Author Topic: My ACA doesn't start coverage immediately after my Cobra ends  (Read 1466 times)

WantToRelax

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My Cobra coverage ends in the middle of next month.  So a few days ago, I applied for ACA, and selected a health plan and dental plan for my family.  After I clicked the Submit button on the website, it showed me that my health and dental plans coverage starts on 7/1/2022.  So essentially, my family will have no insurance coverage for 1/2 month. I was under the impression that my ACA plans will start on 6/1 or at least right after my Cobra ends, as listed in their FAQ: https://www.wahealthplanfinder.org/us/en/faqs.html:

     "I lost my COBRA coverage. Is there anything I can do?

     Apply for a special enrollment period. Loss of COBRA can qualify you to sign up outside open enrollment. Your coverage starts the first of the month after you enroll
."


I can't imagine the health exchange knowingly leaves people with gap in people's insurance coverage. There should be many people who have their prior insurance ends in the middle of a month.

I'm pretty stressed about it. Does anyone know if this is a common ACA practice? I'm in Washington state.

secondcor521

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #1 on: May 12, 2022, 03:48:43 PM »
That's a bit strange.  There is a generic ACA rule of thumb that you have to apply for coverage before the middle of the month prior in order to have it effective the first of the following month.  But in your case you applied around 5/9, which seems like it would be soon enough to start 6/1.

Suggestions:

1.  Call the WA state exchange, explain the situation, and see if they can get it to start 6/1.

2.  Go bare for half a month and just be super careful.  I know most people don't like this idea, but I include it for sake of completeness.

3.  Go buy a short term policy that will cover your family from ~6/15 to 7/1.  You can probably get something like this directly from an insurance company...short term policies don't have to be bought through the exchange and don't have to be ACA-compliant, but for 2 weeks you probably don't care.

jim555

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #2 on: May 12, 2022, 03:49:24 PM »
It always goes by whole months.  Did you elect COBRA?  Are you free riding the grace period?  You have 45 days to decide if you want COBRA, so it is basically a free ride if nothing happens don't elect it.

secondcor521

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #3 on: May 12, 2022, 04:07:53 PM »
It always goes by whole months.  Did you elect COBRA?  Are you free riding the grace period?  You have 45 days to decide if you want COBRA, so it is basically a free ride if nothing happens don't elect it.

It sounded to me like OP elected COBRA and has been on it for the 18 months or whatever already.  So the grace period / free ride idea won't work if that's the case.

lhamo

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #4 on: May 12, 2022, 04:38:28 PM »
Call a healthcare navigator if you are in Seattle I recommend Jennifer Steeves at Neighborcare health lake city branch. She does phone appointments and is my go to person for anything related to the exchange.

WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #5 on: May 12, 2022, 05:38:43 PM »
That's a bit strange.  There is a generic ACA rule of thumb that you have to apply for coverage before the middle of the month prior in order to have it effective the first of the following month.  But in your case you applied around 5/9, which seems like it would be soon enough to start 6/1.

Suggestions:

1.  Call the WA state exchange, explain the situation, and see if they can get it to start 6/1.


I had a 3-way call with my insurance provider and the WA state exchange a couple days ago. I felt that the exchange person was trying to blow me off. She said that 7/1 is the correct date. When I explained that I will have a gap in insurance coverage, she said "yes, you'll have a gap!".  After a bit more of talking back and forth, she opened a ticket and said they will process the ticket and have an outcome in 8 to 10 business days. That's a long time to wait. I called again yesterday to check on the status and this time a different representative told me she is not allowed to even tell me if the ticket is being worked on. She just told me to wait.

2.  Go bare for half a month and just be super careful.  I know most people don't like this idea, but I include it for sake of completeness.

Unfortunately, I have a family member that needs ongoing medical help on a daily basis.

3.  Go buy a short term policy that will cover your family from ~6/15 to 7/1.  You can probably get something like this directly from an insurance company...short term policies don't have to be bought through the exchange and don't have to be ACA-compliant, but for 2 weeks you probably don't care.

We have pre-existing conditions. I think insurance companies won't offer policies directly to us, right?

WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #6 on: May 12, 2022, 05:40:55 PM »
It always goes by whole months.  Did you elect COBRA?  Are you free riding the grace period?  You have 45 days to decide if you want COBRA, so it is basically a free ride if nothing happens don't elect it.

It sounded to me like OP elected COBRA and has been on it for the 18 months or whatever already.  So the grace period / free ride idea won't work if that's the case.

Yes, I've been using Cobra and am using it until it expires mid June.

WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #7 on: May 12, 2022, 05:41:52 PM »
Call a healthcare navigator if you are in Seattle I recommend Jennifer Steeves at Neighborcare health lake city branch. She does phone appointments and is my go to person for anything related to the exchange.

Thanks you, lhamo. I'll give her a call.

secondcor521

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #8 on: May 12, 2022, 06:12:56 PM »
3.  Go buy a short term policy that will cover your family from ~6/15 to 7/1.  You can probably get something like this directly from an insurance company...short term policies don't have to be bought through the exchange and don't have to be ACA-compliant, but for 2 weeks you probably don't care.

We have pre-existing conditions. I think insurance companies won't offer policies directly to us, right?

I'm not sure.  They will offer short term policies directly to individuals, but I don't know if the preexisting conditions matter in this kind of situation.  In your case it's probably worth a phone call since the exchange folks are giving you the runaround.

I'd endorse @lhamo's advice to call a navigator.  She is in WA (I think) and knows more about it than I do because I'm in ID.

lhamo

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #9 on: May 13, 2022, 10:10:12 AM »
Call a healthcare navigator if you are in Seattle I recommend Jennifer Steeves at Neighborcare health lake city branch. She does phone appointments and is my go to person for anything related to the exchange.

Thanks you, lhamo. I'll give her a call.

FYI the last time i spoke with her she wasn't showing up on the staff list but you should be able to make an appointment with her by calling the central line,

Sandi_k

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #10 on: May 13, 2022, 10:25:47 AM »
ACA-compliant plans are not allowed to deny you based on pre-existing conditions. That's one reason why it's such a Big Deal to keep it.

WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #11 on: May 13, 2022, 11:31:29 AM »
ACA-compliant plans are not allowed to deny you based on pre-existing conditions. That's one reason why it's such a Big Deal to keep it.

Are ACA-compliant plans available outside the health exchange?  If anyone can buy these plans, what is the need of the health exchange? A genuine question.

secondcor521

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #12 on: May 13, 2022, 11:46:39 AM »
ACA-compliant plans are not allowed to deny you based on pre-existing conditions. That's one reason why it's such a Big Deal to keep it.

Are ACA-compliant plans available outside the health exchange?  If anyone can buy these plans, what is the need of the health exchange? A genuine question.

I know that one will not receive ACA subsidies for any plan bought off the exchange.  That is one major reason for the exchanges' existence.

I also know that when ACA was being passed, some reasons given for having an exchange were that it was a central place for people to buy plans with minimum guaranteed features, and to shop and purchase a plan easily.

In theory one could buy an ACA-compliant plan outside the exchange, but in practice I doubt that happens.  If an insurer wanted to offer an ACA-compliant plan they'd get many more eyeballs for not much more effort by putting the plan on the exchange.


WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #13 on: May 13, 2022, 04:43:39 PM »
I spoke to Jennifer today. She said 7/1 is the correct date since health insurance coverage always starts on the first of a month, and the new coverage cannot start on 6/1 because I have COBRA until mid June.  She's going to look into something to see if she can change the start date to 6/1 but the chance is super low.  I'm going to pay for the medical services for the 2nd half of June out of pocket. This is really unexpected.  The WA health exchange website should state clearly all these rules regarding dates.

I'm grateful for Jennifer's and this forum's help. Jennifer is very knowledgeable.

jim555

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #14 on: May 13, 2022, 07:54:04 PM »
If your income is low enough in June Medicaid can be retroactive up to 90 days, that may be a way to give you cover for the gap.

WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #15 on: May 13, 2022, 08:14:29 PM »
If your income is low enough in June Medicaid can be retroactive up to 90 days, that may be a way to give you cover for the gap.

So far this year I haven't produced any income yet. My plan is to sell stocks at year end to capture capital gains.  The capital gains will exceed the Medicaid income limit.  My understanding is that if I'm qualified for ACA, then I'm not qualified for Medicaid.  Can I get Medicaid for 2 weeks in mid June and then use ACA starting July 1st?

jim555

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #16 on: May 13, 2022, 08:20:07 PM »
If your income is low enough in June Medicaid can be retroactive up to 90 days, that may be a way to give you cover for the gap.

So far this year I haven't produced any income yet. My plan is to sell stocks at year end to capture capital gains.  The capital gains will exceed the Medicaid income limit.  My understanding is that if I'm qualified for ACA, then I'm not qualified for Medicaid.  Can I get Medicaid for 2 weeks in mid June and then use ACA starting July 1st?
Unlike regular ACA plans with subsidies Medicaid goes by current month income, not calendar year income.  Also we are currently in a public health emergency so once you are in you stay in until the PHE is over.  It expires in July, and gets renewed in 90 day blocks, so maybe until October if they renew it again.  Medicaid has no open enrollment period, it is always open.
« Last Edit: May 13, 2022, 08:39:14 PM by jim555 »

secondcor521

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #17 on: May 13, 2022, 10:06:46 PM »
If your income is low enough in June Medicaid can be retroactive up to 90 days, that may be a way to give you cover for the gap.

So far this year I haven't produced any income yet. My plan is to sell stocks at year end to capture capital gains.  The capital gains will exceed the Medicaid income limit.  My understanding is that if I'm qualified for ACA, then I'm not qualified for Medicaid.  Can I get Medicaid for 2 weeks in mid June and then use ACA starting July 1st?
Unlike regular ACA plans with subsidies Medicaid goes by current month income, not calendar year income.  Also we are currently in a public health emergency so once you are in you stay in until the PHE is over.  It expires in July, and gets renewed in 90 day blocks, so maybe until October if they renew it again.  Medicaid has no open enrollment period, it is always open.

Right, but Medicaid also starts on the first of the month, and having COBRA might be disqualifying.  So I think the answer to the above question is "No".  But worth checking into as a possibility.

jim555

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #18 on: May 14, 2022, 12:13:54 AM »
Right, but Medicaid also starts on the first of the month, and having COBRA might be disqualifying.  So I think the answer to the above question is "No".  But worth checking into as a possibility.

https://www.healthcare.gov/unemployed/cobra-coverage/

At the bottom of the page...
"Can I switch from COBRA to Medicaid outside Open Enrollment?

    You can apply for and enroll in Medicaid any time. If you qualify, you can drop your COBRA coverage early."

secondcor521

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #19 on: May 14, 2022, 09:32:51 AM »
Right, but Medicaid also starts on the first of the month, and having COBRA might be disqualifying.  So I think the answer to the above question is "No".  But worth checking into as a possibility.

https://www.healthcare.gov/unemployed/cobra-coverage/

At the bottom of the page...
"Can I switch from COBRA to Medicaid outside Open Enrollment?

    You can apply for and enroll in Medicaid any time. If you qualify, you can drop your COBRA coverage early."

Cool, thanks!  TIL.

BlueMR2

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #20 on: May 15, 2022, 01:51:28 PM »
ACA-compliant plans are not allowed to deny you based on pre-existing conditions. That's one reason why it's such a Big Deal to keep it.

Are ACA-compliant plans available outside the health exchange?  If anyone can buy these plans, what is the need of the health exchange? A genuine question.

At least in my state they are not.  The only way to get ACA (or actual "health insurance") is through the exchange.  There are short term "emergency insurance" policies that can be purchased online and active same or next day, but they aren't even allowed to call themselves "health insurance" and they are not allowed to cover routine items.  They truly are disaster only policies to tide one over for a few days between losing other coverage and being able to activate ACA.

Curious to hear if this is standard or just my particular state...

ltt

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #21 on: May 19, 2022, 04:59:28 AM »
That's a bit strange.  There is a generic ACA rule of thumb that you have to apply for coverage before the middle of the month prior in order to have it effective the first of the following month.  But in your case you applied around 5/9, which seems like it would be soon enough to start 6/1.

Suggestions:

1.  Call the WA state exchange, explain the situation, and see if they can get it to start 6/1.


I had a 3-way call with my insurance provider and the WA state exchange a couple days ago. I felt that the exchange person was trying to blow me off. She said that 7/1 is the correct date. When I explained that I will have a gap in insurance coverage, she said "yes, you'll have a gap!".  After a bit more of talking back and forth, she opened a ticket and said they will process the ticket and have an outcome in 8 to 10 business days. That's a long time to wait. I called again yesterday to check on the status and this time a different representative told me she is not allowed to even tell me if the ticket is being worked on. She just told me to wait.

2.  Go bare for half a month and just be super careful.  I know most people don't like this idea, but I include it for sake of completeness.

Unfortunately, I have a family member that needs ongoing medical help on a daily basis.

3.  Go buy a short term policy that will cover your family from ~6/15 to 7/1.  You can probably get something like this directly from an insurance company...short term policies don't have to be bought through the exchange and don't have to be ACA-compliant, but for 2 weeks you probably don't care.

We have pre-existing conditions. I think insurance companies won't offer policies directly to us, right?

You mentioned that you have a family member that needs daily on-going medical help.  Are they disabled?  If so, you would have the right to extend your COBRA coverage if the disability happened prior to or during the first 60 days of COBRA coverage, but I believe you would have had to let your COBRA administrator know (my understanding).

« Last Edit: May 19, 2022, 05:08:25 AM by ltt »

WantToRelax

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Re: My ACA doesn't start coverage immediately after my Cobra ends
« Reply #22 on: May 19, 2022, 06:26:59 PM »
That's a bit strange.  There is a generic ACA rule of thumb that you have to apply for coverage before the middle of the month prior in order to have it effective the first of the following month.  But in your case you applied around 5/9, which seems like it would be soon enough to start 6/1.

Suggestions:

1.  Call the WA state exchange, explain the situation, and see if they can get it to start 6/1.


I had a 3-way call with my insurance provider and the WA state exchange a couple days ago. I felt that the exchange person was trying to blow me off. She said that 7/1 is the correct date. When I explained that I will have a gap in insurance coverage, she said "yes, you'll have a gap!".  After a bit more of talking back and forth, she opened a ticket and said they will process the ticket and have an outcome in 8 to 10 business days. That's a long time to wait. I called again yesterday to check on the status and this time a different representative told me she is not allowed to even tell me if the ticket is being worked on. She just told me to wait.

2.  Go bare for half a month and just be super careful.  I know most people don't like this idea, but I include it for sake of completeness.

Unfortunately, I have a family member that needs ongoing medical help on a daily basis.

3.  Go buy a short term policy that will cover your family from ~6/15 to 7/1.  You can probably get something like this directly from an insurance company...short term policies don't have to be bought through the exchange and don't have to be ACA-compliant, but for 2 weeks you probably don't care.

We have pre-existing conditions. I think insurance companies won't offer policies directly to us, right?

You mentioned that you have a family member that needs daily on-going medical help.  Are they disabled?  If so, you would have the right to extend your COBRA coverage if the disability happened prior to or during the first 60 days of COBRA coverage, but I believe you would have had to let your COBRA administrator know (my understanding).

I actually went to the social security office to ask about this. I actually got the form, filled them out but I'm hesitating to submit it.  I'm the family member that needs medical help. Other than daily at-home dialysis, I'm pretty healthy. People cannot tell I'm sick from just looking at me. I play sports and eat normally. So I am not disabled in the traditional sense, could work if I choose to. I don't know if I would get into trouble by applying for disability for the purpose of extending COBRA.  Social Security Administration(SSA) actually has a PDF https://www.ssa.gov/pubs/EN-64-107.pdf that says:

"A request for a disability determination to extend COBRA coverage is not an application for disability benefits, but a determination made by Social Security for COBRA extended coverage only"

The lady at the SSA said the process for applying for disability to extend COBRA vs to get monetary benefits are the same.

I'll probably apply for Medicaid on June 1st so I could get coverage in June.