After Open Enrollment:

Discussion in 'Health Care Reform Forum' started by mmike160, Mar 3, 2014.

  1. mmike160
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    mmike160 Guru

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    Anyone have any thoughts of how individual business may be after 3/31/14?

    I wonder what percentage of people looking after 3/31 will qualify for a SEP?
     
  2. STIBROKER
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    STIBROKER Super Moderator Moderator

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    work the American Indian market...........
     
  3. AllenChicago
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    Has anyone here written an American Indian or Alaskan Native and been paid for their policy?
     
  4. pahealthquotes
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    that's the 64 million dollar question. we also need a clear understanding
    of what CMS constitutes as a qualifying event.
     
  5. RayNY
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    From healthcare.gov Glossary:
    "Qualifying Event: A change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. Examples of qualifying life events are moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby)."

    So, you move, your income changes in a mysterious "certain" way, or changes in family size. No-fault loss of coverage is also implied (employer stops offering, current insurer goes bankrupt, etc.)

    They explicitly said that termination due to non-pay is not a SEP generating event.

    Unhappiness, network inadequacy, displeasure with customer service, buyers remorse, and clerical ineptitude do not generate SEP's either.
     
  6. pahealthquotes
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    ok, so I make 50 k a year and I'm self employed. Just lost a major acct and
    my income drops to 20 K. I currently have no insurance and today is 7/1/2014. Are you saying that is a qualifying event?


    Joe
     
  7. unic.consulting
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    unic.consulting Guru

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    It depends on what they end up defining as "certain". Do they mean annual income change great enough to gain/lose subsidy? More than 5% change? Or do they mean certain as in "I am certain my income changed from what I claimed two months ago"?
     
  8. Ann H
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    I think the key phrase in Pahealthquote's question is "currently have no insurance". There's no loss of coverage here. If the person was currently insured and had a drop in income which would make full-year 2014 MAGI income less than 400% of FPL (or less than 250% for CSR), then clearly an SEP would be triggered. But what if the person was uninsured at the time? I give TaterPeeler credit for bringing this glitch to my attention.
     
  9. RayNY
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    Ann,

    I have the same understanding of what that "certain" income change event is (income drops to a subsidy or CSR eligible level=SEP), so long as you were covered.

    As for those uncovered, my gut says income changes won't generate an SEP, but only time will tell us where they draw the line. Family changes should, I can't see them denying family coverage because there is a new baby or something similar.
     
  10. Evan
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    How exactly is the insurance carrier supposed to know if someone was previously insured? How would they know coverage is being dropped?

    This reminds me of PCIP all over again
     
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