Client Applications Automatically Being Sent To Medicaid....

[InsuranceGuy29]

Anyone else having problems with Healthcare.gov? I swear, this website/system is the dumbest thing ever created. I have helped 3 people try to get insurance, this week, because they lost their jobs. All of their estimated yearly incomes are clearly way over the threshold for Medicaid, and it keeps shooting all of them automatically over to the state medicaid office. One client called Healthcare.gov, last week, and they sorted it out, but is anyone else having this issue? I'm in Illinois, for reference.

P.S. I really hate the government. Just wanted to throw that in there.

 

[Truce]

I tried to bring this up during the last live agent call with CMS. It appears they have updated the income calculator to NOT trust people with unemployment income to calculate it accurately. They are bouncing them all back to their respective states to sort it out. On one hand this makes sense, as the exchange does not want to send credits to people who are assuming a full year of $600 weekly supplements that may or may not last. On the other hand, people who genuinely will qualify for APTC are thrown to the state and will have a couple months of insecurity wondering if they are covered for claims.

So: SEP Single filer $25,000 income listed ALL as wages....approved with tax credits
SEP Single filer $25,000 income split between wages and UIC: refer to medicaid

It;s the same MAGI, so why should they be treated any differently?

Do you want to edit your application and list the identical income amount but put it all as wages....assume it will all work out once they file? That's between you and your client and the IRS, but it will eliminate the referral to medicaid. Tread lightly.

I wanted to ask CMS if they had "inside info" that these extra $600 week payments, which are NOT being reduced by federal withholding even though they are federally taxable, will somehow be excluded from MAGI by filing time next year. Never got that question answered...

 

[InsuranceGuy29]

I tried to bring this up during the last live agent call with CMS. It appears they have updated the income calculator to NOT trust people with unemployment income to calculate it accurately. They are bouncing them all back to their respective states to sort it out. On one hand this makes sense, as the exchange does not want to send credits to people who are assuming a full year of $600 weekly supplements that may or may not last. On the other hand, people who genuinely will qualify for APTC are thrown to the state and will have a couple months of insecurity wondering if they are covered for claims.

So: SEP Single filer $25,000 income listed ALL as wages....approved with tax credits
SEP Single filer $25,000 income split between wages and UIC: refer to medicaid

It;s the same MAGI, so why should they be treated any differently?

Do you want to edit your application and list the identical income amount but put it all as wages....assume it will all work out once they file? That's between you and your client and the IRS, but it will eliminate the referral to medicaid. Tread lightly.

I wanted to ask CMS if they had "inside info" that these extra $600 week payments, which are NOT being reduced by federal withholding even though they are federally taxable, will somehow be excluded from MAGI by filing time next year. Never got that question answered...

Thanks for the information. This whole system is such a joke. It's like applying for a mortgage just to try and get a very basic health insurance policy. Something that used to take me 10 minutes to write up now takes 2 months (by the time State Medicaid gets back to these people).

Meanwhile, their health and welfare is left hanging in the balance of unnecessary political agendas and bloated bureaucracy. If it wasn't for helping out friends and family of existing clients, I wouldn't even write this stuff anymore. God knows there's barely any money in it, and the headaches, leg work, and aggravation involved for those peanuts most-definitely isn't worth it.

When people ask me what my opinion is of Obamacare, potential single-payer, or potential "MedicAID-For-All, my answer is always, "I want the government out of my life as much as possible." I've seen the horrors first-hand.

 

[phoenixlord]

potential "MedicAID-For-All,

Well, it was intended more like MediGAP-for-All (100% coverage, not just 20% of Medicare) but "Someone" made it "MedicAID-For-All".

 

[CalebReynolds]

I did have this problem a couple times. Once, I fixed it buy selecting a qualifying income on the first screen, and then putting the real income on the job/self employment info screen.

The other time, we called