Thursday, February 5, 2015

Separated, uninsured and out of luck?

A reader who's in the process of divorce emailed to ask whether there's any way he can get help paying for health insurance this year.

He works part time and says he'd spend half his take-home pay buying a private policy.  His wife makes a lot more,  and the reader says he was told that because they're not divorced,  his household income includes her pay,  which puts him out of range for tax credits on the Affordable Care Act exchange.

"I was just wondering if I’m screwed until I am officially divorced,"  he said.

I thought I knew the answer  (yes,  but you can apply once the divorce goes through),  but Madison Hardee of Legal Services of Southern Piedmont says it's not that simple.

"Marketplace eligibility for couples who are married but separated is complicated,"  she wrote.  "You are correct that the marketplace asks consumers for their current marital status. However,  at tax filing,  the IRS will consider the marital status on December 31st of the tax year.  For example,  if a consumer is currently married and then gets divorced in July 2015,  the IRS will consider that person unmarried for the entire 2015 tax year."

So if the reader,  who asked that I not share his name,  applies now,  he'll presumably be denied any financial aid based on the combined income.  And if he doesn't enroll in a plan before the Feb. 15 deadline,  he won't automatically be eligible for special enrollment based on the divorce.  But if he enrolls now,  he can go back to after the divorce,  report the change in income and select a new plan if he qualifies for subsidies,  Hardee said.

Hardee is a lawyer who has been trained in ACA enrollment,  so she added even more caveats based on special circumstances.

My takeaway:  Anyone like this reader,  who faces crucial decisions about paying for care,  needs to hustle to take advantage of 10 more days of free assistance.  Don't ask your neighbor or your aunt or even a reasonably well-informed reporter.  Sit down with an expert who can review your individual circumstances and talk you through options.

To get free help in North Carolina, call 855-733-3711 or visit In South Carolina, call 888-998-4646 or visit  Don't dawdle;  I'm hearing that appointments are filling up.

You can also call an insurance broker.  Or do a walk-in at Get Covered Mecklenburg's last-minute enrollment event from 10 a.m. to 4 p.m. Feb. 14 at the Children and Family Services Center, 601 E. Fourth St.

Just don't kick yourself on Feb. 16 for procrastinating.

Read more here:


Garth Vader said...

Yet another complication that proves we need to return to fee-for-service for routine care and real INSURANCE* for catastrophic coverage.

* Wiki definition of INSURANCE: "the equitable transfer of the risk of a loss, from one entity to another in exchange for payment."

Note the words "RISK of a loss". If you are ALWAYS going to have a physical exam, for example, that is NOT a RISK and should not be covered by insurance. Transferring responsibility of payment for that is COST-SHIFTING, not INSURANCE.

To illustrate: Do car insurance policies cover oil changes and tires? No. What would happen if they did? Policy prices would skyrocket. Do homeowner insurance policies cover lawn mowing? No. What would happen if they did? Policy prices would skyrocket.

rky84 said...

I agree that the term insurance,when applied to healthcare, is a bit of a misnomer, except when dealing with catastrophic care. But, I wouldn't make the comparisons to home and auto insurance, as you did. If I don't change my oil on my car, and the engine blows, insurance still won't pay. If I don't mow my lawn or otherwise, don't take care of my home, and the house deteriorates, insurance still won't pay. However, if I don't go for preventative care, and I get very sick, insurance DOES pay and perhaps much more than if I had taken preventative steps along the way.

Richard Kistler said...

Sorry, Garth Vader, but the reason that we do Health Care Plans the way we do them is NOT solely based on the definition of the word "insurance." Health care plans cover things like physical exams and immunizations because this is what the customers want and IT REDUCES THE OVERALL COST. Similar plans would exist (and probably do exist)for cars and houses if there was demand for them.

On the topic of the blog. This situation is one in which The Affordable Care Act needs to be tweaked. Sadly, the Congress we have will not even consider such modifications.

Wiley Coyote said...

Good luck getting covered.

My sister in law made about $15,500 in 2013, separated from her husband and was told she did not qualify for Medicaid even if she was divorced.

Since she isn't divorced, her husband's income was being calculated in.

Neither of them had insurance and still don't, opting to pay the "tax".

I have no idea what they plan to do this year, but there in lies the stupidity of turning the health care business upside down to insure people without insurance, many of whom didn't want it in the first place.

So what's he to do once he gets divorced? His wife?

They obviously have a household income greater than $94,000 dollars. How much does she make? Will she still make over $94,000?

Do they currently have insurance through her employment?

Anonymous said...

What is their rationale for restricting enrollment to a particular time period?

Ann Doss Helms said...

1:01, that's an interesting question. I do know limited "open enrollment" periods are the norm with workplace insurance, so I'd guess it's modeled on that. But I do wonder what the costs and benefits would be to having enrollment an option at any time.