Healthcare.gov Issues

Tkruger

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I have the majority of my self-employed clients being harassed by the marketplace both by mail and by phone calls stating that the information that was uploaded (for the most part Tax Documents) isn't enough to clear the income inconsistencies.

I have called the marketplace about this and it seems to be a really wide spread issue. I mean outside of the 1040 and Schedule K1 documents what more information can be provided? These are by far the most accurate and official calculations of their income.

I'm also being hit with robo calls going out from HC.gov stating that Coverage will end on x date if info is not received. What makes it even more frustrating is that when freaked out clients call and I check the agent facing portal the upload button has disappeared.

Anyone else running into these challenges?
 
I have on a couple.

If I had to guess, two things are happening:

1. The definite incompetence of the marketplace document department and the ridiculously long lag time between warning letters and calls going out, someone actually looking at the documents, and then making a decision on them.

2. In the meanwhile the client has filed their 2015 taxes and it updated the application automatically based on that income, which I believe removes the ability to upload.

Have you looked at their eligibility letters on hc.gov to see if they have changed? Some of mine in this situation were automatically updated when taxes were filed and dated in late March or April they are stating that the subsidy has been adjusted. The readjusted subsidy is based on 2015 income, not what the person estimated for 2016 and proved (or attempted to prove).

I suppose they could call and report a change in income again if that happens, reducing it back to the original estimation...would that start the clock again on the request for documents? I don't know how that works.
 
I was told a while back that if the upload button is not visible that no documents are required. This was while on a call for WBE's with CMS.

Also, for applications submitted via ACAexpress we have the ToDo List for all applicants and a one click to upload feature.
 
I have on a couple.

If I had to guess, two things are happening:

1. The definite incompetence of the marketplace document department and the ridiculously long lag time between warning letters and calls going out, someone actually looking at the documents, and then making a decision on them.

That wouldn't surprise me in the slightest.


2. In the meanwhile the client has filed their 2015 taxes and it updated the application automatically based on that income, which I believe removes the ability to upload.

We saw that happen 14 to 15, however not a request for documents just the automatic updating of the APTC.

Have you looked at their eligibility letters on hc.gov to see if they have changed? Some of mine in this situation were automatically updated when taxes were filed and dated in late March or April they are stating that the subsidy has been adjusted. The readjusted subsidy is based on 2015 income, not what the person estimated for 2016 and proved (or attempted to prove).

Just did that on one and it matches the original and is dated the original enrollment date. Not all of them but I'll look into that as they continue to occur.

I suppose they could call and report a change in income again if that happens, reducing it back to the original estimation...would that start the clock again on the request for documents? I don't know how that works.

:nah: If I/we/they do this all comp is lost. Remember SEP = $0 comp from that date moving forward.
 
I came on today to complain about this. They are about to drive me bat &*#@ crazy. Currently on hold right now for one that I've gone back and forth with at least twice a month each month so far this year. We've uploaded just about everything except for mortgage refinance papers and their veterinary records.

What is so infuriating is that you can't talk to the people who make these decisions. When you call in and talk to the low level healthcare.gov employees, they just read off of a script and offer guesses, "Have you tried this?" "What if you sent in this?". That is utterly stupid to have the very institution you are calling (that sent you the letters and robocalls) to not be able to answer your questions.

This one stems from farming/ranching income. Wife stopped working last year. So all income comes from husband. His $13,000 or so in social security, and then around $7,000 in net income from his small cattle operation.

We'll see what they say on the phone, that's if I don't get disconnected after waiting for 30 minutes.
 
With all honesty I wouldn't hold your breath. As I've noted long ago...you can get more answers by talking to a wall.
 
I've thought about just resubmitting the same stuff over and over, forcing them to either call to say specifically what they want or just get tired of it and approve it.
 
That's unfortunately what I've been forced to do in may occasions. Maybe a person with a tad more commonsense would review the Tax documents.
 
:nah: If I/we/they do this all comp is lost. Remember SEP = $0 comp from that date moving forward.

I know. If the marketplace has gone in and readjusted their subsidy, they automatically "term" the plan and start it again the next month. One of my carriers at zero comp is telling me they will still pay, the other is noncommittal or can't really tell me what is going to happen.


In a case I have right now, the woman was originally asked for documentation of income. (she divorced last year and so her income is/was quite a bit lower for 2016). She sent it in January and has been constantly harassed by the marketplace that they need her docs, she hasn't sent in the docs, send them in or risk losing your subsidy, etc. She finally got a call last week from someone saying they still needed more documentation and what to send in. At some point she has also filed her taxes showing about $10,000 more in income in 2015 (that was for last year, she had alimony or stock sale or something that bumped her up, I wasn't her agent in 2015)

She called me to possibly go in and upload the additional docs, I open up , and there is the new letter with the readjusted subsidy dated April 13th (the person who called her called April 24 or something like that) No ability to upload docs anymore. She says she doesn't know if she can afford the new rate. I told her she could call in and lower the income back down, but to still send in the docs. If the carrier is going to $0 for me, the damage has already been done by the marketplace.

So, the right hand doesn't know what the left is doing. The lag on the letter actually getting to the client is unbelievable. I have people getting letters just now that are dated April 10th. And saying they need to have additional documents in by May 5th. Some still have the ability to upload, others don't.
 
They are so incompetent that on multiple occasions I have had to call to file for extensions because they still haven't reviewed the uploaded documents 45 days later. The lady asked me why I was requesting the extension and my reply was "If the marketplace would actually do their job I wouldn't need to file for this. Isn't uploading on the website supposed to be quicker?" Then came the multiple apologies and anytime I have ever pressed ignorance on their side we always somehow get magically disconnected.

If I ran my agency this way I would starve to death.
 
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