I've been working on an Affordable Care Act application, and found some points for discussion:
The open enrollment period (extended until 12/17 ~ 12/19 depending on state) refers simply to when you can 'enroll' in the program, not specifically related to when you can get coverage.
For example, if you wanted coverage in January, you'd need to have any supporting evidence reviewed by the state documents dept. Not everyone requires this review, but if you do, it takes 7-10 days. The pertinent date 12/15 (original date of ending of open enrollment) being extended doesn't mean that you are covered in January. However, if you had enrolled and have everything reviewed and approved by 12/15 you can be covered in January.
Being covered for a partial month blows their mind. For example, if your primary source of insurance ends in January, you cannot be covered for that month, as it appears that you are over insured for part of the month (they don't mind that you are not insured at all for the remainder of the month due to this).
The 15th again is a key date. If you want insurance to cover you for February, you need everything to be approved by 1/15. While this should include simply the 7-10 day document review period, it is actually controlled by an algorithm that creates the 'docs due date by', if they kindly give you more time, beyond the 15th, it is likely that insurance for the month of February is also not covered, and will commence in March.
The Cobra shuffle
Cobra allows you to maintain your insurance policy from your old employer for 18-36 months (depending on the event) - see DOL rules here. However, Cobra is very expensive, as you pay the full, unsubsidized amount, often resulting in a premium jumping from $100-200 per month to $1000 or so. In the case of the Affordable Care Act application above, with no coverage for January, and perhaps February you might pay $2000 or so to fill the gap until the ACA policy kicked in.
However, there is a retroactive window within Cobra that allows you to elect to take it 60 days after the event. This would mean that you could potentially go uninsured during the gap between leaving the old employer and the delayed ACA plan starting, and should an event occur that required medical expenses, you then elect to be covered by Cobra (and pay premiums back until the start date).
This I have termed the Cobra Shuffle. It is worth noting that the system is not flawless, and may create small windows of not being insured, during application processing.
Making the Affordable Care Affordable
This differs on a State level, but if you earn too little, you won't be eligible for a credit on the 'medal plans' instead, you will be opted into Medicaid. This is good in that it offers free coverage, but bad in that it can hamper who will work with you.
Calculations for what sort of subsidy you receive are based on the Federal Poverty Line, and percentages of that. The number differs based on the number of family members you must support, and range from 100-400% of the FPL. However, if you earn under 138% of the FPL you may be pushed into Medicaid. I tried putting some numbers in the system just above 138% of FPL, and NY State still pushed that into Medicaid. I was told that a higher level of about 154% was needed to escape that.
If you can find the sweetspot between Medicaid and the Silver plans (most discounted) you can get a more traditional health insurance plan for a nominal amount per month.
EDIT - i'll write a follow up post for the max earnings you could create to be subsidized. Original post wasn't correct.
Overall
The system is highly confusing, but there is lots of opportunity to support low income people, such as the couple earning $140K per year or more.
The open enrollment period (extended until 12/17 ~ 12/19 depending on state) refers simply to when you can 'enroll' in the program, not specifically related to when you can get coverage.
For example, if you wanted coverage in January, you'd need to have any supporting evidence reviewed by the state documents dept. Not everyone requires this review, but if you do, it takes 7-10 days. The pertinent date 12/15 (original date of ending of open enrollment) being extended doesn't mean that you are covered in January. However, if you had enrolled and have everything reviewed and approved by 12/15 you can be covered in January.
Being covered for a partial month blows their mind. For example, if your primary source of insurance ends in January, you cannot be covered for that month, as it appears that you are over insured for part of the month (they don't mind that you are not insured at all for the remainder of the month due to this).
The 15th again is a key date. If you want insurance to cover you for February, you need everything to be approved by 1/15. While this should include simply the 7-10 day document review period, it is actually controlled by an algorithm that creates the 'docs due date by', if they kindly give you more time, beyond the 15th, it is likely that insurance for the month of February is also not covered, and will commence in March.
The Cobra shuffle
Cobra allows you to maintain your insurance policy from your old employer for 18-36 months (depending on the event) - see DOL rules here. However, Cobra is very expensive, as you pay the full, unsubsidized amount, often resulting in a premium jumping from $100-200 per month to $1000 or so. In the case of the Affordable Care Act application above, with no coverage for January, and perhaps February you might pay $2000 or so to fill the gap until the ACA policy kicked in.
However, there is a retroactive window within Cobra that allows you to elect to take it 60 days after the event. This would mean that you could potentially go uninsured during the gap between leaving the old employer and the delayed ACA plan starting, and should an event occur that required medical expenses, you then elect to be covered by Cobra (and pay premiums back until the start date).
This I have termed the Cobra Shuffle. It is worth noting that the system is not flawless, and may create small windows of not being insured, during application processing.
Making the Affordable Care Affordable
This differs on a State level, but if you earn too little, you won't be eligible for a credit on the 'medal plans' instead, you will be opted into Medicaid. This is good in that it offers free coverage, but bad in that it can hamper who will work with you.
Calculations for what sort of subsidy you receive are based on the Federal Poverty Line, and percentages of that. The number differs based on the number of family members you must support, and range from 100-400% of the FPL. However, if you earn under 138% of the FPL you may be pushed into Medicaid. I tried putting some numbers in the system just above 138% of FPL, and NY State still pushed that into Medicaid. I was told that a higher level of about 154% was needed to escape that.
If you can find the sweetspot between Medicaid and the Silver plans (most discounted) you can get a more traditional health insurance plan for a nominal amount per month.
EDIT - i'll write a follow up post for the max earnings you could create to be subsidized. Original post wasn't correct.
Overall
The system is highly confusing, but there is lots of opportunity to support low income people, such as the couple earning $140K per year or more.
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