changed my coverage without informing me, upping my premium from $71 to $590

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by ThirtyLastCalls

I turned 26 in the fall of 2017. I applied for coverage, selected a plan, and uploaded my 1099 within 60 days of my birthday. I paid $71 on January 15 for coverage beginning on February 1st. When I logged in to make a payment in Feb, I didn’t have the information I needed (I thought I could pay with a card, I didn’t have my routing or account number). I spoke with a customer service rep who said I had a 3 month grace period, and I made a mental note to get it taken care of when the next bill came through. On April 1, I was billed $142, which I paid on the 6th.

On April 9th, I went to purchase a prescription and had to pay full price. I contacted my insurance provider to ask what the issue was, and I was informed that the marketplace told them to change my insurance plan.

The plan I originally selected had a premium of $71, deductible of $500, and max out-of-pocket of $2000. The plan I have been changed to has a premium of $590, deductible of $3500, and max out-of-pocket $7000. With that deductible, the plan is entirely useless to me, and the premium is unaffordable. I have just barely met my original $500 deductible, there’s no way I will spend $3500 in 12 months.

So, I contacted the healthcare marketplace. I was told that my plan was changed, and that I lost all discounts, because I “did not provide financial documentation in a timely manner.” I uploaded my 1099 the very same day I received it from my employer, and well within the time frame I was given on the site.

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The marketplace rep told me to reapply for coverage. She submitted my application yesterday, and I uploaded my 1099 immediately. She said that I could then appeal the decision made by to change my plan, and that they would grant or deny my appeal in 90 days.

In order to get to the point that I can appeal, my premium has to be paid in full. I have to come up with $1100, that I certainly did NOT budget for, by May 15. Then, I get to wait 90 days and hope that someone at the marketplace thinks my appeal is valid, and hopefully get some of my money back.

Is there any way to get through this without making that $1100 payment? If I do make that payment, what are my chances of “winning” the appeal with the marketplace? If my chances of winning the appeal are slim, should I cancel my policy entirely and get catastrophic coverage?

I can live comfortably without the $1100, so that’s not my biggest concern. My concern is in the long run, I cannot afford to spend the next three months paying an additional $590, on top of the $1100 I now owe for April and May, just to find out my appeal was denied.

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I cannot believe that I didn’t need to sign something that said, “Yeah, I’ll pay $10,000 a year for coverage that I’ll never get to take advantage of because I’ll never meet that $3500 deductible!” I know that I signed a statement in my application that said I understand that I could lose my discounted rate if XYZ, but fuck! I did not expect it to happen like this.

Side note – To throw in another issue that the marketplace rep brought up, my 1099 might not even be acceptable! I started my current job in August 2017, so my documents only cover until December, and therefore don’t show my annual income. Also, I get paid cash, so I have no pay stubs. The 1099 is the ONLY financial document I have.

ETA- Paid $71 on Jan 15 for month of Feb, Paid $142 on April 6 for months of March and April. My bill coming up on May 1st is $1,051. Idk why it’s so high, I can’t view the actual bill because my insurance companies website is shit.


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