How would you handle losing group coverage in this case?

[Northeast Agent]

I have a referral who I'll be speaking with tomorrow:

Client who is enrolled in a GHP is voluntarily leaving their job at the end of the month, therefore will not be eligible for subsidized COBRA.

The spouse who also is on the group plan is under 65, on SSDI and enrolled in Part A. A lot of health issues here.

I was told they want an ACA plan for three months, as COBRA will be too expensive until the new job's GHP kicks in. But you can't get a subsidized ACA plan once enrolled in Medicare Part A or B.

My thought is to recommend paying COBRA for the three months, due to this and the deductible won't carry over to an ACA plan.

I'll also ask the client to possibly do a review for the spouse to see if it makes more sense to enroll in Part B instead of the new group plan.

 

[Yagents]

I would recommend cobra also, and wouldn't put my name on an aca policy. Have them call the marketplace themselves if they want aca.

Or, get themselves fired and be rewarded with free cobra.

Or, leverage 30 day grace period in month 3 of cobra.

 

[BibH]

I learned that from a Veteran of aca . I call aca and do a 3 way call and let them give all the answers on a recorded line . Then when finished i bring it up on health Sherpa and pick the plan .

 

[Northeast Agent]

Yagents said:

I would recommend cobra also, and wouldn't put my name on an aca policy.

You don't write ACA plans at all? Or just in situations like this.

Or, leverage 30 day grace period in month 3 of cobra.

The COBRA, I'm sure will be used by the disabled spouse (currently has issues), so the grace peiod isn't an option.

 

[Yagents]

I learned that from a Veteran of aca . I call aca and do a 3 way call and let them give all the answers on a recorded line . Then when finished i bring it up on health Sherpa and pick the plan .

You think that protects you? They don't record the lines at MP, your NPN is still on the policy using sherpa, and u r taking on all the risk for a low short term commission. Especially when cobra is best option. Risk and reward not worth the inevitable trouble when her doctors don't take the hmo, or rx pre auth or coverage.

You need a new veteran aca agent to get advice from.

 

[BibH]

I’m not talking about this situation . For instance i got calls from several foreigners who had been in the us 1-2 yrs with sketchy income . Let them tell that to the aca rep . He fills out the app.

 

[Helpico_Insure]

I have a referral who I'll be speaking with tomorrow:

Client who is enrolled in a GHP is voluntarily leaving their job at the end of the month, therefore will not be eligible for subsidized COBRA.

The spouse who also is on the group plan is under 65, on SSDI and enrolled in Part A. A lot of health issues here.

I was told they want an ACA plan for three months, as COBRA will be too expensive until the new job's GHP kicks in. But you can't get a subsidized ACA plan once enrolled in Medicare Part A or B.

My thought is to recommend paying COBRA for the three months, due to this and the deductible won't carry over to an ACA plan.

I'll also ask the client to possibly do a review for the spouse to see if it makes more sense to enroll in Part B instead of the new group plan.

The wife should go her way. She should go Medicare if available or a program for such cases in this particular state. The husband can be quoted on ACA and see if Cobra is higher then ACA. He can select what is better for him. They have different needs and I think it is better to shop based on this factor. If both are quoted on ACA and information is placed correctly, the ACA system will do the selection itself.

 

[Northeast Agent]

Helpico_Insure said:

The wife should go her way. She should go Medicare if available or a program for such cases in this particular state.

I considered Medicare as well, but I'm concerned about time constraints. She'll need to apply for Part B, which can take awhile. And also about prior authorization, etc as it's my understanding she's currently having health issues and was just recently hospitalized.

 

[BrokerBri]

Not enough information here. How's her health? How much are they paying fro COBRA? Are the doctors in network with an ACA plan? Do the right thing and ask questions and know your client. If the spouse is receiving SSDI and qualifies for Medicare, and has many health issues, why on Earth is the spouse considering enrolling in COBRA (which is probably awfully expensive) and not enrolled in Part B with a Medicare supplement plan, for what $180/mo for Plan D? For less than $400/mo the spouse can get all of their medical needs paid for mostly 100%. Figure $148/mo for Part B, $180/mo for Medigap plan and another $30-$40/mo for a Part D plan.

 

[BrokerBri]

Also ask how much has the client spent on deductibles so far? Are they healthy and what are their claims to date? Why restart a plan with a deductible that must be met? Again, ask the questions.