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View Diary: ACA Advice Needed- Falling through the cracks? (42 comments)

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  •  I am in exactly the same situation in Virginia. (4+ / 0-)
    Recommended by:
    Iberian, Sylv, awcomeon, Lonely Texan

    Apparently, since the subsidies are based on income, no income = no subsidies. I think this is where the Medicaid expansion is supposed to kick in, but my state didn't accept it. For the time being, I will be uninsured.

    •  Correct (8+ / 0-)

      Up to a certain level of income, you (are supposed to) qualify for Medicaid. If you make too much for expanded Medicaid, you qualify for a subsidy (up to, IIRC, 4 times poverty level). If you make too little and are in a state that refused the Medicaid expansion, you're screwed.

    •  Exactly this. (5+ / 0-)

      In states that didn't expand Medicaid, you fall into the "Medicaid Gap." Subsidies are only offered for people who earn over 100% of FPL.

      Hopefully governor McAuliffe is successful in making Republicans expand Medicaid.

    •  true, unless you can make a good-faith estimate (4+ / 0-)

      of enough income to qualify for heavily subsidized ACA.

      I have not seen official regs on what they plan to do a year from now with people who estimated enough income to get subsidized ACA policies, but whose actual 2014 falls under that line. I am hoping that HHS and IRS together do the common-sense thing and don't try to recapture the subsidy money -- this gap was not built into the law, but results solely from the Supreme Court + Republican intransigence, plus the fact that the subsidies are based on estimated income and estimates don't always pan out.

      I do suspect that people who do this may have difficulty doing it a second year and a third. And hoping that Congress does something to amend the law to help you -- well, we'd have to elect a lot of House Democrats to have a prayer of that.

      The only bright spot is that you are clearly and unequivocally exempt from penalties for not having insurance.

      •  the subsidy IS your tax credit, advanced to you (4+ / 0-)
        Recommended by:
        lgmcp, bmcphail, dragonlady, CoyoteMarti

        in the form of a premium contribution-payment directly to the insurance co, and I agree, what a mess for folks with unpredictable incomes.

        As I understand it, the subsidy is simply an advance of your Tax Credit, they are one and the same thing. You can opt to spend it now, on purchasing insurance thru the marketplace, rather than later as a Tax Refund.

        I went into a lot of detail on this with the Call Center person: What if I guess (predict) wrong?? And you are right, it comes out in the wash, so to speak, on your 2014 Return that you do in April 2015. If you overspent your actual Tax Credit (assessed based on your actual income, past tense, and verified with 1099s or whatever other forms as usual) then you will OWE that difference, the amount of money you already spent buying insurance premiums, to the IRS.   I guess in essence its a loan rather than an advance, heh, but only if you guess/predict wrong in the wrong direction. Oy.

        Also.... they stressed that you should contact them and report a Change In Circumstance during the year if need, so as to avoid getting bit in the ass like that, anytime you have a change, increase or decrease, to report. They will adjust the subsidy amount right then and there, thereby avoiding a big hit in 2015. It does NOT affect what Plan you have, thats a lock and you cant change that until next Open Enrollment, next year.

        If I can't dance I don't want to be part of your revolution. ~ Emma Goldman

        by Lady Libertine on Mon Mar 31, 2014 at 08:09:45 AM PDT

        [ Parent ]

        •  I was under the impression that (0+ / 0-)

          if your income was on the low end of the scale, that the penalty was limited to a low number as well, regardless of the outlay on premiums.  Did your call center person get into that?

          We are the principled ones, remember? We don't get to use the black hats' tricks even when it would benefit us. Political Compass: -6.88, -6.41

          by bmcphail on Mon Mar 31, 2014 at 10:29:17 AM PDT

          [ Parent ]

          •  From US News: (1+ / 0-)
            Recommended by:
            CoyoteMarti
            If your income is less than 200 percent of the FPL, the maximum repayment is $600 for families and $300 for individuals.

            We are the principled ones, remember? We don't get to use the black hats' tricks even when it would benefit us. Political Compass: -6.88, -6.41

            by bmcphail on Mon Mar 31, 2014 at 10:35:05 AM PDT

            [ Parent ]

            •  my head is still spinning (0+ / 0-)

              from all this. You only get dinged with the "penalty" for not having insurance at all. That penalty is a percentage calc of whatever your AGI comes out to when you file next year (& kids are half-price)... as I understand it. I have no idea how theyre planning to manage all that.

              But you're saying something different I think. Have you got a link to that?

              If I can't dance I don't want to be part of your revolution. ~ Emma Goldman

              by Lady Libertine on Mon Mar 31, 2014 at 12:12:22 PM PDT

              [ Parent ]

              •  What happens if my income changes? (1+ / 0-)
                Recommended by:
                Lady Libertine

                What happens if my income changes?

                Do I have to pay back subsidies?

                Most consumers receiving premium subsidies will receive it in the form of an advanced tax credit, with the subsidy applied directly to the cost of their insurance. Since these amounts will be based upon your projected income for the year, the actual amount of subsidies you are eligible will in many cases differ. If you end qualifying for more subsidies than any amount will be received in the form of a tax credit when income taxes are filed. What happens if you actually make more money and therefore qualify for less subsidies than you received?

                In cases where households received higher amounts than they were ultimately eligible for, they are responsible for repayment of some or all of the tax credits they received. How much they have to pay back will depend upon their final household income. Households with a final income over 400% of FPL will be required to pay back the entire premium subsidy amnount. For those households with incomesunder 400% of FPL, repayments will be capped at the following amounts
                Income Range     Repayment Cap
                < 200% FPL     $600 ($300 individual)
                200% to 300% FPL     $1,500 ($750 individual)
                300% to 400% FPL     $2,500 ($1,250 individual)
                - See more at: http://www.valuepenguin.com/...

                We are the principled ones, remember? We don't get to use the black hats' tricks even when it would benefit us. Political Compass: -6.88, -6.41

                by bmcphail on Mon Mar 31, 2014 at 01:10:57 PM PDT

                [ Parent ]

    •  We, too, live in VA. My brother is in exactly the (4+ / 0-)

      same situation.  He is unmarried and has sole custody of his son.  He has been unable to find a job for six years.  

      His only "income" is $450/mo. child support =$5400/yr.  VA's maximum allowable income for Medicaid is $4337/yr in the area in which my brother lives (varies by locale).  

      Since VA Repubs continue to refuse the Medicaid expansion, my brother makes "too much" for Medicaid and makes too little to qualify for a subsidy.  The cheapest private insurance option would cost him about $250/mo and pay only about 70% of costs.  This would still leave $$$$ hundreds/thousands $$$$ out of pocket costs for the care that he is in dire need of at this time.  He/we simply do not have the money, though we are scrambling to find ways to come up with enough for him to get to a doctor and at least try to obtain some type of medical relief for him.

      I am so happy that many others are receiving quality care under the ACA due to the efforts of this president, his admin, and the courageous leaders in the Congress and Senate who fought for these first baby steps in health insurance reform.  I continue to pray for the day when universal, single payer health care finally arrives for ALL.

      And I continue to despise the GOTP with a white-hot, burning passion. Lean Forward- GOTV!!!!!

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