Health care actuaries - help! - adulting your in-laws' health care plan

My father in law has a health care plan since May 2023 with Emblem Health.

I don’t know yet what type of plan, other than that it doesn’t seem to be Medicare related as he has not applied for Medicare (I am unsure if he is eligible).

  • He made payments monthly. It seems he usually made the payments after the due date, but within the same month.
  • He attempted to make a payment in late December, for the month of December, and was initially told it had gone through by the automated system. He also received some notices that a payment was made.
  • He was hospitalized on 12/29, and returned home on 1/3, for having a seizure.
  • He called Emblem on 1/3, to check the status of his plan, and was initially told he needed to pay more for January and was told he was covered. It sounds like he was also told (in what turns out to be false) that his December payment was applied to January. I think this was a miscommunication… see comments later. He asked for confirmation there was no lapse in coverage before paying for January. He was told someone would call him back.
  • When no one did, he called back a bunch of times and was told various stuff, including that there was some billing issue and they would call him back.
  • He waited - no calls back. He then called and was told that the payment for December was declined twice due to insufficient funds. He does not think that there were insufficient funds, but he does not see a debit from his bank statement.
  • At this point (today) he emailed me.
  • I signed up for an online account, and the website says the plan seems to have become inactive after 12/31/23. But the account said if I paid for 2 months at once, half of the payment would be credited to December. This is the text of the statement:
    “It looks like you have an outstanding balance of X from the past year. Because of a federal rule to ensure continued coverage, any payment that you make above will only apply to your new plan year coverage. To include this balance in your next payment, select Custom Amount, and enter 2X to pay.”
  • I think the impression he got that his December payment would be applied to January, was really because of the above rule.
  • I made a payment of 2X with my card … hasn’t shown up yet on my credit card online account yet, but I guess that could take time.
  • Any advice? What do you think are the chances that his coverage will not be considered active for January? Even if the coverage is not active in January, does the fact that he was hospitalized back in December maybe mean that his full stay could be covered? This company seems to be a pretty large one - and this is in the state of NY… so hopefully there are some consumer protections.

sounds like he is still in the grace period, many were liberalized by state and federal law during COVID, at least for MedSupp, and i am not sure those regulations were ever repealed.

Emblem, so NY? How old is he? Is he on Medicaid (low income?) And other than age, why would he not qualify for Medicare?

Not enough covered quarters of work. Could be a recent immigrant. Some people also don’t enroll when eligible even if it makes sense to do so.

i know the rules, i meant for him specifically

FWIW, many readers of this thread don’t know those rules; so I appreciate @SteveGrondin’s post around some of the more common disqualifiers for Medicare.

I would say that most of us would know that age is sufficient to qualify, but not necessary.

My wife is now covered by Medicare Part A due to a disability (for which she is receiving other government benefits) rather than meeting the age requirement.

We’ve opted to not take the remaining Parts at this time since we have other coverages that are sufficient. It’s my understanding that once she reaches 65 (or whatever age Congress ends up setting that threshold), she can opt back in for coverage for Part B/C/D and opting out at that time will result in no longer being eligible for Medicare.

Since this is a congregation of health actuaries (a network? of actuaries) I wonder if I could sneak in a question…

When I last switched jobs I started at my new company in October. On the health insurance I had through my prior employer we’d just about hit the OOPM, but then when I joined the new company we started again from $0, which I hadn’t appreciated would happen. Is that normal? Or is there actually some mechanism whereby your out of pocket spending transcends job changes?

That is Normal Dan

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I think it’s his immigrant status but plan to check with him about this. Yes to NY. Not on Medicaid… not sure if he would qualify. He is not high income, but I’m not sure if they fall in the low income either. Regardless, a hospital bill for 1/1-1/3 is very scary for him.

Just checked my credit card account, and they did now debit my card… hopefully that’s a good sign.

I am now getting away from what I am sure about, but I don’t believe immigrant status matters, if you have the work hours.

I would guess he is most likely on PPACA. The NYS Department of Financial Services Website is pretty good - https://www.dfs.ny.gov/ for things that are based on State Law and not his specific policy.

NY is very strong for rules to protect the consumer

I have always gone by the theory that if they took my money I can assume I am covered

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Does someone have his power of attorney? For the future you should get a copy of his policy or at least find out what his plan is and how to access on-line information

I have his online account and password but due to security codes being sent to his email I need him each time I log in… might add my email account to the online account.

I don’t know if he would be very likely to agree to a POA. They are not that great with stuff like this - my husband used to call the cellphone company monthly on their behalf - but they are still typically private about this until something really bad happens, which is probably much less than ideal.

When my FiL needed help we had access to his e-mail, it helps a lot for the security stuff,
but my wife was also paying all his bills for him at that point

Update: my FIL spent a bunch of hours on the phone with the plan reps after I made the payment, and they reinstated his policy so January is considered active too, not just December. :slight_smile:

They had been worried that the payment I made would count for February or March but not January. They told me that if that would be the case they’d rather not pay, because they no longer trusted their plan. I’d told them that if that happens, then the payment is on me (though I’d been planning to try to get my money back if that happened). It’s possible the many phone calls he made helped with that, but I don’t know.

Anyway, all’s well that ends well.

Hopefully he can get on Medicare soon because I think that was the biggest gamble I’d taken in a while. Who needs Super Bowl gambling? lol .

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