If Cobra 'affordable' Can't Get Subsidy?

[HealthGuy]

During Open Enrollment HC.gov telephone supervisors have been claiming that if a person has Cobra available to them currently or into 2015 and its 'affordable' under the 9.5% rule, that they aren't eligible for a subsidized plan through the Federal Health Exchange even if they are subsidy eligible and regardless of Open Enrollment. I know HC.gov says you can drop Cobra during open enrollment but evidently if its affordable you get no subsidized health plan. What say all of you?

 

[SeniorGurl]

Yes, thank you! Was helping client sign up for coverage for himself and wife since he was planning on retiring at the end of the year. He had no info on COBRA cont. coverage yet, since he had not informed his employer he was leaving. He has set all of his investment income to cover just the basics so he qualifies for a huge subsidy and is holding off on SS. Mid way through the app, we get to the section on do you currently have emp/cobra coverage avail, and if we answer yes, it opens up a huge question section on the employer and what they offer and cost and if it meets the MEC standards etc. We call HC.gov and the worker tells us to answer NO to that quesiton and treat it as it's 2015 and as if he does not have any coverage available. We complete the app and he gets his huge subsidy and enrolls in a plan. Next day I call back after I got another call from someone looking for coverage through the exchange cuz he doesn't like his employers coverage. This time, the woman at HC.gov tells me the answer should have been YES. That he is NOT eligible unless he pays the entire amount. I ask for a supervisor and he confirms that if you are eligible for Empl/COBRA coverage, and it is not deemed "unaffordable" you can only enroll in a plan if you pay the entire amount, NO SUBSIDY. Wonder what is going to happen (if anything) when these people who are signing up and getting subsidies find out!?!

 

[unic.consulting]

Yes, thank you! Was helping client sign up for coverage for himself and wife since he was planning on retiring at the end of the year. He had no info on COBRA cont. coverage yet, since he had not informed his employer he was leaving. He has set all of his investment income to cover just the basics so he qualifies for a huge subsidy and is holding off on SS. Mid way through the app, we get to the section on do you currently have emp/cobra coverage avail, and if we answer yes, it opens up a huge question section on the employer and what they offer and cost and if it meets the MEC standards etc. We call HC.gov and the worker tells us to answer NO to that quesiton and treat it as it's 2015 and as if he does not have any coverage available. We complete the app and he gets his huge subsidy and enrolls in a plan. Next day I call back after I got another call from someone looking for coverage through the exchange cuz he doesn't like his employers coverage. This time, the woman at HC.gov tells me the answer should have been YES. That he is NOT eligible unless he pays the entire amount. I ask for a supervisor and he confirms that if you are eligible for Empl/COBRA coverage, and it is not deemed "unaffordable" you can only enroll in a plan if you pay the entire amount, NO SUBSIDY. Wonder what is going to happen (if anything) when these people who are signing up and getting subsidies find out!?!

Seniorgurl,

Those sound like two separate situations to me. Not liking the coverage from work doesn't mean it's not being offered. No subsidy for him.

However in the first case, it was correct because he won't have work coverage next year. The fact that they had the COBRA drop SEP earlier this year shows me that a COBRA plan being offered does not mean they have to take it. If they choose not to take it, they should be eligible for a subsidy and it should be put into the system based on the effective date of the plan (ie. he won't have coverage on January 1st). If they're already ON COBRA at this point and it's affordable, they might be stuck until it runs out, but they get an SEP at that point.

 

[SeniorGurl]

So, you are saying that the first question would be yes, the second question would be no, but COBRA counts. Technically he would have empl/COBRA coverage available. I need to see the chain of questions again.. it's hard to remember while you are in there helping someone. But at a certain point, Probably quesiton 2 (if you answer YES) you have to start listing info from employer regarding coverage.

In my gut I think the answer is (he) is and will be eligible due to his case being unaffordable, and we will have to modify his original application to reflect true answers, including employer info on premiums, etc. Fact is...he IS eligible for COBRA in Jan if he leaves in Dec. I know agents are writing people and answering NO to these questions due to the lack of clarity on HC.gov and in an effort to get them through the system, but I would hate to see someone get hammered after the fact by someone coming after them for not using the coverage they had available to them.

It's really the same as what you said for situation #1. If they have it and just don't like it...Sorry...No deal. Get a different plan, but you pay all.

Supervisor said, only way to get help with premiums through subsidy is if it is unaffordable. If you are covered, and it meets all standards including affordability, you are SOL.

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The question on the app asks: Will you have emp/COBRA coverage available?
The answer is yes, he will have it available. Doesn't everyone after they leave their job? It doesn't ask if you are going to accept it or take it, it's a question of availability.... isn't it?

 

[unic.consulting]

So, you are saying that the first question would be yes, the second question would be no, but COBRA counts. Technically he would have empl/COBRA coverage available. I need to see the chain of questions again.. it's hard to remember while you are in there helping someone. But at a certain point, Probably quesiton 2 (if you answer YES) you have to start listing info from employer regarding coverage.

In my gut I think the answer is (he) is and will be eligible due to his case being unaffordable, and we will have to modify his original application to reflect true answers, including employer info on premiums, etc. Fact is...he IS eligible for COBRA in Jan if he leaves in Dec. I know agents are writing people and answering NO to these questions due to the lack of clarity on HC.gov and in an effort to get them through the system, but I would hate to see someone get hammered after the fact by someone coming after them for not using the coverage they had available to them.

It's really the same as what you said for situation #1. If they have it and just don't like it...Sorry...No deal. Get a different plan, but you pay all.

Supervisor said, only way to get help with premiums through subsidy is if it is unaffordable. If you are covered, and it meets all standards including affordability, you are SOL.

From healthcare.gov:

During Open Enrollment

During the Open Enrollment period you can drop your COBRA coverage and get a plan through the Marketplace instead. This is true even if your COBRA coverage hasn't run out.

You may qualify for premium tax credits and other savings on a Marketplace plan. This will depend on your income and household size.

When you fill out a Marketplace application, you'll also find out if you qualify for Medicaid or the Children's Health Insurance Program (CHIP)

Learn how to apply.

The Open Enrollment period for 2015 coverage is November 15, 2014 through February 15, 2015.

 

[SeniorGurl]

Yes, I understand and I have read that. However... that does not say you will get a subsidy, it says you might get one. And they told me yesterday it all depends on the 9.5% rule. Sure he can NOT TAKE COBRA, but he will pay.

That's my understanding on this.

I do appreciate all of the input, this is driving me insane!

 

[unic.consulting]

Yes, I understand and I have read that. However... that does not say you will get a subsidy, it says you might get one. And they told me yesterday it all depends on the 9.5% rule. Sure he can NOT TAKE COBRA, but he will pay.

That's my understanding on this.

I do appreciate all of the input, this is driving me insane!

On the page about opting out of employer coverage, it specifically mentions the affordability rules and you may not qualify even if you would qualify on income. There's no mention of that on the COBRA page.

 

[SeniorGurl]

They lump empl/Cobra together on the questions in the app, no difference. Treat as same. It's continuation of empl coverage.... same thing. I get your point, but they don't when you call and ask.

 

[unic.consulting]

They lump empl/Cobra together on the questions in the app, no difference. Treat as same. It's continuation of empl coverage.... same thing. I get your point, but they don't when you call and ask.

I understand the questions on the app are confusing. It's separated on the information pages though, so they have different rules.

 

[HealthGuy]

What SeniorGurl is saying is that if you have affordable Cobra coverage you HAVE TO KEEP it even though its OEP and even if you are subsidy eligible....Of course you can always buy a plan thru the FFM during OEP without a subsidy even if Cobra is 'affordable' under the 9.5% rule, BUT if its AFFORDABLE evidently HC.gov reps are telling us that NO you don't get the subsidy! TRUE? Ann and YAgents what say you?