This may not stay in GQ, but please don’t turn this into a debate over Obamacare.
I got laid off and I only have my previous company’s healthcare plan for two months. They gave me a severance package which includes a health care supplement.
I can use COBRA but I think I’d like to see what’s available though the ACA as well. I live in Illinois.
Although it’s not open enrollment season yet, getting laid off is a qualifying life event that makes you eligible to enroll.
Be careful, however. A lot of the cheap plans have very tiny networks. And if you have a medical emergency, an ambulance driver is not going to ask you what hospital you want to go to or even know which hospital is in network. And a lot of the cheaper plans will have no in-network providers out-of-state or even out-of-county in case you ever need medical assistance away from home. And they will provide no coverage for out-of-network services. The plans that provide even token out-of-network coverage are few and far between.
Exactly so. Here’s a link to the info on Special Enrollment Periods on Healthcare.gov, and losing job-based health coverage is one of the “qualifying life events.”
As you’ll see, your window for buying an ACA plan runs from 60 days from the point that you lose that coverage.
In addition, the Open Enrollment Period will be running from November 1st until December 15th – if you don’t buy a policy during your Special Enrollment Period window, you have until December 15th to buy a policy during Open Enrollment. However, in that case, the coverage won’t go into effect until January 1st.
This is good advice. I was on an ACA plan (in Illinois, as a matter of fact) during 2016 and early 2017. At that point, there were several companies I had never heard of offering inexpensive policies, but they had weak networks – and I know that some of them are no longer offering ACA plans at all.
I wound up buying a plan from Blue Cross and Blue Shield of Illinois – it wasn’t an ideal plan (it was a high-deductible plan, which is what made it at least moderately affordable), but it did give me access to BCBSIL’s network, which is throughout Illinois, and nationwide through the BCBS network.
As it turned out, the price for the policy I bought was fairly comparable to what I was having to pay for my COBRA coverage from my old employer – after I’d gotten laid off, I wound up freelancing for almost two years, and thus, had to buy my own insurance. I finally was able to drop my ACA plan when I got a full-time gig, with insurance.
You can look into meeting with a navigator.
Word of warning, I tried applying for Obamacare in 2018. I got laid off at the end of Dec 2017 and my only income in 2018 at the time was UI.
When I went in to apply, they looked at my UI income (about 1300/month) and said it was too high for me to get medicaid. But then they said my annual income (UI is only for 6 months) was too low to qualify for a subsidized ACA plan.
So I was disqualified from both plans. My income was too high on a monthly basis and too low on an annual basis. Its a major loophole.
I have a question – you were told that your income was too low for a subsidy (which I understand – I know that there is an income “floor” for subsidies for ACA plans). But, while it meant you wouldn’t be able to get a subsidy for an ACA plan, it didn’t mean that you were prohibited from buying an ACA plan at all, correct?
That said, even if you could, legally, have bought an ACA plan without a subsidy, the monthly premiums may have been more than you could have afforded, so you may still have been “prevented” from getting an ACA plan – but due to the cost, and the ineligibility for a subsidy, but not due to ineligibility for a plan.
Yes. But this is only theoretical - if you are making under ~13,500 a year it’s going to be really hard to come up with ~$500 a month for the un-subsidized premium. In practice, it’s a loophole, as you are too poor to be considered eligible for ACA (you were supposed to get medicaid) but too rich for medicaid in conservative Southern states.
Oh, I completely agree – but my point is that, as I understand how the laws and the policies work (and I’ve worked on these sorts of policies for four years as part of my job), I suspect that it wasn’t that Wesley Clark was prohibited from buying a policy due to his income level, it was that he was prohibited from qualifying for a subsidy to help him pay for a policy. Eligibility for an ACA policy, and eligibility for a subsidy, are two different things.
You’re right, it ends up being a de facto “you can’t buy a policy,” but, to be clear, as long as you aren’t on Medicaid, there are, as I understand it, no income restrictions on your legal eligibility to buy an ACA policy.
Ok sure. And then I think about how these policies screw over millions of citizens in these red states where they were instituted.
The problem with Conservatism - and the Republican party - isn’t the people who are voting conservative because it’s in their own best interests. The richest 1% don’t need any help from the government and never will, they have more money than almost anyone else anywhere in the world.
But millions of poor people who do not benefit from conservative governance are taught through false information that they do. And so they become “useful idiots”, voting against their own interests.
I don’t disagree with any of this (and the state where my client operates is a deeply red state, which does, in fact, have the “Medicaid gap” due to the decisions of its Republican government). But, this sidetrack has pulled the thread away from the OP’s question.
Moderator Note
The OP is specifically looking for factual answers regarding what is available through the ACA. They are not looking for a debate on Obamacare.
Feel free to debate Obamacare, just not in this thread, or this forum. Great Debates would be the appropriate forum.
Sorry. Though I think my post is completely factual and supported by all documented evidence. But yes, it’s off topic.
Open enrollment has begun and will continue until 12/15/19 for coverage beginning 1/1/20.
I have COBRA thru 1/31/20 which, I believe, allows me to wait until then and at that point I will have 60 days to get into the “marketplace”.
I wonder if there might be an advantage to dropping COBRA and doing it now though. My wife and I are both healthy but “pre-existing conditions” are no longer disqualifying anyway, correct? Maybe locking in the current price vs a future price?
BTW and FWIW. … we will not be eligible for a subsidy. I note that the subsidy thing derailed the discussion a bit above.
In my experience COBRA is hella expensive, so you most likely will get something cheaper on the exchange. I don’t have a subsidy and I have pre-existing conditions and mine’s about $500/mo for an individual high-deductible plan. COBRA was something like $600/mo way back 15 years ago when I got off my dad’s insurance.
Only catch is I don’t think you can view possible plans unless you are first eligible, and the only way to be eligible is to drop COBRA. I might be wrong on this, though.
But, you could also contact a local broker who can walk you through it. As far as I know they don’t cost anything, they get a cut from the insurance company.
You are correct in that you can’t be disqualified from buying an ACA policy due to a pre-existing condition (and, preventing insurers from using pre-existing conditions as a reason to deny coverage was a key part of the ACA itself).
You’re also correct that the expiration of your COBRA coverage would trigger a “special enrollment period” for you (see explanation here).
If you buy an ACA policy for 2020 during this open enrollment period, that should lock in your price for said policy for the entirety of 2020. You should look into the point at which you’ll be on the hook for paying for your COBRA coverage for January, 2020, so that, if you decide to switch to an ACA policy, you won’t have to pay for two policies for January.
At this point, it’s likely worth at least looking at what your ACA options are, and how they compare to your COBRA coverage (network, deductible, co-pays). When I went off of COBRA, and onto an ACA policy in '16, the cost was pretty similar, but YMMV.
While what you say here is true, I’ve found similar problems with every US health insurance plane. Assuming I’m conscious, I question every step taken in my health care and this has saved me thousands of dollars.
Before taking my morning meds the day after having a coronary artery stent placed, I asked about the cost. The nurse got pretty upset, but I refused the medication until someone answered my question. Turns out I was being discharged and could pick up my prescription on the drive home, saving significant money.
Another time I refused an ambulance until I could call my insurer. A specific ambulance company was free for me, although it had to travel 30 miles to reach me for my 2 mile trip. The ambulance waiting at the curb would have been $800.
Then there was the time I had an MRI. The radiologist with the group my PCP was in gave his evaluation of the test. My PCP told me he had a radiologist/friend who he used to work with and he wanted to get his opinion on the scan. I asked if it would cost me anything and my PCP had no idea. I looked into it and then contacted my PCP to tell him no. Turns out he had already contacted his friend. When I was billed for this, I fought it and got the charge rescinded.
Thanks for the inputs above folks. At risk of derailing this thread I have a question about COBRA.
About 20 years ago I was in charge of health insurance at our small (about 100 employees) company.
At that time I came across a way to enroll and/or keep your COBRA options available without paying anything for a few months. The idea was to wait until you actually needed the insurance coverage before you might be eligible for a plan with a new employer.
I could be all wet on this or the “loop-hole” may have been closed. Anybody ever run into something like that?
Note that, if your income varies significantly from month to month, you’re allowed to use your annual income to qualify for Medicaid. They’ll make you jump through more hoops, but it can be done if you’re patient.
Anyone who’s thinking about buying health insurance for themselves and their family should, before they sign up for anything on “Obamacare”, talk to their insurance agent - yes, the one that handles your car and homeowner’s insurance. They may be able to set you up with a plan that meets your needs and those of your family, possibly at less cost to you than anything on the exchange.
This is what I did when I became self-employed, and I have a BC/BS plan that over the past 2-plus years has paid claims for my cancer treatment, once the deductible was met, with barely a hiccup. THAT has taken a LOT of the stress out of the whole thing.
The amount of the deductible is something I would like to keep private; even though it’s in the four figures, even knowing that I had to pay that much and not the full amount, took a big load off my mind.
I had a terrible experience with healthcare.gov. They out and out refused to cover my children, supposedly because they should be on medicaid, even though they were denied medicaid too. And honestly, I’m still young-ish and healthy, my kids are the main people I wanted to insure, getting insurance for myself was just a bonus. And the only plan they offered my wife and I was $2000/month, but only if we had some way to prove we didn’t have any other insurance, which I’m not sure is even possible. And even getting to that point was a huge pain because the application process and paperwork was absolutely inscrutable. I had to call and talk to a person to have any clue what was going on, and even then I was left with questions that nobody could answer. And the whole process took months. I mean, I was in the Army and I’m an engineer, so I’m no stranger to government paperwork and bureaucracy, and this was beyond the pale. It was set up as if they didn’t want anyone to use the system and wanted to drive people away on purpose.
Are there companies that can handle this for you? I’m thinking about those license companies that can register a car and get you new license plates and things like that. You just pay them money and they deal with all the government bullshit for you, and since they do it everyday, they have the expertise to make it easy and straightforward. Is there somebody like that, but for health insurance?
In the end I just went to the United Healthcare website and bought some short term insurance for ~$300/month. It’s not ideal, but I’m only on a short term contract and should be back to getting employer healthcare in a few months. If I was actually poor and in need of immediate comprehensive insurance and subsidies, I’d be out of luck.