ACA subsidy revoked, then reinstated

[photoguy]

I had the same maddening notifications requesting documentation that we already uploaded. I think I sent in my passport several times. I think they just throw away any mail/faxes they receive.

Regarding income, at least on coveredCA, the support person on the regular helpline was able to look at the docs during a call and approve it right then.


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[photoguy]

I predict big problems for us next year when we apply for cost sharing and subsidy.

They just are not going to believe we went from $260k to $26k income.

I better buy the 1000 minute plan on my cell phone as I think my normal usage is going to go way up.

I think there's another thread that described how people submitted documentation for this case.

We also precipitously dropped in income. All we did is submit a letter explaining that we were retired (no employment income) and stated we expected $X from dividends and retirement withdrawals etc. included tax forms backing up our investment income but we had nothing for planned retirement account withdrawals (Roth conversions).

We did burn a huge number of minutes (hours) on the phone for other reasons though.



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[MRG]

I predict big problems for us next year when we apply for cost sharing and subsidy.

They just are not going to believe we went from $260k to $26k income.

I better buy the 1000 minute plan on my cell phone as I think my normal usage is going to go way up.

In '14 we had half of your drop. I got away with one question; yes our income changed. This year they asked for proof I sent in a letter and projected income for this year. Haven't heard back.

 

[timmar]

I have been asked on three different occasions to send documents to verify my children's income ($0). Each time I call and after a while they say to just ignore the requests.

 

[LARS]

This is one of the reasons I'm paying full freight through the marketplace (in my case, CoveredCA) and will get my "subsidy" back in the form of a refund. My 2014 income was far to high to qualify but now that I'm retired, my 2015 income will qualify. The subsidies are really just tax credits - that you are able to collect in advance if you choose.

My other reason for doing it this way is that CoveredCA has a glitch - if you are receiving subsidies up front then ALL members of the household must be on the same insurance policy... and my husband wanted a different insurer that me and the kids. (This is *not* an issue on the national exchange - it is a software "feature" of CoveredCA and supposed to be fixed for 2016 enrollment.)

Sure I'm giving the government money up front - but I'll get it back and won't have the hassles described here.

The only problem with this approach is that you may be leaving money on the table depending on your income level as the deductible levels are adjusted up or down based upon income (i.e. on same plan lower income gets a lower deductible).

So while you can recapture the premiums paid, you cannot (at least I am not aware you can) get credits if you were eligible for a lower deductible, but paid higher amounts.

At least on my state exchange you were able to play with income levels and it would show you how deductible levels would change.

 

[John Galt III]

I thought about calling, but figured I'd call and get someone who probably knows less about it than I do, then wait for someone who actually knows something to get back to me. And maybe that would never happen. So I figured there would be a path to resolution on the threat letter that I would follow. But let us know what you find out!!

I logged into my account on HC.gov and discovered I have no new messages, and that there is now no visible reference to uploading. The *verify* button, which had changed to a *submitted* button has now disappeared completely, which I see as possibly a good sign. My application status is *complete* and there is no mention anywhere of my needing to send or upload proof of income anywhere. So from the online system, I look AOK. But why did I get that nasty email telling me they have not received any documents. I suppose the thing to do is to call them and clarify. But I have to wait until my fear and loathing subside somewhat ...............

 

[ernow]

I'm very curious to see what my May Anthem bill looks like. On 3/12 HC.gov told me my subsidy ends 3/31, (because they didn't get the docs that I both uploaded and mailed) but Anthem says my April premium was subsidized too. Both online and over the phone they say I'm fully paid thru April and don't owe the subsidy part.

This stuff scares me, because I can see it coming...I'll have a big claim in April and they'll say I'm not covered because the subsidy part was not actually paid. This is why I'm just paying the full amount from here on and getting it back at tax time. I want to know for sure that things are paid.

 

[John Galt III]

I'm very curious to see what my May Anthem bill looks like. On 3/12 HC.gov told me my subsidy ends 3/31, (because they didn't get the docs that I both uploaded and mailed) but Anthem says my April premium was subsidized too. Both online and over the phone they say I'm fully paid thru April and don't owe the subsidy part.

This stuff scares me, because I can see it coming...I'll have a big claim in April and they'll say I'm not covered because the subsidy part was not actually paid. This is why I'm just paying the full amount from here on and getting it back at tax time. I want to know for sure that things are paid.

This is all too bizarre. It's as though HC.gov doesn't want to give someone a subsidy, for whatever reason, and instead of telling the person what new documents are needed, or why the subsidy is being denied, they simply pretend the documentation was never received. Too bizarre. I still haven't called them. Too afraid they will bollix it up even more if I do.

 

[rodi]

The only problem with this approach is that you may be leaving money on the table depending on your income level as the deductible levels are adjusted up or down based upon income (i.e. on same plan lower income gets a lower deductible).

So while you can recapture the premiums paid, you cannot (at least I am not aware you can) get credits if you were eligible for a lower deductible, but paid higher amounts.

At least on my state exchange you were able to play with income levels and it would show you how deductible levels would change.

No worries there- our planned income is closer to the 400% of poverty level than the 200% of poverty level... no cost sharing benefits for us... Just tax credits/subsidies for the premiums.

I would have fought harder to get the premium subsidy/tax credits up front IF I hadn't run into the CoveredCA exchange problem of requiring all family parties to be on the same carrier. DH decided this was the year to try a different insurer, but I liked my doc and the kids pediatrician, so we stayed on Kaiser Permanente.

Long talks with the help line showed they did not fix that issue in time for 2015 open enrollment last fall. It's "supposed" to be fixed for 2016 open enrollment this fall.

I just made sure I had enough cash set aside to cover the premium difference. We would not have qualified for the cost sharing benefits.

 

[MBSC]

I'm very curious to see what my May Anthem bill looks like. On 3/12 HC.gov told me my subsidy ends 3/31, (because they didn't get the docs that I both uploaded and mailed) but Anthem says my April premium was subsidized too. Both online and over the phone they say I'm fully paid thru April and don't owe the subsidy part.

This stuff scares me, because I can see it coming...I'll have a big claim in April and they'll say I'm not covered because the subsidy part was not actually paid. This is why I'm just paying the full amount from here on and getting it back at tax time. I want to know for sure that things are paid.

Health Reform FAQs | The Henry J. Kaiser Family Foundation

For people receiving advanced premium tax credits, if a payment due date is missed, insurers must provide a 90-day grace period during which consumers can bring their premium payments up to date and avoid having their coverage terminated. However, the grace period only applies if an individual has paid at least one month’s premium.

If, by the end of the 90-day grace period, the amount owed for all outstanding premium payments is not paid in full, the insurer can terminate coverage.

In addition, during the first 30 days of the grace period, the insurer must continue to pay claims. However, after the first 30 days of the grace period, the insurer can hold off paying any health care claims for care received during the grace period, which means the enrollee may be responsible to cover any health care services they receive during the second and third months if they fail to catch up on the amounts they owe before the end of the grace period. Insurers are supposed to inform health care providers when someone’s claims are being held. This could mean that providers will not provide care until the premiums are paid up so that they know they will be paid.

People not receiving advanced premium tax credits are expected to get a much shorter grace period; currently, the general practice is 31 days but it may vary in each state.

 

[Mr._Graybeard]

One thing I made a point of doing the last time I called was to write down the name of the person I was talking to. I figure the next time I call (like Monday) I'll be able to say, "But So-and-So told me this last week."

I got the A-OK from the helpline person last Monday but I see that the hc.gov website says I still have incomplete documentation of income. Might as well give 'em a call ...

 

[grasshopper]

I am so glad I have a grandfathered HC plan, and I will be on Medicare in 2016.

 

[MRG]

This is all too bizarre. It's as though HC.gov doesn't want to give someone a subsidy, for whatever reason, and instead of telling the person what new documents are needed, or why the subsidy is being denied, they simply pretend the documentation was never received. Too bizarre. I still haven't called them. Too afraid they will bollix it up even more if I do.

I understand why it seems that way. From other back office clusters I've seen, and w*rked to fix. It's more likely they're not withholding information, but it's simply lost. Yes, for months never resolved. Seems odd I know but if there getting 100,000 pieces of mail daily(guessing) it takes a lot of discipline and well defined processes to handle that volume. They simply don't have well defined processes or discipline.

The proof of that is the lack of consistency with the simplest communication. Last year no one I talked with knew what cost sharing was. This year they can't tell me how to delete the 3 extra accounts I set up last year. Nor can they tell if they've received my documentation. Seldom do I get an answer that's actionable. More like "well maybe try this or that". Well what would you try? "Oh I have no idea sir".

If they can't answer a yes no question, IMHO it's not a rep problem but failed training, processes, documentation and perhaps technology.

 

[John Galt III]

I called the 800 number at HC.gov today and asked them if they needed any more documentation from me at this time. She put me on hold for about 3 minutes. I imagined the worst. But she came back on and said there was nothing *pending* on my account and all was OK. I then mentioned the email I had received a few days ago threatening the subsidy, and she said the email was a mistake. I then asked her to make a note of the fact that I had called today, and that nothing was pending, and she did.

 

[ernow]

Health Reform FAQs | The Henry J. Kaiser Family Foundation

Thanks- this is good to know. Now if I appeal and get the APTC reinstated, I suppose they would cancel and reapply for the same policy again as they did when they stopped my APTC (old ending 3/31, "new" one starting 4/1). Not sure if I want to rock that boat again.

 

[papadad111]

This stuff scares me, because I can see it coming...I'll have a big claim in April and they'll say I'm not covered because the subsidy part was not actually paid. This is why I'm just paying the full amount from here on and getting it back at tax time. I want to know for sure that things are paid.

I will be taking this approach too.

And I predict healthcare subsidy advances will go by the wayside within the next few years. I can see a time where any subsidy will first be asset means tested vs income means tested (as is done for many other subsidies/benefits) and will be paid out one year in arrears or some different approach vs the mess that exists today. Something is gonna have to give.

 

[Fermion]

I will be taking this approach too.

And I predict healthcare subsidy advances will go by the wayside within the next few years. I can see a time where any subsidy will first be asset means tested vs income means tested (as is done for many other subsidies/benefits) and will be paid out one year in arrears or some different approach vs the mess that exists today. Something is gonna have to give.

Actually there are not many other benefits that are asset tested. Most are income tested.

Asset testing is not as easy to do as income testing.

 

[papadad111]

Agree asset testing is harder to do but many programs do have asset testing. Some even have look back rules -- in fact many state and federal benefits are means tested based on assets not income - for example - Medicaid, SNAP (food stamps), section 8 housing, federal Education financial aid , all are asset/means tested not just income tested. It's strange that ACA is income tested only. I predict politicos will get wise to the "millionaires who are getting subsidies" and end that - these subsidies/ discounts as they exist won't last long.

 

[LARS]

While one should never underestimate Politicians (and their utter lack of common sense), the cost of implementing, and maintaining, the infrastructure to administer an asset test for ACA would cost far more than the savings resulting from "weeding" out of low income, high asset individuals receiving subsidies.

 

[Fermion]

Agree asset testing is harder to do but many programs do have asset testing. Some even have look back rules -- in fact many state and federal benefits are means tested based on assets not income - for example - Medicaid, SNAP (food stamps), section 8 housing, federal Education financial aid , all are asset/means tested not just income tested. It's strange that ACA is income tested only. I predict politicos will get wise to the "millionaires who are getting subsidies" and end that - these subsidies/ discounts as they exist won't last long.

Define long. Historically it takes decades for these programs to change significantly. We may see some asset testing in 2030 or thereabouts.

 

[jim584672]

I doubt we will see substantial changes to the ACA. [mod edit]

 

[MichaelB]

Thanks for an interesting discussion.
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