Tuesday, January 13, 2015

Frustrating Client Tricks

First off, let me be clear that it's the client (and myself) that's frustrated. It's just that kind of situation:

Mary is divorced, and has custody of her teenaged son.She is responsible for his health care expenses, but her ex- is supposed to provide health insurance. Unfortunately, he is not terribly reliable: he is frequently unemployed (and uninsured), and he doesn't always let Mary know whether or not their son's actually covered.

In order to alleviate the stress of that inconsistency, Mary has always kept her son on her insurance. Due to some recent employment woes, she purchased a subsidized ObamaPlan from the Exchange.

A few weeks ago, her ex- contacted her to let he know that he'd found new employment, and that he and their son would become active on the new group plan on February 1. This presents her with something of a dilemma:

Once her son is on the group plan, he is no longer eligible for a subsidized plan. And according to Mary, she will also lose her subsidy (although she can keep the plan itself). Since I came into the picture after she'd already gone through the 404Care.gov subsidy eligibility hoops, I really can't confirm this, so I've just taken her at her word.

She also knows, from previous experience, that she really needs to keep her son on her plan, lest her ex- bail on the insurance requirement (yet again).

She asked her agent about what to do, and he referred her to me (this happens with some regularity).

I turned to my trusted posse (a group of colleagues around the country who are both expert and high integrity) for advice. I had a pretty good idea of what was going to happen here, but really wanted some additional input, especially regarding issues I might have missed.

Colorado Health Insurance Insider's Louise Norris came through in a big way.  Louise confirmed my belief that Mary "can't keep her son on a subsidized exchange plan. You can't get subsidies at all if you're even eligible for employer-sponsored coverage that is deemed affordable under the ACA rules (and unfortunately, because of the family glitch, they only look at the cost of coverage for the employee when they determine whether a group plan is affordable, regardless of whether dependents are being added to the plan or how much it would cost to add them)."

Louise also mentioned that Mary shouldn't lose her own subsidy just because Junior came off, but again, I  came in after she'd done that calculus, so I'm going to leave that lie (I have no idea how she completed the process).

Ultimately, it appears that the only way that Mary can resolve her dilemma is to drop her ObamaPlan and buy a new policy off-Exchange, one that will cover both her and her son. I pointed out to her that this solution has its own challenges; for example, having two plans in place often leads to Coordination of Benefits issues between the two carriers. She told me that she's done this before (where she kept him on both the ex-'s and her own plans) to no ill effect.

I am not satisfied with this solution, yet it appears that it's the only viable one if she wants to know that her son always has some insurance in place.

Still, better than nothing, one supposes.
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