ACA for independent child question.

[Mulligan]

Checking to see if anyone is versed on this. Daughter who was on her mothers husband insurance plan has decided to not finish school and head out on her own. Insurance is not really that good as we have had to cover some big deductibles, but was company provided. Mom (my Ex) has said company said she has to be dropped from plan at end of the month since she is not enrolled in school anymore. Now I thought she could stay on plan until 26, but she maybe getting confused with "free employer child insurance" and having to pay now.
Anyways I checked ehealth and due to her very low income, she appears to be eligible for a silver plan, no deductible, and $1400 max OP, for $5.72. Yes, $5.72 a month. My question is; is she immediately eligible for this since she has left college? Must wait until open enrollment?, Or must stay on current plan and pay the money?


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[MichaelB]

Checking to see if anyone is versed on this. Daughter who was on her mothers husband insurance plan has decided to not finish school and head out on her own. Insurance is not really that good as we have had to cover some big deductibles, but was company provided. Mom (my Ex) has said company said she has to be dropped from plan at end of the month since she is not enrolled in school anymore. Now I thought she could stay on plan until 26, but she maybe getting confused with "free employer child insurance" and having to pay now.
Anyways I checked ehealth and due to her very low income, she appears to be eligible for a silver plan, no deductible, and $1400 max OP, for $5.72. Yes, $5.72 a month. My question is; is she immediately eligible for this since she has left college? Must wait until open enrollment?, Or must stay on current plan and pay the money?

Mulligan, loss of coverage is a covered event that makes her eligible for the special enrollment period. She should contact the state exchange folks ASAP to get the application process underway for new coverage.

 

[pb4uski]

She is immediately eligible since she has had a change in circumstances (loss of health insurance coverage on Mom's employer plan).

I thought that she could stay on the plan until she was 26 too.

The Affordable Care Act requires group health plans and health insurance issuers that provide dependent coverage of children to continue to make such coverage available for an adult child until age 26.

Young Adult Coverage | HHS.gov/healthcare
http://www.irs.gov/pub/irs-drop/n-10-38.pdf

 

[rbmrtn]

No actual experience with it but per the FAQ you should be covered, IF the plan offers child coverage

https://www.healthcare.gov/young-adults/children-under-26/

 

[Mulligan]

Mulligan, loss of coverage is a covered event that makes her eligible for the special enrollment period. She should contact the state exchange folks ASAP to get the application process underway for new coverage.

So Michael you think loss of coverage is applicable for her even if option to stay on other plan "at rack rate" instead of free? I have always just split the deductible costs with mom, but haven't been involved in the insuring process. My daughter doesn't seem to have grasped importance of this and just made an off hand comment while I was moving her to her apartment. Mom just kind of dumped it in her lap and said she needed to get health insurance.


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[Mulligan]

Thanks for the links guys. Yep, I hit pay dirt immediately on them. She will be eligible. ACA snagged me but I avoided it by getting mine through ehealthinsurance since I receive no subsidy. Yes, I am glad she can get it, but gee, that is criminally low rates and way better plan that what I can get at about 3% of the cost!


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[MichaelB]

So Michael you think loss of coverage is applicable for her even if option to stay on other plan "at rack rate" instead of free? I have always just split the deductible costs with mom, but haven't been involved in the insuring process. My daughter doesn't seem to have grasped importance of this and just made an off hand comment while I was moving her to her apartment. Mom just kind of dumped it in her lap and said she needed to get health insurance.

Well, this could get a bit sticky.

It's possible the employer was not charging family plan rates while the daughter was in college, and now that she's no longer attending the premium for her mother goes from individual to family. In that case she doesn't technically lose coverage, her mother would lose the paid benefit. That might affect her exchange eligibility and eligibility for premium assistance.

If she is not a tax dependent on either if you and is now living on her own, I think she meets the criteria for special enrollment and premium assistance.

 

[MichaelB]

Thanks for the links guys. Yep, I hit pay dirt immediately on them. She will be eligible. ACA snagged me but I avoided it by getting mine through ehealthinsurance since I receive no subsidy. Yes, I am glad she can get it, but gee, that is criminally low rates and way better plan that what I can get at about 3% of the cost!

So, if this works out, does that mean you can no longer say that you have been hosed by the ACA?

 

[Mulligan]

Well, this could get a bit sticky.

It's possible the employer was not charging family plan rates while the daughter was in college, and now that she's no longer attending the premium for her mother goes from individual to family. In that case she doesn't technically lose coverage, her mother would lose the paid benefit. That might affect her exchange eligibility and eligibility for premium assistance.

If she is not a tax dependent on either if you and is now living on her own, I think she meets the criteria for special enrollment and premium assistance.

Aw, its never simple! I will have to check with Mother. I know she was free with a high deductible, but evidently no more since she dropped out of college. Who the hell drops out of college only 20 hours short of a degree? Oh well, not the issue despite us both being out of money for 4 years and no one got anything from it, but drained bank accounts. I have always let Ex take the tax deduction since she wasn't an evil Ex gouging me needlessly on child support. Daughter is 22 now, so I will have to find out if she was on her returns last year, though maybe that will not matter as this year daughter is on her own. ...As of this summer anyways!


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[Mulligan]

So, if this works out, does that mean you can no longer say that you have been hosed by the ACA?

To be honest it infuriates me more, that she can quit school, get a menial job, and be rewarded with basically free healthcare! But oh well, if its there, I guess I will help her attempt to access it!


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[MichaelB]

Aw, its never simple!

Just to be clear, that was my thought of a worst-case scenario, not the likely outcome. Your daughter "moving out" of her mother's home and setting up on her own is also a criteria that makes her eligible for special enrollment, and it doesn't matter if she was a tax dependent last year - it only matters this year. I think she's safe, but she does need to the process rolling.

To be honest it infuriates me more, that she can quit school, get a menial job, and be rewarded with basically free healthcare! But oh well, if its there, I guess I will help her attempt to access it!

Fair enough.

 

[pb4uski]

To be honest it infuriates me more, that she can quit school, get a menial job, and be rewarded with basically free healthcare! But oh well, if its there, I guess I will help her attempt to access it! ...

I guess I would reframe it as for reasons that are good, bad or indifferent that she is in a situation where she can't afford health insurance (at the unsubsidized rates) and that she can obtain health insurance that she can afford.

And be thankful, because if she couldn't get affordable health insurance it is likely that you would buy insurance for her for your own protection.

 

[Mulligan]

I guess I would reframe it as for reasons that are good, bad or indifferent that she is in a situation where she can't afford health insurance (at the unsubsidized rates) and that she can obtain health insurance that she can afford.

And be thankful, because if she couldn't get affordable health insurance it is likely that you would buy insurance for her for your own protection.

Yes, I have largely refrained from my opinions, and have choose to assist, though she knows this is not what we want from her. Besides Mom has already scorched the earth with her. We both are wanting the self imposed poverty to be a miserable experience and smoke her out of the poverty brush pile and finish that degree (she is in fine academic standing). Getting a bunch of freebees and heck probably even food stamps if she applies, is not going to assist motivation to be on a financially sound footing.


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