Changes from 2015 to 2016... Rules, Premiums, Plans, Exchanges, Etc.
- Thread starter AllenChicago
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- #202
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Somarco, I think they honestly believe that insureds are choosing a different plan for 2016 because they're excited and thankful to have ObamaCare. The people running this administration are just that dumb and out of touch with reality.
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- #204
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January 5, 2016
This https://www.regtap.info/reg_librarye.php?i=1297 clarification/update from HHS is ridiculous, if I'm interpreting it correctly.
HHS seems to be saying that if a person is Newly Eligible for Minimum Essential Coverage (MEC), they need to call the Marketplace and cancel their On-Exchange QHP.
I have a client who just found out today that she's pregnant. In many states, including Illinois, when a lady is pregnant, she's instantly eligible for Medicaid or CHIP.
Does HHS really expect her to call the Marketplace and cancel her QHP, because she's eligible for Medicaid Minimum Essential Coverage now?
ac
This https://www.regtap.info/reg_librarye.php?i=1297 clarification/update from HHS is ridiculous, if I'm interpreting it correctly.
HHS seems to be saying that if a person is Newly Eligible for Minimum Essential Coverage (MEC), they need to call the Marketplace and cancel their On-Exchange QHP.
I have a client who just found out today that she's pregnant. In many states, including Illinois, when a lady is pregnant, she's instantly eligible for Medicaid or CHIP.
Does HHS really expect her to call the Marketplace and cancel her QHP, because she's eligible for Medicaid Minimum Essential Coverage now?
ac
Apparently...enjoy the Medicaid! What a system.
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- #206
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Thanks DGoldenz for confirming that my interpretation of this HHS rule is accurate. Well, she's certainly not going to voluntarily trade in her $500 max OOP Silver, for Medicaid/CHIP.
I don't expect the government to learn on their own that a Marketplace enrollee has become pregnant and is therefore eligible for Medicaid/CHIP. But I do expect these financially strapped health insurers to report the pregnancy to the Marketplace once the first maternity-related claim is filed.
What happens after that could range from "nothing", to an automatic Marketplace plan cancellation and transference to Medicaid/CHIP.
- 1,305
Allen, I had a very direct and personal situation that involved this exact case.
She must correct this ASAP otherwise her check-ups, scripts and so on will be denied.
The reason will be provider will submit claim to the carrier, carrier will deny the claim due to "other" coverage. This is an INSANE loop that won't get fixed until she's about to pop.
Even if she starts the correction process now.
She has no choice in the matter. It doesn't matter if she want's to keep her QHP MP Plan and doesn't want Medicaid. Please make sure she understands this.
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THANK-YOU TKRUGER! The client is going over to the Medicaid office today and taking her new Blue Cross packet with her. Hopefully they're not aware of this new 2016 rule clarification yet. Then, at least she can say that Medicaid was informed of her pregnancy, if BCBSIL balks at claim time. I told Christine to document what Medicaid tells her today. Thanks again.
-Allen
- 1,305
Allen, that's the messed up part about this situation.
She will get Medicaid and could still have Blue. Due to MP Bull$hit handling of plan cancellations she will end up having major issues.
This matter happened during the 15 plan year.
She must call the MP and term the Blue plan...even then the data is already out there that she has a MP plan and if Blue doesn't update their systems in a timely manner then it will create issues.
Case in point....Subject took responsibility for her own health insurance and bought plan X on the MP in 2015. She was pregnant and reported such during the application process and yet was still able to buy plan X.
In FL (Which didn't expand) I believe that she was under the 133% FPL which is what qualified her for Medicaid.
She ended up fighting for care the entire 8.5 months before things were corrected.
I wish your client\contact luck.
She will get Medicaid and could still have Blue. Due to MP Bull$hit handling of plan cancellations she will end up having major issues.
This matter happened during the 15 plan year.
She must call the MP and term the Blue plan...even then the data is already out there that she has a MP plan and if Blue doesn't update their systems in a timely manner then it will create issues.
Case in point....Subject took responsibility for her own health insurance and bought plan X on the MP in 2015. She was pregnant and reported such during the application process and yet was still able to buy plan X.
In FL (Which didn't expand) I believe that she was under the 133% FPL which is what qualified her for Medicaid.
She ended up fighting for care the entire 8.5 months before things were corrected.
I wish your client\contact luck.
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- #210
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TKruger, my client went to the Medicaid office today with her new 1.1.2016 BCBSIL ID Card, explained that she found out on 1.4.2016 that she is pregnant, and asked what she should do. (fyi..She's the spouse on a Husb/Wife plan)
Medicaid's response was, "We're not allowed to advise you what to do Mrs. Smith. You have to consult with HealthCare.gov. They will be able to tell you if you can keep Blue Cross, or if you need to come back and apply for Medicaid."
Christine was pressed for time today, so she'll call Healthcare.gov for guidance tomorrow.
ac
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