Healthcare.gov comes through in a complicated situation

Yesterday's post examined the factors to be weighed by people who face a choice between continuing on an employer-sponsored insurance plan via COBRA and switching to a Qualified Health Plan under the ACA. In brief: an ACA plan is likely to have a lower premium -- especially but not exclusively for those eligible for subsidies -- while a COBRA'd employer-sponsored plan is likely to offer better choice of doctors and hospitals and/or lower out-of-pocket costs.

One sidelight that emerged is that for many in the individual market, income is likely to be variable, and thus subsidy calculation can be delicate. That raises the question of how flexible and fact-specific a new federal bureaucracy is likely to be.  We looked at the case of Marcia, who is in the midst of a divorce just as a her husband is retiring.  Because she is in her mid-fifties, the base price of a silver ACA plan is quite high -- over $600 per month for the cheapest silver plan. Her post-divorce income will qualify her for a monthly subsidy of over $350 per month.  But the interim is uncharted territory. Her husband has just gone off salary and will soon go on Social Security, and their income is pooled for subsidy calculation purposes until the divorce is finalized.

Because of their transitory situation, Marcia and her husband Henry together called the Healthcare.gov help desk last Saturday, focusing for the moment on Marcia's enrollment (Henry plans to enroll before March 15). The quality of the customer service was quite good.  The first rep told them that Marcia would not be eligible for a subsidy until the divorce went through. That would set her premium at just over $600 per month for several months -- just about what they're paying for COBRA. The COBRA'd employer policy offers better coverage -- but if the two of them do not enroll in an ACA plan by March 31, they will miss open enrollment for 2014. They should theoretically be able to claim change of status when the divorce go through and enroll in (separate) plans for the remainder of 2014, but that is an as-yet untested process.

Henry asked to speak to a supervisor and was put through to one. He explained that he was now off salary but that his Social Security had not yet kicked in. The supervisor asked some questions, did some calculations and determined that Marcia would be eligible now for a subsidy close to $200 per month. As Marcia had not yet made a final choice of plans, the supervisor gave her an "application ID" and told her to call when she had selected a plan.

Yesterday evening, Marcia wrote to me:

S U C C E S S!  We successfully enrolled me in:  [a silver plan]. yea! It was so easy...we just called the main number, explained that we had sorted through the details of our somewhat complex situation yesterday with a supervisor and had gotten an "application ID".  The rep was then able to pull it all up...confirmed all the figures, everything jibed and I  am set with an effective date of April 1.

It is good to know that, in this case at least -- unlike with many mortgage modification applications or claims questions with private insurers -- what one rep entered in the system on Saturday was retrieved by another on Monday.  I will add, too, that back in October and November I called Healthcare.gov several times for information, always got a live person, and with one exception was given accurate information that answered my questions.

It's understandable that the dysfunctional website got all the attention last fall. But other aspects of ACA administration may be functioning well.

Related: Switching from COBRA to the ACA exchanges