Changes from 2015 to 2016... Rules, Premiums, Plans, Exchanges, Etc.
- Thread starter AllenChicago
- Start date
- 1,305
Let me know if I can help further.
- Thread starter
- #213
- 8,448
Thanks TKruger, you've helped a lot by preventing me from hiding my head in the sand on this issue. I appreciate your taking time to share your experience and advice. Alerting my client was the right thing for me to do!
If you think about it, every female who's insured by a plan through the Marketplace, is at risk of encountering serious claim-related problems if she becomes pregnant. Especially if she resides in a state like Illinois, where all pregnant women are eligible for Medicaid, regardless of income.
Everytime HHS sends out a REGTAP notice "clarifying" something, it makes ObamaScrew even worse.
- 1,305
Not a problem and anytime.
Are you positive that 1-400% FPL (not a mistake) get's kicked to Medicaid in expansion states? All the state we work in are not expanded.
Just curious...
- Thread starter
- #216
- 8,448
That's correct. Whenever I say "yes" to the "Is anyone pregnant?" question at HC.gov, that person is removed from coverage/subsidy consideration and automatically referred to Medicaid.
But this year, it appears that there is an income-based eligibility threshold for Illinois, since the state is flat broke. And, there appears to be two programs for pregnant women. One is Outpatient and the other is InPatient. Both are in effect simultaneously for the expectant mother.
Ref: Moms & Babies Programs for Pregnant Women
Only government can believe that it's operating more efficiently by splitting a single program into two!
- Thread starter
- #217
- 8,448
Friday, January 8, 2016 (Saga Update)
After the clueless Illinois Medicaid office sent my client home to call the Marketplace for guidance yesterday, she did just that.
The Marketplace rep said that their system was showing incorrect IRS filing status all day, so they couldn't help her, even though all she wanted to know is if she needed to dis-enroll from her family QHPlan, and enroll in Medicaid, because she's now pregnant. She was instructed to "call tomorrow", which was today.
Today, my client called the Marketplace at 10:00am. She was put on hold for 15 minutes while the rep checked the latest rules. She heard a bunch of people yelling in the background all this time...then was suddenly disconnected.
She called again. Got a different person. Was put on hold so a supervisor could be consulted. This person at least put her on mute. Client listened to music for 10 minutes and, CLICK...disconnected.
Client called in to the Marketplace for the THIRD time. This representative was more experienced apparently. She kept my client on the line while she clicked around on the computer and consulted with a higher-up. Five minutes later, she let me client know that even though she found out on 1.3.2016 that she's pregnant, it's OK for her to stay on the BCBS Marketplace (subsidized) family policy that went into effect on 1.1.2016.
My client asked for a reference number for this conversation/dialogue/advice, but was informed that the capability to do this doesn't exist. All she was able to get was the first name, "Mary". Can't be many of those! It was now almost 1.5 hours later and she was worn out.
We'll know in a few weeks if "Mary" gave her correct advice. My client is scheduling her first Prenatal checkup next week.
-ac
So what type of SEP changes are coming down the pike?..............not that it matters at 0%
http://www.modernhealthcare.com/art...ntent=20160112-NEWS-160119970&utm_campaign=am
The CMS is expected to announce as early as this week that it will eliminate some special-enrollment periods and clarify rules for other to prevent enrollment abuse, he said.
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Can anybody see if this WSJ article expands on the release?
Health Law Enrollment Periods to Be Tightened - WSJ
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"State regulators are concerned that consumers are not required to provide documentation to substantiate their eligibility for a special enrollment period," the association said in a letter to the federal Department of Health and Human Services. "We know of many cases where individuals with serious medical conditions purchased coverage midyear by simply checking the right box or using the right language, and their eligibility was not questioned."
http://www.modernhealthcare.com/art...ntent=20160112-NEWS-160119970&utm_campaign=am
The CMS is expected to announce as early as this week that it will eliminate some special-enrollment periods and clarify rules for other to prevent enrollment abuse, he said.
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Can anybody see if this WSJ article expands on the release?
Health Law Enrollment Periods to Be Tightened - WSJ
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"State regulators are concerned that consumers are not required to provide documentation to substantiate their eligibility for a special enrollment period," the association said in a letter to the federal Department of Health and Human Services. "We know of many cases where individuals with serious medical conditions purchased coverage midyear by simply checking the right box or using the right language, and their eligibility was not questioned."
All of this is true, but what documentation? HHS also eliminated COC's.
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