Enrollment reminders on December Deadline day

Enrollment for January 1, 2016 coverage closes at midnight on the 15th for most states.  All states that use Healthcare.gov and most of the state based exchanges have a deadline then.  Here are a few reminders for how to make decisions as you look for on-Exchange healthcare.

  • If you make under 200% FPL (~$23,000 for a single person) look very strongly at Silver as Silver is bumped up to either Platinum Plus or Gold Plus coverage with Cost Sharing Subsidies.
  • Before you shop, write down your maximum comfort level of being hit with a mega bill.
  • Try to find coverage where the out of pocket maximum is slightly less than your discomfort level
  • Write down who your preferred doctors are and what hospitals you use or want to use
  • Check to see if those providers are in network
  • Make sure you have filed your taxes or will file them as soon as possible for 2014.
  • If you make over 400% FPL, look to buy off-Exchange as there are more plans as OFf-Exchange is all On-Exchange plus a few more options.
  • If you live in a Medicaid rejection state and your income is just below 100%, if you can make a good faith estimate to bump your income to 100.1% of FPL, do so.
  • If you need any help, talk to a navigator
  • Use this thread as a resource.  I’ll be checking throughout the day and will help when and where I can.

37 replies
  1. 1
    Baud says:

    I found out that you can now roll over $500 of unused money in your FSA, but you lose your grace period if you take advantage of that option.

  2. 2
    Elizabelle says:

    Thank you, Richard. Viva Obamacare!

  3. 3
    jacy says:

    I’ve switched my coverage from one silver plan to another silver plan with similar benefits but a lower premium. My new coverage starts on January 1st, and that’s when my first premium payment for the new plan is due. I don’t have to pay the premium on the 15th, do I? (I’m enrolled, just haven’t paid my first premium, and I’m covered by my old plan until Dec. 31st.)

    This may be a stupid question. :)

    (And thanks for all your healthcare posts — you’re swell!)

  4. 4
    Richard Mayhew says:

    @jacy: payment is not due tomorrow although the insurer will try to get you to pay early

  5. 5
    Tissue Thin Pseudonym says:

    I’ve been on MinnesotaCare for two years now, since it was midified to be really cheap, good coverage for anyone making under 200% of the FPL. Over the weekend, I was looking at the health plan provided by my employer now that I have a job. As I was reading it, I kept saying, “This can’t be right. Looking at the list of things that are covered, this doesn’t come close to meeting the requirements for a minimum accepted plan under the ACA.”

    It took me several hours of searching to realize that, no, it doesn’t meet what I thought was that definition, because large group plans (i.e. for employers with more than 100 employees) don’t have to meet the requirements for the Established Minimum Benefits to qualify as counting as a minimally acceptable policy to avoid the employer penalty.

    This motherfucking turkey basically doesn’t offer any coverage for prescriptions for chronic conditions; it will pay for one brand name and one generic for a maximum of 36 days over the year. It covers a maximum of a 1 day hospital stay, four times. It will cover exactly one surgical procedure during the year. It doesn’t cover mental health conditions at all.

    And the really big way it means my employer fucks me is that, by offering this complete piece of shit, I can’t qualify for subsidies on the exchange. I will probably be making too much to stay in Minnesota Care by a few thousand dollars. So I’m just fucked.

  6. 6
    Adam L Silverman says:

    So what happens if someone is waiting for the callback from the automated message system that took their number because of high call volume and indicated they would call back this evening to resolve the problem and the healthcare.gov folks don’t actually get to the call back tonight? As you know this question is in regards to the friend I’m trying to shepherd through the process.

    Thanks.

  7. 7
    mclaren says:

    •Before you shop, write down your maximum comfort level of being hit with a mega bill.

    Christ on a minibike. Is Mayhew drunk? Is he high on LSD?

    “Oh, I think I’m okay with paying 11 million dollars for open-heart surgery, but if the bill gets to 27 million, I’m in trouble.”

    Sleep it off, Mayhew. You’ll make sense in the morning.

  8. 8
    Tissue Thin Pseudonym says:

    @mclaren: No. Mayhew understands that policies sold on the exchanges all have an out-of-pocket maximum that cannot exceed $6,850 in 2016 and can have no lifetime maximum. So, the question he is asking is, what is your maximum comfort level of being hit with a megabill that is equal to or less than $6,850, because most people are probably better off taking that higher OOP max and paying less per month in premiums.

    Unfortunately, no matter how much sleep you get, I suspect that you will never make sense.

  9. 9
    Tissue Thin Pseudonym says:

    Fortunately, it looks like open enrollment on MNsure, our exchange, doesn’t close until Jan 31.

  10. 10
    jacy says:

    @mclaren:

    I read that as referring to the deductible you’re willing to pay. I.e., if you have to pay that deductible all at once.

    See, I have a deductible of $850, which is really pretty low, but I still don’t want to pay it all at once, so I’m having surgery on the 23rd, because I want to get it in before my new deductible kicks in — apparently nobody wants to have surgery on Christmas! . So if you have a high deductible, can you cover that all at once? It speaks to the balancing act for each individual of deductible versus premium.

  11. 11
    pseudonymous in nc says:

    @mclaren: boring. Fuck off.

  12. 12
    Richard Mayhew says:

    @Adam L Silverman: they will still be able to complete the application a couple of days after the deadline and start coverage January 1

  13. 13

    @Tissue Thin Pseudonym:

    I would try to get in touch with the MN state department of insurance and double-check. That policy wouldn’t meet California’s minimums, but it may vary from state to state.

  14. 14
    Tissue Thin Pseudonym says:

    @Mnemosyne (tablet): It’s carefully crafted to meet the minimums necessary to avoid the IRS penalty for the company. That’s its only purpose for existence.

  15. 15

    @Tissue Thin Pseudonym:

    IRS minimums may not be state coverage minimums, and if no one else has complained, the state might not be aware of any shenanigans. You can ask anonymously.

  16. 16
    Nick says:

    Why go with temporary stopgap measures? Emigrate to Canada! I did, it’s wonderful (weather aside).

    Edit: Though work like Richard’s here is a wonderful service, I didn’t mean to disparage that.

  17. 17
    Adam L Silverman says:

    @Richard Mayhew: thanks. I already passed the info on to her and told her to get some rack time. I appreciate the guidance you’ve provided.

  18. 18
    Kitty says:

    I am a female, late 50s. Self-employed. Don’t smoke. No health problems. 142% FPL.

    I live in a city where the major hospital system only takes one insurance company.

    When the ACA was launched in 2014 I purchased a Silver Plan with a very reasonable deductible, with my subsidy, the monthly premium was $132.19. When it was time to renew in 2015, that plan was no longer available, but another Silver Plan with a reasonable deductible for $164.65 a month was. I’m on a pretty limited budget, but with some tweaking the $33.00 increase wasn’t a problem. This year, the same plan with subsidy will cost $269.73 per month!

    So, my choices are to figure out how to absorb a $105.00 monthly increase, and continue to see a doctor when I need to. Or switch to a Bronze plan with a $6,000 deductible (and HOPE nothing happens) for $125.00 with my subsidy.

    Back to worrying about the cost of and access to healthcare! It was nice to have 2 years off.

    I finally picked the Bronze plan. I am not happy.

  19. 19
    wasdeaconblues says:

    I have a friend who can’t get her identity verified through the system. She’s a naturalized citizen, Arabic speaking, hard working woman.

    She’s only had one credit card through the years and hasn’t used that in two years or so.

    As a result, the Experian identity verification process kicked us back to the Healthcare.gov phone system for verification Sunday night. Of course, we couldn’t get through.

    Now, she wants to wait until after the December 15th deadline to find a plan on the Exchange.

    We’re in North Carolina. Good idea?

    What about identity verification?

    Thanks very much, Richard, for offering this forum and for the health insurance and refereeing posts.

  20. 20
    Satby says:

    I’m on Medicaid now, but will be moving to Florida to care for my mom in about 6 months. Should I just look for a plan on the exchange now so that I still have coverage when I move?
    Thanks for all the help you provide us all, Richard!

  21. 21

    @wasdeaconblues: I would recommend that your friend get as far as she can go today. Once she hits the point of a rage quit (or ideally 10 minutes before that), walk away from healthcare.gov and get on with the day after a nice cup of tea.

    Healthcare.gov is extremely likely to offer a “waiting in line” extension to people who got a decent portion of their application started but could not finish it for one reason or another. Those people (including your friend) will probably get an extra 3-5 days to finish the process when the servers are not overloaded. They’ll most likely start coverage on 1/1/16

    Your friend’s situation sounds like one of the corner cases where the easy solutions in Healthcare.gov fail and manual intervention is needed. And manual intervention just is not available today or yesterday.

  22. 22

    @Satby: No, don’t look for exchange coverage right now. You are covered, and since you are Medicaid covered, you are not eligible for premium assistance tax credits.

    When you move states, you will trigger a Special Enrollment Period. If you move in May, you can go on Healthcare.gov in May and get coverage that starts June 1.

  23. 23
  24. 24
    Sister Rail Gun of Warm Humanitarianism says:

    @wasdeaconblues: Any chance that she has access to the NC State Employees Credit Union? They have insurance representatives available to help.

    It’s possible other credit unions also have navigators/insurance partners available as a benefit of membership.

  25. 25
    wasdeaconblues says:

    Richard:

    Thanks kindly. I’m not sure she’ll have time to do that today with taking care of her husband and family. I’ll suggest it to her through my wife, though.

    Sister Rail Gun:

    I don’t think she’s a member of a credit union. Good idea though.

  26. 26
    terraformer says:

    Probably a stupid question, but I have the option of HC through my employer. I also signed up to view options via the ACA site to see if it was cheaper (it was close, but the employer’s deal was better in several respects).

    I keep getting warning emails from ACA that I need to sign up or face the monetary penalty – can I assume that since I did sign up for my employer-based plan for my family, that the government will have some means to identify that, and I won’t get charged for not signing up? I only used the ACA to browse after filling in my family information, but didn’t end up using it. TIA

  27. 27

    @terraformer: No worries for you.

    Healthcare.gov is using some heavy “stick” messaging with the mandate penalty going up to $695 or more to get people to enroll. By signing up on HC.Gov, you had identified yourself as a likely target for this message, so you are getting bombarded with it right now.

    When you file your taxes next year, you will see IRS Form 1095-A. This is the form where you declare which months you had qualified coverage (through your employer) in order to avoid the mandate penalty. That is how the Feds will know you have employer coverage.

  28. 28
    eldorado says:

    are native american tribal cardholders still exempt from the deadline?

  29. 29
  30. 30
    Curt says:

    It’s sick that Byron York gets to gloat about shortcomings in the ACA that his ideological comrades have done everything they can to saddle it with, but having just completed my enrollment, I can’t disagree with either of these sentiments:

    The Obama administration is encouraging consumers to shop for a new plan and switch if they can find a better deal. “Financial literacy is important,” said Health and Human Services Secretary Sylvia Burwell, as if everyone is financially literate.

    Beyond that, the administration seems insensitive to the burden of researching, shopping, and switching healthcare plans year after year. “Every year I feel like I’m starting all over again, and I just dread it,” an Oregon woman who is shopping for her third plan in three years told the Times. “My stress level just shoots up.”

    and

    The news came on top of weeks of reports of rising costs for consumers. “Insurers have raised premiums steeply for the most popular plans at the same time they have boosted out-of-pocket costs such as deductibles, copays and coinsurance in many of their offerings,” the Wall Street Journal reported.

    Deductibles and copays, in particular, have shot up so far, so fast, that many Americans feel as if they are paying for a policy but never see any benefit because they have to pay for so much of the costs out of their own pockets.

    “We have insurance, but can’t afford to use it,” one New Jersey man told The New York Times. . . .

    It just costs too much. “Many people who shopped for marketplace coverage but did not choose a plan considered the available options to be unaffordable,” the Johnson Foundation report dryly concludes.

    Despite Richard’s urgings to go with silver plans and his cautions about Ambetter, I couldn’t afford anything with a higher premium than Ambetter’s cheapest bronze. Truth be told, I can’t afford that either, but it will cost me less than this year’s ridiculous mandate penalty. I think I read elsewhere that Ambetter’s gaming of the system is making subsidies lower in their markets, so I’m basically being forced to reward their bad behavior that is screwing me over.

    I know to blame Republicans of course for the things that suck about the ACA, but in my experience they really succeeded in making it pretty sucky.

  31. 31
    PhoenixRising says:

    Longtime listener, first time caller: My state’s insurance commission allowed Anthem/BCBS to keep its Medicaod contracts, group contracts for Fed and state employees but bow out of Exchange.

    We have 2 alternatives on Exchange:
    -Big Scary Health, statewide coverage, tried to kill me when I developed extremely rare disease as an individual member 4 yrs ago. If recurrence, I’d be dealing with their gatekeeping to get to MD Andersen…not attractive.
    -Statewide Co-op, network that covers the same providers as BCBS Medicaid MCO.

    Self-employed, so the past 2 years we’ve estimated income higher than it came in, so that we could buy BCBS Silver on exchange.

    As I read the Statewide Co-op, it has all the same problems (HMO/gatekeeping/no coverage from specialists I might need out of state) as the BCBS Medicaid MCO, but we pay $310/month for those problems. Provider network is a Venn diagram of a circle–no one can afford to not take Medicaid MCO patients here, except if they are also not taking the new co-op’s fee structure.

    Planned to file 2015 taxes in 3 weeks, taking all deductions, which is what we did on ’14 taxes, which bring us to 127% FPL and below the Exchange shopping threshold, into Medicaid coverage. That gives us $3600 to cover anything that isn’t on the formulary, etc.

    Is there anything I’m not seeing here?

  32. 32
    Richard Mayhew says:

    @PhoenixRising: are you in a Medicaid expansion state?

  33. 33
    Richard Mayhew says:

    @Richard Mayhew: #2 310 a month for 94% CSR silver seems very high. Email me bjdick last name . At yahoo

  34. 34
    Chris T. says:

    I have a weird situation.

    My company folded (closed up shop) in Nov, so I can do COBRA (for about $1800/mo, ouch) for 3 months, which spans to end of Jan. I haven’t yet, because of the ability to retroactively sign up.

    According to CoveredCA, I get two months (until beginning of Jan, basically) as a Qualifying Life Event, so I can apparently still enroll after today. A Silver plan with similar coverage to what I had is about $1700/mo.

    Meanwhile it’s very likely I’ll have a new job with employer coverage by mid-Jan at worst. But it’s not guaranteed. Should I sign up for CoveredCA? Or, I can do nothing and am still eligible for COBRA until end of Jan…

  35. 35
    PhoenixRising says:

    @Richard Mayhew: Yes, we are definitely eligible for Medicaid. Used a good faith estimate above our actual taxable in ’14 and ’15 marketplace to get onto Blue coverage, but state provides good benefits close to those offered by the co-op under Medicaid MCO.

    So I don’t think this requires a private consult, but there may be something I’m not seeing. Don’t want to take your time on this night of all nights!

    My sister, who is a provider in a state that hasn’t expanded Medicaid, encouraged us to take it so we can squeal if it turns out to be poor coverage compared to Exchange plans…her experience w/patients on pregnancy-only Medicaid is that they won’t holler about obvious abuses. There’s a political activist angle to this, too.

  36. 36

    @Chris T.: Ooohhh… this is a tough one

    Basically, you’re operating on a different time frame than everyone else on the site. Give it another week to see what the mid-January job looks like. If you are comfortable running quasi-naked as you won’t be paying COBRA unless you get hit by a bus, then sign up for an Exchange policy with a 2/1 start date at the last minute and use COBRA as a default one way option for de facto January coverage. If you are a bit more risk averse, just sign up for coverage on Covered CA this week and cancel the policy as soon as you get coverage at your new job.

  37. 37

    @PhoenixRising: Okay, since you are in a Medicaid expansion state and your income qualifies you for Medicaid expansion, you won’t get Exchange options.

    Now as to what Medicaid Managed Care Organization (MCO) to choose— flip a coin and if one is fucking you over, you can switch MCOs at any time. There have been individuals who have come in and out of Mayhew MCO five times in a month.

    But I am not seeing anything obvious besides the fact that you’ll have an extra 3G in your pocket this year. I would speak with the Medicaid eligiblity office sometime before January 1 to make sure your state does not have any asset tests but you should be able to save/use that new cash flow as you see fit.

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