Understanding ACA subsidies and income

[frugalnacho]

I'm having a bitch of a time with medicaid, and they have canceled coverage for me, my wife, and my son starting 1-1-24.  For some reason our daughter was approved and has coverage.  I'm not sure how the 2 year old qualifies, but the 6 year old doesn't.   I have been dealing with them for 5 weeks now trying to resolve the issue and have spent probably 20 hours dealing with them.  I was originally hopeful it could be resolved before losing coverage, and then I was hopeful it would be reinstated shortly, but they keep giving me the run around and I am pretty sure each of the 6 specialists I've dealt with are complete morons and have absolutely no idea what they are doing, but there is no one up the chain to escalate to.  Every time I call it's an hours long ordeal, and the information I get is different each time.  They keep claiming they need proof of income, and I keep telling them I don't know what the fuck they want me to give them.  I don't have any W-2 income (which blows their fucking mind), but they keep repeatedly asking for it.  I provided them my tax return showing negative AGI for 2022.  I didn't draw any wages in 2023, and not in 2024 yet either. I haven't completed my 2023 return, but it will be under the income limit anyway, which I told them.  [Almost all the money was intentionally reinvested in the business to not only build the business, but to keep my AGI low intentionally so I qualify for coverage].  They still just keep making up shit I need.  "Oh you just need to write a letter explaining all this and upload it to the portal.  Your specialist will sort it out".  Well I did that 5 weeks ago and as of yesterday still no one has even read it. Then I needed to submit a schedule C.  I told them the business is an S-corp and we filed a schedule E not a schedule C, and they have the schedule E along with my entire tax return, but no deal it absolutely has to be a schedule C.  Just do the schedule C and upload and everything will be fine.  So I did that 2 weeks ago and nothing.

Now they are saying there is an asset test.  I pushed back and said that I don't believe there is an asset test, it is income only, and she pushed back and said there is an asset test.  I asked when it was implemented because my understanding was that ACA didn't require it, and it was incorporated into medicaid when it was expanded in the state.  She said that was a covid only policy and the restriction was lifted in June of 2023 and there now is an asset test. Then I asked why the application they sent to me in November says right next to the assets that they are not required for healthcare coverage and are only needed for some other things (long term care, etc)? She said that's a mistake and shouldn't say that.  Then I asked why I was being informed of this on January 16, when I submitted my application in November, submitted a follow up letter in December, and spoke to 5 specialists before her, and literally no one mentioned ANYTHING about requiring an asset test before January 16.  Seriously, I've been dealing with you guys for 5 weeks now, spoken to 6 specialist, my family has been uninsured for 2.5 weeks, I am out of my prescriptions, my son has had to reschedule with 2 separate offices because they won't see him without insurance, he is sick with another ear infection (because he couldn't get into the specialist earlier this month like it's been scheduled for months) and I now have to take him to urgent care and pay out of pocket uninsured prices...and NOW you are informing me of some asset test?  WTF? I inquired about what assets they want to know about, and what are the cut off limits, but she said she can't tell me.   It's like some kind of fucking game, just go gather all your assets and submit them, and then we will make an arbitrary determination later apparently - or not, just enjoy sitting around with no insurance while we do absolutely nothing on your case.  It's still unclear to me exactly what information they want, and why they want it, or how it has any bearing on my eligibility.

Anyway, I'm fucking done with them.  I have reached my frustration limit and cannot deal with them any more, so I am considering just moving to an ACA plan.  The business will make money this year, even if I don't draw W-2 wages just yet, so I figured I would have to transition off medicaid by the end of this year anyway.  But my son needs coverage right now.  Actually he needed it 3 weeks ago.  So do the rest of us.  The specialists I spoke with said if/when coverage is reinstated, it won't be retroactive, so any costs I incur in the mean time will just be my responsibility.  So I guess fuck me if I get into a car accident or something, I can forget FIRE along with pretty much everything else because we'll be financially ruined.

I still have around $80k in taxable brokerage, so I can harvest some capital gains to increase income, and also get money to live on and pay bills.
I also have around $600k in IRAs that I can convert to roth to increase my income if needed.

I plan to call a healthcare navigator and have them help me sort this out and get on a plan, but I want to have a better understanding of it all before I call them.  Every person I have dealt with up to this point cannot comprehend the mustacian mindset, or manipulating your AGI.  To them it's just "give me your paystub, I'll calculate it out for the year, and we'll see where you land".  You just earn as much as you can earn, and fall where you fall.  They seem literally incapable of comprehending manipulating your AGI to be what you want to maximize benefits. Hopefully the healthcare navigator is better than all the morons I've been dealing with at MDHHS, but I'd like to have a thorough understanding myself.

Federal poverty level for a family of 4 in 2024 is $31,200. 

Michigan medicaid eligibility for adults has a cut off at 138% FPL, or $43,506.  I should qualify for this, but they won't fucking give it to me.

According to healthcare.gov AGI needs to be $65,100 (~209% FPL) in order for children to be on an ACA plan.  Income of $65,099 and below requires children to be on medicaid. 

Seems like the obvious choice is to just roll with my actual income and get medicaid coverage for the entire family, but apparently that is actually not an option.  The next best option would be just over the 138% to get me and my wife coverage and get free medicaid for both kids, but apparently that is also not an option.  So it seems like the best actual option to get me and my son coverage is to claim my income is $65,100, get an ACA plan, and then do my best to actually match that by the end of the year.

What are my actual options, and what should I do?!

Will a healthcare navigator be able to interject into the system and help me solve this, or will he merely be able to advise me that yes I should qualify for medicaid and to contact MDHSS to sort it out myself?

If I do go with an ACA plan, what are the ramifications if my estimate is off?

[secondcor521]

I'm saddened that the bureaucracy in your state is really bad.  Suggestions for that:

1.  Drive down to the DHW office where they handle this stuff and talk to them in person.  I did that once and I think it helped.
2.  You can continue to try to escalate, but you said you tried that.  I'd still try again.
3.  You might try getting your member in the US House of Representatives to escalate for you.  Usually this is done for federal agencies like the IRS, but since ACA and Medicaid are both federal laws, they may also help you with your state bureaucrats.

As far as your questions, you first have to get the Marketplace to accept your income estimate of $65,100.  Then you'll choose a plan and pay the first month's subsidized premium directly to the insurance company.  Usually if you do that by the 15th of a month, your coverage will start on the 1st of the subsequent month.  So you can probably get ACA starting on 1 March.

I think a Navigator will just help you shop ACA plans and navigate the ACA signup process.  I doubt they would help you with your main bureaucracy issue.  But I've never worked with one.  They may know the system better than the average Joe, so they might have ideas.  Certainly wouldn't hurt to ask.

If your estimate is off, your subsidies will be reconciled at tax time via Form 8962 which you'll file with your tax return.  You'll either get additional subsidy if your estimate was higher than actual, or pay back some of the subsidy if your estimate was lower than actual.

You might also consider getting a short term health insurance policy directly from an insurance company.  Without the bureaucracy of ACA and Medicaid, you could probably get coverage in a day or two.  A catastrophic policy would at least provide some protection until you get the government stuff sorted.

[reeshau]

I don't know whether a navigator could help, but a brief internet search I cam across the Michigan Medicare Assistance Program, which also says it can help you "understand Medicare/Medicaid eligibility, enrollment, coverage, claims and appeals."

https://mmapinc.org/


Another link I found distinguished between the Healthy Michigan Program and traditional medicaid.  Might that be part of why stories aren't adding up?  Which are you expecting?

On asset limits:
"There is no asset limit for HMP. There is also no asset limit for TM categories for eligible children, pregnant women, and some families with minor children. Most other types of TM have asset limits.  To learn more about a specific category’s asset limits, you can speak with someone at MMAP."

From: https://michiganlegalhelp.org/resources/public-assistance/income-and-asset-limits-medicaid#:~:text=There%20is%20no%20asset%20limit,speak%20with%20someone%20at%20MMAP.

[frugalnacho]

I am using "medicaid" as a blanket term for all state offered coverage.  I believe we were on the healthy michigan program.

[frugalnacho]

I'm saddened that the bureaucracy in your state is really bad.  Suggestions for that:

1.  Drive down to the DHW office where they handle this stuff and talk to them in person.  I did that once and I think it helped.
2.  You can continue to try to escalate, but you said you tried that.  I'd still try again.
3.  You might try getting your member in the US House of Representatives to escalate for you.  Usually this is done for federal agencies like the IRS, but since ACA and Medicaid are both federal laws, they may also help you with your state bureaucrats.

As far as your questions, you first have to get the Marketplace to accept your income estimate of $65,100.  Then you'll choose a plan and pay the first month's subsidized premium directly to the insurance company.  Usually if you do that by the 15th of a month, your coverage will start on the 1st of the subsequent month.  So you can probably get ACA starting on 1 March.

I think a Navigator will just help you shop ACA plans and navigate the ACA signup process.  I doubt they would help you with your main bureaucracy issue.  But I've never worked with one.  They may know the system better than the average Joe, so they might have ideas.  Certainly wouldn't hurt to ask.

If your estimate is off, your subsidies will be reconciled at tax time via Form 8962 which you'll file with your tax return.  You'll either get additional subsidy if your estimate was higher than actual, or pay back some of the subsidy if your estimate was lower than actual.

You might also consider getting a short term health insurance policy directly from an insurance company.  Without the bureaucracy of ACA and Medicaid, you could probably get coverage in a day or two.  A catastrophic policy would at least provide some protection until you get the government stuff sorted.

There is a department of human resources about 2 miles from me.  I am going to go there in the morning and see if I can talk to someone.  I know my case is unusual, but if they just listen to me everything can be explained.  There is no hidden income.  Once I have a specialist on the phone for about 30 minutes they finally start to understand (despite me fully explaining the situation in like 1 minute).  We have to go through the list,

"you need to verify your income"
Yeah I did.  I told you all of it.  I'm not hiding anything, I didn't have any income. It's all there on the tax return.  I don't have a 2023 return yet (applied in Nov 23), but it's similar and well below the federal poverty line. [business made $48k profit after expenses.  50% of that is mine, so $24k]
"oh, then just submit your W2 to substantiate your income"
I keep telling you there is no W2.  There is literally no payroll.  No payroll, no distributions.  That's why you're not seeing it on my tax return, because it doesn't exist.  There is a few thousand dollars from dividends, capital gains, and tradelines, but no salary or wages.  And no distributions.  Technically everything left in the business after expenses is 50% mine and will count as income, but that's not enough to go over the limit because our expenses/deductions are very high bringing the income down substantially.  And that's all documented on the tax return.
"Oh I see...well we need to verify your income"
...Ok, wtf do you want?
"like a W2 or paystub or something"
*sigh*....M'aam...there is no W2.  There are no paychecks.  I'm not paying myself.
"but you're employed?"*
Yes.  I work for frugalnacho inc which I own 50% of.  We are an S-corp.  However I do not pay myself wages, because there isn't enough money to cover all the initial start up expenses AND do payroll.  Not for the first few years at least.
"Then how are you supporting yourself and paying for bills?" (this line is always delivered like it's some kind of gotcha, like I'm just lying and didn't think they would think of the most basic financial question)

I don't know why there is no communication between anyone, because every single conversation with them starts out that way.  I explain it all, finally get the specialist to understand it's a weird situation (after like 30 minutes), but there is no hidden income or scam, then they give me some kind of bullshit task and pass me off.  And the next time I call is brand new fresh start with no one aware of any of the information I have relayed in my previous phone calls. 

The second to last specialist gave the advice of just reapplying.  Then they have up to 45 days to review.  When I asked wtf I was supposed to do for that 45 day wait considering I already needed coverage like 2 weeks ago that point, she had no answer.  Basically said it's a shitty situation but there is nothing she can do, just reapply and wait.  And I have very little faith the reapplication would be properly approved anyway.  Still sounding like it might actually be the best option at this point.  I would hate to start the process over if they are actually on the verge of approving it though.


How do you get the ACA to "accept" your income estimate?  My plan would be to intentionally not pay myself wages, and if we earn a significant amount from the business I would likely just roll that into additional equipment that still needs to be purchased.  We could probably spend $400k on stuff if we had the funds available, so I think we can keep the reported income low if needed.  And if the earned income was too low I would just bump it up with IRA conversions to get it exactly where I want it.  How do you get them to "accept" that, and why does it matter if it gets reconciled at the end of the tax year?  Seems like people operating in bad faith would be caught and the system would correct it after the first year.

The more I look at this the more insane it sounds to realize additional income in order to qualify for an ACA plan, which in turn is going to still cost me a bunch of money to actually use.  The subsidy would take care of a good amount of premiums, but once you account for actually paying for services it seems like it's going to end up costing us a substantial amount.  I'm glad the ACA option is there and can provide insurance when people need it, and it would be a godsend in a situation where you earn money and have no access to health coverage.  But it seems very inferior to the $0 I have been paying in 2022 and 2023. 

*: one of the specialists claimed in my situation I should report it as "unemployed" since I don't pay myself.  That seems wrong to me, but I'm not a specialist.

[secondcor521]

^ I don't know what to tell you.  In my state, the people that work at the Marketplace seem to be able to handle FIRE folks just fine.  Maybe there are more of us here.

How to get them to accept your estimate:  In my state, you apply and say my income is from retirement and it will be $36K per year (or whatever).  Some Marketplace person reviews it and if they believe it, it is accepted.  If they have questions (usually only if your estimate is much lower than your previous return or previous estimate), then they might ask you to write a letter explaining what's up.  Then you write the letter, maybe with some supporting documentation and it then gets accepted.  Not hard, takes maybe a week.  Once you're on ACA, as long as your income estimate changes by less than 20% up or down, it's automagically accepted by a computer somewhere.

The reason for reconciliation:  The ACA was set up so the subsidy could be paid out in advance.  So each month the government pays the subsidy to the insurance company directly, and the taxpayer pays the rest.  Since the subsidy is based on family size and annual income (and the SLCSP), they need to know what income to use.  The 2024 subsidies are based on 2024 AGI, but you won't know your 2024 AGI until next spring.  So how to get the subsidy now?  They let you estimate / guess what your 2024 AGI will be.

Now obviously,  nobody guesses exactly right.  Just like nobody withholds exactly the amount of income taxes that will be due.  So just like the regular part of taxes, where you settle up with the government on your 1040 and get a tax refund or pay more in, you have to do the same thing with the ACA subsidies.  On Form 8962, all the numbers get plugged in, and if your estimated AGI doesn't match your actual AGI (and it hardly ever does), then your subsidy - which was based on the estimated AGI was either too much or not enough.  The Form 8962 adjusts for that, and you either get paid the additional subsidy you were entitled to, or you pay back some of the subsidy if you got too much.

They could avoid this by (a) not providing advance subsidies, (b) making the subsidies for year X based on year X - 1, (c) not tying health care subsidies to income, or (d) not providing subsidies at all.  There are obvious problems with those four options, so we go with what they decided back in 2014 or whenever the law was written.

Surprisingly, the Marketplace doesn't get to see your tax return, although this seems to be slowly changing.  So until recently, there was no feedback loop from the IRS to the Marketplace if people were gaming the system.

If Medicaid or your MHP program are superior to ACA for you, I'm glad.  Sometimes there can be access and quality issues - it depends on the state.  If you do end up on ACA and your family is on average low health care utilizers, you can probably get a Bronze HSA eligible policy and contribute to an HSA and get a tax deduction for the HSA contribution.  The Bronze HSA will act like catastrophic coverage at about $8K OOP, but the subsidized premium for a middle class income should be pretty low.  That's what I do.

[reeshau]

How do you get the ACA to "accept" your income estimate?  My plan would be to intentionally not pay myself wages, and if we earn a significant amount from the business I would likely just roll that into additional equipment that still needs to be purchased.  We could probably spend $400k on stuff if we had the funds available, so I think we can keep the reported income low if needed.  And if the earned income was too low I would just bump it up with IRA conversions to get it exactly where I want it.  How do you get them to "accept" that, and why does it matter if it gets reconciled at the end of the tax year?  Seems like people operating in bad faith would be caught and the system would correct it after the first year.

It can vary by state process, but Texas, minimizing its involvement with the ACA, uses healthcare.gov.  I put in what I have, and it's...just accepted.  On my 4th year, and never once asked for evidence.  I do work to hit my "target" with a late-year Roth conversion, but I have still varied by +/- $20k, because of how strategic stock sales or special dividends have come in.  True up for the year in the tax return, then start the same thing next year.

[frugalnacho]

^ I don't know what to tell you.  In my state, the people that work at the Marketplace seem to be able to handle FIRE folks just fine.  Maybe there are more of us here.

How to get them to accept your estimate:  In my state, you apply and say my income is from retirement and it will be $36K per year (or whatever).  Some Marketplace person reviews it and if they believe it, it is accepted.  If they have questions (usually only if your estimate is much lower than your previous return or previous estimate), then they might ask you to write a letter explaining what's up.  Then you write the letter, maybe with some supporting documentation and it then gets accepted.  Not hard, takes maybe a week.  Once you're on ACA, as long as your income estimate changes by less than 20% up or down, it's automagically accepted by a computer somewhere.

The reason for reconciliation:  The ACA was set up so the subsidy could be paid out in advance.  So each month the government pays the subsidy to the insurance company directly, and the taxpayer pays the rest.  Since the subsidy is based on family size and annual income (and the SLCSP), they need to know what income to use.  The 2024 subsidies are based on 2024 AGI, but you won't know your 2024 AGI until next spring.  So how to get the subsidy now?  They let you estimate / guess what your 2024 AGI will be.

Now obviously,  nobody guesses exactly right.  Just like nobody withholds exactly the amount of income taxes that will be due.  So just like the regular part of taxes, where you settle up with the government on your 1040 and get a tax refund or pay more in, you have to do the same thing with the ACA subsidies.  On Form 8962, all the numbers get plugged in, and if your estimated AGI doesn't match your actual AGI (and it hardly ever does), then your subsidy - which was based on the estimated AGI was either too much or not enough.  The Form 8962 adjusts for that, and you either get paid the additional subsidy you were entitled to, or you pay back some of the subsidy if you got too much.

They could avoid this by (a) not providing advance subsidies, (b) making the subsidies for year X based on year X - 1, (c) not tying health care subsidies to income, or (d) not providing subsidies at all.  There are obvious problems with those four options, so we go with what they decided back in 2014 or whenever the law was written.

Surprisingly, the Marketplace doesn't get to see your tax return, although this seems to be slowly changing.  So until recently, there was no feedback loop from the IRS to the Marketplace if people were gaming the system.

If Medicaid or your MHP program are superior to ACA for you, I'm glad.  Sometimes there can be access and quality issues - it depends on the state.  If you do end up on ACA and your family is on average low health care utilizers, you can probably get a Bronze HSA eligible policy and contribute to an HSA and get a tax deduction for the HSA contribution.  The Bronze HSA will act like catastrophic coverage at about $8K OOP, but the subsidized premium for a middle class income should be pretty low.  That's what I do.

the state medicaid program as been awesome.  It was a bitch to get on in the first place and caused a lot of stress, and this entire kerfuffle has also been stressful.  But for the 2 years of actual coverage it was nice.  Some issues with them not approving medications, and typical back and forth insurance bullshit, but I've had to fight with that with every insurance I've ever been on including employer plans that were "Cadillac" plans. Insurance companies are just plain evil. Everything being absolutely free was so freeing though.  No worrying about copays, prescription costs, extraneous procedures, price shopping around, etc.  Just focus on whatever is best for your health and don't worry about cost.

It was the best most freeing insurance experience...sandwiched between absolute bureaucratic nightmares.

It's actually been so nice and such a sweet deal we were engineering the business income and our personal income in order to qualify for as long as possible.  I thought we were all set for at least another year. 

[MrGreen]

I believe that if you "should" be on Medicaid based on income but are denied for whatever reason, you then qualify for subsidies on private insurance through the exchange. That's the way it works in North Carolina, which uses healthcare.gov. During open enrollment, the income we estimated for 2024 caused our application to say our daughter (2 years old) qualified for Medicaid. This automatically prompted a contact from our local Department of Social Services office to fill out a Medicaid application. We did, and they promptly denied her even though she should be covered at our income level. Of course they did this on the last business day of December so I was nervous about starting 2024 with no insurance coverage for our daughter. The Medicaid denial was reported back to healthcare.gov and we updated our 2024 application to indicate that our daughter was recently denied Medicaid. As a result, we were eligible for a private family plan with subsidies to match. We selected one that same day and felt relieved knowing we were all covered for the new year.

[lhamo]

STRONGLY recommend you find a navigator ASAP (which is what I recommend to everybody and IIRC correctly what I suggested to you several years ago already).  Sorry if that's a little spicy but I get frustrated when people don't at least try this strategy and then end up frustrated in endless phone/email loops that go nowhere.

I can't guarantee 100% that your state will be the same, but my experience with my navigator has been that she has direct access to the state system and can put your stuff in there on the spot and you should know within 24-48 hours if it has been approved and if you are back on medicaid.  They have the medicaid system set up in our state so that they can get people in QUICKLY and it back dates to the start of the current month.  My suspicion is that this is so that social workers at the hospital can get uninsured but eligible people into the system when they show up at the ER without coverage.  Hospitals have to provide care and this is one way of trying to keep them from going bankrupt.

Take all  your financial records for the past 2-3 years with a summary of how it pencils out in terms of monthly average income. 

I hope this works for you and that you find a navigator who knows what they are doing and that you can continue to work with.  I am very grateful that mine has been in her job since 2017 and is still available to help me. 

[frugalnacho]

You did recommend it several years ago, but then I got approved and have been in the system for the last couple of years.  I should have taken your advice from the start, but I never followed through since everything was already approved.  I didn't realize it was necessary to get them involved at this point.  Talking to the specialists directly at MDHHS repeatedly led me to believe this situation could be resolved.

I just went to the MDHHS office and spoke to someone.  What she told me is that they sent a letter (which I never saw) requesting additional information by Dec 4 [the letter is in my portal, but I don't log in to check anything in there unless I get correspondence from them].  When I didn't respond they sent me a cancelation notice which I did see and immediately responded to.  According to her once the Dec 4 deadline passed, the entire application was dead.  There is no reversal, or rectifying anything.  She claimed it's not just a matter of policy, it's physically impossible in the system to go back and alter anything after it's done.  If you get rejected, even erroneously, the only remedy is completing a brand new application, period.  A new application will take up to 45 days to process.  She says there is no mechanism to expedite anything, it's not even possible.  Sorry for you luck pal, it's a real shitty situation and I sympathize with you, but I can't, and no one else can help you either, you just need to fill out a new application and wait 45 days and hope they approve you.

Why did they have me write a letter on Dec 14?  Why did they force me to create a mock Schedule C? Why did they ask me to submit asset records?  Why did they have me do any of this if the decision was final and irreversible as of Dec 4?!?!  Only one of the specialists I spoke with told me to file a new application, and I thought she was bullshitting me because the other specialists said it wasn't necessary.  She obviously didn't have any answers for me. 

I asked wtf I am supposed to do and she said I can call 211 in the meantime for assistance.  It appears 211 is united way and it looks to me like it's more for poor people needing assistance with food, shelter, etc.  When I try to get someone for the healthcare coverage it says there is no one available in my zip code.


I know this thread is a bit of a rant.  I just feel so frustrated, helpless, and defeated.

I contacted a navigator a few days ago, but they never even got back to me. 

I guess I'm off to contact more navigators and fill out a new application.  Then probably copious amounts of drugs and alcohol.

[reeshau]

You should be able to get a short-term / travel policy to cover the gap.  It's not the same as regular coverage, but don't let your anger and distaste for the situation blind you to the risk of having nothing for another 2 months.

The MDHHS office probably isn't used to dealing with people who have the means to get an alternative...

[frugalnacho]

The navigators I have spoken with say that is not a thing and no one has access to the state database.  They can provide no help.  They said they could help me fill out an application, but the process will be identical whether I do it myself or they help me: I will fire it off into the void and wait 45 days. 

[reeshau]

I honestly don't know how much it will short-curcuit a travel insurer's process tomsay you aren't going anywhere.  You need to make sure you have a primary policy, and not a secondary one.  But that's not unusual.  Given the state of ACA plans in Texas, I've felt the need to get travel insurance even in the US, when gone for a length of time, because only emergency service is covered outside of my metro.  (And just because you started in the ER does not mean everything afterward is deemed an emergency!)  It used to be something I only did when travelling overseas.

I've used a number of insurers, so you can shop around.  This NerdWallet article is a decent overview of how they vary:

https://www.nerdwallet.com/article/insurance/travel-insurance

Ones I've used before:

Tin Leg:  https://www.tinleg.com/
Allianz:  https://www.allianztravelinsurance.com/

[frugalnacho]

Application has been fired off into the void.  They should have enough notes on my case, but I summarized everything and preemptively uploaded all documentation I can get to substantiate my 2022 income and 2023 income, along with current expectations of 2024.   I took the advice of one of the specialists and marked myself as unemployed, then supplied an explanation and extra information substantiating the S-Corp pass through to estimate my true AGI. 

With my total 2022 income negative, and my 2023 estimated income below 100% of the FPL, I'm hoping it gets auto-flagged for approval.  Although I am actually expecting them to sit on it for awhile, then contact me at some point and ask for a W2 or something and then act all confused like I haven't explained the situation over and over and over to them. 

[lhamo]

Maybe try Costco?

https://www.costco.com/health-insurance-marketplace.html

You can buy everything else at Costco at mostly reasonable prices -- maybe the same is true for insurance?

I'm sorry you are in this mess. Maybe it is because they are being so aggressive about kicking people off post-pandemic.

[frugalnacho]

That looks like small business health insurance.  Last time I checked into that it was hella expensive.  Also the agents told me they don't sell business plans with only a single participant, it's a minimum of 2 members to open up a plan.  They said it's not just their policy, that's just the way it works, so I would expect the same from Costco.  My business partner gets free health insurance via his employed wife, so he'd had to decline her insurance and pay full price on a business plan along with me also paying full price.  The advice the agent gave me was to ride medicaid out for as long as possible, even after I technically don't qualify and wait for them to actually kick me off.  Don't commit fraud, but the benefits won't end the second I cross the threshold, so milk it until they officially kick me off, and then with denial in hand move into a marketplace plan, even if I won't qualify for subsidies (though very likely would).  Only when we have additional employees requiring insurance should we call him back to start a plan.

I'm just going to sit tight and get drunk tonight.