Problem with marketplace coverage when spouse goes on Medicare

[Z3Dreamer]

Spouse is primary on Healthcare.gov application and BCBS insurance plan. Called both up a month before DW went on Medicare. "What do I do to continue my Marketplace/BCBS coverage?" Answer: "Call us up the last day of the month and we will do the switch over." I called Healthcare.gov yesterday and they revised the application to show that DW no longer needed coverage. Now, when I logon to Healthcare.gov it shows only me needing coverage and the appropriate PTC. Life is good?

Well, BCBS has to wait a day or two for the Healthcare.gov modification to update their system. OK. Then they will cancel the old policy and send me a card with the new policy number on it. Me: "What do I do in the mean time?" BCBS Answer: "Schedule your appointments after you get your new card." Me: "Will my old logon to BCBS work?" BCBS: "No. Since it is a new policy with a new primary, you will have a new logon." Me:"There must be a workaround. What is it?" BCBS: "No. There is no workaround."

I have been trying to get an appointment with a specialist since late January. Had one set up for May 5th. Called them yesterday. They will not see me unless I have that valid card in my hand. Period. They cancelled on me. I hope the problems (which were found in a blood test) are not too severe.

I met my deductible under the old plan. I shudder to think of the battles I am going to have to convince BCBS that I have met my deductible.

I picked a bad time to give up drinking.

 

[Z3Dreamer]

OP here. What I wrote is not believable so I contacted BCBS, again, after I posted the above. It is true.

They confirmed that me meeting the deductible SHOULD transfer to the new policy. They said SHOULD.

BCBS said I should see my specialist and get them to hold up the processing until I have a valid insurance policy. I explained to BCBS that it doesn't work the way they think. You walk up to the front desk at the doctor's office, check in and hand them your card. The front desk runs it through the computer to see if it is valid. If it is not valid, you don't see the doctor. You don't talk to the insurance person. And since I am a new patient, they are not going to grant me some exception.

This is a once in a life-time event but if you have a spouse turning 65 and you are on the same marketplace policy, you should plan for this.

 

[candrew]

Hmm. Interesting situation. I'm curious what might have happened if you had elected to not contact the insurer and Healthcare.gov. Would your spouse merely have been dropped from marketplace coverage and yours continued?

 

[Z3Dreamer]

Hmm. Interesting situation. I'm curious what might have happened if you had elected to not contact the insurer and Healthcare.gov. Would your spouse merely have been dropped from marketplace coverage and yours continued?

Good question. Healthcare.gov step-by-step instructions for when the primary contact switches to Medicare, lead you to believe that if you don't call, the entire application/plan/policy will be cancelled. Again, those are just the written instructions. What would have happened if we just ignored? IDK

 

[jimbee]

Thanks for the reminder on this. My plan is to change health insurance coverage so DW is listed as primary the next time we sign up for ACA. Since I'm eligible for Medicare first, it will hopefully make for a less bumpy transition when I transfer from ACA to Medicare.

 

[pb4uski]

Too late now, but you should have just given the specialist your old card... and then your new card once you received it.... I guess that you still could because technically until they process the switchover the old policy is still officially in force.

 

[SecondCor521]

Another idea to throw out there would be to get two individual ACA policies that year, then just call and cancel the one for the person moving to Medicare.

You'd lose the "family" deductible, but with just two people on the policy and both presumably around Medicare age, that might not be much of a downside.

You'd also get two 1095-As. For tax purposes, my understanding is that you just add together the numbers on the 1095-As and put those into your tax software and/or Form 8962.

 

[Z3Dreamer]

Too late now, but you should have just given the specialist your old card... and then your new card once you received it.... I guess that you still could because technically until they process the switchover the old policy is still officially in force.

Nope. Can't do that because they run it the moment you walk in the office for the appointment. By the 5th, old policy will be cancelled but new one not yet received.

 

[Z3Dreamer]

Another idea to throw out there would be to get two individual ACA policies that year, then just call and cancel the one for the person moving to Medicare.

You'd lose the "family" deductible, but with just two people on the policy and both presumably around Medicare age, that might not be much of a downside.

You'd also get two 1095-As. For tax purposes, my understanding is that you just add together the numbers on the 1095-As and put those into your tax software and/or Form 8962.

You could be right. For me, it is too late, and I don't know if I had that option. But I started this thread to rant and to let those who will have this situation soon know that they need to think about it. If one elected two single policies at the beginning of the plan year, if allowable, it might get around this administrative glitch.

 

[MRG]

How screwed up. Hopefully the providers office will have an empathetic ear and allow you to get rescheduled with the specialist. Sad you have to do that.

 

[Animorph]

I did this late last year. Removed me from the insurance and as primary contact while leaving DW on ACA. Really nutty how they make you wait until the last day. DW ended up with a different ID, so the old card was no use. Luckily she sees a doc only about once a year, so no problems needing a new card. You're just kind of in limbo for a while. Plus the auto payments are not corrected until too late, and we had a refund from 2018 being subtracted. The refund was more than required to finish the year with just one of us on the plan, so they owed us money that was hard to calculate and extract.

We did finally get our money. Doing taxes in TurboTax was a little fun with family coverage and then Medicare + individual coverage. But we should have seen the last of that mess now. A simple individual switch from ACA to Medicare for DW should be a piece of cake.

While I had thought of changing our primary contact or using two individual accounts before all this hit, Healthcare.gov was not terribly clear about how I could do that after creating a family account.

 

[littleb]

The whole process is ridiculous. I changed our ACA last year where DH would be primary since my Medicare date was May 1. To make a simple change is cumbersome on the ACA website so I called in the middle of April to get a rep to drop my coverage May 1. They informed me I would need to call back on 04/30/20 as their system was not capable of entering a future effective date. If I called on 4/30 I was assured my coverage would end at 12 midnight on the last day of April. They also told me if I called in May I could lose all subsidies and the premium could increase.

Ok, so I called 4/30 and went thru the entire 30 minute process with the rep. I explained more than once that my Medicare coverage would start on May 1 and he stated he understood. Imagine my surprise when I looked up the ACA messages yesterday and found my coverage under ACA ended 4/29/2020. Also DH ACA ended same date with new plan beginning 4/30. So I went a day without health insurance. The only reason I wanted a rep involved was due to the ACA system being inflexible

Beware and double check everything when you make a change.

EDITED to add. I remembered DH went to his dr on 4/30 so will it deny based on old plan ending on 4/29? His new ACA plan starts 4/30.

 

[Z3Dreamer]

I did this late last year. Removed me from the insurance and as primary contact while leaving DW on ACA. Really nutty how they make you wait until the last day. DW ended up with a different ID, so the old card was no use. Luckily she sees a doc only about once a year, so no problems needing a new card. You're just kind of in limbo for a while. Plus the auto payments are not corrected until too late, and we had a refund from 2018 being subtracted. The refund was more than required to finish the year with just one of us on the plan, so they owed us money that was hard to calculate and extract.

We did finally get our money. Doing taxes in TurboTax was a little fun with family coverage and then Medicare + individual coverage. But we should have seen the last of that mess now. A simple individual switch from ACA to Medicare for DW should be a piece of cake.

While I had thought of changing our primary contact or using two individual accounts before all this hit, Healthcare.gov was not terribly clear about how I could do that after creating a family account.

Are you telling me that my pain is not over? That they are going to mess up the premium payments, too? Say it isn't so!

 

[pb4uski]

Nope. Can't do that because they run it the moment you walk in the office for the appointment. By the 5th, old policy will be cancelled but new one not yet received.

But the new policy will be inforce by the 5th as welll.. if they can tell that the old policy is cancelled then they should be able to tell that the new one is active... they can call BCBS to confirm coverage if they need to and you could also show them any information you have on the new policy.

Can they email you a new card? Can you pick up a new card at your local BCBS office? There answer to wait until you get the new card in the mail is lame and unacceptable... what if your issues were not elective?

If they give you the same line of bull, ask to speak to a supervisor and if you still don't get satisfaction, tell them that your next call is to the insurance commissioner's office to file a complaint.

DW went on Medicare in March... our transition was good other than they failed to do the automatic withdrawal for my premium and I had to call them to get that sorted out. However, we had individual policies and since we didn't get a subsidy we didn't need to deal with the marketplace... just with BCBS.

 

[pb4uski]

Another idea to throw out there would be to get two individual ACA policies that year, then just call and cancel the one for the person moving to Medicare.

You'd lose the "family" deductible, but with just two people on the policy and both presumably around Medicare age, that might not be much of a downside.

I don't think you want the family deductible... we bought separate his and her policies for that very reason. Our plan had an aggregate deductible at the time we bought it so if we bought a family plan with a $12k deductible then we would need to incur $12k of medical costs before BCBS would be on the hook. OTOH, if we had individual policies with $6k deductibles, it was $6k for one or the other of us. Since we are healthy, it is most likely that only one or the other of us would have a health issue and the individual policies, which were 1/2 the premium of a family policy, would kick in if one or the other of use had $6k of medical costs.

I believe a couple of years later they change the deductible from aggregate to stacked so it wouldn't make a difference but by then we already had individual policies and there was no good reason to change.

I recall the conversation with the BCBS rep to clarify my understanding at the time I made the decision to do individual policies where I posed a hypothetical where one of us had $8k of medical costs and with a family policy they would not be on the hook for anything but with individual policies they would be on the hook for $3k and telling her that we would go with the individual policies.

 

[Z3Dreamer]

But the new policy will be inforce by the 5th as welll.. if they can tell that the old policy is cancelled then they should be able to tell that the new one is active... they can call BCBS to confirm coverage if they need to and you could also show them any information you have on the new policy.

Can they email you a new card? Can you pick up a new card at your local BCBS office? There answer to wait until you get the new card in the mail is lame and unacceptable... what if your issues were not elective?

If they give you the same line of bull, ask to speak to a supervisor and if you still don't get satisfaction, tell them that your next call is to the insurance commissioner's office to file a complaint.

DW went on Medicare in March... our transition was good other than they failed to do the automatic withdrawal for my premium and I had to call them to get that sorted out. However, we had individual policies and since we didn't get a subsidy we didn't need to deal with the marketplace... just with BCBS.

I will let you know as I intend to call daily. BCBS said that the steps are 1) BCBS receives notification and cancels the old policy. 2) BCBS starts a new policy. 3) BCBS sends out a new card.

If I call between steps 1 and 2 I am totally screwed as I have no coverage. They lead me to believe there was a time gap between 1 and 2. If I call between steps 2 and 3, the customer service person will email me a card and I can see if my old appointment slot is still open. If not, they will see me a few weeks later.

Generally, I am not good with threatening up the line as they think I am "going postal" and shut me down, call the nice men in their white coats, and otherwise retaliate.

 

[pb4uski]

... Generally, I am not good with threatening up the line as they think I am "going postal" and shut me down, call the nice men in their white coats, and otherwise retaliate.

Escalating a customer service issue shouldn't be a problem as long as you are calm and civil about it. CSRs are often limited in what they can do, supervisors less so. Where I once worked I would occasionally get a call escalated from a clerk that was an unusual situation that if the caller was civil and there was a sensible solution within my authority I could grant exceptions. Nothing on the clerk... they were just doing there job as it was defined for them and in some cases didn't necessarily understand the big picture implications that an exception would not cause a problem.

 

[blueskyk]

We just did this and had some hick-ups and cost surprise. I turned 65 in April and DH will turn 65 in November of this year. So, called the ACA on 4/1 (I was given instruction to call on the first day of the month when I called to sort out what to do). I had been the primary for our household policy and cancelled that policy and put DH on new individual policy. I was assured DHs insurance company would send new billing.

BTW, ACA premium for the two of us (using subsidy) was $84/month, individual policy for DH going forward is $313/mo (with subsidy) I expected some change but not that much.

We waited a couple of weeks for the new premium bill and received nothing. DH called them and was told, no he’s not enrolled AT ALL and they have no record of him being insured. Some spirited discussion takes place and he gets it all sorted out.

Next, a miracle occurred and he was able to connect to his EMR with his new ID.

So, we went from paying $84 per month on the ACA for the two of us to nearly $600 per month when I moved to Medicare (includes plan G and RX). Still, we were on a HDHP plan and reduced our household deductible from $13k to a little over $6.5k. When DH moves to Medicare, looks like we will continue with medical insurance costs a little under $600 a month. Although I think I read there was a possibility of some kind of discount it you both sign up for the same supplement.

 

[SecondCor521]

I don't think you want the family deductible... we bought separate his and her policies for that very reason. Our plan had an aggregate deductible at the time we bought it so if we bought a family plan with a $12k deductible then we would need to incur $12k of medical costs before BCBS would be on the hook. OTOH, if we had individual policies with $6k deductibles, it was $6k for one or the other of us. Since we are healthy, it is most likely that only one or the other of us would have a health issue and the individual policies, which were 1/2 the premium of a family policy, would kick in if one or the other of use had $6k of medical costs.

I believe a couple of years later they change the deductible from aggregate to stacked so it wouldn't make a difference but by then we already had individual policies and there was no good reason to change.

I recall the conversation with the BCBS rep to clarify my understanding at the time I made the decision to do individual policies where I posed a hypothetical where one of us had $8k of medical costs and with a family policy they would not be on the hook for anything but with individual policies they would be on the hook for $3k and telling her that we would go with the individual policies.

I guess it all depends on one's situation and the offerings at hand. Around here for my situation (Idaho, 50 with three semi-adult offspring, ACA Silver policies), the policies offered typically have both individual deductibles and family deductibles which are, to use your terminology are aggregate. The family deductible is usually 3x the individual deductible.

So if it's me and my DD18 on my policy and the deductibles are $2K / $6K, then I'm covered after I hit $2K, she's covered after she hits $2K, but also she's covered if I hit $6K. I think, but am not 100% certain, that the OOP maximums function similarly.

So for us the family deductible is just an additional nice-to-have feature. But if it's the same price and has drawbacks, as your case, the opposite conclusion is reasonable.

 

[Z3Dreamer]

Candrew and pb4uski are the winners. Even though I cancelled on 4/30, BCBS website shows the policy still in force. If I had not communicated with the doctor's office and allowed them to cancel my appointment, I could have waltzed in, given them a bogus/invalid card and received treatment. This would have been 4 hours from now. Of course, when BCBS denied the claim, I could have denied any accountability, taken no responsibility and given them the new card, whenever that arrives. I guess I just didn't want to take the chance of driving an hour, only to have them deny service. I will let you know when I receive the new card.

 

[Z3Dreamer]

Update. I have been chatting every day with BCBS to see if I have a new policy. Takes anywhere between 10 to 40 minutes, depending on the competence of the BCBS person. In the mail, yesterday, I received a new card for DW. I chatted today and the BCBS person said, yes, that is what the marketplace instructed us to do. Cancel you (under age 65) and set up a new policy for DW (now on Medicare). They realized this was impossible but the solution was that BCBS could not have made an error. Marketplace must have messed up. You must get them to fix it.

While I was chatting with BCBS on my computer, I called Marketplace. They verified what was done 2 weeks ago. And it sounded correct to me. But BCBS towed the company line. Marketplace is escalating.

Meanwhile, BCBS asked me to call their customer support and maybe do a conference call to Marketplace to get this straightened out. Well, I got passed to billing. She saw the error, put me on hold, came back and said her supervisor has escalated and will get back to me in 24 hours. Maybe even with a temporary card. This is after 2 hours of chatting and talking on the phone. And a few times over the last few days, I asked the BCBS person to escalate.

Again, I started this thread to: 1) rant 2) If you are married, are on a marketplace plan and one of you ever turns 65, you will be me.

 

[Z3Dreamer]

I started this thread in early May to let you know the problems that can occur when one family member goes on Medicare and the other stays on ACA.

At the time of the switch (May 1st), the rep also switched the primary person on the policy. Apparently, this destroys the data file (even though it looks OK on the Healthcare.gov website). According to a supervisor in the ACA Marketplace Advanced Resolution Center (ARC), this type of glitch is unrecoverable and there is no solution. According to her, "This is the worst type of call I can make. This is a known problem and you will not have coverage. We cannot fix it." I know. I ruined her day by being such a problem.

After at least 30 lengthy phone calls from various people assuring that this would not be fixed or it would be fixed, and several H.I.C.S escalation cases, I wrote a letter to the VP of Customer Services at BCBS in my state. She assigned a few people to stay on it until fixed. Eventually they got me a new policy. Once I had the new policy, I could download a card. One showed up in the mail a few days later. Finally, 2 weeks later the data showing I had met my deductible showed up. Now, I have to refile or get the provider to refile claims. One provider said they will not refile. "I only file once." Even though they are contractually obligated to refile they won't.

Dates are as follows: May 1st - DW goes on Medicare. My policy is terminated. July 1st - I get a new policy that is retroactive to May 1st. July 13th - Data shows up that I have met my deductible. Only thing left is to get paid for those claims I had to pay out of pocket. No alcohol (or recreational drugs) was consumed during this period!

 

[pb4uski]

Long story, but we ended up with individual ACA policies with BCBS and I wonder if that might be a better way to go as when DW went on Medicare earlier this year it was relatively seamless other than the screwed up the autopay for premium, but that was easily rectified with a single phone call.

 

[NateW]

......Again, I started this thread to: 1) rant 2) If you are married, are on a marketplace plan and one of you ever turns 65, you will be me.

Z3Dreamer I hope you get this sorted out, but so true. DW and I are in the same situation and are having issues with the ACA: https://www.early-retirement.org/fo...23-days-before-beginning-medicare-104739.html

 

[golfnut]

My wife and I have been on aca for quite some time now here in Illinois. Our 2020 premium was $250 monthly. Today, I had to call them them to report that eff. 8/1/2020, I was switching to medicare but my wife is to remain on aca. After a long call, the aca rep confirmed the new monthly premium was $361. Does not make much sense. Premium for 2 people is cheaper than for 1 person??



The above premium amounts are after premium credits have been applied.


Has anyone else experienced this as well?