Hi, and thank you.
THE BACKGROUND
I worked (10 yrs) for a company based in South Carolina, but I live in Maryland. I had benefits through an HR outsourcing company (TriNet) which offers a variety of insurance carriers/plans. I used a high-service Aetna PPO.
After being laid off on 8 June, the overwhelming advice was to go right to the MD Healthcare exchange and sign up and that COBRA would be very expensive in comparison.
I very much do not want to change docs for good reason, so I was very careful to choose a national network UHC) and to check that the specific doctors as well as the hospital network etc were all covered. All of them were listed. I signed up for the highest option offered, a ‘Gold’ level UJHC HMO. No PPO are offered, and Aetna is not available at all on the MD marketplace.
HOWEVER, when I tried to use the insurance, none of my docs were allowed, and 0% coverage for out of network. All indications were that my docs are in fact in-network, but apparently (all of?) the marketplace insurance is strictly limited to in-state only.
In the TriNet COBRA Guide there is a sort of FAQ section which addresses changing between COBRA and Marketplace/Exchange which states that you can go COBRA –> Marketplace, but warns that you may not do the reverse.
Here is the exact wording, and this is the only place in any documents that addresses the topic:
If you sign up for Marketplace coverage instead of COBRA, you cannot switch to COBRA under any circumstances.
The Question(s)
Is this a legal requirement or merely policy?
I did sign up for the Marketplace insurance, and have canceled it already without having made any claims. Unfortunately the cancellation cannot be backdated, so I will have that coverage until the end of July.
My (former) HR is telling me that under COBRA, the coverage is automatic, and that I would need to decline it, and so therefore as long as I elect COBRA before the end of the period, it would remain my primary coverage. I’m advised to submit the COBRA election in early August, pay the premiums and drive on. Obviously the COBRA would be backdated so there’s no break in coverage.
What is my risk that any medical expenses that are paid out under COBRA could then later be charged back to me on the basis of having paid for one month of Marketplace insurance?
As of now I am really regretting trusting the ACA Marketplace, and for not digging in deeper even though all signs were that my docs would be covered. This feels like a big gotcha, but I’m sure there’s some disclosure somewhere that points out that the nationwide network is not really nationwide under Marketplace plans.
submitted by /u/scirocco
[link] [comments]
Hi, and thank you. THE BACKGROUND I worked (10 yrs) for a company based in South Carolina, but I live in Maryland. I had benefits through an HR outsourcing company (TriNet) which offers a variety of insurance carriers/plans. I used a high-service Aetna PPO. After being laid off on 8 June, the overwhelming advice was to go right to the MD Healthcare exchange and sign up and that COBRA would be very expensive in comparison. I very much do not want to change docs for good reason, so I was very careful to choose a national network UHC) and to check that the specific doctors as well as the hospital network etc were all covered. All of them were listed. I signed up for the highest option offered, a ‘Gold’ level UJHC HMO. No PPO are offered, and Aetna is not available at all on the MD marketplace. HOWEVER, when I tried to use the insurance, none of my docs were allowed, and 0% coverage for out of network. All indications were that my docs are in fact in-network, but apparently (all of?) the marketplace insurance is strictly limited to in-state only. In the TriNet COBRA Guide there is a sort of FAQ section which addresses changing between COBRA and Marketplace/Exchange which states that you can go COBRA –> Marketplace, but warns that you may not do the reverse. Here is the exact wording, and this is the only place in any documents that addresses the topic: If you sign up for Marketplace coverage instead of COBRA, you cannot switch to COBRA under any circumstances. The Question(s) Is this a legal requirement or merely policy? I did sign up for the Marketplace insurance, and have canceled it already without having made any claims. Unfortunately the cancellation cannot be backdated, so I will have that coverage until the end of July. My (former) HR is telling me that under COBRA, the coverage is automatic, and that I would need to decline it, and so therefore as long as I elect COBRA before the end of the period, it would remain my primary coverage. I’m advised to submit the COBRA election in early August, pay the premiums and drive on. Obviously the COBRA would be backdated so there’s no break in coverage. What is my risk that any medical expenses that are paid out under COBRA could then later be charged back to me on the basis of having paid for one month of Marketplace insurance? As of now I am really regretting trusting the ACA Marketplace, and for not digging in deeper even though all signs were that my docs would be covered. This feels like a big gotcha, but I’m sure there’s some disclosure somewhere that points out that the nationwide network is not really nationwide under Marketplace plans.
submitted by /u/scirocco [link] [comments]Read Morer/HealthInsurance