Another Healthcare.gov Wrinkle?

[junkman]

I have a client with an individual plan that termed 11/30/2014. She checked rates and enrolled on Marketplace effective 12/1 using a portion of her subsidy to pay the premium.

She gets a bill for January at a higher rate. The bill arrived after 12/15 so she couldn't choose a less expensive plan for Jan. She hasn't paid her Jan premium and is still in the payment grace period.

My understanding is she can still choose a new Marketplace plan for a 2/1 effective date.

Question: Because the 2/1 plan will be a new contract, can she simply ride her grace period then term the old plan retroactively or let it lapse for non-payment? That would save her the Jan premium.

Conceptually, this is equivalent to electing Cobra and lettine coverage lapse by not paying the premium.

 

[azhealthgal]

The new bill was from the new plan? Any chance it was the old one?

 

[junkman]

The new bill was from the new plan? Any chance it was the old one?

No, apparently gov rates are calendar year. I think but haven't confirmed that anyone with a qualifying event gets the current calendar rate until 1/1.

Blue Cross says they are essentially administering claims and providing networks.

I'll call the Marketplace but they can't be counted on to give good information.

Back to the question: can the insured enroll in a different plan effective 2/1 and not pay the January premium? She will have a new BC ID and BC will pay claims filed under the new ID.

 

[azhealthgal]

My understanding (and correct me if I am wrong) is that if she has not paid her first month's premium, she can dis-enroll in the original plan she chose and enroll in a different one.

As you mentioned, the effective date would be 2-1 rather than 1-1.

 

[junkman]

My understanding (and correct me if I am wrong) is that if she has not paid her first month's premium, she can dis-enroll in the original plan she chose and enroll in a different one.

As you mentioned, the effective date would be 2-1 rather than 1-1.

She paid the December premium which was a result of a qualifying event. My understanding is that she is still in open enrollment and can change plans. Can she also skip the Jan premium?

 

[jstocking]

I have a client with an individual plan that termed 11/30/2014. She checked rates and enrolled on Marketplace effective 12/1 using a portion of her subsidy to pay the premium.

She gets a bill for January at a higher rate. The bill arrived after 12/15 so she couldn't choose a less expensive plan for Jan. She hasn't paid her Jan premium and is still in the payment grace period.

My understanding is she can still choose a new Marketplace plan for a 2/1 effective date.

Question: Because the 2/1 plan will be a new contract, can she simply ride her grace period then term the old plan retroactively or let it lapse for non-payment? That would save her the Jan premium.

Conceptually, this is equivalent to electing Cobra and lettine coverage lapse by not paying the premium.

The short answer is yes, she can do that, but if she uses the insurance she will have her claim suspended/denied until she paid the Jan. premium. From a coverage standpoint she is setting herself up for a paperwork nightmare if anything happens in January. She needs to reapply for 2015 coverage in order to reset the subsidy calculations for the coming year and choose a plan based on her expected needs moving forward. The healthcare.gov call center may be able to assist her with those steps and get her a 01/01 effective date if she moves quickly.

Don't you know that the deadlines only apply to us professionals? They have the magical ability to disregard their own rules at will ;p

 

[Tkruger]

She paid the December premium which was a result of a qualifying event. My understanding is that she is still in open enrollment and can change plans. Can she also skip the Jan premium?

The short answer is No she cannot skip the premium payment. If she attempts the monthly bill will be sent to collections.

2 things are happening here.

1) Because she didn't choose to change the plan by Dec 15th she will be re-enrolled into the current plan she has for the 2K14 plan year beginning Jan 1 2k15. The soonest effective date will be 2-1 2K15. This point isn't taking into consideration that the plan itself may be being discontinued by the carrier. In this case the client would qualify for an SEP and be able to take advantage of the 1-1-15 Start date.

2) Remember the grace period that is now in effect. By not paying the premium the plan doesn't cancel. A consumer can not pay the premium for 90 days and the providers are still required to provide services.

90 day Grace Period

 

[junkman]

She'll pay the premium if she has January claims otherwise cancel. She is still within her premium paying grace period.

The nightmare is dealing with healthcare.gov. It would have been helpful to all of the relevant rates, plan design etc. when doing the original selection and subsidy calculation. Pretty much a cluster headache for no money.