My First "Clawback Casualty"

I'm sorry Ann, I follow you as someone I would consider a "guru". That first part is what I have read here on the forum.

They will lose their subsidy, but they won't have to pay it back (so far, that's the consensus). I should've written that that "seems to be the consensus here". Better?

HOWEVER, I've already seen with my two eyes actual letters stating that the subsidies are lost for many people who mis-projected their income. Also, that if they want new coverage for 2015, they have to submit past premium from when they lost subsidy and possibly coverage, to continue coverage. IF they do not do that, they will not be able to obtain coverage. Did NOT want to write a book.

I am certified and do know what MAGI is. This was info from CPAs and tax accountants, the Line 37, for the most part...I'm not trying to write a book, just show that there will be LOSSES. It was stated as fact. I know plenty of them too, and plenty of clients with such professions. I am a very small operation, but I do have a few agents of my own (not micromanaging, theyre trained properly), and many, many friends who are choosing to do Marketplace ACA sign ups....I hear about it and read about it daily, and I make it MY business to familiarize myself with the tax accountants views and what they know and social workers and other professionals who are involved. (seems like I remember you have a tax accountant husband? no? Idk, think I may have read that a long time ago--could be wrong, let me clarify that, really don't have time to go look up all of your posts...I'm human, make mistakes).

Some of the post is of opinion and I felt I stated it as so.

The last paragraph doesn't say anything about it being 'fact' and messing with earned income. I just wrote that "I would not be surprised" (which should be clear it's not a fact). If that gets taken as "fact", then that shouldn't be my responsibility. That would be a misperception on who reads it and how they would get it as fact out of "it wouldn't surprise me..." is beyond me. To each their own. Perhaps I should just read quietly, so as not to offend the heavy writers of this wonderful product...perhaps keep my reasoning and logic to myself. If not yet, on the earned income issue, down the road that is a real possibility, considering it is often garnished based on outstanding medical bills alone...and it has often been a way to recoup money from the Govt. --- BUT, this is an opinion, and wasn't stated as fact.

Just because I am not writing much of ACA, doesn't mean I haven't actively kept my skills sharpened. I've been in the health insurance market for enough years to understand a few things. I still have a LARGE book on 'other' health insurance products. Many people very close to me are writing tons in the MP-ACA. I've thrown out a few questions here and there in this forum, but I always go to the source to double check. Even there, there are conflicting answers for the same questions. Directly to the Marketplace reps themselves. As a rule, I tend to be conservative when it comes to this stuff, which is why I'm just reading and observing for now. Again, I do not see where I was stating "facts". Sorry to offend you, as it seems I did just that.

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According to the IRS that is completely false. You will have to pay it back via income taxes (if they are on subsidies it will be via deducting it from tax returns most likely).

You are giving very dangerous advice.

Also, this was about people who took a subsidy when they really only qualified for Medicaid!! First off, how would the gov't get blood from a turnip. And, wasn't stated as fact, other than it was a "consensus", mostly what I've read here. Since most people haven't done their taxes yet, .... I do realize CLAWBACKS will be real.
 
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Lakshmi, I didn't mean to offend you. However, I took your post kind of like yelling "fire" in a crowded theater. I understand that some of it was just "thinking out loud as you wrote", and sharing your feelings. However, people read this forum for advice from professional agents, and they may read what you wrote and conclude that subsidies wouldn't be clawed back. That's not the truth. They also may be scared into thinking the subsidy will mess with their earned income credit. It won't. Now, if you meant a clawback will be taken from their refund, and that refund was based on earned income credit, then yes, it's the truth. But if you meant the subsidy will lower their earned income credit qualification, then no. Once again, I didn't mean to offend you. But let's make it clear that the clawback is real, and will affect a huge proportion of the people who estimated their 2014 income back in October/November of 2013.

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What about a client who enrolled his family in say January, he was unemployed and his income qualified him for a subsidy. Then in June he got a job, cancelled his subsidized plan due to employer coverage.
I think my interpretation of the Claw-back would be dependent on his year end family's Modified Adjusted Gross Income as to what amount he will owe back to the Government ?
The final calculation would be based on his Annual Income not what he made the prior 6 months when he was unemployed and on a subsidized plan.
Am I correct in this interpretation?

You are correct, JeffLange

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Let's also remember that there is a limit to the clawback. It is:

$600 if less than 200% of FPL
$1500 if 200-300% of FPL
$2500 if 300-400% of FPL
100% if over 400% of FPL

That is for married couples. For singles, it is half that amount.

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Edit: I thought about what I wrote, and Lakshmi, I'm really sorry. You were thinking out loud, and expressing opinion. I hope no reader assumed from it that the IRS isn't going to collect on that clawback, but if they did they just looked for an opinion that they went searching for in the first place. So, please forgive my rash (and probably sleep deprived) flashback at your post.
 
Absolutely...the first half of my response was for a previous poster...if he/she's writing about showing how a $200 premium can go to zero dropping the income a dollar...that's what that was for...can't get blood from a turnip. I made the assumption that if someone's talking about that low of a premium, my conclusion was for probably low income person, hence not much clawback to be had. I suppose that was where I went wrong. Misunderstanding. Of course CLAWBACKS will happen. Absolutely.

And as for the second part, that was precisely what I meant. It would definitely be one of the only ways to recoup subsidy over-payments for some people---by taking an earned income credit---and sadly many lower income people would be affected. Just following past logic of our country's government. It's not much of a stretch. It's all we can do until we know EXACTLY what will happen (except for higher income earners and those with a way to claw back---NOT the lower earners who obtained a subsidy when they shoud've qualified for Medicaid, or nothing at all ). Again, why I'm conservative with that ONE "product"....ACA. The rest I am not at all conservative...still doing plenty of health insurance, among a full array of life, CI, DI, just not much in MP-ACA. Keeping educated on it, however. It's still important to know.

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Ann, no problem. I'm sleep deprived too. Very busy lately, thankfully not with ACA so much. LOL. Although tomorrow is going to be an ACA day. :( I see the mistake I made. I went on a tangent about no clawbacks and NOT clarifying it was written partially to another poster who I assumed was talking about low income people---if people get a zero premium...you know, I already explained. I appreciate the apology.
 
Good Info that's Relevant to this very useful and timely thread..
IRS Rule: Internal Revenue Bulletin - June 11, 2012 - T.D. 9590

I read somewhere in this forum that people/families who end up earning less than 100% or 138% (in Medicaid Expansion States) of FPL do not have to repay any of the APTC/ subsidy received. But I can't find it in the IRS rule.

But I do see that everyone who receives an Advance Premium Tax Credit must file a tax return the following year.. even if they only made $5 in annual income.
ac
 
Good Info that's Relevant to this very useful and timely thread..
IRS Rule: Internal Revenue Bulletin - June 11, 2012 - T.D. 9590

I read somewhere in this forum that people/families who end up earning less than 100% or 138% (in Medicaid Expansion States) of FPL do not have to repay any of the APTC/ subsidy received. But I can't find it in the IRS rule.

But I do see that everyone who receives an Advance Premium Tax Credit must file a tax return the following year.. even if they only made $5 in annual income.
ac

The law says clawback is limited to $600 at 200% FPL or less: https://www.fas.org/sgp/crs/misc/R41137.pdf

I can't find the US Treasury document about not enforcing clawback for those under either 100% FPL /138% level but have definitely read it. Here is a reference to this as written by Kaiser News, although the link in the article is no longer working: http://www.californiahealthline.org...below-poverty-wont-have-to-repay-aca-subsides
 
Cannot imagine they will penalize you for a "positive" outlook on your income for the coming year.

We should all know in about 2-3 months...
 
Yes, time will tell. And for some it already is becoming clear. Letters are rolling in...and some people are gearing up fast for their quarterly income taxes (self employed).

But some things are becoming clear, the very low income as posted in this forum by links, will not have to pay back.

We should all know in about 2-3 months... --Russell, at least for round one, that is...:)
 
My understanding is that those who fall below 200% will have to pay back $300 for single and $600 for couple. See Ann's chart above.

The link was provided by FLM in post #25 (Table 5. Limits on Repayment of Excess Premium Credits Enacted by the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayment Act of 2011 (P.L. 112-9) - on page 16).
 
But what happens in year 2 to these people. Year 1 is a sorry, do it again in year 2 and u got trouble

Year one is a clawback, as applicable under law. No one is sorry.

Year 2+ is also a clawback, as applicable under law. That's it.

Last year's income will never be a guarantee of next year's estimated income. They'll never be able to prove your estimate is wrong. They'll send a letter saying "based on your tax filings, you qualify for medicaid" (which, people rec'd this year, based on their 2012 filings) instead of a renewal.

Then you just log on, re-affirm your income estimate, provide a reason it's different than your last tax filing, and re-enroll.

They really can't do anything about it.
 
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