ACA - additional info required?

[ShokWaveRider]

Quote:

Originally Posted by boog Wonder if your situation involved premium tax credits? If so, did the agent help you validate income for the subsidy, or are you forgoing the subsidy for a tax credit next year?

Yes and No, I told her the number. We are fortunate where we can control our income. We get $1100 in Credits.

[ShokWaveRider]

Quote:

Originally Posted by MRG I'm probably confusing myself. Are you saying that the broker found plans that were not available through the exchange? Or ACA made it possible to now buy insurance due to pre-existing conditions? Thanks.

Not exactly, however, The ACTUAL plan the agent found was the same as shown on the Gov site BUT the terms were different.

Plans from FLBlue have numbers Like say for Example: 1477

The Gov site showed me the 1477 Plan BUT the Agent found a derivative of it, that seems to be only available to agents to choose from. Say 1477c.

In my case this made the deductible $0, lower office visit co-pays, and OOP $4000 less for my family, with a nominal $3 increase in Monthly premium and the Co-insurance went from 80% to 70%. Although the Co-insurance was higher, the Max OOP was significantly lower and off set the difference IMHO.

From what I understand the Agents do not ACTUALLY use the GOV site but the Insurers version, not available to us lay people. However, when my agent set it up I could see it on the GOV site.

It surprised me too.

Does that make sense?

[MRG]

Quote:

Originally Posted by ShokWaveRider Not exactly, however, The ACTUAL plan the agent found was the same as shown on the Gov site BUT the terms were different. Plans from FLBlue have numbers Like say for Example: 1477 The Gov site showed me the 1477 Plan BUT the Agent found a derivative of it, that seems to be only available to agents to choose from. Say 1477c. In my case this made the deductible $0, lower office visit co-pays, and OOP $4000 less for my family, with a nominal $3 increase in Monthly premium and the Co-insurance went from 80% to 70%. Although the Co-insurance was higher, the Max OOP was significantly lower and off set the difference IMHO. From what I understand the Agents do not ACTUALLY use the GOV site but the Insurers version, not available to us lay people. However, when my agent set it up I could see it on the GOV site. It surprised me too. Does that make sense?

Hum maybe. Did you actually enter your income in healthcare.gov or just use the list price of the plan? I'm wondering if the agent entering your income brought subsidies and cost sharing into the picture? If you entered the same data I would expect the same results, but I'm then again, I'm frequently wrong.

[MBSC]

We do not have access to hidden plans. On-exchange Silver Plans come in four versions based on income. The exchange and broker access the same version.

1) The base plan with no cost sharing reduction (1477).
http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477.pdf
2) Cost sharing reductions for 200-250% FPL (1477a)
http://www.bcbsfl.com/DocumentLibrar...2016/1477a.pdf
3) Cost sharing reductions for 150-200% FPL (1477b)
http://www.bcbsfl.com/DocumentLibrar...2016/1477b.pdf
4) Cost sharing reductions for below 150% FPL (1477c)
http://www.bcbsfl.com/DocumentLibrar...2016/1477c.pdf

Brokers use a WBE as a back door to the exchange.
eHealth | Consumer

List of authorized WBE's (HealthSherpa is often mentioned on this forum):
https://www.cms.gov/CCIIO/Programs-a...ust-Update.pdf

[ShokWaveRider]

Quote:

Originally Posted by MRG Hum maybe. Did you actually enter your income in healthcare.gov or just use the list price of the plan? I'm wondering if the agent entering your income brought subsidies and cost sharing into the picture? If you entered the same data I would expect the same results, but I'm then again, I'm frequently wrong.

As I said, I did NOT use Healthcare.gov. The Agent did it all. I only used HC.Gov to look at the plans.

[ShokWaveRider]

Quote:

Originally Posted by MBSC We do not have access to hidden plans. On-exchange Silver Plans come in four versions based on income. The exchange and broker access the same version. 1) The base plan with no cost sharing reduction (1477). http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477.pdf 2) Cost sharing reductions for 200-250% FPL (1477a) http://www.bcbsfl.com/DocumentLibrar...2016/1477a.pdf 3) Cost sharing reductions for 150-200% FPL (1477b) http://www.bcbsfl.com/DocumentLibrar...2016/1477b.pdf 4) Cost sharing reductions for below 150% FPL (1477c) http://www.bcbsfl.com/DocumentLibrar...2016/1477c.pdf Brokers use a WBE as a back door to the exchange. eHealth | Consumer List of authorized WBE's (HealthSherpa is often mentioned on this forum): https://www.cms.gov/CCIIO/Programs-a...ust-Update.pdf

When I did it the Gov site did not offer me cost Sharing. That is exactly the term my agent used. She had to do the application to get the cost sharing option.

Do not ask me why. I entered the same info I gave her, and yes it was Silver. She got me the A version.


Either way, the original point I wanted to make was, if you use an Agent, you do not have any of the hassle of going through HC.Gov yourself, and it cost you no more than if you did.

[RockyMtn]

GF received two requests for income verification. Uploaded docs twice and then decided to send a set as well. Received notification earlier this week that they accepted our explanations. Looks like we are good to go for this year.

[GTFan]

When I initially applied on the exchange last year I didn't check the box to have them verify income. As a result I got an eligibility saying that I needed to upload explanations so I did so.

After doing a little more reading here about experiences, I later did a 'life change' update to the plan with the only change being that they could check income. Original app was done in Nov., updated was right before the 12/15 deadline for insurance to start 1/1/16. And voila, I then got a completed app with nothing further required other than selecting the insurance. And this is with a lot of reported severance income for last year (which ended on 2/15). So apparently they are checking current SS records to see if you're still earning when you apply because based on my 2015 income I would not have been eligible for the subsidy that I got. And my 2014 income was way higher than that.

The problem I have had after the fact is getting letters from them saying that I would lose subsidy if I didn't send them docs, based on the original app (so their stupid system ignored the original uploaded explanation and the app update). I called and marketplace CSR said you're good to go, ignore it but when I got a 'final notice' from them a couple of weeks ago I decided to send in an explanation that they have some sort of system error and please don't let their computers mess this up because my updated app was completed.

I'm waiting now to see what will happen, if anything. Hopefully I'll get nothing more and be done with it, worst case they'll take away the subsidy and I'll have to call and get it fixed.