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So I helped enroll a husband and wife in an ACA plan effective April 1st. He's in his mid-50's, she's turns 65 next month. They were on his COBRA but were paying over $1,100/mo. in premiums. He recently hurt his back bad enough to where he's had surgery and can no longer work. He had a manual labor job. His short-term disability ended in January of this year, and his initial request to get SSD has been denied. At this point, they've started working with a law firm to hopefully get their disability case accepted. If it is, they say they're get SSD income retroactively to when their short-term disability ended (January 2014).
When we filled out the app thru the Exchange, we put in their estimated income for this year assuming he was going to get SSD. So their only incomes would be their 2 Social Security income payments which would total ~$30k for the year. This gave them a decent subsidy, but over the amount to qualify for Medicaid.
Fast forward to today, I do a 3-way call with the wife and healthcare.gov to notify them of a "life change" that she needs to drop off the plan at the end of the month since she's starting Medicare on 6/1. They haven't gotten any updates from the law firm regarding his SSD, so their only 2014 income has been her small SS income. As we talk to the rep, she asks the wife about her income, she tells her the small amount, then the rep checks her status and says his app has been sent to Medicaid and he no longer will have coverage thru his ACA plan. I would imagine though that he'll at least have coverage thru the end of May since they've already paid their premiums, but I'm not positive.
The ACA rep says it'll probably take a month for Medicaid to make their determination. So here are some of my questions:
- Does this mean he won't have any health insurance starting June 1st (possibly even as of today) until they do? He has a doctor appointment June 9th and doesn't know if he'll have any coverage then.
- If he's temporarily without insurance, what are his options? COBRA said he couldn't go back on. How about a short-term non-ACA major medical plan?
- Could Medicaid turn him down? If they do (for whatever reason), would he still be eligible for a subsidy for an ACA plan?
- Anyone have experience with legal action to get their SSD benefits after being declined? Just wondered about the success rate.
- Could they possibly be made to pay back the subsidy they've gotten for April and May if they don't end up with the SSD income because the income we input in the original ends up not to be accurate?
So the immediate need is to make sure he doesn't go without coverage since he's going thru some health issues. But in general I'd appreciate any guidance or advice you could give on his best course of action, or what to expect next.
When we filled out the app thru the Exchange, we put in their estimated income for this year assuming he was going to get SSD. So their only incomes would be their 2 Social Security income payments which would total ~$30k for the year. This gave them a decent subsidy, but over the amount to qualify for Medicaid.
Fast forward to today, I do a 3-way call with the wife and healthcare.gov to notify them of a "life change" that she needs to drop off the plan at the end of the month since she's starting Medicare on 6/1. They haven't gotten any updates from the law firm regarding his SSD, so their only 2014 income has been her small SS income. As we talk to the rep, she asks the wife about her income, she tells her the small amount, then the rep checks her status and says his app has been sent to Medicaid and he no longer will have coverage thru his ACA plan. I would imagine though that he'll at least have coverage thru the end of May since they've already paid their premiums, but I'm not positive.
The ACA rep says it'll probably take a month for Medicaid to make their determination. So here are some of my questions:
- Does this mean he won't have any health insurance starting June 1st (possibly even as of today) until they do? He has a doctor appointment June 9th and doesn't know if he'll have any coverage then.
- If he's temporarily without insurance, what are his options? COBRA said he couldn't go back on. How about a short-term non-ACA major medical plan?
- Could Medicaid turn him down? If they do (for whatever reason), would he still be eligible for a subsidy for an ACA plan?
- Anyone have experience with legal action to get their SSD benefits after being declined? Just wondered about the success rate.
- Could they possibly be made to pay back the subsidy they've gotten for April and May if they don't end up with the SSD income because the income we input in the original ends up not to be accurate?
So the immediate need is to make sure he doesn't go without coverage since he's going thru some health issues. But in general I'd appreciate any guidance or advice you could give on his best course of action, or what to expect next.