I'm having trouble finding on the internet anyone that explains what happens with ACA CSRs (cost sharing reductions) when you have mid-year income change? Plenty is written about ACA subsidies changing, but what about CSRs that come with Silver plans if your income is low enough?
My wife is considering going back to a seasonal summer job next year that would pay her about $4,000. If we assume she doesn't go back, our annual income (we file jointly) will make us eligible for the silver plan we like that comes with CSRs that provide a $375 family deductible, $5,400 out-of-pocket-max, and other benefits. If, say in June 2020 she decides to work and we update healthcare.gov with an estimated income of $4,000 higher, will all that change? I can see during open enrollment that if we estimated our income today to include that $4,000 for next year, the deductible jumps to $3,600, the OOPM jumps to $13,000, and more. So do CSR's change mid-year?
And if it does change, does it change from that point forward, or could the insurance company go back and adjust your previous bills in 2020? In other words, will the insurance company try to "claw back" the bills they've paid earlier in the year that they wouldn't have paid had we had the higher income from the start? We anticipate a costly surgery early in 2020. So if we were to hit our $5,400 OOPM by March, and then increase our income estimate in June if she goes back to work, could they go after the thousands that we did not have to pay earlier in the year based on our lower OOPM at that point? (It could be quite the disincentive for her not to work!)
Thank you for any insights you can share!
My wife is considering going back to a seasonal summer job next year that would pay her about $4,000. If we assume she doesn't go back, our annual income (we file jointly) will make us eligible for the silver plan we like that comes with CSRs that provide a $375 family deductible, $5,400 out-of-pocket-max, and other benefits. If, say in June 2020 she decides to work and we update healthcare.gov with an estimated income of $4,000 higher, will all that change? I can see during open enrollment that if we estimated our income today to include that $4,000 for next year, the deductible jumps to $3,600, the OOPM jumps to $13,000, and more. So do CSR's change mid-year?
And if it does change, does it change from that point forward, or could the insurance company go back and adjust your previous bills in 2020? In other words, will the insurance company try to "claw back" the bills they've paid earlier in the year that they wouldn't have paid had we had the higher income from the start? We anticipate a costly surgery early in 2020. So if we were to hit our $5,400 OOPM by March, and then increase our income estimate in June if she goes back to work, could they go after the thousands that we did not have to pay earlier in the year based on our lower OOPM at that point? (It could be quite the disincentive for her not to work!)
Thank you for any insights you can share!