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You are here: Home / Anderson On Health Insurance / WhatSEP

WhatSEP

by David Anderson|  March 10, 20207:35 am| 2 Comments

This post is in: Anderson On Health Insurance

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Special Enrollment Periods (SEP)s for the ACA exchanges can be triggered due to changes in life circumstances including the loss of a job or a significant change in annual earnings.

Medicaid has continual open enrollment. Income qualifications are based on a monthly income and not a year income.

If you are working in the service sector, and your hours are disappearing, the ACA exchanges and Medicaid are two likely sources of affordable coverage. If you look into the Exchange, look at the total cost of likely scenarios. Total cost will be the sum of premiums from the start of the policy until you end it or the end of the year, whichever comes first plus expected out of pocket spending. If you are unable to take a huge hit, think about the entire out of pocket maximum in your calculation of likely expenses. If you are able to absorb a huge financial shock, you might be able to trade-off lower premiums for lower actuarial values.

California and Maryland currently have a broad Special Enrollment Period for “tax time” and “state based individual mandate” awareness reasons. If you live in those states, and are not insured, look at these options. A low or no premium plan with a high deductible will beat out a no premium plan with an infinite deductible. Low or no premium plans are very likely to be available for folks in their fifties and sixties.

If you have questions, let’s work together in comments to come up with a plan.

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2Comments

  1. 1.

    Ohio Mom

    March 10, 2020 at 11:41 am

    I entered the golden land of Medicare the first of the month; Ohio Son has been covered by Medicaid since he was in elementary school, and Ohio Dad has COBRA.

    If he doesn’t land a new job by the end of his COBRA (the coming recession is not going to help things), he’ll have a five month gap before he can start Medicare. If the ACA is decimated, that five months will be um, interesting.

    If I could wave a magic wand, it would be traditional Medicaid for all (not Medicaid via an HMO, which some are forced into).

    It has paid for everything Ohio Son has ever needed, with no fuss. When the sleep clinic tried to discourage us from insisting on a sleep study, they warned us,”Your Insurance probanly won’t pay for it.” I answered, “He has Medicad, they’ll pay for it.”

    As they did for the tonsillectomy required to treat his severe apnea. If we had been scared away by a lack of coverage — well, not to put too fine a point on it, but apnea can kill.

  2. 2.

    Frank McCormick

    March 10, 2020 at 1:09 pm

    A more than gentle warning: when I was approved for Disability last November (with no documented income previously) I did my due diligence and updated my income information at Healthcare.gov.

    BIG MISTAKE!

    I essentially reapplied for ACA  coverage and its subsidies.  Although I kept the same insurance provider and policy 1) my deductibles and out of pocket expenses starter OVER again on 11/14 and 2) the values for both doubled.  The folks at Healthcare.gov assured me that this was “normal”.  I am now looking at a $3000+ bill for chemotherapy that was previously covered.

    In addition there was some sort of glitch where, although I still qualified for a subsidy, the software failed to send that update to my insurance vendor.  It took four months and way too many phone calls before I received my refund of $1300.

    In short, I would have been better off paying a tax penalty than documenting my “life event”.

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