Author Topic: Getting ACA Coverage  (Read 10069 times)

Firehazard

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Getting ACA Coverage
« on: November 10, 2018, 12:06:34 PM »
Question for those of you who purchased ACA plans with subsidies when you FIRE'd.....

I am planning to give my notice on Monday to end my job as of 1.1.19.   I'll either be gone altogether on 1/1 or I will be working two days a week part-time (it's very possible that my employer will ask for this, and I would consider it).  Either way, I intend to purchase health insurance from the ACA Marketplace.  My income if I don't work part-time will be from 72t withdrawals and will be about $25k per year.  If I do work part-time, after 401k contributions, I'll have an income of about $30k.  At those income levels, I will qualify for a lot of ACA subsidy.

My question is this:  When I go to enroll for the first time and am asked to estimate my 2019 income, it will of course be far lower than what will be shown on my 2018 income tax return.  Will I be allowed to have the subsidies paid directly to the insurer during the year, or will I have to pay the full price premiums myself all year and then get a partial refund when I file my 2019 tax return (and can therefore 'prove' I have low income)?   I can cover the full premiums if need be from savings for that first year and wait for a refund, but of course it would be nice if I didn't have to.

Just looking to see what the experience has been for others.

Frankies Girl

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Re: Getting ACA Coverage
« Reply #1 on: November 10, 2018, 12:26:06 PM »
What happened for me is that the first year, they sent me a notice that I needed to justify my (decreased) income.

What I did was send them a pdf/word doc, stating that my family (me and hubby) were both no longer working as of XX/CCCC dates, and that going forward our income would be from savings and retirement accounts, so previous income based on our last tax return was not going to be accurate. I went on to state that the income for the coming year based off of our best estimates would be $XX,XXX, and that I swore this to be an honest and true statement to the best of my ability.

This was accepted, and my subsidy allowed.

There is a good chance that as the ACA has been around long enough, they won't bother to make you justify the income level, they'll just make you pay it back if you severely underestimated your income. But I know going forward, I've had zero issues (this will be my 4th year on ACA?) .


The only other caution I'd say is make sure you monitor the hell out of your reportable income sources, because even $1 can flip you over the ACA cliff levels. I play it very safe and over estimate my income for ACA by several thousand, but things like savings account interest, jury duty (husband made like $100 due to a few days worth of trial!) and unexpected sources can really mess you up if you're playing it REALLY close to the line.


« Last Edit: November 10, 2018, 12:42:45 PM by Frankies Girl »

Firehazard

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Re: Getting ACA Coverage
« Reply #2 on: November 10, 2018, 12:36:25 PM »
Thank you Frankie's Girl.  Very helpful reply!  I'll review my most recent tax return to see what my savings acct and dividend income looks like and make sure I add an estimate for those items.   Glad to hear they are reasonable about people estimating their income after stopping work.

Mr. Green

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Re: Getting ACA Coverage
« Reply #3 on: November 10, 2018, 03:02:40 PM »
You want your last day of work to be in the beginning of the month. My wife was supposed to quit at the end of June 2018 and it was impossible for us to get the paperwork we needed to finish the ACA enrollment process in time for July 1. So she ended up having to push back her last day to July 2 so we would continue being covered by her insurer through the end of July. This gave us the needed time to get the termination of coverage from her employer and submit it to healthcare.gov in time for our ACA coverage starting August 1.

Firehazard

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Re: Getting ACA Coverage
« Reply #4 on: November 10, 2018, 04:01:01 PM »
Thank you for that tip.  But I thought I saw on healthcare.gov that you had a 60-day window to enroll.  I guess I was thinking that coverage would be retroactive to your date of eligibility, like with COBRA.  Is that not the case?

Mr. Green

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Re: Getting ACA Coverage
« Reply #5 on: November 10, 2018, 05:06:46 PM »
Thank you for that tip.  But I thought I saw on healthcare.gov that you had a 60-day window to enroll.  I guess I was thinking that coverage would be retroactive to your date of eligibility, like with COBRA.  Is that not the case?
You'll want to verify that you can enroll under open enrollment from November 1 to December 15. In that case, what I said may not really apply to you.

Our experience was with a special enrollment period since we lost coverage in the middle of the year. We were very uncertain if it was retroactive based on the language in ACA documentation. It says coverage starts the first day of the month after you pick a plan. The problem is you can't pick a plan until after you've submitted documents and been approved. Even it could be retroactive, we needed to go to some doctors in the first 60 days and I didn't want to deal with visits I had to pay for up front and then seek reimbursement from the insurance company after coverage was confirmed.

https://www.healthcare.gov/coverage-outside-open-enrollment/confirm-special-enrollment-period/

Threshkin

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Re: Getting ACA Coverage
« Reply #6 on: November 10, 2018, 10:03:21 PM »
Check into the impact COBRA will have on your eligibility for ACA subsidies!

I FIREd in late 2016 and was eligible for, and took, COBRA.  It made sense because for 2016 and 2017 my income was too high to qualify for any ACA subsidies.  But when I tried to enroll for ACA for 2018, I was told that if I terminated COBRA early, I would not qualify for any subsidies in 2018.  I had to wait until COBRA ran out in May.  Then it was no problem to do a special enrollment to ACA and get subsidies.

I wanted to quit COBRA as early as possible because it cost ~900/month.  Our ACA Bronze plan before subsidies is about 1300/month but after subsidies it dropped to only 3.50/month for 2 people.

If you will be eligible for COBRA you should check in advance if being eligible is enough to disqualify you from receiving ACA subsidies.  Don't assume and risk getting burned!  Go talk to an ACA advisor in person and explain your situation and concerns.

jim555

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Re: Getting ACA Coverage
« Reply #7 on: November 10, 2018, 10:28:36 PM »
I didn't have any problem with the change to income, I just estimated the new lower amount, they didn't even ask for verification.  Once the unemployment ran out I re-estimated and dropped into Medicaid.

secondcor521

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Re: Getting ACA Coverage
« Reply #8 on: November 10, 2018, 10:58:09 PM »
Depending on which state you live in (it varies), you'll get some minor to medium hassle from the marketplace folks about your lower income, but you should be able to get the advance premium tax credit - that is, you should be able to have your premium subsidized as you go along and not pay it out of savings and recoup at tax time.

I don't think being eligible for COBRA would impact your ACA eligibility.  I was eligible for COBRA and went on ACA when I retired without any impact.  One game you can play is to take advantage of the fact that COBRA coverage can be initiated retroactively for about 60 days after you leave your job.  So leave your job on 1/1/19, for example, and use January and February to sign up for ACA.  If you end up needing the coverage for some horrifically expensive condition, then sign up for COBRA; if not, just go uninsured and delay any medical appointments for a month or so.

As Mr. Green alludes to, also note that some companies will extend your employer health coverage to the end of the month in which you retire.  So if you retire on 1/1/19 or 1/2/19, your employer coverage may last until 1/31/19, giving you an extra month.

I doubt you can sign up for ACA coverage under the current enrollment period because you don't currently qualify (because you're still working).  When you do leave your job, that does create a special enrollment period and you should be able to transition over.

I agree with Frankie Girl's suggestion to monitor your AGI and the cliff so you know where you're at.  For a single person living in the Continental US for 2019, it looks like the cliff is $48,560.  Double check that number yourself, as well as how it is calculated (it's basically line 37 of Form 1040 adjusted by some other items which don't apply to me but may apply to you).

Firehazard

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Re: Getting ACA Coverage
« Reply #9 on: November 12, 2018, 06:42:34 PM »
Thanks so much for all of the replies.  I dug into healthcare.gov and it had this to say about COBRA, just in case it helps anyone:

- If your COBRA coverage runs out outside Open Enrollment, you qualify for a Special Enrollment Period. This means you can enroll in a Marketplace plan outside the annual Open Enrollment Period.
- But you can’t choose to drop your COBRA coverage outside Open Enrollment and enroll in a Marketplace plan instead. The Special Enrollment Period applies only if your COBRA coverage runs out.
- During the annual Open Enrollment Period, you can drop your COBRA coverage even if it’s not running out and replace it with a Marketplace plan.

So I couldn't get my boss on the phone today to give notice, but now I think I'll make my last day Friday, Jan 4th.  It will give me a bit of time to get my ACA plan going, since our plan goes through the last day of the month when you leave the company or lose eligibility. 

Thanks for the head's up about dividends and interest.  I hadn't even thought about those items adding to my income. In my case they don't add up to very much, maybe $3k per year at present.

Padonak

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Re: Getting ACA Coverage
« Reply #10 on: November 12, 2018, 07:14:55 PM »
ptf

Threshkin

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Re: Getting ACA Coverage
« Reply #11 on: November 12, 2018, 07:22:56 PM »
Thanks so much for all of the replies.  I dug into healthcare.gov and it had this to say about COBRA, just in case it helps anyone:

- If your COBRA coverage runs out outside Open Enrollment, you qualify for a Special Enrollment Period. This means you can enroll in a Marketplace plan outside the annual Open Enrollment Period.
- But you can’t choose to drop your COBRA coverage outside Open Enrollment and enroll in a Marketplace plan instead. The Special Enrollment Period applies only if your COBRA coverage runs out.
- During the annual Open Enrollment Period, you can drop your COBRA coverage even if it’s not running out and replace it with a Marketplace plan.

So I couldn't get my boss on the phone today to give notice, but now I think I'll make my last day Friday, Jan 4th.  It will give me a bit of time to get my ACA plan going, since our plan goes through the last day of the month when you leave the company or lose eligibility. 

Thanks for the head's up about dividends and interest.  I hadn't even thought about those items adding to my income. In my case they don't add up to very much, maybe $3k per year at present.

I agree with everything above except for the third bullet.  I tried to do exactly this during open enrollment for 2018 and was told if I voluntarily dropped my COBRA coverage before it expired I could get an ACA plan but I would not be eligible for any subsidies for all of 2018.  I questioned this and my ACA advisor double checked and confirmed it.

This was a deal killer for me because the premiums on my preferred Kaiser Bronze plan without subsidies were higher than what I was paying on COBRA.  I waited 5 months for COBRA to expire and then signed up for the ACA plan without any difficulty.  Subsidies pay almost 100% of my ACA plan.

Firehazard

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Re: Getting ACA Coverage
« Reply #12 on: November 12, 2018, 08:05:12 PM »
Wow, thank you for making that point.  I copied those bullet points directly from their site.  They have feedback buttons everywhere, so I'm going to ask that they make that more clear.  It's an important point to be leaving out.

Mr. Green

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Re: Getting ACA Coverage
« Reply #13 on: November 13, 2018, 03:00:18 PM »
We started our application online at Healthcare.gov and through some confusion about what boxes we were supposed to check regarding loss of coverage,our initial application said we wouldn't get any subsidies. I then called in and someone from ACA customer service walked me through the whole application again, updating things on her end. It took a little time but we got where we needed to be (appropriately qualifying for subsidies). I've had to call in several times for different things and ACA customer service has always been very helpful. If you have any questions about the application process, don't hesitate to call them. Despite what the current administration would like the perception to be, all of my experiences with the program have been smooth.

Firehazard

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Re: Getting ACA Coverage
« Reply #14 on: November 13, 2018, 07:42:58 PM »
Thanks Mr. Green.  I agree....the healthcare.gov website was surprisingly helpful and easy to navigate. 

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #15 on: November 18, 2018, 03:58:10 PM »
I didn't have any problem with the change to income, I just estimated the new lower amount, they didn't even ask for verification.  Once the unemployment ran out I re-estimated and dropped into Medicaid.

Same here.  Even though my estimated MAGI was way less than what my last tax return showed, healthcare.gov accepted my estimate, no questions asked.  They did ask me to prove that I had lost my employer provided health insurance, but at the time I had no documentation, so I just submitted a response saying that, and they accepted it.  I went through the federal government's healthcare.gov website.  Things might be different if your state has its own ACA site.

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #16 on: November 18, 2018, 04:01:46 PM »
I don't think being eligible for COBRA would impact your ACA eligibility.  I was eligible for COBRA and went on ACA when I retired without any impact. 

Same here.  I acknowledged that I was eligible for COBRA, but because I declined it, it did not affect my eligibility for an ACA premium tax credit.  I don't know why anyone who is otherwise eligible for an ACA premium tax credit would take COBRA coverage.  It is considerably more expensive, and once you take it, it locks you out of the cheaper ACA coverage.

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #17 on: November 18, 2018, 04:09:15 PM »
Regarding the subsidy cliff:  My wife and I are MFJ, and have an estimated income in the high 20s to low 30s.  At that level, any additional income triggers a substantial hit to the PTC.  I forget the exact percentages, but it is pretty stiff.  Not only do you lose a part of the PTC, but you also lose cost-sharing on deductibles and co-pays.  I went through the numbers a while back and figured out that if we happen to have a major medical event, increasing our income actually would cost us MORE than the increased income.  So if we make an extra 1,000 and get sick in the same year, the amount we lose to the increased PTC and increased OOP expenses would actually amount to more than 1,000.  Pretty fucked up, but that's the way it is.

AdrianC

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Re: Getting ACA Coverage
« Reply #18 on: November 18, 2018, 05:21:44 PM »
Yup. We're at the subsidy cliff. The writers of the ACA sure didn't think this part through.

secondcor521

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Re: Getting ACA Coverage
« Reply #19 on: November 18, 2018, 05:58:17 PM »
Regarding the subsidy cliff:  My wife and I are MFJ, and have an estimated income in the high 20s to low 30s.  At that level, any additional income triggers a substantial hit to the PTC.  I forget the exact percentages, but it is pretty stiff.  Not only do you lose a part of the PTC, but you also lose cost-sharing on deductibles and co-pays.  I went through the numbers a while back and figured out that if we happen to have a major medical event, increasing our income actually would cost us MORE than the increased income.  So if we make an extra 1,000 and get sick in the same year, the amount we lose to the increased PTC and increased OOP expenses would actually amount to more than 1,000.  Pretty fucked up, but that's the way it is.

The reduction in PTC is about 9.7% between 300% and 400% of the FPL - see Table 2 in the instructions for Form 8962.

Cost sharing reductions are at three tiers (CSR73, CSR87, and CSR94) which hit at breakpoints of 150%, 200%, and 250% of the FPL.

AdrianC

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Re: Getting ACA Coverage
« Reply #20 on: November 19, 2018, 07:52:32 AM »
Here's an easy way to figure your PTC:

https://www.kff.org/interactive/subsidy-calculator/

In 2019 for our family of 5, if we make $117K we get a PTC of $7726. If we make $118K we get a PTC of $0.

That's the subsidy cliff.

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #21 on: November 19, 2018, 06:39:49 PM »
You can also just run your numbers through the healthcare.gov website.  The "see plans and pricing" link lets you do that without actually putting in an application.  It also will show you the plans that are available in your area, along with the deductibles and OOP limits.  There is also a really steep cliff on the cost-sharing for deductibles and OOP limits.

pecunia

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Re: Getting ACA Coverage
« Reply #22 on: November 19, 2018, 11:32:10 PM »
I don't think being eligible for COBRA would impact your ACA eligibility.  I was eligible for COBRA and went on ACA when I retired without any impact. 

Same here.  I acknowledged that I was eligible for COBRA, but because I declined it, it did not affect my eligibility for an ACA premium tax credit.  I don't know why anyone who is otherwise eligible for an ACA premium tax credit would take COBRA coverage.  It is considerably more expensive, and once you take it, it locks you out of the cheaper ACA coverage.

I am thinking of working a portion of next year (2019) and then leaving the work thing,........for good. 

I am expecting that I may be able to take COBRA for the remainder of the year.  I expect I will have earned too much for an ACA subsidy.

My income will be much lower the following year. (2020)  Is there any problem dropping off COBRA (cancelling) and picking up an ACA plan?

With the Democrats in the House, I can't see them causing ACA ruination unless the Republicans do it quickly.  Although, there's not much difference between either one so who knows.

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #23 on: November 20, 2018, 04:42:33 AM »
I don't think being eligible for COBRA would impact your ACA eligibility.  I was eligible for COBRA and went on ACA when I retired without any impact. 

Same here.  I acknowledged that I was eligible for COBRA, but because I declined it, it did not affect my eligibility for an ACA premium tax credit.  I don't know why anyone who is otherwise eligible for an ACA premium tax credit would take COBRA coverage.  It is considerably more expensive, and once you take it, it locks you out of the cheaper ACA coverage.

I am thinking of working a portion of next year (2019) and then leaving the work thing,........for good. 

I am expecting that I may be able to take COBRA for the remainder of the year.  I expect I will have earned too much for an ACA subsidy.

My income will be much lower the following year. (2020)  Is there any problem dropping off COBRA (cancelling) and picking up an ACA plan?

With the Democrats in the House, I can't see them causing ACA ruination unless the Republicans do it quickly.  Although, there's not much difference between either one so who knows.

I have no experience with dropping existing COBRA coverage and trying to pick up an ACA plan.  But Threshkin noted above (reply #11) that you can't do that.

pecunia

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Re: Getting ACA Coverage
« Reply #24 on: November 20, 2018, 10:29:56 AM »


- BIG Snip -

I have no experience with dropping existing COBRA coverage and trying to pick up an ACA plan.  But Threshkin noted above (reply #11) that you can't do that.

Thanks - I guess I will have limited options:

1) Quit before the end of the year and get ACA insurance for next year.
2) Work enough of next year to make expensive insurance worthwhile and take ACA in 2020
3) Work some of next year and live "at risk" without insurance

I think I'd like to just pay the tax and have it like Canada.  It seems like it would be so much simpler.  Going to the doctor should be a basic thing and not made as complex as it has been made to be by unnatural market rules.

jim555

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Re: Getting ACA Coverage
« Reply #25 on: November 20, 2018, 10:40:11 AM »


- BIG Snip -

I have no experience with dropping existing COBRA coverage and trying to pick up an ACA plan.  But Threshkin noted above (reply #11) that you can't do that.

Thanks - I guess I will have limited options:

1) Quit before the end of the year and get ACA insurance for next year.
2) Work enough of next year to make expensive insurance worthwhile and take ACA in 2020
3) Work some of next year and live "at risk" without insurance

I think I'd like to just pay the tax and have it like Canada.  It seems like it would be so much simpler.  Going to the doctor should be a basic thing and not made as complex as it has been made to be by unnatural market rules.
If you have low income in the months after you quit in 2019 you could go to Medicaid for the rest of the year.  Previous income in the year doesn't count, only going forward income.  This would be for an expansion state.

secondcor521

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Re: Getting ACA Coverage
« Reply #26 on: November 20, 2018, 04:15:04 PM »


- BIG Snip -

I have no experience with dropping existing COBRA coverage and trying to pick up an ACA plan.  But Threshkin noted above (reply #11) that you can't do that.

Thanks - I guess I will have limited options:

1) Quit before the end of the year and get ACA insurance for next year.
2) Work enough of next year to make expensive insurance worthwhile and take ACA in 2020
3) Work some of next year and live "at risk" without insurance

I think I'd like to just pay the tax and have it like Canada.  It seems like it would be so much simpler.  Going to the doctor should be a basic thing and not made as complex as it has been made to be by unnatural market rules.
If you have low income in the months after you quit in 2019 you could go to Medicaid for the rest of the year.  Previous income in the year doesn't count, only going forward income.  This would be for an expansion state.

You could also quit mid-2019 and get a subsidized ACA policy for the remainder of 2019.  Leaving your job is a qualifying event that qualifies you for a special enrollment period.

tenant13

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Re: Getting ACA Coverage
« Reply #27 on: November 28, 2018, 08:53:58 PM »
Quote
"If you have low income in the months after you quit in 2019 you could go to Medicaid for the rest of the year.  Previous income in the year doesn't count, only going forward income.  This would be for an expansion state."

Wait, so income before qualifying event doesn't count? My current gig will end on 01.25.2019 and with it my crappy health coverage. That would be the qualifying even allowing me to apply for ACA. Are you're saying that my January earnings wouldn't count towards subsidy calculations? Or it's just for Medicaid?

jim555

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Re: Getting ACA Coverage
« Reply #28 on: November 28, 2018, 09:43:02 PM »
Quote
"If you have low income in the months after you quit in 2019 you could go to Medicaid for the rest of the year.  Previous income in the year doesn't count, only going forward income.  This would be for an expansion state."

Wait, so income before qualifying event doesn't count? My current gig will end on 01.25.2019 and with it my crappy health coverage. That would be the qualifying even allowing me to apply for ACA. Are you're saying that my January earnings wouldn't count towards subsidy calculations? Or it's just for Medicaid?
Just for Medicaid.  ACA subsidies are calendar year income.

TomTX

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Re: Getting ACA Coverage
« Reply #29 on: December 24, 2018, 10:16:55 AM »


- BIG Snip -

I have no experience with dropping existing COBRA coverage and trying to pick up an ACA plan.  But Threshkin noted above (reply #11) that you can't do that.

Thanks - I guess I will have limited options:

1) Quit before the end of the year and get ACA insurance for next year.
2) Work enough of next year to make expensive insurance worthwhile and take ACA in 2020
3) Work some of next year and live "at risk" without insurance

4) Work long enough next year for the maximum ACA subsidy, don't sign up for COBRA, and sign up for ACA after quitting.

COBRA only stops you from getting ACA coverage if you actually sign up for COBRA.

pecunia

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Re: Getting ACA Coverage
« Reply #30 on: December 25, 2018, 06:26:40 PM »
"4) Work long enough next year for the maximum ACA subsidy, don't sign up for COBRA, and sign up for ACA after quitting."

Actually, if your employer does not offer insurance, you can be signed up now,  I guess one should quit with a margin prior to reaching the subsidy level or you need to pay Uncle Sam.

Paul der Krake

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Re: Getting ACA Coverage
« Reply #31 on: December 31, 2018, 08:18:21 PM »


- BIG Snip -

I have no experience with dropping existing COBRA coverage and trying to pick up an ACA plan.  But Threshkin noted above (reply #11) that you can't do that.

Thanks - I guess I will have limited options:

1) Quit before the end of the year and get ACA insurance for next year.
2) Work enough of next year to make expensive insurance worthwhile and take ACA in 2020
3) Work some of next year and live "at risk" without insurance

4) Work long enough next year for the maximum ACA subsidy, don't sign up for COBRA, and sign up for ACA after quitting.

COBRA only stops you from getting ACA coverage if you actually sign up for COBRA.
So if you ride the 60 day thing using COBRA and something happens in the second month, you are stuck using COBRA until the next enrollment season?

MissNancyPryor

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Re: Getting ACA Coverage
« Reply #32 on: December 31, 2018, 08:34:38 PM »
gonna stick a pin in this

iluvzbeach

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Re: Getting ACA Coverage
« Reply #33 on: December 31, 2018, 10:47:12 PM »
PTF.

Trifle

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Re: Getting ACA Coverage
« Reply #34 on: January 01, 2019, 12:37:46 PM »
Following

DreamFIRE

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Re: Getting ACA Coverage
« Reply #35 on: January 01, 2019, 02:04:29 PM »

Knowing the rules mentioned is one thing, but you can still be denied subsidies when answering the questions the way you think you should.  Some examples:

https://www.reddit.com/r/HealthInsurance/comments/94ockn/question_about_cobra_on_aca_application/

https://insurance-forums.com/community/threads/can-anyone-help-me-with-this.76715/

Laura Ingalls

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Re: Getting ACA Coverage
« Reply #36 on: January 01, 2019, 06:56:16 PM »
Yup. We're at the subsidy cliff. The writers of the ACA sure didn't think this part through.

I would agree it’s unfair.  I think the authors knew exactly what could/would happen. 

pecunia

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Re: Getting ACA Coverage
« Reply #37 on: September 22, 2019, 06:21:46 PM »
Yeh - I was thinking of calling her quits last Spring so I was going to limit my income.  My employer decided to provide health insurance after a few months into the year.  So, I cancelled the ACA insurance.  I also kept working.  I will have to pay a couple of months of subsidy when I do my taxes.  I'm thinking of paying it ahead of time to make tax time less costly.

This also happened to me a few years back when I was out of work.  I obtained work and made too much for the subsidy so I had to pay back the subsidy.

I really don't think the politicians will take health care away from people.  The GOP guys took a beating when they tried to do it before.  Luckily, Mr. McCain stymied their efforts before he died.  Unless the country is masochistic, I can't see them voting some of those rascals back in next election.

jim555

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Re: Getting ACA Coverage
« Reply #38 on: September 22, 2019, 06:22:48 PM »
Poking a really old thread:  I made a lot of W-2 income this year (FIRED 9/4/19) and am paying full freight for ACA through the end of the year for an HSA-eligible bronze plan. 

From here on out I will be living on my investment dividends and capital gains and probably won't sell any stock in 2020.  I will consume some cash on hand to make up any needed difference for living expenses.  I am finding my feet in my first year of FIRE and will cement my drawdown plan from there, plus it will be interesting to see what happens with the 2020 election.   

My expected income will therefore be quite low and I see from the upthread information that I am supposed to state my best guess of 2020 during ACA open enrollment this fall. 

What if I am wrong?  I worry because I received an extra large LT capital gain on one mutual fund last December because the fund managers were peeing their pants during the Christmas slide (I was piddling myself a bit there, too).  I really feel like I have no control and even being $5K off has big monthly impacts on my premium. 

I googled this and see a really old response about some Premium Tax Credit form 8962 that gets filed with your taxes, allowing for reconciliation.   

Anyone have experience with this?   
https://www.healthcare.gov/taxes-reconciling/

"How to reconcile your premium tax credit

If you had a Marketplace plan and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you’ll have to “reconcile” when you file your federal taxes. This means you’ll compare 2 figures:

    The amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower.)

    The premium tax credit you actually qualify for based on your final income for the year.

Any difference between the two figures will affect your refund or tax owed.

    You should get your Form 1095-A in the mail by mid-February. It may be available in your HealthCare.gov account as soon as mid-January. If you don't get it, or it's incorrect, contact the Marketplace Call Center. See how to be sure the information is correct."

MissNancyPryor

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Re: Getting ACA Coverage
« Reply #39 on: September 22, 2019, 07:01:30 PM »
Thanks @jim555 that is what I was looking for. 

Paul der Krake

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Re: Getting ACA Coverage
« Reply #40 on: October 04, 2019, 04:43:14 PM »
https://www.healthcare.gov/taxes-reconciling/

"How to reconcile your premium tax credit

If you had a Marketplace plan and used advance payments of the premium tax credit (APTC) to lower your monthly payment, you’ll have to “reconcile” when you file your federal taxes. This means you’ll compare 2 figures:

    The amount of premium tax credit you used in advance during the year. (This was paid directly to your health plan so your monthly payment was lower.)

    The premium tax credit you actually qualify for based on your final income for the year.

Any difference between the two figures will affect your refund or tax owed.

    You should get your Form 1095-A in the mail by mid-February. It may be available in your HealthCare.gov account as soon as mid-January. If you don't get it, or it's incorrect, contact the Marketplace Call Center. See how to be sure the information is correct."
Okay so I'm looking at something similar for 2020, because I'm quitting work this December but have no idea what my household income will be for 2020.

It could be as low as 27k, at which point we qualify for the CSR 94 and pay virtually nothing, or I could restart employment mid-year and it could be 200k, or anywhere in between.

"Best" case scenario: we really make 27k in 2020 and stay on the ACA plan all year.
"Worst" case scenario: we make 200k, switch to employer coverage midyear and I have a complicated reconciliation worksheet to work through.

As far as I can tell, in the "worst" case scenario there's no mechanism to clawback the CSR (how would that even be done?) that was given to us during the period of ACA coverage.

Sooooo, is there any incentive to NOT write in the income that gives you the absolute best subsidy from the get go and repay the extra later?



Monkey Uncle

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Re: Getting ACA Coverage
« Reply #41 on: October 04, 2019, 06:22:14 PM »
If you have a major change in your income situation mid-year, you are supposed to report that immediately so they can adjust your PTC and cost sharing accordingly.

seattlecyclone

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Re: Getting ACA Coverage
« Reply #42 on: October 04, 2019, 08:14:05 PM »
Sooooo, is there any incentive to NOT write in the income that gives you the absolute best subsidy from the get go and repay the extra later?

Not really. @Monkey Uncle is right that you're supposed to notify the marketplace if you have a major income change and are still planning to continue with the ACA insurance. If the main way you could see your income increasing again is to get another corporate job with health benefits, you'd just cancel the insurance and repay the premium subsidy at the end of the year with your taxes. Either way the CSR for your low-income period is not clawbackable.

I do believe that the repayment of excess premium tax credits does count toward your total owed through estimated taxes and/or payroll withholding throughout the year. Be aware of that when setting your withholding if and when you go back to work so that you aren't stuck with any underpayment penalties at the end of the year.

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #43 on: October 05, 2019, 03:44:13 AM »
Although the CSR does not appear to have any clearly stated clawback provision in cases where income is underestimated, I guess I have a bit of heartburn with deliberately flouting the clearly stated rule about reporting mid-year changes in income.  Seems like the IRS could make a case against you if they wanted to.

Paul der Krake

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Re: Getting ACA Coverage
« Reply #44 on: October 05, 2019, 07:10:57 AM »
Although the CSR does not appear to have any clearly stated clawback provision in cases where income is underestimated, I guess I have a bit of heartburn with deliberately flouting the clearly stated rule about reporting mid-year changes in income.  Seems like the IRS could make a case against you if they wanted to.
Oh I'm not suggesting not reporting changes in income, quite the opposite. The second I land the potential mid-year cushy corporate job, I report it (and likely drop the ACA plan). What I'm suggesting is ignoring the likelihood of landing said corporate job.

Let's say I start cushy job Jul 1, 2020. If I have a signed letter of employment dated November 1, 2019 with the July 2020 start date, then the IRS could make a reasonable case that I knew all along my 2020 income wasn't going to be what I stated to get the CSRs.

Or maybe if I there was a pattern of doing this multiple years in a row.

Monkey Uncle

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Re: Getting ACA Coverage
« Reply #45 on: October 05, 2019, 06:27:50 PM »
O.K., that makes sense.  I agree, there's no point in missing out on a partial year's worth of CSR just because you might land a job.