Filling a short term health insurance coverage gap

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Topic Author
MildlyEccentric
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Filling a short term health insurance coverage gap

Post by MildlyEccentric »

I’m trying to assist my adult son (34 years old) in obtaining health insurance to fill a gap in his coverage. He currently has COBRA coverage and is starting an ACA (Obamacare) policy January 1. The problem is the COBRA policy stops on Dec. 15. I figured since he was losing his insurance, he would qualify for an ACA special enrollment period (SEP) and could get ACA coverage until his new policy started. His online ACA application for coverage was rejected, and a follow up call to a Marketplace representative seemed to confirm that coverage was not possible. The reason given was they wouldn’t cover a short two week period and offered no alternative remedy.

Obviously, he could just go without coverage for two weeks, but I was wondering if there were any other reasonable options for covering this gap.
KlangFool
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Re: Filling a short term health insurance coverage gap

Post by KlangFool »

MildlyEccentric wrote: Mon Nov 16, 2020 11:59 am I’m trying to assist my adult son (34 years old) in obtaining health insurance to fill a gap in his coverage. He currently has COBRA coverage and is starting an ACA (Obamacare) policy January 1. The problem is the COBRA policy stops on Dec. 15. I figured since he was losing his insurance, he would qualify for an ACA special enrollment period (SEP) and could get ACA coverage until his new policy started. His online ACA application for coverage was rejected, and a follow up call to a Marketplace representative seemed to confirm that coverage was not possible. The reason given was they wouldn’t cover a short two week period and offered no alternative remedy.

Obviously, he could just go without coverage for two weeks, but I was wondering if there were any other reasonable options for covering this gap.
MildlyEccentric,

You may want to reverify this first. As far as I know, as per COBRA, the coverage is by the whole month.


KlangFool
mhalley
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Re: Filling a short term health insurance coverage gap

Post by mhalley »

If the plan does indeed end mid month, he could check out a catastrophic or short term plan.
https://www.insure.com/health-insurance ... rance.html
https://www.insure.com/health-insurance/short-term.html
Topic Author
MildlyEccentric
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Re: Filling a short term health insurance coverage gap

Post by MildlyEccentric »

KlangFool wrote: Mon Nov 16, 2020 12:04 pm You may want to reverify this first. As far as I know, as per COBRA, the coverage is by the whole month.
Unfortunately, the COBRA coverage does stop on the 15th. The one compensation is the premium is half of the prior months.
mhalley wrote: Mon Nov 16, 2020 12:14 pm If the plan does indeed end mid month, he could check out a catastrophic or short term plan.
I will look into the short term plans. Hopefully, they will not have similar issues to the Marketplace.
Big Dog
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Re: Filling a short term health insurance coverage gap

Post by Big Dog »

MildlyEccentric wrote: Mon Nov 16, 2020 8:01 pm
KlangFool wrote: Mon Nov 16, 2020 12:04 pm You may want to reverify this first. As far as I know, as per COBRA, the coverage is by the whole month.
Unfortunately, the COBRA coverage does stop on the 15th. The one compensation is the premium is half of the prior months.
mhalley wrote: Mon Nov 16, 2020 12:14 pm If the plan does indeed end mid month, he could check out a catastrophic or short term plan.
I will look into the short term plans. Hopefully, they will not have similar issues to the Marketplace.
What about an appeal to HR to extend COBRA for 2 more weeks (if he pays for it of course)?
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lthenderson
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Re: Filling a short term health insurance coverage gap

Post by lthenderson »

MildlyEccentric wrote: Mon Nov 16, 2020 11:59 am His online ACA application for coverage was rejected, and a follow up call to a Marketplace representative seemed to confirm that coverage was not possible. The reason given was they wouldn’t cover a short two week period and offered no alternative remedy.
The reason you got denied is because you are only wanting a two week policy. You can cancel ACA at any time though you are on the hook for the entire month. I would sign up, pay the first month's premium and then cancel it after two weeks when the other insurance policy is in effect.
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MildlyEccentric
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Re: Filling a short term health insurance coverage gap

Post by MildlyEccentric »

lthenderson wrote: Mon Nov 16, 2020 8:45 pm The reason you got denied is because you are only wanting a two week policy. You can cancel ACA at any time though you are on the hook for the entire month. I would sign up, pay the first month's premium and then cancel it after two weeks when the other insurance policy is in effect.
As part of the ACA special enrollment period application process, you are required to provide the date you lose your COBRA coverage. It's my understanding, that once COBRA starts, you must wait until COBRA ends in order to qualify for a special enrollment, so ending COBRA early was not an option. Other than missrepresenting the end of coverage date, I didn't see a way to request a 12/1 start date. It's likely moot at this point anyway as the Marketplace usually requires an approved application by the 15th to obtain coverage starting the 1st.
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lthenderson
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Re: Filling a short term health insurance coverage gap

Post by lthenderson »

MildlyEccentric wrote: Tue Nov 17, 2020 1:14 pm
lthenderson wrote: Mon Nov 16, 2020 8:45 pm The reason you got denied is because you are only wanting a two week policy. You can cancel ACA at any time though you are on the hook for the entire month. I would sign up, pay the first month's premium and then cancel it after two weeks when the other insurance policy is in effect.
As part of the ACA special enrollment period application process, you are required to provide the date you lose your COBRA coverage. It's my understanding, that once COBRA starts, you must wait until COBRA ends in order to qualify for a special enrollment, so ending COBRA early was not an option. Other than missrepresenting the end of coverage date, I didn't see a way to request a 12/1 start date. It's likely moot at this point anyway as the Marketplace usually requires an approved application by the 15th to obtain coverage starting the 1st.
I misread your initial post and after reading it again, I don't understand why your son signed up for ACA starting Jan 1 if he knew his Cobra coverage was running out on Dec 15th. When you Cobra runs out, that is considered a qualifying event and he should have signed up for an ACA plan starting on Dec 16th and his premiums for the December would be prorated. It seems like he may have shot himself in the foot by deliberately creating a gap in coverage and probably the only way to now get coverage for the gap is to cancel the policy starting Jan 1 and starting the process all over again. To me, there should have been some sort of flag during the application process warning you that there was a gap between Cobra ending and requested start date for ACA.
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MildlyEccentric
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Re: Filling a short term health insurance coverage gap

Post by MildlyEccentric »

lthenderson wrote: Tue Nov 17, 2020 2:05 pm I misread your initial post and after reading it again, I don't understand why your son signed up for ACA starting Jan 1 if he knew his Cobra coverage was running out on Dec 15th. When you Cobra runs out, that is considered a qualifying event and he should have signed up for an ACA plan starting on Dec 16th and his premiums for the December would be prorated. It seems like he may have shot himself in the foot by deliberately creating a gap in coverage and probably the only way to now get coverage for the gap is to cancel the policy starting Jan 1 and starting the process all over again. To me, there should have been some sort of flag during the application process warning you that there was a gap between Cobra ending and requested start date for ACA.
I agree with your sentiment, but I fear your description of ACA plans is how you and I would hope that they work and not how they actually work. Unfortunately, I believe all ACA plans begin and end with the calendar year, so if you want coverage during 2021, you need a 2021 plan. To get coverage during 2020, you need a 2020 plan. So, even if we could have obtained a plan starting on December 1, 2020, we would still need a new plan starting on January 1, 2021. Even more annoying, the plan starting in December 2020 would have the same annual deductible as someone who started coverage in January 2020.
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lthenderson
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Re: Filling a short term health insurance coverage gap

Post by lthenderson »

MildlyEccentric wrote: Wed Nov 18, 2020 12:12 am
lthenderson wrote: Tue Nov 17, 2020 2:05 pm I misread your initial post and after reading it again, I don't understand why your son signed up for ACA starting Jan 1 if he knew his Cobra coverage was running out on Dec 15th. When you Cobra runs out, that is considered a qualifying event and he should have signed up for an ACA plan starting on Dec 16th and his premiums for the December would be prorated. It seems like he may have shot himself in the foot by deliberately creating a gap in coverage and probably the only way to now get coverage for the gap is to cancel the policy starting Jan 1 and starting the process all over again. To me, there should have been some sort of flag during the application process warning you that there was a gap between Cobra ending and requested start date for ACA.
I agree with your sentiment, but I fear your description of ACA plans is how you and I would hope that they work and not how they actually work. Unfortunately, I believe all ACA plans begin and end with the calendar year, so if you want coverage during 2021, you need a 2021 plan. To get coverage during 2020, you need a 2020 plan. So, even if we could have obtained a plan starting on December 1, 2020, we would still need a new plan starting on January 1, 2021. Even more annoying, the plan starting in December 2020 would have the same annual deductible as someone who started coverage in January 2020.
Yeah, I kind of blurred the line by mentally mixing up loss of primary insurance with loss of Cobra. If you wait until Cobra runs out, then normal rules apply which means you wait until the new year. If your son had applied before his primary insurance before Cobra ran out, that counts as the qualifying event and it would take affect at the first of the next month, no matter when that was, and then Cobra could be used to fill the gap.
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MildlyEccentric
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Re: Filling a short term health insurance coverage gap

Post by MildlyEccentric »

mhalley wrote: Mon Nov 16, 2020 12:14 pm If the plan does indeed end mid month, he could check out a catastrophic or short term plan.
I checked into short term plans and ended up submitting an application to one of the short term plan providers. The provider had a 30 day minimum policy, but permits cancellation with a pro rated refund for the unused balance, so, in effect, a 15 day policy. Medical underwriting is required, but I don't anticipate a problem qualifying. Thanks for everyone's suggestions.
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