Loss Coverage 4/15/14 Any Chance to Get a SEP ?

[yogooglethis]

I know it sounds obvious that my friend is out of luck for the 60 day loss of coverage SEP but is she really ? Any loopholes? She was unemployed for almost 4 years and the coverage she lost 4/15/14 was from a subsidized plan funded from a county contract with local hospital for people with no insurance and low income which was actually very good major medical coverage.She said she was not notified by the city contract plan that she only had 60 days to enroll in the ACA plan or she would be SOL.She will qualify for a subsidy even if she worked all year because she would only make 28k if she works all year but she works for a temp agency and only guaranteed she will work 6 months so her total guaranteed annual income is really only 14k. The cost of her diabetic drugs alone retail price about 400.00-500.00 a month so if it comes to it I think she would qualify for a SEP once she gets approved for a medically needy status through Florida Medicaid.

Any possibility of still qualifying for 60 loss of coverage SEP?

What does a person who starting working for a temp agency 1/15/14 at 540.00 per week state as her 2014 income for subsidy eligibility if she is only guaranteed 6 month of employment ?

 

[Yagents]

Someone told me that HC.gov asks for the actual day coverage ended within past 60 days, and then at the end (determination letter), it does not ask/require the person to send in proof of loss of coverage like the insurance companies are doing for off exchange SEP enrollment. Ripe for fraud if you ask me, but I didn't build this monster.

 

[somarco]

I didn't build this

https://www.youtube.com/watch?v=YKjPI6no5ng

 

[yorkriver1]

This morning, I got the word that my new client does not need to mail in proof of coverage loss to the Marketplace. Several interesting points about the app:

A verbal statement of coverage loss date was all it took last night to get the phone rep at HC.gov to override the eligibility letter denying SEP, and causing the green enrollment buttons to appear immediately on my screen. Answers on app around annualized vs. monthly income and/or Medicaid app date seem to have been the denial reason, not the loss of coverage date, which was 4/30/14. Call was made when letter stated subsidy yes, SEP, no.

Agreeing with yagents, no requirement for coverage loss proof, did a revised app on phone, got new eligibility letter. I had double checked with HC.gov this morning along with confirming that client could not get a 7/1/14 effective date. Apparently they are sticking with the 15th of the month rule. Just by chance the person answering at HC.gov today was a "SEP determination specialist".

I am interested in anyone's experience with the enrollment deadline/effective date situation. The specialist checked and told me today that since the date was assigned by HHS, he could not change it. I thought there was a previous thread where agents did get coverage after the 15th cut off for SEP's. No 15th cut off for off exchange, but thought it was also true on HC.gov.

 

[Ann H]

I know you said you weren't intersted in anyone's experience with this, since the hc.gov SEP specialist said there was a 15th cut off date, but I just wrote 7 apps on hc.gov yesterday, all losing coverage 6/30/2014, and all granted an SEP with effective dates of 7/1/2014.

On the two questions about losing coverage (did you recently lose coverage, and will you be losing coverage within the next 60 days), I said "yes" to the last question, since the loss of coverage will be June 30th, and I was doing the apps on June 26th. That is different than your case, where the client lost coverage almost 2 months ago. I don't know if that makes any difference or not, but somehow all 7 of my apps got through yesterday with an SEP and without the 15th of the month cut-off issue.

 

[yorkriver1]

Ann, I wrote that I am interested in feedback, I know you are busy, so thanks for your response.
I wondered when I saw the question about losing coverage in the next 60 days if saying yes would have an effect. It's so puzzling what triggers certain outcomes.
Glad you wrote, because I am enrolling a family of 5 today who is losing coverage on 6/30/14. We have the app done, & eligibility letter, went all the way through the process end of May, and all we have to do is choose coverage, the couple is in business startup mode and was hard to pin down.
This tells me that if something goes wrong with enrolling at the last minute, we can start over.

Now, what can be done about my 8/1/14 person? Anything?
Maybe cancel and start over because the policy won't go into effect until 8/1?

Can't believe that the specialist at HC.gov was unable to deal with this situation and help fix it.
I'm just grateful to have you and others here with real world experience. Thanks!

 

[Ann H]

Ann, I wrote that I am interested in feedback, I know you are busy, so thanks for your response.
I wondered when I saw the question about losing coverage in the next 60 days if saying yes would have an effect. It's so puzzling what triggers certain outcomes.
Glad you wrote, because I am enrolling a family of 5 today who is losing coverage on 6/30/14. We have the app done, & eligibility letter, went all the way through the process end of May, and all we have to do is choose coverage, the couple is in business startup mode and was hard to pin down.
This tells me that if something goes wrong with enrolling at the last minute, we can start over.

Now, what can be done about my 8/1/14 person? Anything?
Maybe cancel and start over because the policy won't go into effect until 8/1?

Can't believe that the specialist at HC.gov was unable to deal with this situation and help fix it.
I'm just grateful to have you and others here with real world experience. Thanks!

Thank-you for your kind words, Yorkriver1. However, I am certainly not the forum expert on questions about using the Exchange, and determining what data input will result in what outcome! The large majority of my sales were OFF exchange this year. Hopefully someone who uses the Exchange a lot will answer your questions.

 

[yorkriver1]

Ann, you help regardless, thanks to you and everyone else who is active here on this forum.
Just to confirm, were the apps you just wrote off exchange?
Those are issued up to last day of the month with all the carriers I use right now, and you, of course, are up on that.
It's on Marketplace where the issues with effective dates have shown up, so just making sure if your reference was to on exchange effective dates. Thanks!

 

[Ann H]

Ann, you help regardless, thanks to you and everyone else who is active here on this forum.
Just to confirm, were the apps you just wrote off exchange?
Those are issued up to last day of the month with all the carriers I use right now, and you, of course, are up on that.
It's on Marketplace where the issues with effective dates have shown up, so just making sure if your reference was to on exchange effective dates. Thanks!

The apps I wrote the other day, (which are the apps that received a 7/1 effective date even though the apps were submitted on 6/26/2014) were all ON the FFM Exchange.

By the way, here in AZ, it is just recent news that carriers will allow OFF exchange business to be written up to the last day of the month for effective dates of the 1st of the month when there is an SEP. Until very recently, we had a 15th of the month cut-off.

 

[yorkriver1]

Thanks, Ann for letting me know.
Now if there were a way to fix this for my client. I will search/read through a previous thread I seem to recall on the topic of "no 15th of month cut off for SEP" on Marketplace.