Anyone Get Approved for Subsidy with 100% to 133% FPL (non Medicaid Expansion State)

[John Galt III]

Hi,

Someone asked this question before, but never got a confirmation.

I'm wondering if anyone has gotten approved for a subsidy with a projected 2014 income between 100% ($11,490) and 133% ($15,xxx) of federal poverty level. This would have to be in a state that has decided not to expand medicaid, like Pa.

Healthcare.gov website and the Kaiser subsidy calculator say that in Pa (my state) I would qualify for a subsidy with the above income range, via a plan I select on the exchange.

The eHealthInsurance website says I will not get a subsidy in Pa unless my income is over $15,000. I did an online chat with them and they did not change their stance.

I will have to withdraw from an IRA each year to supplement my pension and interest to get my income up to $11,490. Don't want to have to get the income all the way up to $15,xxx, though.


With all the surprises happening with the Healthcare.gov website, I thought I'd just try to get some confirmation of someone having been approved for the subsidy given that low income range of $11,490 to $15,xxx.

Thanks

[modhatter]

Wish I could answer your question, but I can't. I wondered the same thing. My son falls into this category, but the state we are in did raise the limit up to 133%, so now he needs to get his income up to over the new threshold. I have read on line about this gap being an unintended gap.

I have not read the entire bill obviously, so I do not know if they specifically say the subsidy will start at anything above the 133% PL, but I assume it does. So in that case, you qualify for nothing. Problem is, I don't think Obama will be very successful in getting that amended any time soon, so if my assumptions are correct, you may need to raise your income up to this threshold, until some future date when it can be fixed. For your information in case you do not know, the new law also eliminates the "asset" test for medicaid medical insurance for people below age 65. Not the best selection of doctors I know, but better than nothing, and there's lots of folks surviving just fine on it.

This is just a guess on my part, so I would keep searching for confirmation. If you find out differently, make sure to post.

[Onward]

Quote:

Originally Posted by John Galt III if anyone has gotten approved for a subsidy with a projected 2014 income between 100% ($11,490) and 133% ($15,xxx) of federal poverty level.

To my knowledge:

Below roughly $15,800 you get Medicaid if your state offers it. It's free: no premiums and thus no subsidies.

If your state did not expand Medicaid, and you're below $15,800 but above your state's threshold for Medicaid, then you get nothing. You have to buy your own health insurance, and you will recieve no subsidies.

If you're above $15,800 you can buy a health plan on the exchange and receive subsidies.

[rbmrtn]

If your state expands medicaid, then below 138% you are covered by medicaid.

If your state is not expanding, then above 100% you can buy on the exchange with subsidies. Below 100% is where the "gap" for no coverage.

https://www.healthcare.gov/what-if-m...nding-medicaid

[John Galt III]

Quote:

Originally Posted by rbmrtn If your state expands medicaid, then below 138% you are covered by medicaid. If your state is not expanding, then above 100% you can buy on the exchange with subsidies. Below 100% is where the "gap" for no coverage. https://www.healthcare.gov/what-if-m...nding-medicaid

rbmrtn,

yes, this is what I am hoping will be the case when I apply via healthcare.gov. It would be helpful to know that someone actually was awarded the subsidy, in the $11,490 to $15,800 income range, and what questions they had to answer, what documents they had to upload, what sources of income were accepted, etc.

[John Galt III]

Quote:

Originally Posted by modhatter Wish I could answer your question, but I can't. I wondered the same thing. My son falls into this category, but the state we are in did raise the limit up to 133%, so now he needs to get his income up to over the new threshold........

Modhatter,

Are you saying your state initially had the threshold at 100% FPL, then increased it to 133% later?

[modhatter]

Quote:

Originally Posted by John Galt III Modhatter, Are you saying your state initially had the threshold at 100% FPL, then increased it to 133% later?

No we recently (this year) moved to a state that did raise it to the $15,800. So I'm saying that though he would have earned shy of this amount next year as I'm closing a business we own, I will now need to make sure his income goes up next year so he qualifies for subsidy as opposed to Medicaid. I do not feel comfortable with Medicaid. Though it may be fine here being in a bigger city with lots of different income levels. Back where I came from you would be real hard pressed to find a doctor that accepted Medicaid.

But I lived in a very upscale area, so you can imagine the problem there.
I would hope (though I might be dreaming) that you could still find some fine doctors who were dedicated, and put compassion above money.
Am I being naive? I almost feel embarrassed saying that.

[ziggy29]

Keep in mind that if you qualify for Medicaid based on income in a state which did not expand it, asset limits will likely apply.

[John Galt III]

Quote:

Originally Posted by ziggy29 Keep in mind that if you qualify for Medicaid based on income in a state which did not expand it, asset limits will likely apply.

Yes, asset limits apply here in Pa, for Medicaid. Pa did not expand medicaid. I was in the "learn more' section of the ppaca website, and went into a form asking for my stats, to see if eligible for pa medicaid. For bank account funds, when I entered more than some number ($10,000 or so, can't remember) it said I was unqualified. It never asked if I owned a car or a house though.

I have a few different ways to get get my estimated income over $11,490 for 2014. I have a modest pension, plus some interest income from cd's, which together will only add up to about $10,000 per year. I wonder if they they would accept a promise of getting a part time job in 2014? Otherwise I would have to "promise" to withdraw some cash from IRA's in 2014.

Also I am collecting unemployment insurance now, which may or may not be renewed in 2014.

The 800 number at healthcare.gov won't answer any questions unless I give them my name and phone number. I don't want to lock myself into any certain answers without knowing the consequences first.

I really wish they had a number to call anonymously to get accurate info.

If you apply and get rejected for a subsidy, I wonder if you can reapply with different income sources, and get approved.

[John Galt III]

Got an anonymous chat session started at Healthcare.gov, (clicked on "contact us" at the bottom of the page, and chat came up as an option) and asked what was the lowest 2014 income with which I would qualify for an exchange AND a subsidy, in the state of Pa. The chat person had to research it for 5 minutes and came back with "I will have to forward that question to the Advanced Resolution Center. Please give me your phone number so they can call you back within 2 business days".

[susswein]

I live in Utah, which has decided not to fund medicaid, and my taxable income also falls below the $16,000 threshold. I've come up with 3 different ways to increase my taxable income without paying a penalty for an early withdrawal from my IRA:

1) Sell stocks (or other appreciated assets) to harvest the gain, then buy them back, increasing your tax basis.

2) Do a ROTH conversion

3) Set up a 72(t) withdrawal from your IRA.

In all 3 cases you'll pay income tax, but the tax will be a LOT less than the health insurance subsidy. If you're single and take the standard deduction you don't pay any tax on income up to about $11,000, and 15% on amounts over that, so if you bring your adjusted gross to $16,000 you'll pay about $900 in tax.

[FUEGO]

You guys can always count your gambling winnings, right?

[modhatter]

Quote:

Originally Posted by ziggy29 Keep in mind that if you qualify for Medicaid based on income in a state which did not expand it, asset limits will likely apply.

Ziggy, I'm trying to recon with this so to speak. What I read said (I thought) that come 2014 asset limits would not be imposed for qualifying for medicaid health insurance. Why, if your state didn't raise the limit, and you earn say $11,000 for the year, would it not apply to you as well?

Is the expansion part between $11,400 and the expanded amount $15,800 considered part of ACA act, and the former not? That just wouldn't make any sense. Now I know that if you earn, say $14,000, your just out of luck, because now your caught in the unexpected hole (too high and too low).

[John Galt III]

Quote:

Originally Posted by FUEGO You guys can always count your gambling winnings, right?

Fuego,

Seriously, that may be a smart option. I wonder if they would ask for proof of your winnings. Seems like the ACA is giving people an easy way to increase income, on paper, anyway, with the "gambling winnings" field. I suppose if you use it as income, you would have to declare it on your 2014 income tax. But it would be a quick and easy way to get the income up to the threshold on the application, and the govt gets the extra tax income.
At this point I can't bring myself to actually use the gambling winnings gambit, though.

[John Galt III]

Update. Got a chat session going with Healthcare.gov. The supervisor eventually came on the chat. They simply would not answer my question of whether $11,490 or higher income as single male age 58 would get me into an exchange plan with subsidies, in state of Pa. They said to just apply and find out !!!

I told them my projected income could vary a lot in 2014, so I would like to know the threshold income to receive subsidy and be accepted into the exchange. They said they were not allowed to give me that information !!!
Just apply and find out. I told them I should know the rules before applying not after.

Just gave me lots of double-speak and told me stuff I already knew.

They kept saying that with a low income I should be accepted and everything would be fine. I kept telling them I needed to increase my income to above the $11,490 and they just ignored it. Really frustrating. They act like they don't know about any minimum income level.

One ray of hope is that they said if I called the 800 number, I would not be locked into any certain answers I gave to their income questions. Hmmmm.

Still haven't found anyone on my googling who has gotten a subsidy in Pa in the $11,490 to $15,800 income level. Not that anyone has tried and failed, just no info either way. Frustrating.

And............ I called a local health ins agent and he said in Pa you need $15,800 to qualify for subsidies. And the hc.gov website says $11,490. And the KFF website says $11,490. Jeez......

[MichaelB]

JG III, to be eligible for an exchange policy with premium assistance and cost sharing subsidy in a state that did not implement expanded Medicaid, income must be greater than 100% of the FPL. That much we know, it is the way the law is written.

Your post seems to imply that your income is variable and could be higher or lower. That could lead to some confusion, especially when you are asking for a firm committed response, so some wavering there is not a surprise. The eligibility and subsidy will be based on verifiable income (see here). If yours will derive at least in part from tax deferred holding and investment income, you may need to meet in person with a navigator to get that process started.

[John Galt III]

Quote:

Originally Posted by MichaelB JG III, to be eligible for an exchange policy with premium assistance and cost sharing subsidy in a state that did not implement expanded Medicaid, income must be greater than 100% of the FPL. That much we know, it is the way the law is written. Your post seems to imply that your income is variable and could be higher or lower. That could lead to some confusion, especially when you are asking for a firm committed response, so some wavering there is not a surprise. The eligibility and subsidy will be based on verifiable income (see here). If yours will derive at least in part from tax deferred holding and investment income, you may need to meet in person with a navigator to get that process started.

MichaelB, Thanks very much for responding.

Yes, my income for 2014 can be variable, if I want it to be. My 2014 income will be about $10,500 if I leave my sources as they are (pension and interest from cd's). To get above the 100% FPL ( $11,490 for individual) level I will have to have more income, which I could easily get by cashing in an IRA cd.

HOWEVER................... my main frustration currently is that the health insurance broker I contacted a few days ago in Pa is telling me I will need at least 138% ($15,800 approx) to qualify for subsidies and cost sharing. He is quite competent, afaik, since I have spoken to him before. Maybe he is wrong about this. I hope so.

The healthcare.gov website states I only need 100% of FPL, and so does the KFF estimator.

eHealthInsurance is telling me I need 138% FPL in Pa.


Yes, I can bring my income up to 138% FPL with more IRA distributions, but I'd rather not cash in that extra $4,000 approx if I don't have to.

Do you understand my frustration ? I'm turning into a Nattering Nabob of Negativity, perhaps.

Oldtrig thought he had the correct info when he applied, but ended up getting the shaft.

Another complication is that I am collecting unemployment insurance which may or may not be there in 2014. If it is, it will of course bring my income up, since it is one of the acceptable sources of income, and could even bring me over the $15,800 level.

I called a few navigator numbers I got from hc.gov. They said I could leave a message and they would get back to me in a few days. One of them had a recording telling me to call hc.gov. Perhaps I could look into more navigators to contact, and find one that is useful.

But no matter what the navigator says, I won't feel comfortable until I hear some empirical evidence of someone in Pa who has actually gotten the subsidy in the $100% to 138% income range.

It seems such a simple question, and with the internet available, should be so easy to find out, but no.

I'm stuck here until I know whether $11,490 or $15,800 is the right number.

[robert l]

Well, all I can say is I went to the IRS website to read the details on income for myself awhile back. I was actually interested in something different than you but it was clear on what I read. I mean they spell it out rather well. They didn't mention anything about the ACA using anything but the Federal Poverty level to get subsidies.

I think maybe the confusion is there is an actual gap between the 100%-133% getting Medicaid, meaning it could go either way if in that gap.

But, the IRS website is clear saying the subsidies are based on FPL. I'm in SC and of course they didn't expand Medicaid and most of the state government, especially the governor wants it to fail. Only Texas might be wanting it to fail more.

But, I put in 12,500 and got a $509.00 subsidy and I have no reason to believe it is different in any state. I guess it could be on the ones run by states but I haven't read it.

All I can tell you is go to the IRS website and read it for yourself. Also you can try the "see my plans" at the Marketplace. I put in Pa. and it showed the regular 100% number as the beginning amount to get a subsidy.

Also just go ahead and apply if you can get the Marketplace to work. Its not like you will be locked into anything. Just create another account if its not what you wanted to see.

I been trying since Oct. 4th and did finally get to the end, but like some I cannot get it to confirm enrollment. It just stays on the same page and acts like its not connected to the insurance company.

[Sue J]

My son is 26 and wants coverage. He's self employed and his income varies. He doesn't make a lot but has no debt so he's fine.

A couple of times I've talked to him about setting up an account and getting started, but be sure you estimate enough income to get a subsidy. He set up an account but put in income about $20 under the 138% of FPL. Why? Because he refuses to accept that his mother knows a little bit about all this!

Now his application says he has an eligibility letter but clicking it does nothing. When I went through the process for DH and I mine showed up as a pop-up at the bottom of the page. His isn't showing up. He was able to look at plans but none of them have a subsidy applied so I'm guessing that he isn't eligible for one because he estimated too low.

So he called the 800 number and explained that he can't see his eligibility letter and he needs to get into his application and update some info. Yada yada yada, they will escalate his call and call him back within 2 business days.

In the meantime we made another account with another email address and filled out all the info but with a better estimate of income. Still can't see the eligibility letter with that account either.

I just hope that he hasn't screwed it up too bad by estimating too low or if having 2 accounts will make things worse.

[John Galt III]

Sue J, since you are talking about 138 % of FPL, I assume you are in a state that has expanded Medicaid for the ACA, correct? JG III