DW Unknowingly Canceled Her ACA Coverage 23 Days Before Beginning Medicare

[NateW]

Heads up for anyone with ACA subsidized medical insurance transitioning to Medicare, Do Not cancel your ACA coverage before Medicare coverage begins. This seems like a no brainier, but somehow DW did just the opposite, thinking she set up a seamless transition to Medicare. ACA cancellation is instantaneous, and coverage Does Not end on the last day of the month.

DW turns 65 in August and in early July was taking care of getting everything in place for Medicare coverage. She believes she read on Healthcare.gov that in order for her healthcare coverage to end on the last day of the month, prior to starting Medicare on the 1st of the following month, she had to "cancel" her ACA coverage before the 15th day of the last month she needs coverage, otherwise, she would have ACA insurance through the first month she is also on Medicare. So on July 8 she updated our ACA application and cancelled her medical insurance. Yesterday, she received a "We hate to see you go" letter from our health insurance provider, noting she no longer has medical coverage.

I immediately called the ACA staff and they verified DW cancelled her insurance, effective as of the date of cancellation. I explained the situation, but got absolutely nowhere, other than "your wife can file an appeal". I was told under no conditions can she be reinstated for the 10 days until Medicare coverage starts. She has some health issues, so we do not want her to be without coverage for 10 days, especially with the pandemic raging.

I think at this point the best solution is to contact the insurance company and see if they can provide 10 days of coverage for DW at their full rate.

Have any of you experienced anything similar to this, and if so, how did you handle it?

Thanks.

 

[njhowie]

Self-quarantine, keep her in the house on a tight leash until the end of the month.

The extremely high likelihood is that she'll be fine for the 10 days.

On a different note - even though she "cancelled" before end of the month, did you not pay the monthly premium in advance? If you've paid, then you are covered. Did they send you a refund for the portion of the month not used? Unlikely.

Lastly, it is extremely doubtful you will find an insurance company that will provide 10 days of coverage beginning immediately, not on the first of the following month. Travel insurance is the only thing which comes to mind, but if you are staying at home, it won't work.

 

[pb4uski]

....If you've paid, then you are covered. Did they send you a refund for the portion of the month not used? Unlikely. ...

I would have thought so as well but had a recent experience to the contrary.

DS was on ACA on autopay and then got employer coverage... then we cancelled his ACA coverage on healthcare.gov mid-month. We did it on a weekend and his partial month premium refund hit his account a couple days later.

I remember because I was suprised that it happend so quickly and I thought we would probably need to chase the insurer for any refund of premium.

 

[njhowie]

I would have thought so as well but had a recent experience to the contrary.

DS was on ACA on autopay and then got employer coverage... then we cancelled his ACA coverage on healthcare.gov mid-month. We did it on a weekend and his partial month premium refund hit his account a couple days later.

I remember because I was suprised that it happend so quickly and I thought we would probably need to chase the insurer for any refund of premium.

Thanks - interesting.

So on OP's situation, my original thought - keep her locked up for 10 days.

A couple years ago, due to a billing glitch, I found myself without coverage as of Feb 1 that year. No way to reinstate coverage. I went without for the rest of the year, and then had to pay the federal penalty for not being covered for 11 months of the year. I tried not to think about it, though it did enter my mind periodically.

 

[MichaelB]

There may be short term coverage available. It doesn’t meet ACA guidelines or deal with chronic illnesses, but these aren’t needed right now. It may provide coverage for accidents, which have a higher priority. UHC is a major provider of short term plans.

 

[anethum]

Heads up for anyone with ACA subsidized medical insurance transitioning to Medicare, Do Not cancel your ACA coverage before Medicare coverage begins. This seems like a no brainier, but somehow DW did just the opposite, thinking she set up a seamless transition to Medicare. ACA cancellation is instantaneous, and coverage Does Not end on the last day of the month.
<snip>
Have any of you experienced anything similar to this, and if so, how did you handle it?

I had the opposite experience. When people starting Medicare should cancel their ACA insurance depends on the rules in their state. In Washington, DC, if you wait until you have already started Medicare, the ACA insurer (Blue Cross) will bill you for each day in the overlapping period. For example, if you cancel on the 3rd of the month, they will bill you for 3 days of health insurance. In Maryland, if you cancel on any day in the overlapping month, even the 1st of the month, Blue Cross will bill you for the entire month. And in each case, if you were getting a subsidy, you have to pay the full non-subsidized price whether it's for a prorated period or for the entire month. The other major insurer in the region is Kaiser, and I have no idea if ACA cancellation would be any different with them.

 

[Texas Proud]

There may be short term coverage available. It doesn’t meet ACA guidelines or deal with chronic illnesses, but these aren’t needed right now. It may provide coverage for accidents, which have a higher priority. UHC is a major provider of short term plans.

This is what I was thinking... get catastrophic insurance and then stay at home...

 

[njhowie]

This is what I was thinking... get catastrophic insurance and then stay at home...

A potential issue is that for these short-term catastrophic plans (in the states where they are offered), they generally do not cover pre-existing conditions. If they do, there is generally a waiting period of maybe 90 days before they kick in.

OP has indicated that DW has pre-existing conditions.

 

[Sue J]

I came close to having this happen. I turned 65 in Feb so I knew Medicare would start Feb 1. In January I went to our healthcare.gov acct and went through the steps that I thought I needed to do, I think it was report a life change. I got to a certain point where it gave me a message or wouldn't continue. I tried it again and finally decided it was worth a phone call.

When I called and explained what I was trying to do and why, they told me that I DID NOT want to end my enrollment before the actual end date because it would stop my coverage immediately. What I needed to do was call on Feb 1 and tell them I was starting Medicare and to end my coverage.

So I made a note in my calendar and called on Feb 1. The customer rep had to go through every step of the healthcare.gov application, just as I had tried to do and then end my coverage due to starting Medicare. Talking to them they made it sound like it had to be done that way because DH was the primary name on the application and I was the spouse. That sort of made sense.

I told them that DH was also starting Medicare in a few months on April 1st. They told me to have him call in on April first and end his enrollment. That's what he did.

 

[NateW]

Thank you all for replying. Good point about staying home (we have been doing that anyway). Tomorrow I'll call our insurer and explore options.

Great point about whether or not we paid July's premium: our insurance provider has charged our (cash back) credit card for July's premium and not issued a credit. I'll remind them of that when I call tomorrow.

I will say that my experience with the ACA and specifically the healthcare.gov website has not been good. This is our first year of dealing with the ACA. For the last 35 years or so we were covered by Megacorp group plans. We both have 4-year college degrees and think we are of at least average intelligence, but find the ACA application process, and specifically updating our application, quite a challenge. Each time an update has to be made, the application must be completely redone. I recently updated my anticipated 2020 taxable income because I received income I was not expecting. I almost selected "No" for the question "Have you lost your health coverage" because I still have ACA coverage, but I believe the question is related to employer provided coverage, so if I answered "no", I would be deemed as not qualifying for ACA coverage. That is an example of how unclear the US government has made the process of applying for and updating one's application.

 

[Sue J]

I will say that my experience with the ACA and specifically the healthcare.gov website has not been good. This is our first year of dealing with the ACA.

The current version has evolved from problems with all the previous versions. We started with ACA in 2014. Do you remember how awful it was, just to get an account started? Many applications just didn't work, people had to keep making logons that never went anywhere. I think we used 3 different names and emails just trying to get started.

Now, reading your post and thinking about our transition to Medicare, I think HealthCare.gov sent me a letter telling me that it was time for Medicare and that I should go into my account and update it. And do it before the 15th! Their left hand still doesn't know what the right hand is doing!

I hope your wife's experience with Medicare goes as well as ours has. It's been a few months now and both of us have had claims and everything has proceeded smoothly through Medicare and our supplement. Once we decided how we wanted to do Medicare (original Medicare and supplement instead of Medicare Advantage) we could toss all the ads coming in the mail and ignore all the stuff on tv.

 

[NateW]

Thank you for your input Sue J. You would think that after 6 years the government would get better at designing their websites and applications. They do ask on the ACA site for improvement suggestions and I bet they have received many good ones.

When I first completed my ACA application during open enrollment last fall, since I was covered under COBRA at the time, I answered "Yes" to the "Are you covered by an employer qualified/provided plan" (or similar wording). I was denied an ACA plan because my "Yes" answer indicated an employer provided (paid for) my coverage. I completed another application and answered "No" to the same question, after I figured out what was being asked. No problem getting the credit after that.

 

[kimcdougc]

What I find interesting is one year you have a plan on the ACA for the doctors you want to use and the next year the plan is no longer available. So you have to start the process all over again. What a pain in the butt. The plans change every year. The prices go up every year so far. I appreciate all the knowledge here for when DH has to apply for medicare in 2 years.

 

[Texas Proud]

A potential issue is that for these short-term catastrophic plans (in the states where they are offered), they generally do not cover pre-existing conditions. If they do, there is generally a waiting period of maybe 90 days before they kick in.

OP has indicated that DW has pre-existing conditions.

Agree, but it would cover a major accident if it happened. Or something that was not preexisting.