ACA Exchange Application Issues

[FUEGO]

We just applied for ACA coverage for us. We won't have employer provided coverage after 2/29/2016, and so I thought we are eligible to apply for health insurance through the exchange since we are within 60 days of being uninsured.

I applied and it says DW and I aren't eligible for subsidies but our 3 kids are (). I was expecting it to say DW and I are eligible but that the kids aren't because they are eligible for the State Childrens Health Insurance program. The eligibility report from ACA stated they needed additional info for the 3 kids (but not us).

I called, and got approximately zero help from their call center rep. She was clueless about the issues on my account and didn't offer any suggestion. I suggested that maybe I should revise the application once DW is no longer working (in early February) and see if that changes anything. The call center rep went along with this plan of action, thinking it was a good idea.

My intent was to get the process started ASAP to avoid last minute issues. Now it looks like I'll have to wait until 2/6/2015 when DW is no longer employed and then revise the application. That will give us 23 days to provide additional info and ensure payment is received at the insurance company.

Any sage advice? What's the normal process for applying for ACA coverage when retiring early? I thought you could get an exchange policy once you were within 60 days of losing your health insurance.

 

[MichaelB]

Just a reminder, if you are eligible for premium assistance, even if the exchange doesn't recognize it you will still get the tax credit when you file 2016 taxes in 2017.

 

[FUEGO]

Just a reminder, if you are eligible for premium assistance, even if the exchange doesn't recognize it you will still get the tax credit when you file 2016 taxes in 2017.

Thanks for the reminder.

I'll double check to see which plan options it gave me. If I get the gold plated silver plan with $0 deductible I might go ahead and sign up and pay the $500-600 or whatever premium for the two of us, then work out the advanced premium tax credit down the road.

Edit:

I checked and I have access to the exact same gold plated silver plan, but the gilt is gone. Same plan ID number (54332NC0030006) but with $10000 deductible instead of $0 and $13k max OOP instead of $1k. I think the income estimates they are using are what's throwing off the % of FPL and pushing us out of the cost sharing subsidy levels below 200% of FPL. They must be using DW's current income that will end in 1 month (which I put in the application), but projecting the income all year.

I think I'll wait and see whether we gain access to advance premium tax credits and the cost sharing subsidy plan after DW's last day. Might be cleaner overall instead of buying 1 plan now and then trying to get it correctly switch to the cost sharing variety later with APTC.

 

[sengsational]

I waited until my employer coverage ended, then applied. I answered I did not have COBRA since I did not agree to it. The COBRA option was open to me, but I had 60 days to say "yes". End of job to ACA start was 45 days. If I needed significant health services in those 45 days, I would have said "yes" to COBRA. So it's a strange kind of gap.

As to keeping the kids and yourself out of the programs that serve the vey poor, make sure you put in on the order of 250% poverty level for your family size.

 

[FUEGO]

I waited until my employer coverage ended, then applied. I answered I did not have COBRA since I did not agree to it. The COBRA option was open to me, but I had 60 days to say "yes". End of job to ACA start was 45 days. If I needed significant health services in those 45 days, I would have said "yes" to COBRA. So it's a strange kind of gap.

As to keeping the kids and yourself out of the programs that serve the vey poor, make sure you put in on the order of 250% poverty level for your family size.

Okay, thanks. I think I read your post here saying you were doing exactly that, and I think that's our back up plan if March 1 rolls around, we have no coverage and something catastrophic happens. Pay the $1500 or whatever COBRA will be for 1 month and then work out the ACA/Health Choice coverage in the meantime.

We are okay with the kids being on NC Health Choice. Our doctor and dentist are in network and they have access to nearby hospitals. We'll see how it goes for 10 months of course, then re-evaluate if it doesn't work out. Other than yearly physicals and immunizations, we haven't needed medical care for the kids more than 1x per year on average.

I think the AGI test is 212% to avoid Health Choice for kids. We'll be closer to 149.99% AGI (in rough terms ). To get to 212% of FPL would cost us the cost sharing subsidies on the silver plan ($0 deductible; $1000 max OOP) and replace them with $10000 deductible, $13k max OOP.

 

[MichaelB]

sengsational has a good point with Cobra, it gives you a window of coverage without losing your option for an ACA policy on 3/1. You can't pay just one month of Cobra, however, as ACA rules are if you select Cobra you have to wait for the next open enrollment to then apply for ACA. Cobra rules give you 60 days to choose and pay, and coverage is retroactive, so you have to keep it as a sort of option of last resort while you apply on the exchange.

The 2016 tax credit will cover premium assistance but not cost sharing. You need to get that upfront. It looks like the exchange may just be deeming you not eligible because you still have employment income and they aren't trained to look that far forward. I'd go back on Feb 1 to get the ball rolling again, you need to pay by Feb 15 to have coverage Mar 1.

 

[FUEGO]

sengsational has a good point with Cobra, it gives you a window of coverage without losing your option for an ACA policy on 3/1. You can't pay just one month of Cobra, however, as ACA rules are if you select Cobra you have to wait for the next open enrollment to then apply for ACA. Cobra rules give you 60 days to choose and pay, and coverage is retroactive, so you have to keep it as a sort of option of last resort while you apply on the exchange.

Ouch. So 10 months locked into COBRA would be $15000 premiums plus $10-12k OOP max on our COBRA policy. Much more than our ACA policy would be for premium+Max OOP (even without cost sharing subsidy).

The 2016 tax credit will cover premium assistance but not cost sharing. You need to get that upfront. It looks like the exchange may just be deeming you not eligible because you still have employment income and they aren't trained to look that far forward. I'd go back on Feb 1 to get the ball rolling again, you need to pay by Feb 15 to have coverage Mar 1.

I can't think of anything else it would be other than they view us as having $90k income or whatever because they forecast DW's full income (instead of the $7k she'll actually earn) into 2016.

I input that she would only have $7k income in 2016 (plus another $35k for us from my 1099 income and some dividends/CGs), but maybe they don't use the estimate and instead they use the current earned income.

 

[sengsational]

Given that your family typically has such low utilization of health services, I'm surprised that the silver policy is a better bet. What I did is add up the premiums of a silver and pretended that the three or four expected doctor visits would be free, not counting preventive visits, since they are always free. Then I priced-out paying 100% of the three or four doctor visits using the negotiated rates, added that to the premium of a bronze plan. This bronze deal was much cheaper. Yes, if something bad/expensive happened, silver would likely be better due to the cost sharing, but the two policies become identical again when the cost goes above the max out of pocket (which is the same on both policies).

I was pretty confident in my logic, but I wonder if I'm missing something. I just didn't find a way to make cost sharing worth much to a healthy family, so it got buried in the premium difference. And of course the tax credit is identical.

 

[sengsational]

Re-reading, I see the silver max out of pocket is very low for you..1000. That might be a good deal for you then, if you're going to be certain to exceed that by quite a bit, even with a healthy family.

 

[FUEGO]

Re-reading, I see the silver max out of pocket is very low for you..1000. That might be a good deal for you then, if you're going to be certain to exceed that by quite a bit, even with a healthy family.

We're essentially over-consuming insurance due to the cost sharing subsidy. It appears the premium is $683 whether it has no CSRs or has the $1000 max OOP. So we're getting what would probably be a $1000 premium for $130/month. The cheapest bronze plans are near $0 but are basically high deductible plans (high copays, huge deductible).

I'm betting we'll need some kind of significant medical care once every 10-15 years or so. If I'm right, the silver plan will be a better deal. But I hope I'm wrong of course!

 

[spncity]

Had a somewhat similar situation, retro COBRA was the backup plan while applying for insurance.

I greatly benefitted from using a broker.

YMMV.

 

[MBSC]

I suggested that maybe I should revise the application once DW is no longer working (in early February) and see if that changes anything.

Now it looks like I'll have to wait until 2/6/2016 when DW is no longer employed and then revise the application.

The income estimate used is the one you provide. If the system has an issue with your estimate, you will be given 90 days to provide documentation supporting the new income level.

It sounds like you may have completed the ACA enrollment application using today's information. That is, you currently have access to job based coverage. Since the application is for 3/1/16 coverage, it should have been completed using 3/1/16 information. That is, you do not have access to job based coverage.

You do not qualify for subsidies at 149% FPL if you implied you currently (3/1/16) have access to job based coverage. You can delete the current application and complete a new one using 3/1/16 information. Or, as you stated, wait until 2/6/16 when it will be easier to provide 3/1/16 information.

I'd go back on Feb 1 to get the ball rolling again, you need to pay by Feb 15 to have coverage Mar 1.

You're thinking of annual enrollment. Special Enrollment Periods have their own special rules.

During the yearly Open Enrollment Period, you can enroll in or change a health plan any time. Enroll by the 15th of the month and coverage starts the first day of the next month.

If you have certain life changes, you can qualify for a Special Enrollment Period. If you do, your coverage could start sooner. Pick a plan by the last day of the month and your coverage can start the first day of the next month.

Reference: https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

 

[photoguy]

I waited until my employer coverage ended, then applied. I answered I did not have COBRA since I did not agree to it. The COBRA option was open to me, but I had 60 days to say "yes". End of job to ACA start was 45 days. If I needed significant health services in those 45 days, I would have said "yes" to COBRA. So it's a strange kind of gap.

I remember being in a similar situation when we applied for ACA coverage in 2014 -- i.e. we could ride for a month or two without any coverage due to being able to claim COBRA after the fact. ACA coverage was ~$600/month for two of us so it was not insignificant.

In the end we started right when employer coverage ended and didn't use our COBRA wait-and-see option.

sengsational has a good point with Cobra, it gives you a window of coverage without losing your option for an ACA policy on 3/1. You can't pay just one month of Cobra, however, as ACA rules are if you select Cobra you have to wait for the next open enrollment to then apply for ACA. Cobra rules give you 60 days to choose and pay, and coverage is retroactive, so you have to keep it as a sort of option of last resort while you apply on the exchange.

I suppose if one were close enough to open enrollment (or the difference between ACA and COBRA costs small), it might be worth the gamble.

 

[sengsational]

I'm betting we'll need some kind of significant medical care once every 10-15 years or so. If I'm right, the silver plan will be a better deal. But I hope I'm wrong of course!

I did a similar calculation. 95% chance of being the same as last year (very low usage) and a 5% chance of hitting the max out of pocket. That came out in favor of the low premium.

When I did the calculation, I ignored the tax credit and used the real premium price since the PTC calculation always returns the same amount, irrespective of your choice (well, as long as your policy is more than the PTC, which for me has always been the case).

 

[FUEGO]

I did a similar calculation. 95% chance of being the same as last year (very low usage) and a 5% chance of hitting the max out of pocket. That came out in favor of the low premium.

When I did the calculation, I ignored the tax credit and used the real premium price since the PTC calculation always returns the same amount, irrespective of your choice (well, as long as your policy is more than the PTC, which for me has always been the case).

We'll be getting the highest cost sharing subsidy, so even a relatively minor health incident could cost us more out of pocket on a bronze vs. silver. And the first year we'll probably consume a bunch of health care for a few lingering things that might be good to check out but aren't urgent.

If we ever end up with a high enough AGI to push us out of the generous cost sharing subsidies, then I bet the cheaper bronze plans will be a better deal.

 

[Nunthewiser]

Keep in mind you don't have to do this as a family. Wife is a consumer and I (generally) am not, so I get a bronze plan ($0) and she gets a silver with cost sharing. I actually don't use all my allocated tax credit and subsidize her plan.

 

[utrecht]

When they ask for your income in relation to getting a subsidy, does it include dividends, capital gains ect? If so, how do you know in advance what they will be?

 

[Fermion]

When they ask for your income in relation to getting a subsidy, does it include dividends, capital gains ect? If so, how do you know in advance what they will be?

You don't know but you just tell them you do know and they seem happy.

 

[FUEGO]

You don't know but you just tell them you do know and they seem happy.

That's what I did. Based it on 2015 dividends (which I can document).

 

[sengsational]

When they ask for your income in relation to getting a subsidy, does it include dividends, capital gains ect? If so, how do you know in advance what they will be?

Generally, it will be whatever you think will be your MAGI on your distant future 1040, plus 1040s of your kids that are dependant as defined on the 1040. Divide by 12 to answer the monthly questions.