Question about Affordability exemption for Retiree Health Insurance

[Ashmeade]

Hello everyone,

Asking the superior collective mind a question that I cannot get information on.

Client of mine retired at age 55 from employer/union with retiree insurance (not COBRA) and an HRA to draw from to pay for qualified expenses.

HRA is now diminished. Client is not close to Medicare and on hook for over 2K/mth for insurance.

Health insurance marketplace states that voluntarily dropping retiree benefit does not qualify for enrollment into Marketplace. I also cannot verify whether the affordability calculation for employer sponsored health plans applies. The MKP call center simply states to attempt the application with them, but I am reluctant to do so and am choosing to be proactive asking for advice here before committing to the 'living' MKP app.

Has anyone been in this situation or can advise?

Thank you!!!

 

[Yagents]

The marketplace app does not ask if the loss of coverage was voluntary or not. It just asks for a date for loss of coverage to create Special Enrollment for the following 1st of the month, and the MP is not requesting for proof of loss of coverage at this point.

And since there has been a change in premium / subsidies mid year, that also creates an SEP event. And technically, it's not an employee group plan, it's a retiree health plan, and he can drop it anytime he wishes in this situation.

Another SEP he may qualify for is the "family glitch" affordability calculation, at 2k per month, I'm sure he qualifies unless really high income.
https://www.kff.org/health-reform/i...r-consumers-with-employer-sponsored-coverage/

 

[Ashmeade]

The marketplace app does not ask if the loss of coverage was voluntary or not. It just asks for a date for loss of coverage to create Special Enrollment for the following 1st of the month, and the MP is not requesting for proof of loss of coverage at this point.

And since there has been a change in premium / subsidies mid year, that also creates an SEP event. And technically, it's not an employee group plan, it's a retiree health plan, and he can drop it anytime he wishes in this situation.

Another SEP he may qualify for is the "family glitch" affordability calculation, at 2k per month, I'm sure he qualifies unless really high income.
https://www.kff.org/health-reform/i...r-consumers-with-employer-sponsored-coverage/

Thanks for the great information. You have been a great help. Thank you very much!