Please Help With Under 65 Health Client!

[AOKING]

Here is the situation......Customer is non-smoker (Male) born on 1/26/1958(resident of IN-zip code 46992). He has not had insurance for several years. He just visited the Doctor, and he has been told he needs to see a vascular surgeon for a potential blockage in his groin.

I tried to run some quotes through healthcare.gov and came up with nothing immediate.

My guess is that the only way for him to have coverage for whatever the vascular surgeon diagnoses would be to purchase an Obama care plan.

If this is the case.......are there any subsidies still available? Would he be able to enter a CHM plan and be covered without a pre-existing clause for this issue?

Also, if a broker has good solution.....and wants to write him, that would be fine too.

Thanks,
AO

 

[TN_agent]

Barring some other special election eligibility (is he Native American?),unless he is a business owner who can establish a group plan with a 12/1/2017 start date, no one (including CHM) is going to cover his recommended groin surgery before 1/1/2018. He is eligible to enroll in a QHP for 1/1/2018 because it is open enrollment. He should have gotten health insurance during open enrollment last year.

 

[AOKING]

Barring some other special election eligibility (is he Native American?),unless he is a business owner who can establish a group plan with a 12/1/2017 start date, no one (including CHM) is going to cover his recommended groin surgery before 1/1/2018. He is eligible to enroll in a QHP for 1/1/2018 because it is open enrollment. He should have gotten health insurance during open enrollment last year.

I did scold him about not getting the insurance before. He is sorry.
So.....some CHM plans qualify as QHP's? And if they do, they must have open enrollment and no pre-existing clause?

Also, is anyone else having issues getting Obama care quotes through health.gov? All I get is pointed in the direction to call the company......

 

[TN_agent]

I take it you are not a licensed health agent? No, CHM is not a QHP. CHM is not insurance and sets their own rules. Generally, though, they won't cover pre-existing for a period of time if they take you at all. QHP are Obamacare, ACA-compliant, etc, whatever you want to call the individual plans that file their rates and plan designs with CMS and follow their rules for enrollment periods and not asking health questions, etc.

I see plans from ambetter, caresource available in Miami county portion of that zip code for a 1/1/2018 start date. I see plans from caresource for the WAbash portion of that zip code. He is SOL for a 2017 start date.

 

[AOKING]

Thanks TN_agent
Yes, I am a licensed life and health agent. I do not currently practice and when I did......I specialized in 65+. Are you licensed in IN? Could you write him? Also, you mentioned the group option (that is within our capability potentially.....he is the owner's father) what strategies are decent for a 25 person group nowadays.

Thanks,
AO

 

[TN_agent]

I don't sell in IN. There are a lot of options for a 25 person group (no underwriting in TN on that size group, I assume same in IN but again I don't sell there). The pay is good in group, you should get into touch with a local group broker, a good chance he will split the commission with you for bringing in the lead if you are licensed.

 

[timamr]

I did scold him about not getting the insurance before. He is sorry.
So.....some CHM plans qualify as QHP's? And if they do, they must have open enrollment and no pre-existing clause?

Also, is anyone else having issues getting Obama care quotes through health.gov? All I get is pointed in the direction to call the company......

On the healthcare.gov site u can simply click on "Get Answers" tab at the top and a few lines down it says something like "see 2018 plans and prices" Click on that and he/you can put in his zip, age, etc and it will tell you what they offer. However, it will be an effective date of 1/1/18, unless he has a qualifying life event to still get coverage in 2017. I am no expert but that will let you look at 2018 plans and prices without filling out application.

 

[J.R.]

I just checked and it looks like the subsidies ran out about 10 mins ago. HC isn't working and I'm currently looking at a disclaimer saying that more money is currently being printed, but expect there to be a 24-48 period before monies can be allocated.

He should look into moving to Canada and becoming a citizen. A broker I've known for 50 years told me everybody up there gets free health care. Perhaps he could qualify for dual-citizenship.