<p>Trying to help my sister and nephew with health insurance information. She almost panicked with me on the phone last night when she realized her son will be 26 the end of this month. She received a letter from her insurance company yesterday about continuing with the policy via COBRA—a monthly cost of more than $680. </p>
<p>Background: Nephew is a 3rd year medical student, no employment for 3 years now, lives on borrowed money and what his mom throws his way, which isn’t a lot. She has been carrying him on her insurance but that ends with his 26th birthday. His school has insurance available but it’s very expensive. She doesn’t have those figures but he says he will get them. He’s obviously up to his ears with school work, hospital rotations, etc and she’s trying to help him figure it all out. </p>
<p>He’s as healthy as the proverbial horse, with no pre-existing conditions, but must have health insurance coverage. He will need a policy of he own for less than 2 years. Presumably, he will be a resident with coverage from his employer as of summer, 2016.</p>
<p>Has anybody here been down this road? Any sense of what a decent policy should cost? Any advice I can share with them? Have all the problems/horror stories with the exchange been resolved? I thought this may have already been covered on CC and did a brief search but was didn’t find a thread. Thanks in advance for any help you can offer.</p>
<p>I’m afraid she’ll have to take the COBRA for December, as it’s too late to sign up for a policy. But she/he will certainly be able to find something cheaper than $680/month for 2015. Something in the neighborhood of $150-300/month is more likely.</p>
<p>She should go to [url=<a href=“https://www.healthcare.gov/]healthcare.gov[/url”>https://www.healthcare.gov/]healthcare.gov[/url</a>]. That will direct her to the right site for her state, either the state exchange if her state has one, or the federal exchange. Enrollment starts this Saturday, but she can shop and compare plans now. The problems with the 2014 exchanges have been largely ironed out. Hopefully, the process will be smooth this time. </p>
<p>Her son will most likely be eligible for a subsidy, if he is not her dependent on her tax returns. If he does get a subsidy, his monthly cost will be less than $100, probably.</p>
<p>If she is certain that her son is not eligible for a subsidy, then she can also go to an insurance broker. She wouldn’t have to pay the broker, as insurance brokers are free for the customer because the insurer pays.</p>
<p>We bought coverage for our D through the Affordable Health Care Exchange for the District of Columbia. She got a very good Blue Cross policy and, since she is “low income”, she only pays $48/month and the deductible was waived. She had to send in proof of residency and proof of income in order to get the government subsidy. </p>
<p>When DD was a medical student she took the school’s coverage, which, if I recall, was about $2500 annually. She could have applied on the exchange, but since there is no income, that means Medi-Caid. If he is eligible for Medi-Caid then he won’t qualify for a subsidy so would have to pay the full price on the exchange.</p>
<p>My two med student daughters have utilized 3 different option for healthcare coverage–</p>
<p>1) student health insurance policy available thru the university/medical school (generally though student needs to elect this option at the beginning of the semester/quarter and cannot pick it up mid way through the term). In my daughter’s case it costs about $1200-$1300/year but there are coverage gaps. (For example, it paid for her emergency appendectomy surgery, ER stay, drugs & all tests, but not her anesthesia during surgery.)</p>
<p>2) Medicaid–if the student lives in a Medicaid expansion state, he ought to be eligible (One daughter has chosen this option and has very good coverage, including medical, dental, prescription and mental health.) Medicaid enrollment requires copious paperwork and takes about 60 days to become effective. Monthly cost $0. FWIW, this the was the medical school’s recommendation for all its over-26 year old students.</p>
<p>3) short term “gap coverage” (6 month max) to tide him over until he can either become Medicaid-eligible or can enroll in the student insurance program at his university. Policies are available thru the state’s healthcare exchange/ (In our state it’s $350/month for basic coverage–but enough to satisfy any med school. D used it to satisfy health insurance requirements at all her away rotations without an issue.)</p>
<p>Because the son is in his clinical years, he must have an minimal in-force health policy at all times in order to train in a hospital/clinic setting.</p>
<p>The son should contact the Office of Medical Student Affairs at his med school to see what the specific requirements for coverage minimums are or to see if they have any provider recommendation.</p>
<p>P.S. Medical residents do get health insurance as part of their employment contract, but there will be a gap between med school graduation (usually in May) and the beginning of residency (July 1). </p>
<p>DD went off of ours last month, was able to sign up through the state exchange 30 days ahead of time and was assigned medicaid. There was a good provider for her close by and she seems to be happy with it. It was an expansion state. </p>
<p>Yes, if he is in a medicaid expansion state, he will probably qualify for that. To qualify for tax benefits under ACA, he has to make between 100-400% of the poverty amount.</p>
<p>He doesn’t have to take COBRA or have a gap for Dec. This is a ‘life event’ when insurance is suddenly not available (marriage, loss of job, turning 26, death of primary insured, etc.) so he can sign up for medicaid or ACA exchange insurance outside the yearly enrollment period, but needs to get on it. Also, your sister should read the notice she received carefully. Sometimes the insurance will run until the end of the month the child turns 26 or even until the end of the policy year. He would also have 60 days to elect the COBRA, so he could wait and see if he has a claim during Dec, and have the new insurance start in Jan. If not claim, don’t pay the COBRA premium, but if something were to happen in December, he could just pay the COBRA premium and have coverage.</p>
<p>He needs to go on his state exchange. By working his way through the process he will find out all he needs to know. Change of circumstance is what DD filed under and was able to complete the paperwork 30 days ahead and have her card and all in place the day she was off our plan. </p>
<p>DS takes his school’s medical insurance. The premium is $2102 per year.</p>
<p>Yes, it hurts. But, like one of my colleagues once said to me, “it is an investment (for your future.)” His income at work is even lower than, say, $80,000 a year and he still thinks it’s worth it.</p>
<p>Paid my D’s cobra BC/BS about 680 also. When I pay it monthly it looks like I can drop it anytime. The three limit will be up in the summer. I seem to recall a 30 day grace period to start it but I cannot exactly recall. </p>
<p>He is a resident of Pennsylvania and there are certain coverage perameters required by his medical school–ie: psych coverage. Insurance is so complicated and the exchange sounds like such a process! </p>
<p>Keep the thoughts coming. Thanks so much for your help.</p>
<p>The exchange really isn’t that much of a process, honestly, as long as it’s working well. Presumably it won’t be nearly so buggy this year.</p>
<p>Have you tried going onto the exchange and doing the estimator? That should very quickly give you an idea of what, if any, subsidy he’d be eligible for, and the plans available including cost. </p>
<p>Remember that applicants no longer have to provide health history information, which is what used to make applying for health insurance so onerous and treacherous.</p>
<p>DD was able to sign up for ACA (Obamacare) coverage in a couple of hours in September after her graduate school health insurance ran out in August. With the subsidy I think she is paying about $25/month.</p>
<p>D’s enrollment took far less than two hours; I’d be surprised if it took half an hour. It’s been awhile but as I recall, the application consisted of: name/address/SSN, estimated income, marital status/number of people in family, smoker/nonsmoker, and a few Yes/No questions (I can’t remember what they were). Then you get your subsidy if any, and a list of plans you can enroll in. (Or I expect it’s at this point you’d be directed to Medicaid if applicable). You pick a plan, click Enroll, and pay (at least in WA, you pay on the exchange, in CA and federal, you pay the carrier).</p>
<p>The list can be daunting at first glance. I think D got something like 40 plans she could enroll in. We quickly narrowed it down to Silver, which left us with 8 or 10. From there, we eliminated the coop, and then it was a matter of choosing the carrier, and the premium/out-of-pocket tradeoff she was comfortable with.</p>
<p>DD is a student and in a medicaid expansion state. She qualified for a plan that incudes dental and eye care. She did not take the school insurance. Even that which looks inexpensive is more in loans </p>
<p>OP here…My sister says the annual cost is just over $4000 for his school’s insurance. If they purchase on the exchange, school says it must be Gold or Platinum. Nephew tells her he plans to check out the exchange for a better rate. This is one of those times when having adult children drives you crazy! She’d like to get it done–he only has 2 more weeks of eligibility on her insurance–but he seems to be dragging his feet! </p>
<p>Is there a wait time? Can he sign up and get immediate coverage?</p>
<p>I appreciate all the input here. I’m learning a lot–mainly that I’m glad I have insurance through my employer!</p>