My daughter, age 27 and currently unemployed (because of an injury), is on Dirigo. When I first got her on, she had just finished school and started a new job that didn’t include a health insurance benefit. What will happen to her once the Dirigo plan ends at the end of 2013? What will her options look like?
Dirigo Alumna To Be
Dear Dirigo Alumna To Be,
The Dirigo plan benefits will differ from what your daughter will find in the post 1/1/2014 world. Some things may be more generous, others slimmer. For example, the Dirigo plan has a “deductible rollover” which allowed her to count her expenses in the last three months of the year toward her next year’s deductible. I doubt this feature will be available in the plans for next year. On the other hand, the Dirigo plan’s maximum out-of-pocket is probably higher than the new plans. The Affordable Care Act has strict rules about the deductibles and out-of-pocket amounts.
You will be able to get details about the benefit plans after October 1, 2013 for coverage starting January 1, 2014. Since you know she will need the coverage, you might want to get started as soon as you can in October.
The new plans will otherwise treat her the same as the past, except that she may qualify for subsidies to pay her monthly premiums or to pay the deductible and co-pays. By “treat her the same,” I mean that they will have to accept her, cover her current medical condition, and will not be able to charge her extra for her health conditions. She will have choices of deductibles and co-pays. Since she has an ongoing medical condition, she probably won’t want a catastrophic plan. People under age 30 can choose a higher deductible plan than older people can.
When she does find a job with benefits (every parent’s fervent hope!), the employer can make her wait up to 90 days to join their group plan. So, she will need to keep her individual plan until she has an employer-based plan. She can go up to 90 days without coverage, and still not have to pay the penalty/tax. This is probably not a viable option for her, if she has a medical problem; and not advisable for a number of reasons.