I am so frustrated with our healthcare system (but that is a post for another day). My D was laid off at the end of November. She decided that COBRA was too expensive so I sat with her as we went thru the marketplace to apply for an IBX plan.
We did most of this around Christmas when were together. At one point, the marketplace website application told her she may qualify for Medicaid and she had to wait until a determination was made. (Side note: she is very familiar with Medicaid because she works with disabled folks. She cannot believe that her salary, for a job where you need a minimum of a BA or BS is low enough to qualify for aid. Sad).
So we signed off to wait until we heard from Medicaid. She went in and loaded her desired plan into her cart for 2025 too.
Nothing has been happening, no word from Medicaid, so today we live chatted with the marketplace. They are telling us that she can no longer get coverage for January 1 because she did not advise them of her qualifying life event until after 12/15. And also that she did not enroll before January 1.
We explained that she chose the plan but could not move forward back in December. And that healthcare.gov says you have 60 days from a QLE to choose coverage.
I don’t want to list all the details (we had live chatted in December too), but does anyone know if you have 60 days to choose new insurance after a QLE?
I feel like the rep was confusing us with people who just decide to enroll for their own insurance. I know they have to enroll by 12/15. Her job loss just coincided with open enrollment.
The COBRA paperwork from her old job was not even postmarked until 12/4. Is it possible that she was supposed to research all of this and make a decision in less than 2 weeks??
We spent 2 hours on this today with them and working on her application. We both have degrees and she works in social work and we were confused. I can certainly understand how people end up going without insurance. As of now, I guess my D is uninsured. I don’t knwo what we do if she gets sick or hurt.
Dr Google says that according to the Affordable Care Act you have 60 days from QLE to deal with insurance. That’s the rule with my BC/BS insurance also.
I believe you have 60 days to sign up for Cobra. If she’s unable to start the new insurance immediately she could be prepared to sign up for Cobra within the 60 days if she needs medical treatment (and it’s retroactive). My D had 2 months without insurance when she changed jobs. She filled in all the Cobra forms and let people know where they were so they could immediately be mailed should she have an emergency need for treatment before the new plan kicked in. Cobra was expensive so only to be used in emergency. Health insurance is a nightmare, sorry your D’s having this trouble.
My husband and I were talking about this also. How do people with less education, less resources and less time navigate this.
Today I called our new insurance company. I was trying to confirm some coverage. I was told that my birthday was wrong, that the marketplace got my birthday wrong and I needed to call them to fix. They couldn’t give me any information including what the birthdate they had was.
It’s correct on the information I have and it’s correct when I called the marketplace. Marketplace told me I need to call the insurance company.
So I get to call the insurance company again, with a different customer service agent and try to impress on them that they have the wrong birthdate.
Round and round it goes. Misinformation everywhere.
You have 60 days, but I think insurance may only kick in at the start of the next month and that is dependent on enrolling before the 15th, so her coverage would not have started Jan 1 since you hadn’t completed enrollment prior to Dec 15. If you complete enrollment now, coverage would begin Feb 1. However, if you wait until after January 15, then the earliest start would be March 1.
“You have 60 days, but I think insurance may only kick in at the start of the next month and that is dependent on enrolling before the 15th, so her coverage would not have started Jan 1 since you hadn’t completed enrollment prior to Dec 15. If you complete enrollment now, coverage would begin Feb 1. However, if you wait until after February 15, then the earliest start would be March 1.”
This is what confuses me. If I have 60 days, then I should be able to enroll 18 days after losing my job right? If I have to enroll before the 15th of the month prior, then I don’t really have 60 days.
I think that is what we are going to do. Know that we can elect COBRA if needed.
But if we don’t actually end up needing it, then she was technically uninsured. It seems like a stupid system. In the meantime, she can’t refill Rx or make doc appointments because they all need valid insurance cards.
Luckily her med is a generic and it is only $5 or so.
Yes, you can enroll, but coverage won’t kick in until the following month.
American health insurance is ridiculous.
But the idea is that there is open enrollment when people can enroll in a new health plan or renew their current health plan. Once open enrollment ends, you are stuck and can not get health insurance for that year UNLESS you have a qualifying life event, such as job loss with corresponding loss of insurance. If that happens, you are allowed to enroll in an insurance outside of open enrollment, but must do so within 60 days.
However! Even though you are allowed to enroll at any time during those 60 days, your insurance coverage does not begin immediately. It either begins at the start of the following month - if you enroll prior to the 15th - of at the start of the month after that - if you enroll after the 15th.
So if you had enrolled, say, December 14th, then your coverage would have started on January 1st. If you had enrolled on December 16th, then January gets skipped, and coverage starts on February 1st.
Now we’re in January. You are still eligible to enroll and if you enroll today, coverage will start Feb 1st. If you wait until after January 15th, coverage will start March 1st.
So the date you enroll is NOT the date that coverage begins. Why? Because America.
And if you go past the 60 days, you will not be able to enroll in a plan at all until this year’s open enrollment period which means you will either need to take COBRA or go without insurance until whenever open enrollment is (usually October or so?). So don’t go over the 60 days!
If she applies within the 60 dayi window, coverage will be retro.
“You have 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, you will be covered by COBRA starting the day your prior coverage ended. You will receive a notice from your employer with information about deadlines for enrollment.”
Sounds like a State/broker issue. California allows 60 days to enroll in its marketplace if you lose employer coverage.
But you DO need it. Right now. You can’t look at this as “what if she doesn’t get hit by a car tomorrow?” She NEEDs insurance, that’s what COBRA is for, to replace her “employed” policy with a new, non-employed policy, until her new job’s insurance kicks in. Don’t overthink it. One of my kids took a job that had an insane waiting period until their insurance began, AND the interviewing/job offer phases took so much longer than the company had thought/anticipated. And a different kid needed a security clearance (which took forever- Trump had imposed a hiring freeze and the FBI was completely backed up and couldn’t hire new agents to clear the backlog). Thank god for COBRA during the waiting period… it was a moderate freak out (no paycheck) instead of a huge freak out (no paycheck and no health insurance).
You just don’t know how long until a new employer and policy will come around. Sign up for Cobra, she needs to spend her time finding a new job, not arguing with an insurance company or trying to get one of her providers to see her without proof of insurance.
I know I sound cynical… but job hunting takes time, energy and initiative, and any time-sucking activities that will interfere with Job 1- out they go!
Oh I agree she needs insurance. It feels vaguely unethical to not sign up for something on the off chance she doesn’t get sick. December is complete so I guess she was technically uninsured then?
She did not want to use Cobra as it is 3x more expensive than buying a plan off the marketplace. (Or more, depending on if she is Medicaid eligible).
She is happy to pay for the IBX plan until she gets a new job and her new insurance kicks in.
There are also exceptions to enter the market place if you lose your insurance. We had our niece and nephew actually use their city health center and there was a lady there who helped them navigate the system. She was fantastic and new some tricks also. There are also insurance broker’s that can help to answer your questions or help you navigate the process.
THANK YOU. I followed this, although I have a HUGE problem with it, but thank you for explaining it to me. So even if she had called and enrolled the day after her job loss, there is no way she could have gotten coverage in December. Because that coverage would not start until the NEXT month, is what you are saying. So “60 days” doesn’t really mean what I think it means.
Her COBRA paperwork was postmarked December 4, so it would have been nearly impossible to do that in time.
What an incredibly stupid system, and how incredibly difficult they make this. My D spent her days literally dealing with government agencies, at apparently poverty wages, and still we could not understand this.
What was her official last day on the payroll? (if she had unused and accrued vacation time, her official “last day” may not have been in November.) Even if it was December 1, she was probably insured for the entire month anyway (without her knowing it).
It’s confusing, it’s awful, but it is what it is until someone figures out how to describe and then pass “universal coverage” in a way that doesn’t trigger the “Oh but that’s socialism” crowd. Or trigger the folks who believe that some people don’t “deserve” health care coverage…
I just check Healthcare.gov and they actually have a page that explains it pretty well, I think. And we’re actually still in open enrollment until January 15th so the QLE doesn’t even matter right now if she enrolls right away.
November 1: Open Enrollment starts — first day you can enroll in, renew, or change health plans through the Marketplace for the coming year. Coverage can start as soon as January 1.
December 15: Last day to enroll in or change plans for coverage to start January 1.
January 1: Coverage starts for those who enroll in or change plans by December 15 and pay their first premium.
January 15: Open Enrollment ends — last day to enroll in or change Marketplace health plans for the year. After this date, you can enroll in or change plans only if you qualify for a Special Enrollment Period.
February 1: Coverage starts for those who enroll in or change plans December 16 through January 15 and pay their first premium.
My kid, in a different state from me, was told by former employer that her plan ended at the end of the month, too late. She missed the mid month deadline to apply for Medicaid for the first of the next month. Because she has serious health issues, I paid for a private plan in the interim.
In my state, you can go to a hospital financial counseling office and get on Medicaid, or any plan, that same day. In fact you probably can do that online but we go to the hospital office.
My S left a job, and his insurance ended the day he left (not the typical last day of the month). It was a small company, so they didn’t offer COBRA. He had to wait at his new job before coverage kicked in (a month or two, maybe?). The only solution in order to make sure he had some coverage in case of an accident or emergency was to get into a short term plan. And guess what? It ONLY starts on the first of the following month. I swear, I was on pins and needles until he was covered. Our health care system is awful.