Hardship Exemptions to Buy Catastrophic Plans

[FLM2]

One of the allowable reasons for requesting an exemption to get a Catastrophic plan is termination of the prior plan and a claim that 'all of the other plans are not affordable'.

There are no financial guidelines about affordability, of course, so it's another gray area in the law (no surprise to any of us). Here is a link to the HHS document that describes this exemption: http://www.cms.gov/CCIIO/Resources/...cellation-consumer-options-faq-01-03-2014.pdf

According to the Marketplace explanation of the exemption to get a Catastrophic plan, the form must be submitted to the insurance company with the application, not the marketplace:
http://marketplace.cms.gov/applications-and-forms/exemption-application-instructions.pdf

Has anyone actually gone through this process with any carriers? And, if so, what were the results?

The reason for my question is that Aetna's catastrophic plan in Florida is about 25% lower in premium than the equivalent Bronze plan and the only difference in the plans is the Catastrophic plan doesn't have copays for Rx, the costs go towards the deductible.

Without any information, I would guess that the carriers accept all of these requests, after all, why not?

 

[cadylou]

One of the allowable reasons for requesting an exemption to get a Catastrophic plan is termination of the prior plan and a claim that 'all of the other plans are not affordable'.

There are no financial guidelines about affordability, of course, so it's another gray area in the law (no surprise to any of us). Here is a link to the HHS document that describes this exemption: http://www.cms.gov/CCIIO/Resources/...cellation-consumer-options-faq-01-03-2014.pdf

According to the Marketplace explanation of the exemption to get a Catastrophic plan, the form must be submitted to the insurance company with the application, not the marketplace:
http://marketplace.cms.gov/applications-and-forms/exemption-application-instructions.pdf

Has anyone actually gone through this process with any carriers? And, if so, what were the results?

The reason for my question is that Aetna's catastrophic plan in Florida is about 25% lower in premium than the equivalent Bronze plan and the only difference in the plans is the Catastrophic plan doesn't have copays for Rx, the costs go towards the deductible.

Without any information, I would guess that the carriers accept all of these requests, after all, why not?

I asked Coventry about this with their cancellations here in KS & MO and was told that they "wouldn't be offering a catastrophic option" in 2015. In addition, when I asked about the guidance you talk about above - where you send the application directly to the carrier, and not the marketplace - there is confusion on the part of the carrier.

Without having visibility to 2015 plan information from other carriers on catastrophic options yet, it is almost impossible to advise clients on their options right now. My assumption is that they really aren't interested in granting hardship and allowing catastrophic options anyway. . . .just my opinion.

 

[FLM2]

I called Aetna Broker Support this morning and they confirmed that obtaining a Catastrophic plan (if available) upon prior plan termination is an automatic acceptance whether it is a SEP or during Open Enrollment, it is just a matter of submitting the Hardship Exemption form with the application.

As to which carriers will offer these plan that is another story-Aetna seems interested in this as does Assurant and United Healthcare, I can't speak for anyone else.