ACA - end of year move to another state, kids in college elsewhere

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Bruce T
Posts: 72
Joined: Wed Mar 28, 2018 8:34 pm

ACA - end of year move to another state, kids in college elsewhere

Post by Bruce T » Fri Nov 01, 2019 1:39 pm

Hi All,
DW and I (both in 55-60 YO range) have FIREd and are moving from Indiana to NC in mid-December, I am looking for guidance or resources that would help sort out ACA-related health insurance coverage. The salient factors include:
1. DW, 2 sons and I are all on an Indiana ACA policy (AMS/Ambetter) now, $1850/month prior to premium tax credits (more on that later).
2. Son #1 (21) is at college in Indiana
3. Son #2 (19) is at college in Kentucky, but close enough to be able to get Indiana in network coverage
4. Move is to Asheville NC area approx 15 Dec., 2019
5. ACA premiums in Asheville (for whole family) are $35K+/year with Blue Cross/Blue Shield of NC (which appears to have a bit wider network coverage, including outside of NC, if I properly understand). I think individual policies for the kids in other states would be a net savings.
6. Will probably qualify for premium tax credits in both 2019 and 2020 and beyond (thank goodness).

Questions:
1. Since the move is late in the year, should we use a special enrollment period after the move, or standard enrollment period (using NC as the 2020 location and carrying the ~2 week risk on Indiana vs. NC location) or other?
2. Given that the kids are now at some distance from us and still need coverage, should we get individual ACA policies for each of them in our geography, or in their respective geographies, or get high deductible non-ACA policy, or other? (the colleges they attend do not offer student health insurance excepting to grad students, which they are not).
3. Kids are dependents, I assume that the fact that they will be domiciled in another state from us (or perhaps not, if their permanent address remains at our location??) would not impact on consideration for family size vs. ACA premium tax credit eligibility/level determination? (i.e. does where your kids live affect "avoiding the cliff?".)
4. Any other factors/considerations come to mind in sorting this out?
5. Any on-line resources to recommend to help sort this out?
6. 2019 tax year will be our first on ACA plan, I have not filed for premium tax credits previously, but ought to qualify in 2019 ... so some of these questions are out of ignorance on the filing process... we have just been paying full freight on the premiums - question: what is the mechanism to get premium tax credit factored into insurance company's billing process and billed amout?

Thanks in advance!
Bruce T

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MP123
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Re: ACA - end of year move to another state, kids in college elsewhere

Post by MP123 » Fri Nov 01, 2019 7:13 pm

1. The plan you sign up for by December 15th starts on Jan 1. So as I understand your plans you could do it during the regular enrollment period and keep your current coverage through the end of the year. You could also do it as a special enrollment but check the policy start and end dates, and the lag time to get the new policy active. It might be simplest to just use the regular enrollment considering the time frame.

2. The big question is whether your kids would be covered in network while living in another state. I would assume not unless you verify that specifically, some plans may but many won't except for emergency care. It may be best to get them their own plans. Will they be living with you when not in school? Would they come there for regular type Dr. visits?

3. Not sure.

4. Depending on the state the kids might end up on Medicaid rather than an ACA plan if you try to get them their own plan and their income is low.

5. Not sure.

6. Be sure to get the policy through Healthcare.gov or your new states exchange. Don't go directly to the company if you expect to qualify for a subsidy.

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teen persuasion
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Re: ACA - end of year move to another state, kids in college elsewhere

Post by teen persuasion » Fri Nov 01, 2019 8:20 pm

Work with a health navigator, they know the ins and outs of this stuff.

Are all of the states using the federal website? My state has its own, so I cannot use the federal website, making comparisons difficult.

Students living at college are considered as living at home, even if they are only physically at home a few weeks a year. Even if they are not your dependents, they can be on your family plan until age 26 (and thus be eligible for their own family HSA contribution as non-dependents), but it's complicated. We never did figure out how to connect DS2 with our coverage, for the few months DH was between jobs. Which brings me back to - work with a health navigator! My library has one scheduled for several sessions in the next few weeks. Patrons can make appointments or drop in (with photo id and pay stubs.

marcopolo
Posts: 2913
Joined: Sat Dec 03, 2016 10:22 am

Re: ACA - end of year move to another state, kids in college elsewhere

Post by marcopolo » Fri Nov 01, 2019 8:21 pm

Bruce T wrote:
Fri Nov 01, 2019 1:39 pm
Hi All,
DW and I (both in 55-60 YO range) have FIREd and are moving from Indiana to NC in mid-December, I am looking for guidance or resources that would help sort out ACA-related health insurance coverage. The salient factors include:
1. DW, 2 sons and I are all on an Indiana ACA policy (AMS/Ambetter) now, $1850/month prior to premium tax credits (more on that later).
2. Son #1 (21) is at college in Indiana
3. Son #2 (19) is at college in Kentucky, but close enough to be able to get Indiana in network coverage
4. Move is to Asheville NC area approx 15 Dec., 2019
5. ACA premiums in Asheville (for whole family) are $35K+/year with Blue Cross/Blue Shield of NC (which appears to have a bit wider network coverage, including outside of NC, if I properly understand). I think individual policies for the kids in other states would be a net savings.
6. Will probably qualify for premium tax credits in both 2019 and 2020 and beyond (thank goodness).

Questions:
1. Since the move is late in the year, should we use a special enrollment period after the move, or standard enrollment period (using NC as the 2020 location and carrying the ~2 week risk on Indiana vs. NC location) or other?
2. Given that the kids are now at some distance from us and still need coverage, should we get individual ACA policies for each of them in our geography, or in their respective geographies, or get high deductible non-ACA policy, or other? (the colleges they attend do not offer student health insurance excepting to grad students, which they are not).
3. Kids are dependents, I assume that the fact that they will be domiciled in another state from us (or perhaps not, if their permanent address remains at our location??) would not impact on consideration for family size vs. ACA premium tax credit eligibility/level determination? (i.e. does where your kids live affect "avoiding the cliff?".)
4. Any other factors/considerations come to mind in sorting this out?
5. Any on-line resources to recommend to help sort this out?
6. 2019 tax year will be our first on ACA plan, I have not filed for premium tax credits previously, but ought to qualify in 2019 ... so some of these questions are out of ignorance on the filing process... we have just been paying full freight on the premiums - question: what is the mechanism to get premium tax credit factored into insurance company's billing process and billed amout?

Thanks in advance!
Bruce T

We are on ACA health insurance, moved to a different state that our college student child earlier this year, my answers are based on my experience with that so far.

1) I would recommend you try to time your move a little before the 15, if possible. Technically, you can't apply for insurance in NC until you move there. By ACA rules, if you get your application completed before the 15th of the month, your insurance takes effect the 1st of the next month. If you apply after the 15th of the month, the insurance does not take effect until the 1st of the month after next. So, a Dec 17th application would not start your insurance in that state until Feb 1st. Also Dec 15th is deadline for open enrollment, easier to apply then instead of having to use special enrollment after that date.

2) This really depends on what is available in your new state/county. If you can find a policy that will provide in-network coverage in the area where your kids go to school that is probably the best option. With individual policies, you will have separate deductibles, which can end up costing quite a bit. We found that the local BCBS plan provided access to BlueCard which the BCBS nationwide network of providers. You usually have to get a PPO or indemnity plan instead of an HMO to get in-network coverage in far away states.

3) Mo as long as they are your tax dependents, then all your income gets lumped together as family income for qualifying for subsidy

4) If managing your income to get subsidies, don't forget that any income you kids get from summer/part time jobs, investments, etc. gets added into your family income when computing eligibility for subsidies. This can be substantial when kids are doing internships/co-ops.

5) Healthcare.gov is the definitive source of information. HealthSherpa also has some useful information

6) I am a bit confused about this. Where did you get your ACA plan for 2019? Indiana uses the federal exchange. When you fill out an application you are required to estimate your income for the coming year. This automatically set your subsidy level which is paid directly to the insurance company you choose. You get billed for the difference. Any discrepancy between your estimated income and actual income for the year is reconciled when you file your taxes. There is a way to tell them that you do not wish to receive the subsidy in advance like this, but you really have to go out of your way to do that. In any case, if you really did get your ACA plan on the Federal exchange, any subsidy you are entitled to will be sorted out on your taxes
Once in a while you get shown the light, in the strangest of places if you look at it right.

Katietsu
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Joined: Sun Sep 22, 2013 1:48 am

Re: ACA - end of year move to another state, kids in college elsewhere

Post by Katietsu » Sat Nov 02, 2019 8:22 am

4) If managing your income to get subsidies, don't forget that any income you kids get from summer/part time jobs, investments, etc. gets added into your family income when computing eligibility for subsidies. This can be substantial when kids are doing internships/co-ops.


I have not dealt with this since the 2018 tax law change so have not looked to see how this works now. But, I think the kid’s income only gets added if they have enough income such that they are required to file their own return. Note that a filing requirement is different than choosing to file just to get a refund.

donall
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Joined: Tue Mar 13, 2012 6:45 am

Re: ACA - end of year move to another state, kids in college elsewhere

Post by donall » Sat Nov 02, 2019 9:26 am

For ACA marketplace insurance you should always use all members of your family that are eligible, as your premium will be lower. Because your kids are dependents, then they should be on the ACA application. But kids can get individual policies outside of the ACA family policy. On the application, a box should be checked that they have insurance. Sometimes health insurance costs can be less if young adults get policies outside of the ACA policies. These individual policies should be from the state you are moving to, as they are considered residents.

Pretty sure that you can sign up for insurance in the new state before you move during open enrollment, as long as you are sure about the new address. There is a spot for comments where you can indicate that you are moving. I would also indicate that correspondence should be by email.

Work with a navigator from your new state or use the national ACA phone number to complete an online application. Note that the knowledge of the phone enrollment assister varies. College students are considered residents of where you reside, so most health insurance plans that are PPOs should work. There may be some restrictions with HMO plans. I would check with your current insurance carrier about coverage for the last few weeks of December. Most insurance plans are monthly, so changes do not happen immediately.

marcopolo
Posts: 2913
Joined: Sat Dec 03, 2016 10:22 am

Re: ACA - end of year move to another state, kids in college elsewhere

Post by marcopolo » Sat Nov 02, 2019 2:06 pm

Katietsu wrote:
Sat Nov 02, 2019 8:22 am
4) If managing your income to get subsidies, don't forget that any income you kids get from summer/part time jobs, investments, etc. gets added into your family income when computing eligibility for subsidies. This can be substantial when kids are doing internships/co-ops.


I have not dealt with this since the 2018 tax law change so have not looked to see how this works now. But, I think the kid’s income only gets added if they have enough income such that they are required to file their own return. Note that a filing requirement is different than choosing to file just to get a refund.
Yes. that is correct. Child's income only gets included if required to file. But, that is a pretty low hurdle if the child is doing a paid internship/co-op.
Once in a while you get shown the light, in the strangest of places if you look at it right.

marcopolo
Posts: 2913
Joined: Sat Dec 03, 2016 10:22 am

Re: ACA - end of year move to another state, kids in college elsewhere

Post by marcopolo » Sat Nov 02, 2019 2:09 pm

donall wrote:
Sat Nov 02, 2019 9:26 am
For ACA marketplace insurance you should always use all members of your family that are eligible, as your premium will be lower. Because your kids are dependents, then they should be on the ACA application. But kids can get individual policies outside of the ACA family policy. On the application, a box should be checked that they have insurance. Sometimes health insurance costs can be less if young adults get policies outside of the ACA policies. These individual policies should be from the state you are moving to, as they are considered residents.

Pretty sure that you can sign up for insurance in the new state before you move during open enrollment, as long as you are sure about the new address. There is a spot for comments where you can indicate that you are moving. I would also indicate that correspondence should be by email.

Work with a navigator from your new state or use the national ACA phone number to complete an online application. Note that the knowledge of the phone enrollment assister varies. College students are considered residents of where you reside, so most health insurance plans that are PPOs should work. There may be some restrictions with HMO plans. I would check with your current insurance carrier about coverage for the last few weeks of December. Most insurance plans are monthly, so changes do not happen immediately.
If you enroll in the college before family moves out of state, many states provisions of how the student can maintain their residency in the old state. This can make a huge difference if it effects in-state vs out-of-state tuition. In some cases it may be beneficial for the student to jump through the hoops and maintain residency. Getting insurance in that state is often one part of that.
Once in a while you get shown the light, in the strangest of places if you look at it right.

Topic Author
Bruce T
Posts: 72
Joined: Wed Mar 28, 2018 8:34 pm

Re: ACA - end of year move to another state, kids in college elsewhere

Post by Bruce T » Sun Nov 03, 2019 9:44 am

@Marcopolo and others, from OP:
First - thanks for all the great responses!

re: my question on getting premium tax credits recognized in insurance premium billing:
6) I am a bit confused about this. Where did you get your ACA plan for 2019? Indiana uses the federal exchange. When you fill out an application you are required to estimate your income for the coming year. This automatically set your subsidy level which is paid directly to the insurance company you choose. You get billed for the difference. Any discrepancy between your estimated income and actual income for the year is reconciled when you file your taxes. There is a way to tell them that you do not wish to receive the subsidy in advance like this, but you really have to go out of your way to do that. In any case, if you really did get your ACA plan on the Federal exchange, any subsidy you are entitled to will be sorted out on your taxes
The answer is "I don't remember" ... while enrolling I had a potential large lump-sum income (that may still occur in December) that I may have factored into the estimated income input ... I don't think I went out of my way to select an option to avoid the subsidy being recognized in billing process. In any event, I think you answered the question (i.e. if the income level vs. family size warrants it, then its automatic), so thanks for that!

As a followup questions:
1. has anyone evaluated the pros/cons of ACA compliant catastrophic plans for dependent students? I briefly looked at them and I think had the impression that the premium difference does not reflect the catastrophic nature of those plans (or to put it differently, it looks like almost all ACA health plans these days, with such high deductibles, are essentially catastrophic oriented, when unsubsidized).
2. for fairly healthy students (with parents able to fill the $ gap on infrequent "regular" or preventative care), what are the considerations for using a ACA-non-compliant short term policy (i.e. closer to addressing the needs of a truly catastrophic situation). Does use of such a plan qualify as being "insured" relative to the ACA rules for the rest of the family?
3. A reply above suggested getting a out-of-state student coverage in the family's state of residence (using a PPO rather than HMO plan) ... I have had a hard time determining coverage for out-of-state providers using the federal marketplace tools and am not too familiar w/ PPO vs HMO provisions. With PPO, does a provider still need to be "in network" to get the favorable in-network insurance treatment? How many providers are "in network" for an insurance plan based in another far-away state - seems relatively unlikely. I am probably not understanding something here (other than that I am a combination of not well informed and confused).
Thanks again to all for the valuable insights!

marcopolo
Posts: 2913
Joined: Sat Dec 03, 2016 10:22 am

Re: ACA - end of year move to another state, kids in college elsewhere

Post by marcopolo » Sun Nov 03, 2019 2:10 pm

Bruce T wrote:
Sun Nov 03, 2019 9:44 am
@Marcopolo and others, from OP:
First - thanks for all the great responses!

re: my question on getting premium tax credits recognized in insurance premium billing:
6) I am a bit confused about this. Where did you get your ACA plan for 2019? Indiana uses the federal exchange. When you fill out an application you are required to estimate your income for the coming year. This automatically set your subsidy level which is paid directly to the insurance company you choose. You get billed for the difference. Any discrepancy between your estimated income and actual income for the year is reconciled when you file your taxes. There is a way to tell them that you do not wish to receive the subsidy in advance like this, but you really have to go out of your way to do that. In any case, if you really did get your ACA plan on the Federal exchange, any subsidy you are entitled to will be sorted out on your taxes
The answer is "I don't remember" ... while enrolling I had a potential large lump-sum income (that may still occur in December) that I may have factored into the estimated income input ... I don't think I went out of my way to select an option to avoid the subsidy being recognized in billing process. In any event, I think you answered the question (i.e. if the income level vs. family size warrants it, then its automatic), so thanks for that!

As a followup questions:
1. has anyone evaluated the pros/cons of ACA compliant catastrophic plans for dependent students? I briefly looked at them and I think had the impression that the premium difference does not reflect the catastrophic nature of those plans (or to put it differently, it looks like almost all ACA health plans these days, with such high deductibles, are essentially catastrophic oriented, when unsubsidized).
2. for fairly healthy students (with parents able to fill the $ gap on infrequent "regular" or preventative care), what are the considerations for using a ACA-non-compliant short term policy (i.e. closer to addressing the needs of a truly catastrophic situation). Does use of such a plan qualify as being "insured" relative to the ACA rules for the rest of the family?
3. A reply above suggested getting a out-of-state student coverage in the family's state of residence (using a PPO rather than HMO plan) ... I have had a hard time determining coverage for out-of-state providers using the federal marketplace tools and am not too familiar w/ PPO vs HMO provisions. With PPO, does a provider still need to be "in network" to get the favorable in-network insurance treatment? How many providers are "in network" for an insurance plan based in another far-away state - seems relatively unlikely. I am probably not understanding something here (other than that I am a combination of not well informed and confused).
Thanks again to all for the valuable insights!

I hope you get some other responses to get a diversity of perspectives. But, i will try to answer your questions based on our experience.

1) We did look at catastrophic plans for our college age child. But at least in our coverage area, the cost difference was pretty small, and did not seem to be worth it.

2) We did not consider non-compliant plans

3) HMOs typically have relatively smaller local networks, although there are some nationwide ones like Kaiser. PPO's typically have a little more flexibility in providers. You still have in-network issues, but they often do provide some out-of network coverage, but your co-pays are likely to be higher. It is very plan specific. Some PPOs are associated with a large nationwide network like BlueCross, so even though you have a local network, you can actually get coverage nationwide on most BlueCross network. This is what we ended up choosing. We have coverage through a local PPO network in our state. Our son who is away at college in a very distant state is able to get in-network coverage, including the school health center, through BlueCross, using their BlueCard program. It is difficult to find out about out-of-area coverage on the federal marketplace website. What I ended up doing was going to the insurer's web site and looking for that information there.

Good luck.
Once in a while you get shown the light, in the strangest of places if you look at it right.

Topic Author
Bruce T
Posts: 72
Joined: Wed Mar 28, 2018 8:34 pm

Re: ACA - end of year move to another state, kids in college elsewhere

Post by Bruce T » Sun Nov 03, 2019 3:02 pm

@Marcopolo
Awesome - thanks. Fortunately the one ACA provider in our new county/state is BC/BS, so PPO under that for our student sons might be the best option.

I really appreciate you sharing your experiences & knowledge!

HereToLearn
Posts: 659
Joined: Sat Mar 17, 2018 5:53 pm

Re: ACA - end of year move to another state, kids in college elsewhere

Post by HereToLearn » Sun Nov 03, 2019 8:39 pm

Bruce T wrote:
Sun Nov 03, 2019 3:02 pm
@Marcopolo
Awesome - thanks. Fortunately the one ACA provider in our new county/state is BC/BS, so PPO under that for our student sons might be the best option.

I really appreciate you sharing your experiences & knowledge!
You might want to check the provider network of the BC/BS plan for the areas where your son will attend school. I have found that the BC/BS ACA plan does not include the typical BC/BS nationwide network.

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