ACA special enrollment & subsidy question

[travel2020]

Hello MMMs,

Our DD is graduating and will be moving back to WA for job search. She applied for ACA and was confirmed for insurance coverage starting next month, however her monthly insurance payment is almost $300 for a Regence Bronze Essential plan.

She only had a small income <$5K  last year and none this year so far,  though hopefully that will change. I suspect she missed/skipped something in the ACA application which caused her premium to come out so high.

Is there a way to fix this? If not, will she be able to get a refund of the excess premiums at tax time?

I haven’t dealt with ACA / ACA marketplace asside from looking at options a few years ago, so appreciate any guidance from people who are familiar with the setup.

Thanks

[NotJen]

If she put an income too low (where I live, that's under $20,200/yr), she would be eligible for Medicaid, and not eligible for an ACA subsidy.

Did she apply in WA?

What did she put as her estimated income for 2024?

Did she elect to have her subsidy applied to premiums, or reconciled at tax-time?

[travel2020]

Thanks @NotJen

Yes, applied in WA.

I will ask her what she put for estimated income and subsidy treatment with respect to premiums vs tax time reconciliation.

[seattlecyclone]

Yes a single person with no income should be offered Medicaid (aka "Apple Health" in Washington). There's no charge for this coverage. They can choose to turn down Medicaid, but if they do they will not be offered any subsidies for the Marketplace plans.

Also is she currently your tax dependent? If so she may be required to report your income as part of a multi-person family rather than just her own income as a single person.

[sonofsven]

It's confusing when you're filling out the form for the first time because it wants you to estimate your monthly income, so everything is based off that estimate, and any difference is made up at tax time. If you don't have a steady income it's hard to know what to put.
In Washington the cutoff for Medicaid/ACA is based on 138% of the Federal Poverty Level, which is $15,060 (X 138%) = $20,782.80, so yearly income below that number and you get shunted to Medicaid, and above you get the ACA. The lower your income above that cutoff, the bigger your ACA subsidy. You can also choose to have all, or none, of your ACA subsidy applied to your monthly premium payment.
Some people estimate their income to land above that $20,782 number in order to stay in the ACA, even if they could qualify for Medicaid. If you estimate your income and it's a little off they are not likely to claw back the subsidy after the fact, because technically you are not eligible for an ACA subsidy if you qualify for Medicaid. To make it more complicated, Medicaid eligibility is based on your monthly income, which is why they ask for your monthly income in the first place. In Washington the max is $1,732/mo. But you can make more than that in one month, just not for two months in a row. So you can stay on Medicaid even if you have a big income event (say, from selling stocks) in any one month, as long as your monthly income is back below the cutoff the next month.

It sounds like your daughter should plan on staying on the ACA if she is likely to get a job soon, as making less than $1,732/mo is unlikely.
She can go to the Healthcare.gov site and report a life change. You can go on too and input different income levels and see what that does to plan cost and deductibles and max out of pocket charges.
Since you have to estimate an income level, it's wise to guess low (within reason) since a lower income in the ACA gets you a lower deductible and max OOP, at least in the Silver plans.
Since she's young and (hopefully) in good health, she might look into a high deductible health plan that is HSA eligible once she starts making more money, if she's not covered by an employer plan, because then she can open an HSA and contribute to that every year for a nice tax break.

[lhamo]

She should try to speak with a Healthcare Navigator to get things sorted out.  She should report CURRENT MONTHLY INCOME, not estimated annual income.  That will get her on Apple Health.

If you are in Seattle the navigator at Neighborcare Health in Lake City is great -- that is who I have worked with since 2017. 

I have been happy with Molina Apple Health.

If she does end up getting a job with more income but without health insurance coverage, have her look into the different Cascade Silver and Gold plans.  At lower incomes above the Apple Health cutoff the Silver (and some of the Gold) plans can sometimes be a much better deal with dramatically lower costs overall due to CSRs + much lower deductibles, copays and OOP limits.  I find that under $50k or so of income the Silver/Gold plans make more sense than Bronze.

[travel2020]

Thanks everyone for the detailed replies. We did claim her as a dependent last year, so that muddies the picture a bit. This will change after she has graduated and has a job, etc.

@lhamo thanks for the suggestion about health navigator. I will have her reach out to them for more authentic guidance than what I can provide.