In my last post I bored you with discussed the nuts and bolts of my experience getting subsidized Obamacare health insurance on my state’s health insurance exchange. An experience that included several challenges. Some expected. Others not so much.
I left off at a point where I’d become more knowledgeable about cost sharing reductions (CSRs) and the Children’s Health Insurance Program (CHIP), and figured that by inputting a projected 2025 MAGI of $B (a dollar amount lower than $A, the minimum MAGI that’d qualify use for subsidies) into the health insurance application, we’d qualify for healthy subsidies and CHIP coverage for Thing Two (The Younger). But not qualify for CSRs.
And now for the boring and tedious exciting conclusion to the story!
Challenge #5 — Severance
An expected (once we learned that to get subsidies, only I, Thing One (The Elder) and Thing Two could go on an exchange plan and The Missus would have to stay on her employer-sponsored plan) challenge we had to address was severing me and Things One and Two from the plan offered by The Missus’ employer so that we three could go on the exchange plan come the new year. Complicating things, however, was the fact that The Missus’ employer’s benefits plan year doesn’t match up with the calendar year. Why? I have no fluting idea. But the result was yet another wrinkle: getting me and Things One and Two off of the employer plan in the middle of that plan’s year.
After some back and forth with The Missus’ employer’s human resources department and the plan administrator (and, much to my amusement, confusion by those folks not just as to why we’d not only want off the plan, but our desire to go on an exchange plan), we got the green light to proceed as desired.
Here’s a new recap of where things stood before exchange plan open enrollment began. With a reported MAGI of $B we’d: qualify for subsidies, apparently qualify for CHIP; not qualify for CSR. And I and Things One and Two would seamlessly transition from health coverage under The Missus’ employer’s plan to exchange-plan coverage as of January 1, 2025. At this point in the process, I felt like a gymnast who’d so far executed his routine well, but needed to nail the technical landing.
Challenge #6 — Muddy waters
Finally, open enrollment came. Gulping hard, I started our application. Fun fact: completing and submitting an exchange application? Not entirely intuitive or easy. After a few calls to an exchange customer service representative, I completed and submitted an application.
And what did I see? Nicely subsidized premiums, as expected . . . and CSRs?! What the what?! We were supposed to get CHIP coverage but not CSRs.
I was . . . very confused. And now confronted with questions: First, as to CHIP coverage. Did Thing Two qualify for it? If not, why? I mean between the cost estimator results I’d earlier gotten, and my subsequent research seeming to verify that a reported MAGI of $B qualified Thing Two for CHIP coverage, I was pretty certain that we should’ve seen a CHIP-coverage option.
Second as to CSRs. I didn’t think that our $B MAGI qualified us. But I guess it did?
And third, regardless, was the result I got cheaper and better than all other scenarios? Also, should I leave well enough alone? Or call an exchange representative?
I ended up making two calls. First, to the broker with whom the navigator I’d worked with all along had conferred. The broker said a few things that influenced my thinking. One, that if the exchange application site said that we qualified for CSRs, then we qualified for CSRs. Two, that the CSRs offered were good. Very good. And three, that the result we got likely was the best scenario financially speaking.
I next called a CHIP customer service representative to find out why our MAGI didn’t qualify us for coverage for Thing Two. I figgerd that if I was right that Thing Two did qualify, we might end up getting said CHIP coverage (and consequently even lower premiums once the exchange policy adjusted to reflect two (me and Thing One), instead of three, people on it) and keeping the CSRs.
The representative insisted that Thing Two wasn’t eligible for CHIP coverage. I won’t get into all the details (which I still dispute). But I was told that it was because CHIP coverage isn’t based on reported MAGI, but rather a higher income number.
Challenge #7 — Decisions, decisions, decisions
Following that call, I circled the wagons of my thoughts. Was the application result that we’d gotten the scenario I expected? No. Was it the best possible scenario? Maybe no, maybe yes.
But was it a good scenario? Yes. A very good scenario? Yes. And could my trying to get what might be the true best result backfire and kill the bird in the hand? Yes. Yes, it could.
So, what did I do, Dear Reader?
I took the W, accepted the offer of subsidies and CRSs, paid the premium for the first month of coverage, and called it a day. I also resolved to further educate myself in 2025 to perfect my understanding of CSRs and CHIP eligibility MAGI/income requirements. Also to explore getting dental and vision insurance on the exchange (I did a little research on this in 2024, but it looked like the cost and coverage wouldn’t be materially different than what we have through the plans offered by The Missus’ employer).
After math
In time, January 1, 2025, came ‘round. Would our exchange plan go into effect that day, I wondered? Would I and Things One and Two be severed from the plan we had through The Missus’ employer as of that day? Would The Missus’ health insurance policy transition that day to one covering just her instead of The Family, with an according premium price reduction?
The answers, Dear Reader, I am happy to report were yes, yes, and yes. Yesss!!!
Today, a few months into our new situation, I can report that we’re all happy with the exchange plan coverage and jump-up-and-down excited pleased with our lower health insurance expenses. The former is similar to that of the plan offered by The Missus’ employer. And as to the latter, as I explained in an earlier blog post, we’re saving five figures of monies this year alone. Noice!
And in the end . . .
So, there you have it, Dear Reader. A happy accident leading to discovery of a modified rule, a lotta research, and a lotta work later, we find ourselves in a pretty good position. Now we can focus on . . . hoping that Obamacare the Affordable Care Act continues in its current form. But I’ve read that even if it’s killed off, things will be just fine.
