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I think something is wrong, but I'm not sure, and I need someone who understands the ACA better than I to give me some advice.  

My wife (kossack yellowfroggyattack) and I returned to the States after six years in Japan on March 27th.  We just got connected to the internet yesterday- just in time to beat the ACA enrollment deadline!  Well, I called in because the website traffic was so heavy, and I enrolled... and got shafted, I think.  

Below the squiggly we go...

yellowfroggyattack and I are planning to start a business, so our income calculations have been hard to figure.  While I was waiting on the phone to get signed up, I used's calculator to figure out our subsidy level and pick out a plan.  I entered Michigan, county of Oakland, 2 adults, our ages, and for estimated income I put down $25K.  It showed me a bunch of plans and said that we likely qualified for a tax subsidy of $383.  Yippee!  I chose a decent silver plan that would thus cost us $25 a month.  After a long hold, I spoke to the helper on the phone and she helped me choose a dental plan for $43 a month.  She signed us up, gave me the numbers of the insurance companies, and told me I'd be paying $451 a month.  Wait, what?

She said that since Michigan didn't expand medicaid, we didn't qualify for subsidies.  Wait, I thought there was some sort of federal subsidy?  No, she said.  Well, then why did the calculator tell me I'd get $383 per month?  Well, that's inaccurate, she said.  Around and around we went.  

Is she right?  Is there really no federal subsidy available?  Do I really have to pay full price for these plans?  Who screwed up here, if anyone?  Are my wife and I really going to have to pay $5400 a year for basic health insurance when our income might well be next to nothing?  

What is going on here?  Any help, advice, etc. would be greatly appreciated.

Update- Please note that I am not some sort of Redstate troll or anything.  I still recognize the benefits of the ACA- like the fact that my wife won't be kicked off because of her preexisting condition, etc.  I'm just completely confused about the fact that the prices are sky-high and there's nothing to be done about it.  

Tue Apr 01, 2014 at 4:24 AM PT: UPDATE II - First off, thank you very much to everyone who commented on my diary.  Thanks to you and calling back and waiting patiently on hold, I was able to figure it out.  Here's what happened:  When I initially completed my application over the phone, I was asked for income data.  I asked if I should give my estimated income or only income that I knew about for sure.  The latter, she said.  So I counted some investments and rental income but nothing else, which gave me a yearly income of $7K per year... well below the line for receiving tax credits.  Since Michigan hadn't expanded medicare yet, this meant that I had fallen in the gap, but the person who helped me couldn't articulate this well.  So I called back again and started over fresh (old application thrown out, new one begun) and this time I gave them my anticipated income which qualified me for a tax credit.  Still deciding what exactly I should do based on all of your good advice, but the point is I will indeed be able to get good and affordable coverage via the ACA.  Thank you all again!

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Comment Preferences

  •  Tip Jar (11+ / 0-)

    Odds and ends about life in Japan:

    by Hatrax on Mon Mar 31, 2014 at 05:50:45 AM PDT

  •  I am curious what people have to say (5+ / 0-)

    about this. my girlfriend is in a similar situation. She was told her insurance would cost about $350 a month. She is a mother of two without an income currently. We are trying to figure out how she is supposed to pay for insurance if she isn't working. And she wasn't told about any subsides either.

    "The next time everyone will pay for it equally, and there won't be any more Chosen Nations, or any Others. Poor bastards all." ~The Boomer Bible

    by just another vet on Mon Mar 31, 2014 at 06:13:37 AM PDT

  •  Subsidies are seperate from Medicaid (8+ / 0-)

    As far as I understand, Michigan IS expanding Medicaid as of 4/1/2014... so while there is a gap now, you should quality for Medicaid and there is no deadline for that (the 3/31 deadline doesn't apply).

    The "coverage gap" is a result of the SCOTUS decision that states could opt-out of Medicaid expansion; the subsidies were only supposed to cover those making too much to qualify for the expanded Medicaid, so by states choosing not to expand they are leaving the people in that gap without the same affordable access as everyone else.

    I'm not sure of the specific rules since Medicaid expansion is going into effect in Michigan on 4/1 (tomorrow) - but I do believe you should qualify either for that expansion or the subsidies.  Did you check again?

  •  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:
            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:

                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!!!!!

  •  The important thing is (10+ / 0-)

    if you have confirmation of your having initiated the process.  That way you have the extension to finish up.  It was my impression that the subsidies are wholly separate from the Medicare extension.  The subsidies should be what you saw on

    I'd call again because you'll get someone else.  Tell them exactly what you found when you got into the website.  Also, try the website again to make sure you are at least recognized as having started.

    Someone smarter than I am will help you.  And your post didn't sound like Red State trolling at all.  Good luck.

    Also, if you don't get an adequate answer, repost your diary later -- after it falls off the list.  

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Mon Mar 31, 2014 at 06:31:43 AM PDT

  •  Medicaid and the subsidies are totally separate (3+ / 0-)
    Recommended by:
    political mutt, Sherri in TX, Sylv

    If you make less than a certain amount, you're supposed to qualify for expanded Medicaid and you don't qualify for a subsidy.

    If you make more than that but less than (IIRC) four times the poverty level, you qualify for a subsidy; Medicaid is irrelevant.

    I believe the person you talked to on the phone was misinformed. Try again.

  •  well one thing I found out was (2+ / 0-)
    Recommended by:
    gchaucer2, Sylv

    theres a glitch where, if you did your App and Enrollment by phone, you wont be able to find it on the website under your LogIn account (if you make one) to review it, so take good notes.

    Id strongly suggest you go in person if at all possible and ask for a Navigator to assist you.

    Worst case scenario, you do have the right to Appeal the decision but I dont think you'll have to resort to that.

    good luck!

    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 06:48:31 AM PDT

    •  Unless you are in Florida. (2+ / 0-)
      Recommended by:
      Lonely Texan, Calamity Jean

      FACT !!!!    My son owns a small carpet cleaning business and makes less than 12K a year... His income tax has been held up and he has no health insurance.. Was turned down for medicaid.. He is 45 and has no income at this point due to no chemicals for his machine and little business.
      Florida is messing with the poor really really bad !!!!!

      We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

      by Vetwife on Mon Mar 31, 2014 at 08:43:31 AM PDT

      [ Parent ]

  •  Couple of things (11+ / 0-)

    1. Michigan is expanding Medicaid. If you expect to make under 21,700 in 2014 you should enroll in Medicaid. The expansion of Medicaid starts April 1st.

    From your diary, your combined income is over 138% of FPL which means you are eligible for subsidies.

    2. If the information you gave is correct, then you should be eligible for subsidies.

    Either way, your navigator is dead wrong. Please reply to this comment with more details and I can help you if necessary.

    One issue is that the system may not be accurately measuring your income because of your circumstances.

    •  BTW News Article about Medicaid expansion (2+ / 0-)
      Recommended by:
      gchaucer2, Sylv

      It may be due to your current personal circumstances as entrepreneurs (I assume you don't have a current income?), you qualify for Medicaid.

      This seems to be my impression from how you describe your conversation with the person on the phone.

    •  I think I found the problem (8+ / 0-)

      When I spoke to the first person on the phone, I told them that I had absolutely no idea what my income was going to be because I'd moved from abroad and was starting a business.  She encouraged me to only tell her the income I was 100% sure of.  This included rental property income plus the interest from our bank accounts, which comes to something like $6K.  So according to that, I didn't qualify for tax credits.  I just got off the phone and was able, this time, to give them my estimated income for 2014 and was able to qualify for tax credits through that... though the plan's out-of-pocket and yearly maximums increased.  More updates to come.

      Odds and ends about life in Japan:

      by Hatrax on Mon Mar 31, 2014 at 07:59:59 AM PDT

      [ Parent ]

      •  Good! I was getting worried. (2+ / 0-)
        Recommended by:
        sulthernao, Lonely Texan

        Welcome back to Michigan!
        I imagine you have a LOT to do to get settled, but I hope you and your wife can make a meet-up soon.

        Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

        by peregrine kate on Mon Mar 31, 2014 at 08:02:56 AM PDT

        [ Parent ]

      •  Excellent. I figured it might something like this (1+ / 0-)
        Recommended by:

        Regarding the out-of-pocket maximums. This change is likely to differences in the amount of cost-sharing subsidies you are to receive. People under 250% of FPL receive special cost-sharing subsidies to lower their deductibles, out-of-pocket maximums, and co-payments. The amount of these subsidies are scaled by your income. The more you earn the less you get in both premium tax credits and cost-sharing subsidies.

        Not sure why it changed in your case, but might be because your income estimate was different (?).

        Glad that it looks like you are going to get the subsidies!!!

      •  Oh right, the PPACA got rid of the asset test. (0+ / 0-)
        This included rental property income plus the interest from our bank accounts, which comes to something like $6K.
        I'd completely forgotten you can still have considerable assets and receive Medicaid now.
  •  Indiana refused the expansion also, but I got (2+ / 0-)
    Recommended by:
    Sylv, awcomeon

    subsidies. I went through the website.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Mon Mar 31, 2014 at 07:21:41 AM PDT

  •  Do subsidy retroactively on tax return (3+ / 0-)
    Recommended by:
    JJ In Illinois, lgmcp, ybruti

    One option, if your bank account can handle it, is to yes, pay full unsubsidized price for an ACA policy. Then on your 2014 tax return (the one you'll file in 2015), there will be a form to reconcile this against your actual 2014 income -- and if you're entitled to a subsidy, you'll get it in the form of a tax credit at that time. (We'll all have to do this anyway, since everyone's subsidy is based on an estimate. It will be massively confusing.)

    For people whose 2014 income is a complete unknown, like yours, that seems the best route -- again, if your bank account can carry the full premiums in the meantime. Then when you sign up (in fall 2014) for your 2015 coverage, you'll have a much better idea of your actual income level, and presumably the systems will be better functioning as well.

    And actually, if you're getting a two-person silver plan for $415, you may be getting a subsidy anyway, despite what she said.

    I think I'd try calling back and talking to a different navigator. But the backup would be to go ahead and sign up, and work it out a year from now based on actuals rather than estimates.

  •  Maine (3+ / 0-)
    Recommended by:
    Vetwife, JJ In Illinois, awcomeon

    my sister is having the same problem in Maine. Makes too little to qualify for a fed subsidy, but too much to qualify for medicaid.

    •  Can she take on (1+ / 0-)
      Recommended by:
      Calamity Jean

      a part-time job just enough to earn up to the starting point of subsidies?

      I would think in some cases, it would be to a person's advantage to declare income from babysitting or some activity in the home and paying the few dollars in taxes on that, just to get the several hundred dollar per month subsidy.

  •  This diary brings up some good questions.. (0+ / 0-)

    The diarist sates they estimated $25k in income for their business.

    #1 - Couldn't he have estimated just a bit higher and been eligible for the subsidies?

    #2 - What if they are very successful and make twice that amount?  What happens when they file taxes and show $50k income?  Do they have to pay back the subsidies they were not entitled to?

    #3 - What happens if they fail to make as much as they estimated?

  •  138% of poverty for 2 = $20,941 (0+ / 0-)

    You don't qualify for Medicaid.  I'm in Oregon, where the system is a complete mess; CoverOregon seemed to use 2013 income alone to determine status/subsidy, rather than projected 2014 income....for what it's worth.

  •  I know we're supposed to support (0+ / 0-)

    the ACA - and I do, on the whole. A lot of people will be helped.

    But my God, this is one fucked up system they designed.

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