health insurance question
October 6, 2016 2:31 PM Subscribe
My husband lost his health insurance and I can't add him to mine. Can you give us any advice on how best to proceed?
My husband dropped out of his graduate program at the end of September, and they are now telling us that this means his health insurance through the program lapsed as of the beginning of the semester (so end of August). This means I can't add him to my health insurance until 1/1/2017 because my work says they can only add him mid-year if his insurance lapsed within the last 31 days. Until January, then, he needs health insurance. I'm not sure what the smart thing to do is - just get the cheapest option? Something else? We're located in New York state, if that matters. Any and all advice appreciated very much!
My husband dropped out of his graduate program at the end of September, and they are now telling us that this means his health insurance through the program lapsed as of the beginning of the semester (so end of August). This means I can't add him to my health insurance until 1/1/2017 because my work says they can only add him mid-year if his insurance lapsed within the last 31 days. Until January, then, he needs health insurance. I'm not sure what the smart thing to do is - just get the cheapest option? Something else? We're located in New York state, if that matters. Any and all advice appreciated very much!
Yeah, I'd keep asking. My husband and I were recently in a similar situation--his previous workplace didn't provide any documentation that he was no longer employed until the 30-day window had already passed. It was very nervewracking and took several conversations with my employer's health insurance office, but once we got to someone who had the authority to do so, she immediately waived the 30-day limit. He was then covered retroactively from the start of the month where he left the previous job.
(Also, I'm sorry. That makes NO sense as a school policy.)
posted by cogitron at 2:56 PM on October 6, 2016 [1 favorite]
(Also, I'm sorry. That makes NO sense as a school policy.)
posted by cogitron at 2:56 PM on October 6, 2016 [1 favorite]
I would go back to your work too. The "life event" was him quitting, as far as he knew, he had insurance up to that date.
If that's still a no go:
Assuming your husband is healthy and with luck will not require healthcare between now and 1/1/2017, you may want to consider how much your household's penalty would actually be for him not being covered for the four months of September-December.
The penalty is prorated, so even though this gap is longer than the "short gap" 2 month extension that would get him out of a penalty all together, you'd only be looking at 4/12 of the yearly penalty. The yearly penalty, is capped at a number that hasn't been determined for 2016, but was $2,484 in 2015 (so, say $850) (if you don't hit the cap, the yearly penalty will be the higher of 2.5% of your household income, or $695).
Once you know that number, it will be easier for you to evaluate your options for on the New York exchanges. If your husband is relatively healthy, you might want to look into how you can best take advantage of the short gap exemption. For example, if you signed up for a bare-minimum level, high-deductible plan for November and December only, the September-October gap would be exempted.
But, maybe it would be cheaper for him to sign up for a bare-minimum level, high-deductible plan for November only, and take the exemption for September-October, and pay 1/12 of the yearly penalty for December. Or maybe there's another option.
posted by sparklemotion at 2:59 PM on October 6, 2016
If that's still a no go:
Assuming your husband is healthy and with luck will not require healthcare between now and 1/1/2017, you may want to consider how much your household's penalty would actually be for him not being covered for the four months of September-December.
The penalty is prorated, so even though this gap is longer than the "short gap" 2 month extension that would get him out of a penalty all together, you'd only be looking at 4/12 of the yearly penalty. The yearly penalty, is capped at a number that hasn't been determined for 2016, but was $2,484 in 2015 (so, say $850) (if you don't hit the cap, the yearly penalty will be the higher of 2.5% of your household income, or $695).
Once you know that number, it will be easier for you to evaluate your options for on the New York exchanges. If your husband is relatively healthy, you might want to look into how you can best take advantage of the short gap exemption. For example, if you signed up for a bare-minimum level, high-deductible plan for November and December only, the September-October gap would be exempted.
But, maybe it would be cheaper for him to sign up for a bare-minimum level, high-deductible plan for November only, and take the exemption for September-October, and pay 1/12 of the yearly penalty for December. Or maybe there's another option.
posted by sparklemotion at 2:59 PM on October 6, 2016
Also, isn't there COBRA coverage? And can't you pay COBRA retroactively for some number of months should something occur?
posted by straw at 3:05 PM on October 6, 2016 [1 favorite]
posted by straw at 3:05 PM on October 6, 2016 [1 favorite]
For grad student health insurance? Usually not, no.
posted by listen, lady at 3:20 PM on October 6, 2016
posted by listen, lady at 3:20 PM on October 6, 2016
Assuming your husband is healthy and with luck will not require healthcare between now and 1/1/2017, you may want to consider how much your household's penalty would actually be for him not being covered for the four months of September-December.
Luck being the key word.
I'm healthy and was lucky until I fell off my bike in June. Without insurance it would have cost me more than $10K. With insurance it still cost me $2K.
Gamble with other shit. Don't do it with your life.
posted by srboisvert at 3:59 PM on October 6, 2016 [10 favorites]
Luck being the key word.
I'm healthy and was lucky until I fell off my bike in June. Without insurance it would have cost me more than $10K. With insurance it still cost me $2K.
Gamble with other shit. Don't do it with your life.
posted by srboisvert at 3:59 PM on October 6, 2016 [10 favorites]
send me a message if you need the name of a great health insurance broker. When I left my job he got me set up with a plan and a subsidy, and then got me re-enrolled in a free plan the year I didn't work. You don't pay him, and he can help with the ny state insurance marketplace website if it comes to that.
posted by the twistinside at 5:05 PM on October 6, 2016 [2 favorites]
posted by the twistinside at 5:05 PM on October 6, 2016 [2 favorites]
I would contact your state insurance commissioner. It seems pretty unbelievable that his insurance could retroactively not exist - if he'd made claims before dropping out would they be asking for that money back?
posted by the agents of KAOS at 9:32 PM on October 6, 2016 [3 favorites]
posted by the agents of KAOS at 9:32 PM on October 6, 2016 [3 favorites]
Re: COBRA - I am currently on COBRA for grad student coverage (graduated and don't have another option for insurance yet), so it is a possibility.
posted by pemberkins at 6:01 AM on October 7, 2016 [1 favorite]
posted by pemberkins at 6:01 AM on October 7, 2016 [1 favorite]
You don't have to escalate this to your state insurance commissioner just yet. The next step is to ask your work to ask your insurance carrier for an exception to their usual deadline due to the circumstances. This just entails sending in a letter (written and signed by your employer) along with your enrollment change form explaining the situation, and including proof in the form of any dated documentation your husband received from his insurance carrier. The fact that he wasn't notified in time to meet the 31-day qualifying event deadline should work in his favor. There is of course no guarantee that the carrier will approve this request, but I've seen it happen in many similar situations.
Note that if they do approve it, his coverage will almost certainly be effective retroactive to the date after his old coverage ended, so you'll be paying catch-up deductions assuming your work doesn't cover dependents 100%.
Source: Benefits lady who sends these letters all day every day.
posted by rhiannonstone at 6:42 PM on October 7, 2016
Note that if they do approve it, his coverage will almost certainly be effective retroactive to the date after his old coverage ended, so you'll be paying catch-up deductions assuming your work doesn't cover dependents 100%.
Source: Benefits lady who sends these letters all day every day.
posted by rhiannonstone at 6:42 PM on October 7, 2016
Response by poster: Sincere thanks to all of you. Encouraged by your answers, I went back again to HR and kept pushing them to reconsider, and they did! This is such a better outcome for us, and I am very grateful to you for your practical suggestions and for your general urging on.
posted by prefpara at 11:07 AM on October 12, 2016 [4 favorites]
posted by prefpara at 11:07 AM on October 12, 2016 [4 favorites]
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posted by Sweetie Darling at 2:35 PM on October 6, 2016 [17 favorites]