Individual ACA Plan Vs. Medicare MAPD

[csyjnapapa]

I met with a person who has a silver ACA plan with Anthem BCBS for himself his wife and two children. The interesting part his wife is on disability and has Medicare. She is using some expensive medications. Question: Would he be able to drop his plan and let her have a SEP for a MAPD plan and get a short term plan (6 months) to cover himself and his two children or he stuck with the plan he has until open enrollment. It is an individual plan not a company plan.

 

[Tkruger]

First question is how is she on both an ACA plan via HC.gov and Medicaid? Based on some prior experience billing should be really jacked up. What I mean is that the provider is submitting it to the carrier and they are denying it because the client has Medicaid....likewise if submitted to medicaid they would deny due to ACA Coverage.

Are you 100% positive that she is covered on the ACA Plan?

 

[somarco]

Put your reading glasses on, Ted. She has Medicare, not Medicaid.

 

[Tkruger]

Then replace Medicaid with Medicare....question is still the same.

 

[FLM2]

I met with a person who has a silver ACA plan with Anthem BCBS for himself his wife and two children. The interesting part his wife is on disability and has Medicare. She is using some expensive medications. Question: Would he be able to drop his plan and let her have a SEP for a MAPD plan and get a short term plan (6 months) to cover himself and his two children or he stuck with the plan he has until open enrollment. It is an individual plan not a company plan.

I don't understand why the wife would be on an ACA plan when she has Medicare (any subsidy they get will have to be repaid if that is the case).

If the wife has just become Medicare eligible then she can enroll, I don't see any valid SEP in your description.