Lost health insurance, ? On ACA

[JAM]

Sorry for 2 posts in 1 day, but it has been a day
We were notified today that we are no longer covered on my PAL’s private insurance plan bc my husband reveives Medicare. My husband, myself and our 24y/o were all covered. My 24 y/o has a job and is looking into whether he can get on their insurance. That leaves me… ACA open enrollment is closed, however there is a “life changing” exception that allows you to get enrollef outside of the enrollment period, which I hope I will qualify for?? Does anyone have experience with this??

 

[Nikki J]

Yes you can enroll if thereis a life event I think you have 60 days to apply but not sure. You also should be able to get cobra as there is a provision for dependents separate from the primary enrollee.

Your son if he can’t get work insurance is probably better off with aca as there is age pricing. You should compare cobra with aca prices for yourself. If your household income is lower but not too low you would be eligible for decent aca subsidies. You can go online and see the aca plans. Be sure to check networks for your doctors, hospitals and formularies

 

[swalker]

I had a health insurance through my employer that covered both my wife and me. When I transitioned off of that insurance onto Medicare, my wife got an ACA policy.

It was very expensive where we live (one of the most expensive counties in the US for ACA policies), but we did not have any other practical options.

She was then on an ACA policy until she qualified for Medicare.

Steve

 

[lgelb]

General note -- many states have additional COBRA eligibility laws that kick in if someone is not eligible under Federal law (most commonly because their employer's plan is self-funded). They vary, so always look at your State's page on this. Extensions past the normal 18 months of COBRA due to SSDI determination or under other provisions of State law, especially for State employees, may also apply.

This is Wisconsin's page on its own law:

OCI Fact Sheet on Continuation Rights in Health Insurance Policies

oci.wi.gov

And this is the overall "what are the options" page:

Consumer Guide: If You are Unemployed or Lost Group Health Insurance

Learn about your options if you lose your job and no longer have group health insurance.

www.dhs.wisconsin.gov

 

[JAM]

Steve,
Where are you? What a state? Can you give me idea of what she paid - message me if you want it private. Ty

 

[JAM]

My son’s company told him he had to let them know within 30 days of the life changing exception. We only found out today, but our private insurance is canceling us retroactive to when Medicare started (9/1 I believe- which means we anre out if the 30 day window) Any suggestions. My head is spinning.

 

[Nikki J]

If that is true ( and shame on them if they didn’t tell you) then if you are out of windows for his work and aca I think in Wisconsin you can buy private plans and short term plans to cover until you can get work or aca coverage

 

[KatyC]

Hi Jam.
I have an ACÁ policy due to my husband starting Medicare march 1. I have ALS and pretty much one month of RX puts me over my deductible and my Max out of pocket. When you look at policies make sure you compare both of those. We have always chosen to get high deductible, lower premiums since in the long run that is less yearly outgo.

All states ACAs rules are not equal. I am in California and there is a scale that allows us to make more and still qualify since the cost of living is so high. It is Coveredcalifornia. Not healthcare.gov. We retired early and collected social security so I dont qualify for medicare due to ALS. I am 63, I put our income at 68,000 yr, we have an HSA compatible high deductible plan and my Kaiser premium is 94.00/mos. My yearly deductible and max out of pocket is 6650.00/yr I put the max in my HSA per yr which this yr is 5150. for me. The HSA is deductible from your income when factoring the premium. That includes my extra 1000. For being over 50. An HSA plan does not allow for different copays for different services. It is one deductible for everything. I have to explain that to the kaiser billing dept yearly. Sit down and figure out what you actually spend in healthcare/yr. Pre ALS we never came close to meeting our deductible so we chose a higher deductible/lower monthly premium. Everyone’s needs and comfort zones are different.

It might be worth it for you to talk to a licensed ins agent that is affiliated with the ACÁ. My brother is in Utah and the figure the agent gave him was lower than what he figured. Your situation should qualify for a life changing event since loosing your ins I believe is on the list. I hope this long winded email helps

 

[swalker]

JAM, we live in the mountains of Colorado.

On my computer, a person's country and state are displayed below their member name (if they have provided it). I don't mind at all repeating that information in this post, but just wanted to let you know that information is generally available while you are viewing posts.

I don't remember the exact figures, but here is a pretty good idea of what we paid.

This was for a high deductible policy. The premiums were about $15,000 per year, the deductible was about $5,000 (may have been more, I can't remember), and the out of pocket max was $10,000. My wife typically hit the out of pocket max each year.

The policy this premium paid for was not very good. It provide more than the Bronze level of coverage, but was really very limited.

As I said, we live in a county with some of the highest ACA premiums in the country. For quite a few years, we were number 1. And were in the top 3 each year she used an ACA policy. I would expect costs to be substantially less elsewhere.

Also note that ACA policy costs vary by age. A younger person will likely pay much less.

I was diagnosed in 2014 (I have slow progression). When I was diagnosed, there was a period of time before I was eligible for Medicare. During that gap, we used COBRA from my work. In 2014, COBRA cost $22,000 per year for the two of us. I don't even want to think about what it would cost today.

Steve

 

[JAM]

Ty! I only go on the forum from my phone- nothing is displayed under your name.