back last year in aep I had a few that this happened to... we debated it and we thought it was because of tax issues... ie owing irs money...do ya think this is what happened?
Family of 5, QLE, Under 400% FPL, No Subisdy
- Thread starter FLM2
- Start date
- 8,448
I experienced this in September. Was a glitch in the exchange software that they could not trace down. Thank goodness it was only a single lady and small potenrial subsidy. We purchased off exchange.
Can I ask the premium of the reference silver plan for the county of this client?
At an income that close to the 400% cutoff (~396%), the affordability test uses the full 9.5% of annual income, or about $840/month. If the reference silver was equal to or less than this amount, they wouldn't be eligible for a subsidy even though they are under 400%FPL. There are quite a few places where subsidy eligibility doesn't even extend to 300% for this reason.
At an income that close to the 400% cutoff (~396%), the affordability test uses the full 9.5% of annual income, or about $840/month. If the reference silver was equal to or less than this amount, they wouldn't be eligible for a subsidy even though they are under 400%FPL. There are quite a few places where subsidy eligibility doesn't even extend to 300% for this reason.
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- #14
That is an interesting thought, thanks-I doubt very much that they are in arrears-they are both salaried employees (husband is taking a 1099 position in November) that have payroll deductions and don't seem like a family that would cut any corners. I have a meeting at her place of work tomorrow, though, and am meeting with her earlier to discuss Off Exchange plans and will ask.
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another good thought but the reference plan is about $1500 a month and their income is $106K, that is about 7%.
the weird thing is that the subsidy calculator on healthcare.gov says they could be eligible for a subsidy, it would take into account the reference Silver plan in the calculation.
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Thanks, I was hoping someone else would have had the same problem-it's probably the same thing and they will probably be OK for next year when it's a full year calculation instead of something for a November 1st effective date.
- 1,745
Marketplace recommended work around for those covered now on employer plans and losing coverage, say, at end of current month. I was told by Marketplace a couple months ago to (ignore the actual facts), say that the person has no coverage and then say they are losing coverage in the next 60 days. Sounds crazy, but is apparently a work around Marketplace has discovered. This worked for my clients if they were covered at time of app but losing coverage, say at the end of the current month.
When I did that, they got SEP and subsidy, when income eligible for it.
There must be some glitch in the system that throws out the subsidy "when there is employer coverage", even if ending within the next 60 days. Answering that plan is ending within 60 days worked even when the other question is answered that they have no coverage now. I noted in the file that Marketplace suggested this work around. It's been a few weeks since I did this, but it has worked twice for me.
When I did that, they got SEP and subsidy, when income eligible for it.
There must be some glitch in the system that throws out the subsidy "when there is employer coverage", even if ending within the next 60 days. Answering that plan is ending within 60 days worked even when the other question is answered that they have no coverage now. I noted in the file that Marketplace suggested this work around. It's been a few weeks since I did this, but it has worked twice for me.
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- #16
Thanks, I will try that tomorrow and see if it goes through, this is exactly what I was looking for.
Thanks for the details. That was the idea I was trying to get across in my posts. It worked for me too.
- 8,448
YorkRiver1, BIG THANKS for bringing that valuable TIP to our attention!
Sometimes we have to play with the answers and pray for the desired results don't we. I do this all the time to keep kids out of Medicaid hell.
ac
Sometimes we have to play with the answers and pray for the desired results don't we. I do this all the time to keep kids out of Medicaid hell.
ac
- Thread starter
- #19
I haven't tried out the solution for my family (yet) but really wanted to thank everyone who posted on this thread and contributed to adding to my knowledge of ACA and how the Marketplace works.
This thread, for me, is exactly why I participate in this forum and why it is such a valuable resource for me-I've been able to accelerate my understanding of the new law and becoming the absolutely best advisor I can be for my clients.
I think that, as a group, we are light years ahead of almost every health insurance agent in our understanding and knowledge and I look forward to continuing to help add to that database in the coming months and years.
This thread, for me, is exactly why I participate in this forum and why it is such a valuable resource for me-I've been able to accelerate my understanding of the new law and becoming the absolutely best advisor I can be for my clients.
I think that, as a group, we are light years ahead of almost every health insurance agent in our understanding and knowledge and I look forward to continuing to help add to that database in the coming months and years.
- 1,745
Thanks, Ray, for explaining this so well! Short and simple.
And, Allen, I may have to search Forum for what you do to keep kids out of Medicaid jail. I underscore what you said, FLM2. I went full time in health insurance not quite a year ago. Could not have felt as confident to do so without the support here. Really talented, generous agents. Thanks again from me!
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