Insurance Got Terminated - PLEASE HELP!

Jul 25, 2016

  1. ACAScrewedMe
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    ACAScrewedMe New Member

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    I purchased a UMPC (Pennsylvania) plan on the Marketplace, and my coverage was just terminated for non-payment. I got the termination letter on 7/20 that says my coverage was canceled effective 5/31. After doing some research, I found that my May payment was short (I accidentally only paid about 40% of the bill), but I didn't know about it until the next bill came out. I never received a warning letter or phone call, although my provider says they did both.

    I have electronic billing set up, and I never got a notice in my plan message box nor in my email. I paid my bill in full (including outstanding charges for May) in June, then I paid my bill for July. I also saw several doctors due to an unfortunately timed problem with my leg. I did all of this under the assumption that I had healthcare. Which makes sense, because UPMC kept accepting my payments.

    I already filed an escalation with the Marketplace, and UPMC denied my request for reinstatement. They said that I fell outside the "CMS guidelines" for payment grace period. Even worse, they're going to cancel the payments for all of the healthcare I received in June, so I'll need to pay for that now. I called the Marketplace for assistance, and they told me that I don't qualify for a Special Enrollment, but I can appeal the decision or apply for healthcare in January.

    I'm already technically without healthcare for the past 2 months, so I'm guessing I'll get a tax fine for that? If I appeal, they said it could take up to 3 months, so that's probably 3 more months of fines. With my income, that's over $1500 worth of fines.

    I'm completely at a loss, and my leg is still injured. I thought ACA was supposed to make getting healthcare easier! I'm not sure whether I should appeal or get a lawyer or sign up for a cheap health plan & pray that the tumor in my leg isn't cancer. PLEASE HELP!!!!
     
  2. yankee466
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    yankee466 Guru

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    My understanding is that if you purchased through Healthcare.gov, you have a 90 day grace period for payment. If you went straight through the carrier, aka no subsidy, you can be term'd after 30 days. The poor people have all the advantages in this system. :skeptical:

    I've had some clients re-instated with appeals, and others were told to pound sand. You get quicker appeal response if you are in need of medical attention.

    Short term plans are much cheaper if you can live with the pre-ex clause + penalty.
     
  3. Yagents
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    Yagents Guru

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    If you don't get tax credits from the Marketplace, you only get a 30 day grace.

    If your appeal is approved, I'm sure it will be retroactive.

    You, my friend, KNOW EXACTLY WHAT YOU ARE TALKING ABOUT. No way you could have made this up. This is the most succinct recap of ACA nightmares all wrapped up into one. But, you won't hear about it at the DNC this week.

    Just know, you are not alone, and you're heading in the right direction in getting it cleared up. It's the only way to get past claims, and remaining part of the year claims...........paid.

    Vote accordingly.
     
    Yagents, Jul 25, 2016
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  4. ACAScrewedMe
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    ACAScrewedMe New Member

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    Marketplace plans with a subsidy have a 90 day grace period. Marketplace plans without a subsidy have a 30 day grace period. I learned this the hard way.

    My income is high enough that I'll get hit with the maximum penalty ($2,085) for not having coverage for the rest of the year. So, it's clearly not a problem with me being able to afford the coverage - it's just that I literally didn't know that I was short on the payment for one month.

    I'll try the appeals process, because I'm told that there are no non-Marketplace ACA-compliant health plans anymore. However, they probably won't classify my condition as "in need of medical attention", since I was still in the diagnosis stage. I literally don't know what to do right now.
     
  5. kgmom219
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    kgmom219 What's Next?

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    Do the ACA appeal. And file a complaint with DOI. Neither may work, but its worth the 30 minutes to try.
     
    kgmom219, Jul 26, 2016
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  6. FLM2
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    FLM2 Guru

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    Call the Marketplace, tell them your income has changed (pick a new, somewhat lower number for the year) and see if they will give open a Special Enrollment Period for you. The next effective date would be September 1st and that would eliminate the potential penalty.

    And put yourself on automatic debit, not electronic billing, in the future, these mistakes won't happen with EFT
     
    FLM2, Jul 26, 2016
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  7. kgmom219
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    kgmom219 What's Next?

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    I think the original post said the term date was 5/31. If so, he hits the 2 months, 29 days and the penalty will apply.
     
    kgmom219, Jul 26, 2016
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  8. FLM2
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    FLM2 Guru

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    FLM2, Jul 26, 2016
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  9. ACAScrewedMe
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    ACAScrewedMe New Member

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    I'll do both, but since the escalation didn't work, I doubt this will. I already did some research & found out that there are no non-Marketplace "minimum essential coverage" plans available in my state. I'm literally out of options, and this is causing me some severe anxiety. Which I can't see anyone about, because I don't have health insurance.

    The CMS guidelines for Qualifying Life Events are much stricter in 2016, and they now require verification. In order to qualify for health insurance via an SEP, I'd essentially have to quit my job or move to a different state.
     
  10. FLM2
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    FLM2 Guru

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    I have hundreds of clients on Marketplace plans, you don't have to explain things to me-the verification has a 90 day window so you would have coverage during that time, good luck.
     
    FLM2, Jul 26, 2016
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