Arizona Expands Medicaid

[Yagents]

Where are you getting this information?

Based on what your saying is: If a person has 10 kids and her portion of the premium is under 9.5% of income she gets NO subsidy.....really???

I posted straight off the IRS document.

Cite your source please.

My source is my brain from educating myself for the past 3 years. If you haven't heard of the Obamacare "glitch", you're obviously just getting caught up. Read this thread and report back what you find out:
http://www.insurance-forums.net/forum/health-insurance-reform-forum/obamacare-glitch-t49425.html

 

[houcoogster]

My source is my brain from educating myself for the past 3 years. If you haven't heard of the Obamacare "glitch", you're obviously just getting caught up. Read this thread and report back what you find out:
http://www.insurance-forums.net/forum/health-insurance-reform-forum/obamacare-glitch-t49425.html

Don't feed me that crap, cite me source not a thread!!!

 

[Yagents]

Don't feed me that crap, cite me source not a thread!!!

I'm done. You asked me for advice, I gave it to you. Do you own research

 

[houcoogster]

I'm done. You asked me for advice, I gave it to you. Do you own research

You gave false information.
Perhaps you should do some of your own research and not be so dependent upon threads.

Here ya go! Let me educate you a little!

Please note, the safe harbors are only used for determining affordability for purposes of the employer penalty and do
not affect the employee’s eligibility for Exchange subsidies, which will still be based on the employee’s household
income.

 

[Yagents]

You gave false information.
Perhaps you should do some of your own research and not be so dependent upon threads.

Here ya go! Let me educate you a little!

Please note, the safe harbors are only used for determining affordability for purposes of the employer penalty and do
not affect the employee’s eligibility for Exchange subsidies, which will still be based on the employee’s household
income.

Love that source? Bold must mean that it's true?

 

[houcoogster]

Love that source? Bold must mean that it's true?

United States Treasury good enough for you?


http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf

 

[Ann H]

Wow, houcoogster, you threw in a complicated one.

Let me see if I can segregate the issues:
* - will she get a subsidy
* - will she get a subsidy for the child
* - will the mother's employer pay a penalty if she gets coverage from the exchange
* - will she even be able to get coverage from the exchange if her employer offers her adequate (minimum value) and affordable (it costs her less than 9.5% of her household income for her share of the premium, based on the self-only premium which doesn't include premium for adding dependents).
* - re-explain that self-only rule! (the family glitch)
* - How about the Father's coverage
* - Are the mother and father divorced?

There are 2 main tests to getting a subsidy. The first is income (under 400% of FPL). The second is eligibility for other coverage that is affordable and adequate. There are some other minor issues, but those two are the big ones.

When you have a child and a divorce, as you indicated in your post that said, "Has BCBSTX group plan she pays $200 a month just for her self the child is covered by her Fathers plan," then it gets more complicated.

Let's start with the basic rules, then we'll throw in a divorce situation.

1 - Her income is less than 400% of FPL. So far so good.

2 - Is she eligible for other coverage that is both adequate and affordable? It sounds like her employer is offering a plan that is adequate (minimum value) and affordable (because you said that she is paying less than 9.5% of the premium). If that is the case, she does not get a subsidy, and neither does the child. It doesn't matter if she wishes to waive this coverage, the very fact that she is eligible for it means she will get no subsidy.

3 - The child will get no subsidy either. This is the "9.5% of self-only premium" rule (also known as the family glitch). Her employer's plan is considered affordable if the employee's share of the premium is less than 9.5% of household income, based on the premium for SELF-ONLY (meaning just the premium for the employee), without regard to how much it costs to cover dependents.

4 - Regarding the employer, if the business is in fact offering minimum value affordable coverage according to this "self-only" rule, then it will have no $3,000 penalty.

5 - Now, how about that father? Whether the couple is married or not, if his coverage is employer sponsored adequate and affordable coverage, then that would also block a subsidy for the child. If the couple is still married, it could block a subsidy for the mother too, if the group plan allows spouses to be eligible. That is because group plans can make spouses inelligible, but they cannot make children inelligible. But what if the Father's coverage is not employer-sponsored adequate and affordable coverage? If he has his other coverage that is at least minimum essential coverage (MEC), nobody who is actually enrolled in that plan will get a subsidy as long as they remain enrolled in it. Being eligible for MEC coverage won't block the subsidy, but being enrolled in it will.

6 - Are they divorced? Because if they are divorced, and if either of them could possibly qualify for a subsidy, then the parent that claims the child as a dependent on his/her tax return is the parent that gets to apply for a subsidy for the child.
- - - - - - - - - - - - - - - - - -
Also, Houcougster, you are correct that the safe harbor is only for employers, and employer can base their 9.5% of self-only premium rule on the employee's W-2 wage as shown in box 1. But nonetheless, when the family goes to get a subsidy, they still must use their entire household income. Don't confuse this, however, in thinking that the family will get a subsidy even though the employer used w-2 wages. If the employer's plan was adequate and affordable based on the family's HOUSEHOLD INCOME, the subsidy application will be denied. There are situations where the household income could be less than the income that one parent shows on their Box 1 W-2 wage. Take for instance investment losses, or Schedule C business losses that reduce the family's household income (MAGI).

 

[taterpeeler]

houcog... you and I spoke on the phone about this very issue this week and I told you at that time there would be no subsidy... also, I informed you that there are several of us on here that have spent years and years... hours and hours attending CMS and insurance carrier meetings about all these topics.

to continue, once we "put a matter to bed" we move on. We don't keep a file on every ruling that they release we discuss it in threads and move on... that's why yagents referred you to the other thread.

in closing, bill(yagnet) and ann are correct until such time as the feds make a different rulling.

 

[timsip]

I like to think of this site as a collection of some of the top agents across the nation. We also have some of the not so top agents across the nation. Yagents has been around the block. In fact, I would say he helped build the block. He has established himself as one of the most knowledgeable agents on this site. He does not post information unless he knows it to be true. I myself rely on him when I am looking for an answer. Basically what I am getting at, I wouldn't publicly deride him when he answers the question you asked. He is professional enough to tell you he doesn't know if he doesn't know. If he tells you the answer, I would give him the benefit of the doubt.

Now Ann H is just as knowledgeable. She is more patient with people that are misinformed so be grateful that she took the time to break everything down better than anyone on this site could have done just for you. I would trust either of these agents with my grandmother's health insurance needs if she lived in Arizona (or Florida where Yagents also is licensed) knowing that she would be very well taken care of.

 

[Ann H]

I like to think of this site as a collection of some of the top agents across the nation. We also have some of the not so top agents across the nation. Yagents has been around the block. In fact, I would say he helped build the block. He has established himself as one of the most knowledgeable agents on this site. He does not post information unless he knows it to be true. I myself rely on him when I am looking for an answer. Basically what I am getting at, I wouldn't publicly deride him when he answers the question you asked. He is professional enough to tell you he doesn't know if he doesn't know. If he tells you the answer, I would give him the benefit of the doubt.

Now Ann H is just as knowledgeable. She is more patient with people that are misinformed so be grateful that she took the time to break everything down better than anyone on this site could have done just for you. I would trust either of these agents with my grandmother's health insurance needs if she lived in Arizona (or Florida where Yagents also is licensed) knowing that she would be very well taken care of.

Thanks for the compliment. Send me your grandmother's case now!

Seriously, that family glitch thing is so complicated, I don't blame anyone for needing a refresher course. There's an employer safe harbor that doesn't apply to employees, two applications of 9.5%, divorces, MV, MEC, eligible for, enrolled in... Oh my!