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Subsidy Question
Old 10-21-2013, 03:27 AM   #1
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Subsidy Question

While trying to find out about doctors and hospitals for a particular Blue Cross BS plan offered on the exchange, I contacted BCBS and was referred to a an outside agent.

The agent answered some questions and told me she could take my application over the phone (this is for my son) When I asked her if she could still take the application if my son was entitled to a subsidy, she said yes. I am in a state that has it's own state exchange.

Tonight reading some posts on another forum, it was stated that in order to receive a subsidy, you must make application on line, or make an appointment with a facilitator and physically go there.

I was about to call the agent back, but now I am wondering if she is correct. Does anyone have the answer to this?
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Old 10-21-2013, 07:00 AM   #2
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The exchange must verify income and certify eligibility for the subsidy. It can be done starting from the insurers website if they have the authorization and the application exists. In this case the agent would need access to that component of the insurer's online system. I would guess BCBS can do this.

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The rule allows a customer to be sent briefly to a special section of the federal or state-run marketplaces only to see if their income qualifies them for subsidized coverage, and then can go right back to the WellPoint or Blues site to buy their coverage. These customers may not necessarily see the other options for insurance available on the exchange, and the other plans may cost less or include a wider provider network.
Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors - Kaiser Health News
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Old 10-21-2013, 10:29 AM   #3
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Our local area Blues website has a link to healthcare.gov, with a note stating if you want to try for a subsidy you must use the federal site. YMMV.

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Old 10-21-2013, 01:32 PM   #4
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Our local area Blues website has a link to healthcare.gov, with a note stating if you want to try for a subsidy you must use the federal site. YMMV.

MRG
When I called local BCBS today they suggested they could help out and still get subsidies.

I was calling to find out details on their policies. Then the gal asks are my facilities in plan? I thought so, she says their not. Oh yea when healthcare.gov throws you the BCBS the network is not filled in. According to this person, 'all our ACA plans are under a new smaller network'. Think the closest real hospital is 30 miles from here. None of my DR's are in it........

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Old 10-21-2013, 05:18 PM   #5
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Yes, you really have to do your homework on some of these plans' provider networks. In my area, BCBS has Preferred Care Blue (the larger, more expensive option) and a new, smaller, less expensive Blue Select. But the links to the networks can give inconsistent answers, so I just kept calling BCBS -- and my doctors -- until I got answers that matched and made sense. Same thing with the drug formularies. Read, study, download and print, and then call. "Assume nothing..." Good luck!
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Old 10-22-2013, 05:02 AM   #6
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Our local area Blues website has a link to healthcare.gov, with a note stating if you want to try for a subsidy you must use the federal site. YMMV. MRG
Yep ... And from first hand experience, I can now say that link KINDA works.

So I'm sitting here with a "submission complete" application and a receipt for the first months premium from our local Blue after using that proces.

They told me yesterday that they're having issues with the system and have no idea who I am.
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Old 10-22-2013, 07:46 AM   #7
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Yep ... And from first hand experience, I can now say that link KINDA works. So I'm sitting here with a "submission complete" application and a receipt for the first months premium from our local Blue after using that proces. They told me yesterday that they're having issues with the system and have no idea who I am.
In fairness, I just received an email from The Blue Cross salesperson I spoke with yesterday.....

"Everything now looks good on this end. Congratulations on successfully navigating the Marketplace. You're now in an elite group."

So....yes, the system of enrolling thru the Florida Blue website, going thru the exchange from there (using Explorer with a clean cache and no cookies), does eventually work.
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Old 10-22-2013, 08:44 AM   #8
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So....yes, the system of enrolling thru the Florida Blue website, going thru the exchange from there (using Explorer with a clean cache and no cookies), does eventually work.
Congratulations! I do believe this is a forum first.

IIRC, you were applying for a policy with subsidies, correct? That means the income verification and subsidy engines at healthcare.gov must be working.
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Old 10-22-2013, 11:01 AM   #9
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Congratulations! I do believe this is a forum first. IIRC, you were applying for a policy with subsidies, correct? That means the income verification and subsidy engines at healthcare.gov must be working.
I'm not 100% ready to accept congratulations just yet. I'll postpone those until I actually receive the policy and written confirmation in hard copy. :-). But it at least appears that it's all done.

Yes...this included a subsidy (significant subsidy).

As a side note, I heard a news person on local TV mention, this morning, that you need to clear your cache and cookies before logging into the site (as I found last week) so perhaps word will start getting out. I also found that the site simply works better (works at all?) using Internet Explorer ... Like websites of the 1990's and early 2000's, it seems that the site was built with a browser specific coding. I had no success with Firefox and my second choice of Chrome also didn't work. Once I went in with IE and a cleared cache and cookie file, it actually went pretty smoothly.
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Old 10-22-2013, 04:06 PM   #10
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I'm not 100% ready to accept congratulations just yet. I'll postpone those until I actually receive the policy and written confirmation in hard copy. :-). But it at least appears that it's all done.

Yes...this included a subsidy (significant subsidy).

As a side note, I heard a news person on local TV mention, this morning, that you need to clear your cache and cookies before logging into the site (as I found last week) so perhaps word will start getting out. I also found that the site simply works better (works at all?) using Internet Explorer ... Like websites of the 1990's and early 2000's, it seems that the site was built with a browser specific coding. I had no success with Firefox and my second choice of Chrome also didn't work. Once I went in with IE and a cleared cache and cookie file, it actually went pretty smoothly.
UPDATE: Had an interesting conversation with the good folks at Blue Cross this afternoon. Seems that, yes, they have the application submission. They have record of the subsidy amount information being transferred from the Exchange. And they have record of me providing the payment information (credit card) for payment of the first month's premium.

When questioned when I'll actually receive anything from them showing I'm all good to go, etc., I was told that "we don't yet have that information but it should be within a reasonable amount of time." (Nothing like hedging, huh?).

I explained that I have a payment coming due from United Healthcare and that, on November 1st, they'll be charging me a quarterly payment ($5,700) for coverage through January 31st. I asked if I would be receiving anything prior to November 1st so that I could have confidence in cancelling United Healthcare on January 1st.

The answer (and a direct quote): "I'm sorry but there's no way that's going to happen. We have been told that information will be forwarded as soon as possible but, at this point, we do not have confidence in the information received from the Exchange. No further communication will be taking place with new applicants until that confidence level is established."

Obviously she was reading from a script .... so I asked one more question: "So, you're saying that you don't have confidence in the amount of the subsidy currently indicated with the policy, right?"

"Exactly."
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Old 10-22-2013, 04:55 PM   #11
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we do not have confidence in the information received from the Exchange. No further communication will be taking place with new applicants until that confidence level is established."
Well, that states it all loud and clear. The right hand and the left hand aren't sure they are attached to the same body.

SCARY.
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Old 10-23-2013, 12:17 PM   #12
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UPDATE: Had an interesting conversation with the good folks at Blue Cross this afternoon. Seems that, yes, they have the application submission. They have record of the subsidy amount information being transferred from the Exchange. And they have record of me providing the payment information (credit card) for payment of the first month's premium.

When questioned when I'll actually receive anything from them showing I'm all good to go, etc., I was told that "we don't yet have that information but it should be within a reasonable amount of time." (Nothing like hedging, huh?).

I explained that I have a payment coming due from United Healthcare and that, on November 1st, they'll be charging me a quarterly payment ($5,700) for coverage through January 31st. I asked if I would be receiving anything prior to November 1st so that I could have confidence in cancelling United Healthcare on January 1st.

The answer (and a direct quote): "I'm sorry but there's no way that's going to happen. We have been told that information will be forwarded as soon as possible but, at this point, we do not have confidence in the information received from the Exchange. No further communication will be taking place with new applicants until that confidence level is established."

Obviously she was reading from a script .... so I asked one more question: "So, you're saying that you don't have confidence in the amount of the subsidy currently indicated with the policy, right?"

"Exactly."
Wow thanks for that update, I got a different shock yesterday. I'd been comparing the two insurers in this area. I'd talked to a marketing/sales person at BCBS the day before. She was very helpful, then when I learned about the limited providers in their network, I paused. I have more questions for BCBS, but I'm thinking.

So yesterday I look at Coventry, OK lower premiums more out of pocket so what about the providers. Healthcare.gov throws me into Coventry's site where I can search. I have learned to ask what network, so I call Coventry.

Person is very pleasant, so I'm chatting and tell her where I am in the Healthcare.gov process, and have questions about Coventry provider networks. She responds "healthcare.gov isn't working yet". I tell her some of the issues I've had (and others on the board) and assure her I'm ready to hit the enroll button when I can get answers to providers, and formulary. She responds back "well your the first we've heard of, and we don't have the network defined for ACA coverage yet". I double checked that I heard correctly and asked when do you expect to know? She's very hesitant to talk but suggests "maybe the end of the week, but I'm not counting on that".

It gets better, she want's to know how I got through enrollment? I've told her everything I've heard here, new account, IE, and clear cache. She then thanks me but say when she started to enroll suddenly everybody on the application gets duplicated just like some of us.

So I guess some of the insurers aren't as ready as I'd wanted to believe.

MRG
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Old 10-23-2013, 12:49 PM   #13
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My daughter is attending college and will be included in the family health care plan. She is a resident assistant and receives free room and board and free meals for being a resident assistant. I’m trying to find out if this will count as income for the ACA subsidy?
Any information will be greatly appreciated.
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Old 10-23-2013, 12:57 PM   #14
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My daughter is attending college and will be included in the family health care plan. She is a resident assistant and receives free room and board and free meals for being a resident assistant. I’m trying to find out if this will count as income for the ACA subsidy? Any information will be greatly appreciated.
From my reading, as long as she is under 26 and is listed as a dependent on your tax return, she can still be listed under your plan. Her income is effectively irrelevant.
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Old 10-25-2013, 05:24 PM   #15
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From my reading, as long as she is under 26 and is listed as a dependent on your tax return, she can still be listed under your plan. Her income is effectively irrelevant.

I could be wrong, but I thought all household income was included for the subsidy.
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Old 10-26-2013, 07:12 AM   #16
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My daughter is attending college and will be included in the family health care plan. She is a resident assistant and receives free room and board and free meals for being a resident assistant. Iím trying to find out if this will count as income for the ACA subsidy?
Any information will be greatly appreciated.
The RA job is considered a form of financial assistance, which is considered taxable if it exceeds the tuition and fees (but not room and board or books). So to be considered taxable she would also need a tuition scholarship. Even in that case, many Universities do not prepare W-2 for RAs, it often needs to be self-reported.
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Old 10-26-2013, 07:46 AM   #17
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The RA job is considered a form of financial assistance, which is considered taxable if it exceeds the tuition and fees (but not room and board or books). So to be considered taxable she would also need a tuition scholarship. Even in that case, many Universities do not prepare W-2 for RAs, it often needs to be self-reported.

Thank you for the information. She also receives a tuition scholarship along with the RA free room and board and free meals. After the scholarship and RA benefits we pay around $2000.00 per semester for tuition. Under these circumstances do you think we need to claim the RA benefits as income?
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Old 10-26-2013, 07:49 AM   #18
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Thank you for the information. She also receives a tuition scholarship along with the RA free room and board and free meals. After the scholarship and RA benefits we pay around $2000.00 per semester for tuition. Under these circumstances do you think we need to claim the RA benefits as income?
If the sum of tuition plus fees is greater than the sum of scholarship plus the room and board credit, none of it should be taxable.

Edit: remembering my own time as an RA, which I really enjoyed.
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Old 10-26-2013, 07:59 AM   #19
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If the sum of tuition plus fees is greater than the sum of scholarship plus the room and board credit, none of it should be taxable.

Edit: remembering my own time as an RA, which I really enjoyed.

Thanks again for the information. My daughter also really enjoys being an RA.
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Old 10-26-2013, 08:02 AM   #20
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I could be wrong, but I thought all household income was included for the subsidy.
Sorry ... I researched it and, you are correct. They refer to "household" income.

However, I also saw solutions to that in having her file for her own individual coverage. With subsidies, she would likely be receiving very low cost, perhaps free, coverage. That would entail your not being able to claim her as a dependent but you'd need to do the math to determine which way works best, subsidies or reduced tax deduction.

Sorry for that misstatement regarding her income earlier.
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