Pre-existing Come 2014

[ctg]

Will pre-x be covered under Obamacare? In this specific instance, prospect does not have insurance currently. Most likely would be declined for individual because of an anticipated hip surgury. (resurfacing? He is from Minnesota-sounds like a Zamboni reference)

Will this procedure be covered if he waits until 2014?

Part B question: He's getting married in May and may be able to get on his wife's group plan if she takes a new job she's interviewing for this week. I'm not certain of the specifics of the new employers plan. Would this procedure be covered under her group plan?

Part C question: Can my Hawkeyes finish just one basketball game this season?

 

[STIBROKER]

Part B question: He's getting married in May and may be able to get on his wife's group plan if she takes a new job she's interviewing for this week. I'm not certain of the specifics of the new employers plan. Would this procedure be covered under her group plan?

does he have coverage now..............

 

[ctg]

No coverage currently...healthy, non-smoker, no meds. The hip thing came from playing hockey for many years.

 

[Yagents]

Will pre-x be covered under Obamacare? In this specific instance, prospect does not have insurance currently. Most likely would be declined for individual because of an anticipated hip surgury. (resurfacing? He is from Minnesota-sounds like a Zamboni reference)

Will this procedure be covered if he waits until 2014?

Part B question: He's getting married in May and may be able to get on his wife's group plan if she takes a new job she's interviewing for this week. I'm not certain of the specifics of the new employers plan. Would this procedure be covered under her group plan?

Part C question: Can my Hawkeyes finish just one basketball game this season?

Hip will be covered under Obamacare. Schedule the surgery for 8am on Jan 1st and you're all set. Then call the CBO to tell them to update the cost of the Obamacare.

Hip will only be covered on the group if they do not have a waiting period for pre-ex conditions, since he won't have a certificate of creditable coverage given he's not insured now.

Disclaimer: I don't do group, so I may be mistaken on the second part.

 

[AllenChicago]

Will pre-x be covered under Obamacare? In this specific instance, prospect does not have insurance currently. Most likely would be declined for individual because of an anticipated hip surgury. (resurfacing? He is from Minnesota-sounds like a Zamboni reference)

Will this procedure be covered if he waits until 2014?

Part B question: He's getting married in May and may be able to get on his wife's group plan if she takes a new job she's interviewing for this week. I'm not certain of the specifics of the new employers plan. Would this procedure be covered under her group plan?

I recommend that this prospect take the EMPLOYEE GROUP option if all of the following are true:
1. He really does marry the insured.
2. She gets the job she's applying for.
3. The Group's family coverage is effective relatively soon after hire.
4. The Out-of-Pocket is ultra low.

If any of the above are not true, he should:
1. Sign up for a Platinum Deluxe Obamacare policy when open enrollment arrives at his state exchange on October 1, 2013. 2. Once approved for the plan, he should schedule the surgery to happen as soon as possible after January 1, 2014.
3. When his operation and the ongoing therapy is behind him, your client could downgrade to a higher deductible, less expensive policy, if he wishes.

You'll likely receive additional input from other colleagues here on the forum, CTG. Digest it all and best of luck to you with your decision and soon-to-be client.
-Allen

 

[Yagents]

I recommend that this prospect take the EMPLOYEE GROUP option if all of the following are true:
1. He really does marry the insured.
2. She gets the job she's applying for.
3. The Group's family coverage is effective relatively soon after hire.
4. The Out-of-Pocket is ultra low.


3. When his operation and the ongoing therapy is behind him, your client could downgrade to a higher deductible, less expensive policy, if he wishes.


-Allen

Allen, don't some groups have pre-ex waiting period without a CCC?

And, You cannot downgrade / change your exchange plan until open enrollment period at the end of the year

 

[AllenChicago]

Allen, don't some groups have pre-ex waiting period without a CCC?

And, You cannot downgrade / change your exchange plan until open enrollment period at the end of the year

1. What's CCC?
2. But so far as we know, you will be able to purchase a non-exchange guaranteed issue plan at any time??
3. If my next door neighbor is any example, he underwent hip-replacement surgery in 2011 and the guy is STILL going through rehab and having minor complications pop up. If the Super Duper Platinum is worth the premium in this situation, the insured will probably stick with it for quite a long time.
ac

 

[Yagents]

1. What's CCC?
2. But so far as we know, you will be able to purchase a non-exchange guaranteed issue plan at any time??
3. If my next door neighbor is any example, he underwent hip-replacement surgery in 2011 and the guy is STILL going through rehab and having minor complications pop up. If the Super Duper Platinum is worth the premium in this situation, the insured will probably stick with it for quite a long time.
ac

CCC = certificate of creditable coverage. You get one when you come off of a real major medical policy

OEP = Open Enrollment Period which will be ON and OFF the exchange. You will NOT be able to buy a policy anytime you want, they won't let you game the system, it's call adverse selection

You can not change plans mid year.....unless you have a qualifying life event.

 

[AllenChicago]

Thanks for that information, YAgents. It's a good thing that you're able to pull together the important bits from all the materials and sum them up so succinctly. It looks like HHS isn't quite as dumb as I thought they were. But a 6 month open enrollment (Oct thru March) is year is a big window.
-ac

 

[ctg]

Would it be prudent to try to get this guy on a plan, even if he has exclusions for the hip, so he has a CCC six months down the road? It won't really matter in October for January GI enrollment though, right?

I suppose I'm asking for future reference as well. I'm certain some of us will come across clients with similar but different issues.