Some readers want to figure out how to become eligible for coverage on the health insurance marketplaces, while others want to figure out how to avoid it. This week I answered questions from both.
I am covered by my employer’s health plan, but I’m not happy with it. My son is 21 and currently covered under my plan. While I realize that I am not eligible for Obamacare, I am curious if I can terminate my son’s policy so that he might be eligible.
Since the open enrollment period to sign up for coverage on the state marketplaces ended Feb. 15, in general people can’t enroll in a marketplace plan until next year’s open enrollment period rolls around.
If you drop your son from your employer plan, however, his loss of coverage could trigger a special enrollment period that allows him to sign up for a marketplace plan. Whether he’s entitled to a special enrollment period depends on whether his loss of coverage is considered voluntary, say officials at the Centers for Medicare & Medicaid Services. In general, voluntarily dropping employer-sponsored coverage doesn’t trigger a special enrollment period for individuals or their family members. But if you drop your son’s coverage on his behalf without his consent, his loss of coverage wouldn’t be considered voluntary and your son could qualify, according to CMS.
Whether he’ll be eligible for premium tax credits to make marketplace coverage more affordable is another matter, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.
If you claim him as your dependent, he generally won’t be eligible. If you don’t claim him as your dependent, he would have to qualify for subsidies based on his own income.
I received a notice from the Pennsylvania Children’s Health Insurance Program that says they are eliminating CHIP coverage for participants who pay full-cost CHIP because it isn’t compliant with the Affordable Care Act. They are forcing us onto the marketplace where the premiums are higher and our deductibles are higher. I believe the state is using the ACA to dismantle its CHIP plan. What can we do?
You should be able to keep your full-cost CHIP coverage after all because state and federal officials reached an agreement on the issue, say consumer advocates in Pennsylvania.
CHIP offers coverage to children in families that earn too much to qualify for Medicaid, the joint federal-state health program for low-income people. But in six states – including Pennsylvania – the program allows families that earn too much to qualify for CHIP under its guidelines to enroll their kids if they pay the full cost of coverage.
The federal government, however, determined that, among other things, the CHIP buy-in program didn’t comply with the health law because plans had annual limits on certain types of coverage, such as behavioral health and physical therapy, that aren’t allowed, says Ann Bacharach, special projects director at the Pennsylvania Health Law Project. That meant that the families of roughly 3,600 kids in the program would face penalties because the kids wouldn’t be considered to have “minimum essential coverage.”
But after notifying families that the full-cost CHIP coverage was ending, Pennsylvania Gov. Tom Wolf this month announced that his administration had reached an agreement with the federal government so that coverage could continue without penalties. Insurers, meanwhile, will work over the coming months to bring the plans into compliance with the health law.
I recently had a disability hearing that went well. If I receive Medicare later in the year, will I be able to terminate my state marketplace plan?
In general, Medicare coverage doesn’t begin until two years after someone is approved for and begins receiving payments for Social Security Disability Insurance.
Once your Medicare coverage starts, it probably makes financial sense to drop your marketplace plan, says Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)
“Individuals covered by Medicare are not eligible for marketplace subsidies,” Neuman says.
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