2014 FPL Guidelines Released

[Yagents]

So, these will be used starting WHEN? After OEP, next OEP?



2014 FPL Levels
1 $11,670
2 15,730
3 19,790
4 23,850
5 27,910
6 31,970
7 36,030
8 40,090


What's Poverty? HHS Gives Us New Figures | New York Daily News

 

[cadylou]

These are the Poverty levels (gross income correct?), not necessarily the MAGI levels for an income subsidy when purchasing healthcare. Wouldn't these be used for Medicaid eligibility and other programs that are driven by these on a calendar year basis? Am I interpreting this correctly?

 

[RayNY]

As per the law, each OEP should use the FPL figures in place for the year it starts. If you want the exact wording, fire up Google.

So, OEP in Oct-Dec 2014 (for a 1/1/15 eff date) uses 2014 FPL figures. As we know, this year's OEP is using 2013 figures, because it started in 2013.

(I've been explicitly told no less than 5 times by my exchange that NY isn't following this rule. They claim to use the FPL figure for the year the income is estimated. They have not yet been able to cite numbers, so I doubt the validity, but 5 separate representatives insist.)

Cadylou, these programs use the same levels. What is defined as "income" (MAGI, AGI, Personal, Household, Joint, Separate, Etc) is different for each program, but the levels are the same.

 

[cadylou]

ok, thanks for that. It helps explain it more clearly.

 

[ActuaryGuy]

As per the law, each OEP should use the FPL figures in place for the year it starts. If you want the exact wording, fire up Google.

So, OEP in Oct-Dec 2014 (for a 1/1/15 eff date) uses 2014 FPL figures. As we know, this year's OEP is using 2013 figures, because it started in 2013.

Per proposed rules, OEP for 2015 will run from November 15, 2014 through January 15, 2015.

 

[AllenChicago]

When someone uses the Special Enrollment Period (SEP) to buy a plan, will they be subject to the current year Federal Poverty Level income tables?
ac

 

[CHUMPS FROM OXFORD]

Actually looking forward to those SEP situations. Gee, I hope there's a lot of them!

 

[RayNY]

Actuary Guy, thanks for jogging my memory, I forgot they decided to delay next years enrollment until after the elections, before this one was even done.

Wanna place bets it gets changed again?

AC, great question. I'm going to quote IRS guidelines and let you decide. "In the case of any qualified health plan offered through the Exchange for coverage during a taxable year beginning in a calendar year, the poverty line used shall be the most recently published poverty line as of the 1st day of the regular enrollment period for coverage during such calendar year."
http://www.gpo.gov/fdsys/pkg/USCODE...leA-chap1-subchapA-partIV-subpartC-sec36B.pdf

Title 26, subtitle A, Chap 1, Sub Chap A, Part IV, Sub part C, Sec 36B, (3)(B) (page 142).

Say that 5 times fast.

My interpretation: "Regular enrollment period" is open enrollment period. It appears that the FPL chart available on the 1st day of the OEP is the chart used for all plans with an effective date within that year. At the beginning of the next OEP, the new FPL levels are used.

To answer your question: No, it appears they are subject to the "prior year's" FPL, the same one we used for everyone else who had a 2014 effective.

 

[Ann H]

Good job researching the answer, Ray.