Questions Re: Adding Baby/subsidy/coverage Change

[yorkriver1]

I have a case study here. I am considering how to best help this young family with planning for OOP's.

Recently married, so SEP for 4/1/15. That gets the husband covered. I say family because the wedding date was moved up due to a surprise. The baby will be born late fall. Wife doesn't need coverage now, as still on parent's health insurance for much less than adding her on to policy with spouse.

They don't qualify, it seems, for much of a subsidy, but if either one of them has fewer work hours, they would. I want them to be set up for that.

Given their lack of savings, I believe having a $1,000 deductible Gold plan would be the best use of their money between now and the birth, as something could go wrong with the baby, and the treatment OOP would be a big burden if the deductible is multi thousands. Since the wife will still be on the parent's policy, that saves at least $200/mo that could go into savings toward the deductible for baby and mom, as the couple will have to pay that.

I am concerned about what happens when the baby is born, as in, when does coverage begin. I think it's backdated to the date of birth. I also think that there is a SEP opportunity, but I doubt that, say, a higher deductible plan could be replaced with a lower one, with the better coverage backdated to the baby's birthday. So, to protect them, get the dad a gold plan now. That's my idea so far.

What has your experience shown are pitfalls and best practices for this type of situation?

 

[taterpeeler]

The Answer: SEP for birth of kid and can add mom and change plans.... HOWEVER, my subsidized cases(income at a certain level) in TEXAS(we did not expand) the mom and kid go to MEDICAID... no choice and you are left with your pud in your hands.

You indicated their income was "close" to subsidy eligible so you may? slip by with no medicaid for a year on mom and kid....

Since mom has parents coverage does that plan cover the new kid(doubt it but need to know the answer)

1) if moms parents plan will cover the new kid then why put the dad on a gold, not needed and a waste of cash

2) if moms plan does not cover the new kid the sep will be back to the date of birth so again, why put dad on a gold? waste of money

 

[Yagents]

Can a just born baby get their own on exchange gold plan without a parent on the plan, backdated to birth date, and not ask for income assistance to avoid Medicaid??

 

[taterpeeler]

Can a just born baby get their own on exchange gold plan without a parent on the plan, backdated to birth date, and not ask for income assistance to avoid Medicaid??

never tried it but i suppose if income was jacked up enough you could i just have never tried it.....

wait... last year i got a newborn and mom covered but their income seemed to be over 250%... down in my laredo office

 

[yorkriver1]

1. great ideas 2. I will check with carrier + Marketplace, see what they say
3. I do know, because it's come up a couple times on one of my group plans that only the under 25 kid can be on the parent's policy (married or not), and not the kid's spouse or offspring.
4. so, best option, if it works, could be, Bronze or Silver on young dad, then Gold at birth late fall, 2-3 mo. at most, then, if all are healthy, they can choose another option for 1/1/16. If, as they say, the wife quits her job, they will get higher subsidy.
5. Not sure if they can apply for CHIP before the baby is born, if the wife quits her job, which is what they would like, their income may make the CHIP app a necessity for Marketplace. Tough decision, how do you keep the kid covered and apply for CHIP. At one time, here, you were turned down if the child was covered elsewhere, have to check again.

 

[taterpeeler]

in regards to getting a newborn covered by themselves and get no subsidy on exchange... yes, can do that one

 

[yorkriver1]

Good options, more than I thought at first.