There are some wrinkles or exceptions – but think of it this way:
The ACA was designed around the idea that records concerning eligibility for premium subsidies would need to be reconciled with IRS. So IRS needs to be able to pull up tax records, compare them to insurance subsidy data, and make sure it all reconciles.
You probably can’t claim your 28 year old son as a dependent – so in 2015 his tax return is not going to be connected to yours in any way. So he should estimate his income based on what he is no making, apply for a subsidized ACA plan in his own name (assuming that he can’t hang onto the grandfathered plan or doesn’t want to) – and take the subsidy.
I’d add that ACA reforms allow you to keep your children on the same policy as you until age 26, not later – so your son is too old to be on your policy in any case. If he can’t be on the same policy as you and your wife, and can’t be claimed as a dependent – then he’s not a member of your “household” for ACA purposes.
Thanks for the replies. I will go ahead and have him sign up for his own ACA policy. He is currently paying $150/month for the non-ACA plan, and after subsidy will probably only pay around $50/month for the new ACA plan. The big difference to me is that the ACA plan has no lifetime limit, while his current plan does have a limit. That defeats the major purpose of health insurance; to protect you from a devastating financial loss.
I thought I was losing insurance as of Jan 1 because my job ended. However, as of today, I still have it. This means I am covered through the end of the month, yeah? (The HR person was NOT helpful and I think the HR office is very short staffed as today is the only day of this week they’re open.) He said that I would get COBRA info in the next few weeks and then that would have the date of ending coverage.
If I do not get the info before Jan 15, the date I have to apply by to get coverage for Feb 1 through the marketplace, is there any provision for getting coverage sooner if there is a job loss? I can get COBRA for Feb if needed (the prices are actually very reasonable for very good coverage) but it would be much cheaper through the marketplace.
I’ve never dealt with employer insurance or COBRA so this is all new territory for me.
Not necessarily – I seem to remember that when my daughter left her last job she had a gap in coverage because of insurance from job #1 ending mid month.
However, you can purchase COBRA retroactively – for example, lets say that it turns out the employer coverage ends on January 20th – and by then it’s too late to buy marketplace coverage that will start before March 1st. You can simply pay nothing – and if it turns out you get sick and have to see the doctor on February 25, you would be able to THEN elect he COBRA coverage, pay for the period you weren’t covered only – because of course by then you will have already signed up for the ACA coverage to begin in March. That’s because the COBRA notice will give you an election period and you are allowed to activate COBRA any time within that period – I think it’s 60 days from the date of your notice.
In other words, if you got the notice next week – say on January 10th – you would have until March 10th to make the COBRA election.
Keep in mind that open enrollment for ACA ends Feb. 15th. IF you elect COBRA,you can still switch and sign up for ACA during the open enrollment period – but not afterward. So you would be ok to elect COBRA for January & February, and switch to ACA for March, but you would not be able to take COBRA in March and get on ACA in April, because of the end of open enrollment. You don’t have to take COBRA, but once you do have it, then voluntarily stopping it is not a “qualifying event”.
Though I would note that I believe that getting married IS a qualifying event for getting marketplace coverage… so in your case you might have a whole new set of decisions about health insurance to make in June.
Thanks so much! I’ll wait until I get my COBRA info and then make decisions. I have to call the marketplace anyway to submit my app as they can’t verify my identity (common problem with me).
Let’s just all do a quick good luck dance to the PhD gods that I get into a PhD program here as then my soon-to-be spouse and I will be covered for at least the next 5 years or so… sigh.
I am seeing more issues this year with people’s plans not transferring to the insurance company. An AZ company told me last year it was 24 hours, today I checked on a plan that was submitted in November and still does not link to the company, she found it manually.
In that case it was a person who had 2014 ACA coverage, then the system glitched and wanted him reverified even though he already had been verified. But the system would not ask the questions. Hours on the phone with the exchange “Help” desk resulted in his account being locked, a new login account created and still, the help desk had to take the info manually and submit a paper app. LAME
And my very own coverage is currently paid on the exchange, but the insurance company shows no coverage , yay!
I don’t think it’s a mess that Sutter discovers they can’t charge any amount of money they want and still get the insurance companies to pay. They do indeed deserve to be kicked in the shins.
We’ve been following that saga before deciding which insurance to buy. We wanted our policy to contain Sutter doctors, but I hate Sutter too. Maybe we should just switch to Kaiser and stop having to deal with this nonsense.
We joined Kaiser. So far, so good. Easy to get appointments. My daughter has already had one. My wife has three this week. I have my first appointment tomorrow after not seeing a doctor for 7 years. I chose a doctor similar to me.
We are going to have to change birth control pills for my daughter. She takes them for acne. The prior pills worked great. I hope the new pills work in a similar fashion.
Yikes! That’s a huge problem for me – I’m with Blue Shield precisely because they included Sutter/PAMF – I’m very happy with the care I have been getting, but if this isn’t resolved soon, I think I’ll need to switch to Kaiser during open enrollment. The Sutter facilities (such as PAMF) are the dominant provider in my area, and Blue Shield is currently the only insurer that covers them … so I’m not sure how they survive without Blue Shield dollars. (And not sure how Blue Shield will weather the loss of customer base – they are the most expensive choice in my area, so I’m thinking that I won’t be the only one shifting to Kaiser over this mess.)
But I won’t assume this is the final word… I’ll hang on to the end of the month to see what happens. Somehow I think that this is posturing that will get resolved in the interim.
Dstark, I’m happy to hear about your positive experience with Kaiser. Here’s what I really like about my Sutter experience:
Not only are appointments easy to get, but there is no wait once I arrive. If I have an appointment at 2pm, I get seen at 2pm
I love the online communication stuff-- if I have a non-emergency medical problem, I just go to the web site and email a question – they are very prompt about responding and if it is something important, they will call me to talk about it – they even phoned in a prescription a few weeks ago.
So I’d be interested in knowing how Kaiser compares.
My son joined Kaiser. But my regular doctor of over 25 years, and a couple of specialists that I like, are at a Sutter facility. Mr. Fang has doctors he likes there too.
I think in my area Health Net is going to include Sutter; they’ve already announced they’ll include Sutter through June. But I hate this game-playing. Kaiser is honest and straightforward. Mr. Fang and I will talk about it tonight and figure out what to do.
I wish Kaiser were an option - but they are not in our county. There is a 6 month transition period where current patients can continue to use a Sutter provider with in-network rates. But if things are not resolved by July 1, 2015 those patients will be paying out of network rates.
I know, Dietz. I said I think Health Net is going to include Sutter. But they haven’t finished negotiations yet. We have until Feb. 15 to decide what to do for this year. Kaiser is looking better and better.
I wonder why Sutter was allowed to build up that big quasi-monopoly in the first place. They buy up all these hospitals and medical groups, and then raise prices. “Rates at Alta Bates Summit Medical Center and other Bay Area sites jumped by 29 percent to 173 percent after being acquired by Sutter, Blue Shield said, citing its own data and a Federal Trade Commission study.”
I like Sutter. I like Cal Pacific. It has been awhile but I used to know top notch doctors at Cal Pacifc. Calmom, sounds like Sutter has good service. I think Sutter is trying to become a high end Kaiser.
One thing I am not sure about is pricing at Kaiser. My wife’s cataract surgeries were cheaper with Anthem approved doctors than Kaiser. Insurance companies have negotiated rates. Kaiser doesn’t do that.
I do like not having to worry about which doctor is out of network around here. Hated that.
I don’t know how Kaiser deals with out of state or out of country network issues. I think Kaser is ok. That’s not good enough though. I don’t know the mechanics of how Kaiser deals with these issues.
