Life Change/SEP Question

[beachbum2012]

I've called healthcare.gov and I've talked to the HAP rep for ACA plans and have gotten 2 opposite answers to this question, so maybe y'all can help clear it up: If a husband and wife have a family ACA plan now, and the wife is aging into Medicare in July getting her own medsupp + PDP, does the husband have a SEP to choose a different plan thru the marketplace or does he have to stay with the one he's on now and not be able to switch til the fall AEP?

 

[Yagents]

My vote would be it is NOT an SEP or QLE and must stay on current plan

 

[taterpeeler]

OK, going off memory here... I just had this happen.... first, who is primary? if the medicare person is primary there needs to be a new hc.gov app (according to ffm rep.... I tried to submit with a CIC and it went nowhere.)

next, I think this maneuver created an SEP since it was a new application. I guess not an sep since it was a new app.

there you go... new application and new plan

 

[beachbum2012]

Tater, the primary person is the husband, and thus not the one going on Medicare.

 

[taterpeeler]

Just remove the wife via CIC

 

[RayNY]

In that case, the husband does not have a QE, as far as I understand (in agreement with Yagents and Tater). Remove the wife, husband is stuck on that plan.

In the case of soon-to-be medicare eligibles, the first to become eligible should be primary so that when they drop coverage and obtain Medicare, the other has a QE due to no-fault loss of coverage and may re-apply as an indiv. If the first to gain eligibility is the dependent, that QE never happens.

Let's run through all 9 QE's defined by law:
-He has not lost coverage
-He has not gained a dependent
-He has not gained citizenship
-His enrollment wasn't due to error
-The carrier hasn't substantially violated a material provision of the contract
-Not newly eligible/ineligible for APTC/CSR
-Hasn't moved
-Isn't a native american
-Good luck proving "exceptional circumstance" to the exchange/HHS (although, technically, this one may work).

 

[beachbum2012]

Just remove the wife via CIC

Does CIC mean "change in coverage"? I guess I'm not sure exactly what to do.

Should the original application be changed, or is it "Apply for new coverage"? How about "Report a life change"? Or is it easiest just to do a 3-way call with the client and Healthcare.gov to get her removed?

 

[Yagents]

3 way call. Takes an hour. "Change in Circumstance" dept