Catastrophic Plan Exemption

[drnoitall33]

I have a client, family of 5, who makes about 80K a year. Definitely a bit of a subsidy, but they have a child who is about 8 months old who racked up about $1.5mm in health costs last year.

They are getting off of their group plan, and want to enroll in the cheapest plan possible (catastrophic plan) because they'll hit their MOOP extremely quickly regardless of the plan, and would rather pay the least amount each month.

I was using the direct enrollment pathway from my agency, but I think this one may have to either be done on the standard app or a call in.

Have you guys done a catastrophic exemption? What is the process like? I know I can call in to hc.gov and ask, but I'm assuming you folks would know better than the person who answers the phone. Thanks!

 

[TxOnline]

CAT Plans are MORE expensive than Bronze ACA plans in my areas.
Run a quote for them to check the prices before you attempt the cumbersome exemption route.
- Healthcare.gov
- "See Plans & Prices"
- Catastrophic Plans (left column.....sorting function)

Exemption process:
https://www.healthcare.gov/fees-exemptions/apply-for-exemption/

..

 

[FLM2]

I have a client, family of 5, who makes about 80K a year. Definitely a bit of a subsidy, but they have a child who is about 8 months old who racked up about $1.5mm in health costs last year.

They are getting off of their group plan, and want to enroll in the cheapest plan possible (catastrophic plan) because they'll hit their MOOP extremely quickly regardless of the plan, and would rather pay the least amount each month.

I was using the direct enrollment pathway from my agency, but I think this one may have to either be done on the standard app or a call in.

Have you guys done a catastrophic exemption? What is the process like? I know I can call in to hc.gov and ask, but I'm assuming you folks would know better than the person who answers the phone. Thanks!

Catastrophic plans are much less expensive in some parts of the country but there are only specific exemptions that can be used-go to healthcare.gov, download the Hardship Exemption form, and figure something out for them if it makes sense.

 

[drnoitall33]

CAT Plans are MORE expensive than Bronze ACA plans in my areas.
Run a quote for them to check the prices before you attempt the cumbersome exemption route.
- Healthcare.gov
- "See Plans & Prices"
- Catastrophic Plans (left column.....sorting function)

Exemption process:


..

Interesting. We've done that and here in VA it's over $100 cheaper.

Catastrophic plans are much less expensive in some parts of the country but there are only specific exemptions that can be used-go to healthcare.gov, download the Hardship Exemption form, and figure something out for them if it makes sense.

On that form, it's #9 that is their exemption from the healthcare.gov exemption listing (I can't post a link because I haven't posted 20 times yet!) but it says:

"You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member". I'd assume the child with a collapsed lung and huge million$+ surgeries qualifies them? Did I miss something on the application that asks that sort of question, as his eligibility notice didn't qualify them for an exemption.

 

[Yagents]

First, no tax credits on CAT plan.

Second, wants "cheapest" means HMO and I wouldn't write it unless that kid is on a PPO.

Third, CAT plan exemption I believe requires gov't pre-approval, and carrier paper app in all probability.

Fourth, write the kid a platinum OFF exchange, and write the family with APTC on a bronze HSA. Kid premiums for rich policies are well worth extra small cost in premium.

 

[drnoitall33]

First, no tax credits on CAT plan.

Second, wants "cheapest" means HMO and I wouldn't write it unless that kid is on a PPO.

Third, CAT plan exemption I believe requires gov't pre-approval, and carrier paper app in all probability.

Fourth, write the kid a platinum OFF exchange, and write the family with APTC on a bronze HSA. Kid premiums for rich policies are well worth extra small cost in premium.

Two questions... 1) Why would you recommend a platinum plan when they are going to hit their max out of pocket in about 2 weeks? Also, if the kid is off the exchange, can the rest of the family still get their subsidy??

Sorry to sound so dumb, I am a relatively new health agent, very good at the 99% of situations out there, just this one is throwing me for a loop.

Good to know about the CAT plan exemption. I did not know that it requires pre-approval, paper apps, etc.

 

[Yagents]

Two questions... 1) Why would you recommend a platinum plan when they are going to hit their max out of pocket in about 2 weeks? Also, if the kid is off the exchange, can the rest of the family still get their subsidy??

Sorry to sound so dumb, I am a relatively new health agent, very good at the 99% of situations out there, just this one is throwing me for a loop.

Good to know about the CAT plan exemption. I did not know that it requires pre-approval, paper apps, etc.

Run the premium differences. Would you pay an extra $100/mo to save $4000 in out of pocket? Younger people and kids the premium difference is so small, doesn't work as well with older people.

Yes, rest of family will get a subsidy, but it will be lower amount since premium is lower.

CAT plan exemption process is not worth the time.

 

[kgmom219]

Two questions... 1) Why would you recommend a platinum plan when they are going to hit their max out of pocket in about 2 weeks? Also, if the kid is off the exchange, can the rest of the family still get their subsidy??

Sorry to sound so dumb, I am a relatively new health agent, very good at the 99% of situations out there, just this one is throwing me for a loop.

Good to know about the CAT plan exemption. I did not know that it requires pre-approval, paper apps, etc.

Its actually area specific. Multiply the premium by 12, add the OOP. Compare platinum vs highest deductible PPO HSA. Then decide.

Y's =platinum
Dallas =Bronze

 

[dgoldenz]

x2 on everything Yagents said. For a child the platinum plan will be the best option - probably Assurant PPO Platinum or UHC PPO Platinum if this is in Virginia. Assurant OOP max is $2k, UHC is $1500. Catastrophic plan OOP max is $6600.

 

[kgmom219]

x2 on everything Yagents said. For a child the platinum plan will be the best option - probably Assurant PPO Platinum or UHC PPO Platinum if this is in Virginia. Assurant OOP max is $2k, UHC is $1500. Catastrophic plan OOP max is $6600.

Its not just the OOP. Its also the annual premium cost. You have to combine the two to get the actual annual cost.