Loss of Subsidy = Loss of Insurance.

[G.Gordon]

Client after client, documents submitted, re-submitted, call marketplace, "everything is ok".

Then they get the subsidy termination notice which is followed by the premium bill for the entire amount.

Reality is that they can't afford to pay 100% of those premiums. So in reality, the broken system is forcing them to turn off their insurance due to circumstances beyond their control and in disregard to their efforts to comply with demands of the marketplace.

One household lives on only Social Security, don't know why they government sending them $$ can verify that they are sending them $$ every month or why sending in SS 1099's and bank statements showing month by month deposits isn't enough proof, but they sure turned off the subsidy.

Calls to the marketplace result in a fix for August 1, but they have to endure a 100% premium bill for July? They can't, so not paying July will effectively terminate their plan, right?

So tired of the time sink this crap has become.

 

[Tkruger]

Calls to the marketplace result in a fix for August 1, but they have to endure a 100% premium bill for July? They can't, so not paying July will effectively terminate their plan, right?

So tired of the time sink this crap has become.

Nope, remember the 90 day grace window. My suggestion to them would be to take the amount for July and split it into 3 separate payments. Make the monthly payment and then 1/3rd of the July payment each month until it's caught up.

Also, remind them that they will get the money back at the end of the year when they file their taxes due to the over payment in July.

Something else to note....this could become moot between Thursday and Monday. Thus the fix for August won't matter and they will loose coverage anyway.

 

[Yagents]

The best way to solve it is to move them to a NEW carrier if possible and have SEP created. (with no large claims on current policy). Cleans up billing and commission issues.

They are still insured for July with current carrier if they need or want to pay the higher premium. Realistically, they will go uninsured for month of July as they can't afford it.

If rewrite with same carrier, most won't update the paid thru date until all monies received covering all 3 months (or 2mo or 1 mo).

 

[Tkruger]

Question, how would moving them based off moving them from the current carrier issue create an SEP for July 1 coverage?

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Only other suggestion would be to go through the appeals process but that in and of it's self takes 30 days.

 

[G.Gordon]

The best way to solve it is to move them to a NEW carrier if possible and have SEP created. (with no large claims on current policy). Cleans up billing and commission issues.

They are still insured for July with current carrier if they need or want to pay the higher premium. Realistically, they will go uninsured for month of July as they can't afford it.

If rewrite with same carrier, most won't update the paid thru date until all monies received covering all 3 months (or 2mo or 1 mo).

That part has been verified with the carrier. Same carrier, all things carry over. Only other carrier choice is Blue, it would have to be a bronze plan without CSR or a silver at $112/mo per month more than her silver Coventry plan. Really a no-win situation this crappy system has us stuck in.

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Question, how would moving them based off moving them from the current carrier issue create an SEP for July 1 coverage?

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Only other suggestion would be to go through the appeals process but that in and of it's self takes 30 days.

I don't hold a lot of faith in the appeals process.

 

[MedicareAgent]

I have gone through exactly what Gordon is saying, my subsidy was cancelled due to no documents being sent in, (sent them in 4 times by mail, 4 times by upload and 4 times faxed) had an appeal back in March, they didn't receive paperwork, closed appeal, I opened appeal again and it was closed again. I gave up.
Went through all of this last year too and just received my bill of $205.00 for not having coverage last year, hilarious !!

 

[cadylou]

The whole thing is a mess. I'll try to work with the people I have that get subsidies during this next enrollment & see how it goes, but may have to drop all subsidized business after this year. Can't afford the time, and it's very frustrating to have the marketplace in the way & not be able to actually help anyone when they make a mistake (or many mistakes . . .).

I'm not going to take any new subsidized clients going forward - that decision has been made. . . .I feel sorry for the consumers caught in this quagmire . . . .

 

[kgmom219]

The whole thing is a mess. I'll try to work with the people I have that get subsidies during this next enrollment & see how it goes, but may have to drop all subsidized business after this year. Can't afford the time, and it's very frustrating to have the marketplace in the way & not be able to actually help anyone when they make a mistake (or many mistakes . . .).

I'm not going to take any new subsidized clients going forward - that decision has been made. . . .I feel sorry for the consumers caught in this quagmire . . . .

I'm right there with you, but haven't made a decision for 2016 OEP. Trying to figure out how to do it from a practical perspective.

How are you going to handle the referrals?

Joe Smith calls in. You find out he's subsidy eligible after 15 minutes. "I'm sorry. I can't help you. You need to go to hc.gov"?

Send them a Sherpa link and tell them any issues are their problem?

Get the family size and income within the first 5 months and THEN tell them "Sorry, I can't help you" Then the client calls the referral source and the referral source gets mad?

I just can't see how it works from a practical perspective unless you have a person to send the Exchange clients to.

I cannot figure out how to do "no subsidy" business. I can see eliminating individual business, but not subsidy vs non subsidy.

 

[G.Gordon]

Like you, KG, I'd have to refuse all individual health clients or alienate a whole community after just a few "turn away" clients start spreading the word that I'm not doing that any longer. I get so many legacy clients (those that age in, get Medicare due to DI, or have family they refer that are on Medicare) from doing on-ex business it would really hurt my business model to turn them away. As long as I make enough to pay the support staff and turn a profit, I'm game for the frustration. I'm good at educating them, getting them to not expect a Cadi at Kia prices and build great relationships. After that I have a girl (now two) that can fight the battle of keeping them compliant and responsive to requirements after the fact. If it were easy everyone would do it.

 

[FLM2]

I'm right there with you, but haven't made a decision for 2016 OEP. Trying to figure out how to do it from a practical perspective.

How are you going to handle the referrals?

Joe Smith calls in. You find out he's subsidy eligible after 15 minutes. "I'm sorry. I can't help you. You need to go to hc.gov"?

Send them a Sherpa link and tell them any issues are their problem?

Get the family size and income within the first 5 months and THEN tell them "Sorry, I can't help you" Then the client calls the referral source and the referral source gets mad?

I just can't see how it works from a practical perspective unless you have a person to send the Exchange clients to.

I cannot figure out how to do "no subsidy" business. I can see eliminating individual business, but not subsidy vs non subsidy.

Here is the approach I am considering for the next OEP regarding subsidized plans:

I tell the client upfront that my role is to obtain the subsidy, help them choose the best plan, get them enrolled, and then everything else is on them.

I will put together a FAQ of how to deal with things related to the Marketplace but will not offer any other help other than an email response.

I will not make any calls to the Marketplace on their behalf or try to resolve things with carriers, it is far too frustrating. I've already started telling that to my clients who want me to hold their hands and it is working fine.