credit: $100 (subsidy)
Amount due by 1st of month: $200

 

[shortstop14]

You can only voluntarily end COBRA during the annual ACA open enrollment period. Voluntarily ending COBRA any other time of the year is not a qualifying life event so it will not create an ACA special enrollment period.

Source: Health Reform FAQs | The Henry J. Kaiser Family Foundation

Useful information, thanks. I'm just figuring out that I should look into this earlier than I had planned. COBRA runs out in April, but since we're on a high deductible plan, making a transition in mid-year would make us have to satisfy the high deductible twice for 2016 for the different plans. That could make for an expensive year, so I might be better off switching in January.

We also have the option of a state teacher's retirement plan, so there's some tedious comparison research to do. Not planning to manage my income for ACA subsidy - rather use up the 15% tax bracket to flush out capital gains for 0% income tax and then Roth conversions.

 

[big-papa]

Thanks bp, So at they time you enrolled online there was no real transaction and the insurance co. sent a bill directly to you? Was your tax break already figured into the insurance co. bill? I guess I'm having a hard time believing it go so well after all the negative talk I've heard.

Thanks, Murf

That's right. I put my estimated MAGI for the year in and my payments were figured accordingly. As others have noted, you can also leave that part alone and instead take care of it at tax time. Now, 6 months into it, I went back to work. I called ACA and the insurance company to cancel the policy. At tax time, because I made too much for the second half of the year, I had to pay back the 6 months of subsidies. But since I already knew that, I figured that into my withholdings once I went back to work.

Really the biggest problem was right at the very beginning of ACA because of website malfunctions. After that the only issue I had was with the insurance company for a medication for my daughter that was clearly in the formulary. So every month it was go to the pharmacy, be told it was $165, then go home and call the insurance company and after 30 minutes it was fixed and was $10. Go back to the pharmacy and pay $10 and pick it up. It seems it was always handled as an exception by the insurance company instead of the insurance company fixing it permanently.


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[Murf2]

One more?. Are you only covered in your state if you don't buy a national network plan? Seems like a bad deal. What happens if your traveling and get sick?
Seems like a big step backwards from private insurance.

Murf

 

[jim584672]

I think they cover emergency and urgent care only for out of state.

 

[ziggy29]

One more?. Are you only covered in your state if you don't buy a national network plan? Seems like a bad deal. What happens if your traveling and get sick?

How sick? If you aren't on a "multistate" plan, as far as I can tell, you're only covered for emergency and urgent care.

 

[MBSC]

One more?. Are you only covered in your state if you don't buy a national network plan? Seems like a bad deal. What happens if your traveling and get sick?
Seems like a big step backwards from private insurance.

All ACA compliant plans cover emergency services (heart attack, stroke, car accident, etc.) that occur within the U.S. You may be interested in this E-R post.

Healthcare.gov link: https://www.healthcare.gov/blog/knowing-where-to-go-for-care/

PPO plans offer broader coverage but their premiums are higher. HMO/EPO plans have more restrictive provider networks for non-emergency care. Not all providers within the state will participate in the network. Most Blue Cross Blue Shield plans participate in the BlueCard Program. This expands your home state's BCBS provider network to other states.

Be careful when you see the term "multi-state plan" on the ACA exchange as it can be misleading. It actually means the same plan benefits can be purchased by residents of different states but each state may have its own separate provider network. It's very important to review the provider network directory before you purchase any plan.

 

[Murf2]

Hi, I was speaking of "National Provider Networks" not "multi-state" plans. The wording is very tricky on those isn't it? So if we were traveling and had a problem, we'd have to got to the emergency room. Just like all the uninsured do now?

Murf

 

[MichaelB]

Hi, I was speaking of "National Provider Networks" not "multi-state" plans. The wording is very tricky on those isn't it? So if we were traveling and had a problem, we'd have to got to the emergency room. Just like all the uninsured do now?

Murf

Just like other private insurance, each policy offers its own coverage network plan. You need to research the offerings and judge the network. All insurers have a search tool in their website to allow members and prospective clients to browse their provider network.

There is now little difference in coverage among ACA compliant plans. The differences are to be found in cost sharing and network coverage.

 

[MBSC]

So if we were traveling and had a problem, we'd have to go to the emergency room. Just like all the uninsured do now?

Some plans also allow you to go to an urgent care facility but the problem still has to meet the prudent layperson definition of emergency to be covered out of network.

 

[Murf2]

In the other COBRA thread I saw Huston55 suggested overlapping the COBRA coverage with private coverage. Is this advisable or even possible when going to ACA from COBRA? I would gladly pay an extra payment to insure coverage.

Thanks, Murf