ACA Family Policy - Moving One to Medicare

Mar 2, 2016

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  1. healther
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    Have a family of 2 enrolled in ACA plan. Husband becomes Medicare eligible next month, wife will continue on ACA plan until next year.

    Anyone had any success transitioning one member of a family off of their ACA plan?

    I don't see a clean way to remove a family member and just called our friends at healthcare.gov. They suggested cancelling the plan and opening an SEP up for the non-Medicare spouse enroll herself effective the following month. That appears to be the only way to do it. Thoughts...
     
  2. Chazm
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    Have you called the insurance company that they are on? I would think they could just drop her off of it
     
    Chazm, Mar 2, 2016
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  3. Tkruger
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    If it's an on exchange plan (by the sounds of it I believe it is) removal of one person from the plan would have to come from the marketplace via the updated 834 file.

    Problem you'll have is that once the plan is termed and you re-enroll the other members into a new plan via the SEP you will lose all remaining comp on that plan.

    This is provided the carrier (most have) has reduced or eliminated comp for SEP enrollments.
     
    Tkruger, Mar 2, 2016
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  4. TN_agent
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    I did not think the carrier was allowed to term coverage through the marketplace except for non-pay. Not sure if you can call carrier direct to drop in this case.

    There are a few threads on this issue I believe.

    I have enrolled my people in this situation (most are couples without dependents so no benefit to them being on a family plan anyway) in separate plans on the marketplace to try to make this easier. Fingers crossed I can keep commission on the non-medicare folks!
     
  5. healther
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    Enrolled with Tax Credits via healthcare.gov, must come from the marketplace. Wish it were that easy!

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    That's ok, thankfully I am just here to help. Have enough income, and faith that it will work out in open enrollment, to make that my sole purpose right now. That said, the Medicare enrollment pays.

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    I looked for those threads, I think they exist but didn't see them.

    Like the idea of breaking them up on the front end, that is certainly an easier transition.

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    ***UPDATE***

    The plan told me they can map the client's old plan and deductible to the new plan and deductible so long as the individual enrolls in the same plan and I call in to the plan to have them marry the plans manually...
     
  6. Chazm
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    Glad I spend 1/1000 of my time on ACA plans. Such a mess
     
    Chazm, Mar 2, 2016
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  7. Yagents
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    I do many of these.

    The only and correct way is to:

    1. Do a Life Change, and remove the spouse from list of people "applying for coverage", but keep on in household income.

    2. Do it on the LAST day of the month, ie March 31st. If you do it any other day, the person is removed ON THAT DAY the life change is done.

    3. Other spouse will get SEP for April 1st, new 834 file is sent, carrier should update and keep on same policy number if primary is the same. If not, who knows what the carrier will do with policy number and commissions.

    4. Client will have a lag on new medical cards and billing adjustments
     
    Yagents, Mar 2, 2016
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  8. yorkriver1
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    Hey, Y, do we still need to say the spouse remaining on the plan is losing coverage the same day the T65 spouse is dropped? I didn't do that on one last summer and they skipped her to the following month for coverage start date. What a mess getting that straight. Now on the 1095A, it's still not right. There have been payments and refunds still out there, whew!
    T
    Another case, for some reason there were two app ID's. Not sure how that happened since I removed 1st Medicare spouse from app on day before, as we should, but when the 2nd spouse went on Medicare 3 months later, one of the apps didn't cancel for 11/30/15, the one I didn't know about. There was coverage showing for the last termed client for a couple months afterward on my agent portal. Not sure if that was the pending app for 2016 that the carrier left open, it's a mess, & they denied receiving any cancellation from HC.gov. Escalation, because I don't want them having 1095A's with tax credits showing for months they shouldn't have had them, when I properly handled the removal & 11/30/15 cancellation on my end. Glad I took screen shots.
     
    Last edited: Mar 16, 2016
  9. healther
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    Just followed these instructions, no SEP awarded.
     
    healther, Mar 31, 2016
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  10. Yagents
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    What were the results?
    Don't know what you did exactly.
    If not desired result, select loss of coverage for remaining spouse as of today to generate SEP.
     
    Yagents, Mar 31, 2016
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