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Old 01-20-2014, 05:21 PM   #21
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One thing I learned, some insurers knew a lot less about ACA and cost sharing than the members on this board.
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Old 01-20-2014, 09:32 PM   #22
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Also, Medicaid is available for people earning up to 138% of the federal poverty level in expansion states, but subsidies are available to anyone earning over 100% which I think that I did not make clear above.
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Old 01-20-2014, 10:11 PM   #23
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If your actual income is higher than expected you are responsible for paying back the excess premium assistance you received, but not the cost sharing.

Here's a KFF brief with more detail. http://kaiserfamilyfoundation.files....13/01/8154.pdf
So we should all "expect" to earn <138% of FPL in 2014 so that eventually we repay only the premium subsidy

--"Well now ya see Mr IRS auditor, when I filled out that thar' Exchange application last November I EXPECTED I was bein' laid off in early January from my whoppin' six-figure j#b with no prospects of gettin' back ta' w#rk anytime soon. But then the economy improved SOOOO much that it turned out I wasn't laid off after all. In fact, things went so good I got a huge bonus! If that don't beat all. Now ya can't hold a fella responsible for his expectations bein' wrong, can ya?"
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Old 01-21-2014, 05:35 AM   #24
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So we should all "expect" to earn <138% of FPL in 2014 so that eventually we repay only the premium subsidy
I'm not sure I fully understand all the nuances of the question, but since you direct it to me, I'll do my best to respond. Income needs to be verified by the exchange. Prior year tax returns and data from IRS and SSA will be used. If those are not sufficient, Equifax data will also be consulted. If projected income still cannot be verified using these tools the exchange navigators can document it using other sources and proceed. These need to be verified after three months, however, and then again until either eligibility is confirmed by actual earnings or the policy is discontinued. You can find more detail here http://www.healthreformgps.org/wp-co...cation-8-6.pdf
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Old 01-21-2014, 06:45 AM   #25
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The mechanics of the cost sharing subsidy appear to be pretty simple from what I've seen. For each silver policy (only silver qualifies for cost sharing) there are three sub-policies, one for each of the cost sharing levels determined by income % of poverty level.
Now I understand why I got a warning message about cost sharing when I selected a HSA bronze plan. This is way too complicated.
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Old 01-21-2014, 06:12 PM   #26
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I'm not sure I fully understand all the nuances of the question, but since you direct it to me, I'll do my best to respond. Income needs to be verified by the exchange. Prior year tax returns and data from IRS and SSA will be used. If those are not sufficient, Equifax data will also be consulted. If projected income still cannot be verified using these tools the exchange navigators can document it using other sources and proceed. These need to be verified after three months, however, and then again until either eligibility is confirmed by actual earnings or the policy is discontinued. You can find more detail here http://www.healthreformgps.org/wp-co...cation-8-6.pdf
While the written ACA application does ask those with variable income streams for what they "think" their total 2014 income will be, my attempt at sarcasm was clearly misguided

Obviously there are significant penalties (inc possible perjury) for willfully mis-stating income, and (hopefully) effective methods for detection & enforcement.
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Old 01-21-2014, 06:37 PM   #27
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Originally Posted by ERhoosier View Post
While the written ACA application does ask those with variable income streams for what they "think" their total 2014 income will be, my attempt at sarcasm was clearly misguided

Obviously there are significant penalties (inc possible perjury) for willfully mis-stating income, and (hopefully) effective methods for detection & enforcement.
Having $1,200,000 in a stock account generating $14,000 of dividends, good.

Having $300,000 in a 5 year Penfed CD ladder paying $9,000 of interest, ok.

Getting cost sharing on a silver plan while doing the above: priceless
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Old 01-22-2014, 11:22 AM   #28
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Having $1,200,000 in a stock account generating $14,000 of dividends, good.

Having $300,000 in a 5 year Penfed CD ladder paying $9,000 of interest, ok.

Getting cost sharing on a silver plan while doing the above: priceless
This raises an interesting question. What if one loses their six-figure job Jan 1, 2014 (Corp shutdown, ER, disability, whatever). No pension or SS, just investment portfolio similar to Fermion's example. How might Marketplace handle that situation? Worst case seems like you would deal with it on 2014 income tax filing, but paying full Silver premium/deductibles/co-pays could pose a serious cash flow issue for the year.
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Old 01-22-2014, 11:32 AM   #29
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This raises an interesting question. What if one loses their six-figure job Jan 1, 2014 (Corp shutdown, ER, disability, whatever). No pension or SS, just investment portfolio similar to Fermion's example. How might Marketplace handle that situation? Worst case seems like you would deal with it on 2014 income tax filing, but paying full Silver premium/deductibles/co-pays could pose a serious cash flow issue for the year.
I am going to assume that you would just show that you are unemployed and have little income and sign up for cost sharing and subsidy. I am hoping we hear a few stories about this on ER.org because there are a number of people doing ER in 2014 that will be getting silver plans.
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Old 01-22-2014, 01:10 PM   #30
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I am going to assume that you would just show that you are unemployed and have little income and sign up for cost sharing and subsidy. I am hoping we hear a few stories about this on ER.org because there are a number of people doing ER in 2014 that will be getting silver plans.

In the example above you would report that you are retired and that your income source is investments. Total income would be 14,000 dividends plus 9,000 interest for $23,000 total. For a household of two this would put you under the $23,265 limit for 150% FPL and qualify you for both cost sharing and subsidy for a silver plan. You can make up to 250% FPL and still be eligible for cost sharing although as your income increases your premiums increase and cost sharing decreases.
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