Marketplace takes away rebate

[Hopes]

I don't sell individual health plans and am not familiar with how the Marketplace works other than what others tell me.

I have a woman 54, smoker, single, employed, earns about $20k/yr., no real assets other than home left to her by mother, facing cancer diagnosis.

Her ACA Ambetter plan $54/mo, $600 deductible (I think) is going away because there is a "data matching error". May 1 plan will be around $800/mo with $14k deductible. If she shows tax returns, June 1 will go back down to $150ish, $1250ish deductible.

This happened to her last year. Her plan changed four times due to "data matching error" and each time she had to jump through a hoop to prove her personal situation had not changed. She has proof of mailing tax return for 2017 but never received her $8 refund so now she's worried it was never processed.

I'm just trying to come up with a solution for May. Too late for cancer plan, hospital indems and short term health won't help, too much income for Medicaid.

Any ideas I can give this woman would be appreciated.

 

[kgmom219]

Welcome to the marketplace. She's SOL for May.

My only suggestion is that she changes her application so she gets mail, in addition to emails. If something arrives in the mail, she needs to open it, read it and call her agent. Or the FFM.

 

[yankee466]

I don't sell individual health plans and am not familiar with how the Marketplace works other than what others tell me.

I have a woman 54, smoker, single, employed, earns about $20k/yr., no real assets other than home left to her by mother, facing cancer diagnosis.

Her ACA Ambetter plan $54/mo, $600 deductible (I think) is going away because there is a "data matching error". May 1 plan will be around $800/mo with $14k deductible. If she shows tax returns, June 1 will go back down to $150ish, $1250ish deductible.

This happened to her last year. Her plan changed four times due to "data matching error" and each time she had to jump through a hoop to prove her personal situation had not changed. She has proof of mailing tax return for 2017 but never received her $8 refund so now she's worried it was never processed.

I'm just trying to come up with a solution for May. Too late for cancer plan, hospital indems and short term health won't help, too much income for Medicaid.

Any ideas I can give this woman would be appreciated.

Sadly....she has to pay the May premium, and then she will get all the money back when she does her taxes if her income comes out as expected. She can appeal the subsidy for that month by filling in the appeal forms, but I would not hold my breath. She can put the payment on a credit card, and pay it off over time until she gets her tax refund.

 

[Hopes]

Thanks for the replies. I spoke with her earlier today and made a 3-way call to the marketplace. Had to speak with a supervisor to get the details.

It had nothing to do with data-matching or tax return. Verification of income was never received. In January they sent a 90 day notice to the agent but heard nothing back so....

She was set up to receive electronic messages but nothing was in her email or inbox. No excuses though. kgmom, she definitely needs to set up paper mail delivery instead of electronic. yankee466, they did explain the appeal process and she is going to do that.

 

[kgmom219]

Typical. The FFM threw the agent under the bus.

Hopes....agents don't get copies of the letters sent to clients. Its a feature (not a glitch) of the FFM. We see the initial eligibility letter and that's it.

The biggest fault here is that she was set up with email only. The FFM sends so many emails, clients cannot keep up. Gmail puts them into the promotion tab. Its a mess.

 

[Hopes]

Yeh, that is a mess. I'm sure people think it will be easier to keep up with the emails. I really don't get the impression she checks hers that often either.

At least now I know how about the notification process so I can provide that information when it comes up.

She has family that is going to help with her May premium and she is reapplying for June. I'm going to let her know she has to be diligent in checking her email from now on - better yet, just switch to paper.

 

[kgmom219]

Yeh, that is a mess. I'm sure people think it will be easier to keep up with the emails. I really don't get the impression she checks hers that often either.

At least now I know how about the notification process so I can provide that information when it comes up.

She has family that is going to help with her May premium and she is reapplying for June. I'm going to let her know she has to be diligent in checking her email from now on - better yet, just switch to paper.

She will still get the emails. Those never stop. What I tell my clients is:

"I am marking your application for paper notices. You will still get a ton of emails and I am fine with you ignoring every single one of them. However, if they send you something, its important. I need you to read it immediately and call me, because I am not copied on the letters. If you call me a month later, chances are that it will be too late and I won't be able to help".

 

[Hopes]

I'm making a note of this great advice.

I'm thinking some of these people are not briefed on what to expect or how to handle it. This lady is the perfect example with the problems she's had in the past two years.

I've thought about taking the Marketplace certifications to service my existing clients' family members but have had every excuse not to. With the questions that come up from the small book I do have, it would probably be a good move.

 

[kgmom219]

I'm making a note of this great advice.

I'm thinking some of these people are not briefed on what to expect or how to handle it. This lady is the perfect example with the problems she's had in the past two years.

I've thought about taking the Marketplace certifications to service my existing clients' family members but have had every excuse not to. With the questions that come up from the small book I do have, it would probably be a good move.

Are there any plans in GA paying a commission?

 

[Hopes]

No. There's only KP and Ambetter. I think KP will pay a referral fee if I send an app but that may just be on MAPDs.

I guess I just want service my clients so they don't go anywhere else and I know some of the people coming my way are going to be aging in to Medicare in a couple of years so why not help them now.
(edited for grammar)