We Are Closed !!!
- Thread starter Yagents
- Start date
- 10,276
I also has four procrastinators but I couldn't write three and one gets a short-term plan.
- 5,056
u guys keep beliving that, ....oh look I found a nickle, my income has changed......SEP....here we come
- Thread starter
- #4
Not the case, you must be enrolled in marketplace plan already, not many of those out there.
https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2
For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions
- 15,319
I wonder if the service calls will start this month or wait until May 1?
Rick
Rick
Yagents,
To quote the law (qualifying event #6, from 45cfr 155.420 (d)):
"An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP."
I hope that's a clear enough indication that there are ways to get an SEP based on a change of income even if you're not enrolled. I had a carrier confirm that they will take an uncovered individual any time, so long as their income went from a subsidy eligible level to an ineligible level, under this rule.
My state recently gave a 90 minute seminar on SEP's. They confirmed half a dozen times that if one person in a "coverage household" has a QE, all eligible's have one as well.
(They defined "coverage household" as those who could apply on a single contract, and I'm sure we know the rules around that already.)
My specific question, they directly responded to:
Q: If 2 non-covered individuals get married, does that generate a SEP and allow them to freely choose a plan?"
A: Yes, SEP starts on the day of marriage, even if both are currently uncovered. Any dependents would be allowed to enroll at that time as well. (In compliance with other rules and guidelines, of course).
Looks like there might be more slack in these QE's than we though initially.
To quote the law (qualifying event #6, from 45cfr 155.420 (d)):
"An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP."
I hope that's a clear enough indication that there are ways to get an SEP based on a change of income even if you're not enrolled. I had a carrier confirm that they will take an uncovered individual any time, so long as their income went from a subsidy eligible level to an ineligible level, under this rule.
My state recently gave a 90 minute seminar on SEP's. They confirmed half a dozen times that if one person in a "coverage household" has a QE, all eligible's have one as well.
(They defined "coverage household" as those who could apply on a single contract, and I'm sure we know the rules around that already.)
My specific question, they directly responded to:
Q: If 2 non-covered individuals get married, does that generate a SEP and allow them to freely choose a plan?"
A: Yes, SEP starts on the day of marriage, even if both are currently uncovered. Any dependents would be allowed to enroll at that time as well. (In compliance with other rules and guidelines, of course).
Looks like there might be more slack in these QE's than we though initially.
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Wow! That is incredibly good information. Thanks, RayNY.
- 2,127
Ann is correct, even if the family did not have health insurance and there is a birth the qualifying event is for everyone in the family.
Thanks for the credit, but it's RayNY that said that.
This is the funniest type of Qualifying Event and SEP process I've ever seen, but it should make life interesting in the next few months!
- 599
So should we invite Clambake back and tell her to get divorced?
