Sep Question
- Thread starter kstein
- Start date
- 1,304
If there was an account and coverage prior there may have been a shot. It's been our experience that having no coverage and having a change of income doesn't guarantee an SEP.
Despite going through the qualifiers via HC.gov and answering the questions including a change of income where the site states you may qualifiy, we've found that it doesn't.
If someone has figured out a work around on this we'd love to know.
Despite going through the qualifiers via HC.gov and answering the questions including a change of income where the site states you may qualifiy, we've found that it doesn't.
If someone has figured out a work around on this we'd love to know.
- 5,056
$0 income from 1-1 to now, and its going to earn $13k from Sept to Dec 31st? Not likely, but ok. Mb u meant will earn 13k next year?
- Thread starter
- #4
- 213
It sounds like getting denied for medicaid is a qualifier according to the exchange, however it sounds like he would qualify and not be denied.
I believe I read somewhere a new s.e p reason was created a few months ago for people in non Medicaid expanded states, that allows s.e.p if income was too low initially, but then gets a job, and expects above 100% f.p.l
Whether healthcare.gov software allows for it, is a different story
Whether healthcare.gov software allows for it, is a different story
My interpretation based on what I read was that the SEP would only go into effect for people who had actually attempted to purchase coverage through the exchange during annual enrollment (and were then given an exemption due to low income). So, if you never applied or set up an account in the first place, they weren't going to let you use that SEP in the event you did get your income up.
I remember that now too
- 213
We recently observed the marketplace process an application based on Medicaid denial since Nov 2014. I'm not convinced they are interpreting the law correctly, but if this is correct and consistently works then theoretically a prospect making too much for Medicaid could apply, get declined, and get an SEP anytime they want.
It reminds more greatly of getting folks denial letters so they could go on PCIP back in the day.
It reminds more greatly of getting folks denial letters so they could go on PCIP back in the day.
Apply with whom? In TN, you are directed to the marketplace to my knowledge for your initial application. It may be possible to apply in person I suppose, but I don't deal with that so I wouldn't know. If you make too much, your application is never sent to the state medicaid office from healthcare.gov, there is no record of a medicaid (TNcare) denial.
Saying that you have been denied when medicaid never got an application from you is playing with fire.
Now, I have had people whose determination letter stated that they were most likely eligible for medicaid/TNcare (so they couldn't purchase from exchange at that time), then later receive a letter denying medicaid/TNcare. In that case, they could truthfully answer they had been denied Medicaid and get the SEP for marketplace coverage.
Saying that you have been denied when medicaid never got an application from you is playing with fire.
Now, I have had people whose determination letter stated that they were most likely eligible for medicaid/TNcare (so they couldn't purchase from exchange at that time), then later receive a letter denying medicaid/TNcare. In that case, they could truthfully answer they had been denied Medicaid and get the SEP for marketplace coverage.
