Loss of Subsidy = Loss of Insurance.

[YouGotMyMoney]

In order for ACA biz to be profitable, you really do need premiums north of $600+ mo .

I'm talking about agents whose focus is health , and not outlives so get referral only biz...etc etc .

Next OEP, I'd like to add 3-5k solid clients - not these degenerate non-pay, dont have income verification because they've been unemployed for the last 18 months crap.

Need to focus on Cigna, BCBS (Some Markets) , Humana, UHC's market's off-exchange next year.

Otherwise by the time you add : COA (Leads/Marketing) + Pay support staff for service and sales - people who don't pay, marketplace / carrier fluck ups , it get mighty expensive.

$150.00 in internet leads per client for COA
$60-75 in sales and support comp per client

Your already at $210-225 per client sign up.....

 

[MaryDallas]

I worked with a client several hours yesterday on the income verification. I could not get into his file that he and I had set up together. When we called in he had 3 files that had information I certainly never entered. Marketplace even had both of them disabled and requiring assistance in daily living activities. It was a mess.

The client had sent in his 2014 documentation on his disability income and they were asking for 2015 income verification. His 2014 income was too low so they dropped his subsidy. He did not send in 2015 with his wife's income as well.

And he has called and called the Marketplace creating a nightmare for himself. It took hours to get straightened out. Unless these clients have someone to hold their hand it just does not work. And we do not have time for hand holding. This is truly a mess.

 

[wehotex]

I'm right there with you, but haven't made a decision for 2016 OEP. Trying to figure out how to do it from a practical perspective. How are you going to handle the referrals? Joe Smith calls in. You find out he's subsidy eligible after 15 minutes. "I'm sorry. I can't help you. You need to go to hc.gov"? Send them a Sherpa link and tell them any issues are their problem? Get the family size and income within the first 5 months and THEN tell them "Sorry, I can't help you" Then the client calls the referral source and the referral source gets mad? I just can't see how it works from a practical perspective unless you have a person to send the Exchange clients to. I cannot figure out how to do "no subsidy" business. I can see eliminating individual business, but not subsidy vs non subsidy.

Am I missing something?!! There hasn't been a SCOTUS RULING yet, has there?

 

[Tkruger]

Nope...Thurs, Fri or Mon.

Helpful links:

http://www.supremecourt.gov/default.aspx

Monday round-up : SCOTUSblog

 

[kgmom219]

Am I missing something?!! There hasn't been a SCOTUS RULING yet, has there?

No, but I don't know how you got to that question with my post, either?

 

[G.Gordon]

In order for ACA biz to be profitable, you really do need premiums north of $600+ mo .

I'm talking about agents whose focus is health , and not outlives so get referral only biz...etc etc .

Next OEP, I'd like to add 3-5k solid clients - not these degenerate non-pay, dont have income verification because they've been unemployed for the last 18 months crap.

Need to focus on Cigna, BCBS (Some Markets) , Humana, UHC's market's off-exchange next year.

Otherwise by the time you add : COA (Leads/Marketing) + Pay support staff for service and sales - people who don't pay, marketplace / carrier fluck ups , it get mighty expensive.

$150.00 in internet leads per client for COA
$60-75 in sales and support comp per client

Your already at $210-225 per client sign up.....

My COA per client is no where near that. I do zero marketing other than one post card mailing during AEP, a constant newspaper ad in the local rags, and the rest come from referrals. I'd say that north of 95% of my new clients were referred. I do no internet leads, no direct mail, no cold calling, all inbound request for insurance.

This AEP we are doing a EDD (every door direct) post card that covers Medicare and ACA, we will drop it six to eight times during the AEP, when we get to December 1 we will drop the Medicare part off and continue with ACA.

 

[healther]

Nope, remember the 90 day grace window. My suggestion to them would be to take the amount for July and split it into 3 separate payments. Make the monthly payment and then 1/3rd of the July payment each month until it's caught up.

Also, remind them that they will get the money back at the end of the year when they file their taxes due to the over payment in July.

Something else to note....this could become moot between Thursday and Monday. Thus the fix for August won't matter and they will loose coverage anyway.

If the client loses 100% of their subsidy the 90 day window is automatically converted to a 30 day window effective the date of the lost subsidy.

I've had clients take the exact approach you suggested, per my suggestion, and then have their catch up payments refunded to them and their policy cancelled... per the 30 day rule which is applicable.

Most of the clients I have had with this issue recently seem to be clients that have not filed taxes for 2014 or an extension. Not certain this is the issue, but it seemed to be a common thread in 3 out of the 5 cases I worked on Monday. I did not ask the question to the other 2. I will be asking people for the next couple weeks that very question to see what the issue is. Many of the people simply receive Social Security and seem to have forgotten the tax filing requirement that I absolutely hammered home during our appointments.

 

[Tkruger]

Is that carrier specific? Who was the carrier you had this happen with?

 

[healther]

Is that carrier specific? Who was the carrier you had this happen with?

No, it's marketplace guidance. The last particular case was a Blue.

 

[FLM2]

In order for ACA biz to be profitable, you really do need premiums north of $600+ mo .

I'm talking about agents whose focus is health , and not outlives so get referral only biz...etc etc .

Next OEP, I'd like to add 3-5k solid clients - not these degenerate non-pay, dont have income verification because they've been unemployed for the last 18 months crap.

Need to focus on Cigna, BCBS (Some Markets) , Humana, UHC's market's off-exchange next year.

Otherwise by the time you add : COA (Leads/Marketing) + Pay support staff for service and sales - people who don't pay, marketplace / carrier fluck ups , it get mighty expensive.

$150.00 in internet leads per client for COA
$60-75 in sales and support comp per client

Your already at $210-225 per client sign up.....

I know you are good at what you do but that is a very tough business model to sustain with all of the crap that goes on during the year...