ACA help please! We are in Texas with no exchange

[aja8888]

Sorry for this post but I am helping my daughter get through the ACA application process and we are stumped (we searched here and just got more confused). I do not need to go through it as I am over 65.

She completed an application over time (Oct - now) and does not "see" any subsidy information on the ACA website. She is single, 34 years old and makes under $30K this year. Her employer offers health care but she does not qualify being a part time worker.

When she went to enroll with BCBS (Texas) she sees the least expensive bronze policy cost @ $159.00 (HMO).

When using the HealthSherpa web site, we see that the same bronze policy allows for a direct subsidy of $88.88 per month.

HealthSherpa

The question is: Where is this ACA subsidy info supposed to show up? Or does it?

She has not called the ACA line since the last few calls during the application process were less than productive. Should she call BCBS before actually enrolling with them at the $159.00 cost? ....Maybe do a new application with ACA (even though she is approved)?

Thanks for any suggestions.

 

[ziggy29]

I'd try again with another application. The ones from October may be borked up still and there is no way to fix them (the "report a life change" is still not operative).

It's also possible she may have inadvertently said "yes" to the question about being eligible to be covered by an employer plan. But I'd start over anyway. I don't trust the earlier applications to work properly at this point.

 

[aja8888]

Thanks, one thing we see is the constant message to report a life change (are you smoking now?). We keep answering this and it just keeps coming back. I suppose if we start a new application we should use a different username and password.

I believe she said on the question of "does your employer offer health coverage", she said yes. But she said she doesn't remember if there was an option to say that she is not eligible for it though.

And you can't go back and edit these applications once submitted.....

 

[Theduckguru]

I ran an estimate on Kaiser Family Institute. You daught is right on the edge for a subsidy depending on insurance rates for her zip code. She may not get a sub being single.

Her employer is not offering health care becausevtheyvaren't paying at least part of it.

 

[ziggy29]

I ran an estimate on Kaiser Family Institute. You daught is right on the edge for a subsidy depending on insurance rates for her zip code. She may not get a sub being single.

Insurance rates in her zip code have nothing to do with eligibility for a subsidy. It's based off the ratio of income to the federal poverty line (FPL). The only time location matters for this purpose is that the FPL is higher in Alaska and Hawaii.

The FPL for a single person is $11,490 (in the contiguous 48). Since the tax credits phase out completely at 400% of FPL, a single filer with an income below $45,960 can still receive it if otherwise eligible.

$30K would be about 261% of the federal poverty line. Below 250% ($28,725 in this case), cost sharing (reduced deductibles and OOPM) would kick in for a Silver-level plan.

 

[aja8888]

Yes, I see that too and a subsidy is available. We are going to attempt another application this weekend and I'll report back here with our success.

Thanks

 

[rbmrtn]

She should be well within the limit to get a subsidy. Did a subsidy ever appear and does your application say complete when you login ? I would also agree with starting a new app, I had several started in Oct none got all the way. I started one in Nov. and it went right thru to completed with no problems ( that I know of ). You need to use a new email and ID, make sure to keep the browser clean, cache, temp files etc

Qualification for subsidy does not depend on zip code; however the amount of the subsidy can vary by zip code.

Also the question about employer coverage may have gotten misread. I think it says "are you eligible for coverage through a job", she should select NO. The forms/questions may have changed since Oct.

 

[aja8888]

She should be well within the limit to get a subsidy. Did a subsidy ever appear and does your application say complete when you login ? I would also agree with starting a new app, I had several started in Oct none got all the way. I started one in Nov. and it went right thru to completed with no problems ( that I know of ). You need to use a new email and ID, make sure to keep the browser clean, cache, temp files etc

Qualification for subsidy does not depend on zip code; however the amount of the subsidy can vary by zip code.

Also the question about employer coverage may have gotten misread. I think it says "are you eligible for coverage through a job", she should select NO. The forms/questions may have changed since Oct.

Her application says complete and there is no way to go back and edit anything. I also believe the question on employer coverage was answered wrong since they do offer coverage, but not to her at this time (maybe if she gets a full time offer later). She may have answered 'yes" at the time and expected another question like "if yes, do you receive coverage from them?"

I wonder why you can't just print out the completed application for your records? (and to see your answers)

We will do this application on my computer which has not been on the site filling out any applications.

 

[Katsmeow]

Insurance rates in her zip code have nothing to do with eligibility for a subsidy. It's based off the ratio of income to the federal poverty line (FPL). The only time location matters for this purpose is that the FPL is higher in Alaska and Hawaii.

The FPL for a single person is $11,490 (in the contiguous 48). Since the tax credits phase out completely at 400% of FPL, a single filer with an income below $45,960 can still receive it if otherwise eligible.

$30K would be about 261% of the federal poverty line. Below 250% ($28,725 in this case), cost sharing (reduced deductibles and OOPM) would kick in for a Silver-level plan.

I thought that was the way it worked too. That said, I looked on Healthysherpa and put in someone residing in my zip code in Texas and made the person under 30 and have a household income of $40,000. No subsidy came out. Basically, healthsherpa didn't show a subsidy until I brought the income all the way down to 28600 at which time the monthly subsidy was $.94. On the other hand if I put in someone who is 64 with a $40,000 income then a subsidy is shown.

I don't know if that is just wrong or if premium cost affects whether you are offered a subsidy even if you are below 400% of FPL

 

[rbmrtn]

I don't know if that is just wrong or if premium cost affects whether you are offered a subsidy even if you are below 400% of FPL

The subsidy is calculated based on the premium not exceeding 9.5% of your income at 400%FPL. Then it is the difference between that and the premium. The subsidy is calculated from the cost of the second lowest cost silver plan available to you. Something like

Max premium = 9.5% * income <--- this the max premium you should pay

SLP2= premium for second lowest cost silver plan

Subsidy = SLP2 - MaxP

The max premium @ 400% would be $4366, if the premium for the second lowest silver plan was already less than that then there would be no subsidy.

 

[ziggy29]

It could be that the premiums for younger folks are low enough that they are still considered "affordable" at their income level without the tax credits.

 

[Theduckguru]

The subsidy is calculated based on the premium not exceeding 9.5% of your income at 400%FPL. Then it is the difference between that and the premium. The subsidy is calculated from the cost of the second lowest cost silver plan available to you. Something like

Max premium = 9.5% * income <--- this the max premium you should pay

SLP2= premium for second lowest cost silver plan

Subsidy = SLP2 - MaxP

The max premium @ 400% would be $4366, if the premium for the second lowest silver plan was already less than that then there would be no subsidy.

That is my understading too. Income is only part of formula.

 

[aja8888]

Success!

Well, we went on the healthcare site, deleted the original application, started over, answered the question on "does your employer offer health insurance (to you)" (we answered "no") and finished the application. Based on the subsidy for a wage of $25K annually, she got a BCBS Bronze plan (005) with a premium of $72/month.

This is really like catastrophic insurance, but that's what a healthy and fit 30+ year old needs.

 

[audreyh1]

That's actually better than a catastrophic plan. We have the same plan and the savings to cover deductibles, etc.

That is so great that the do over is working!

That plan is HSA eligible, BTW - in case she wants to do some pre-tax saving to cover expenses in the future.

 

[aja8888]

That's actually better than a catastrophic plan. We have the same plan and savings to cover deductibles, etc.

Yes, I'm sure it is but it seems like one since the daughter is very healthy and in great shape (nice being young). Plus, she doesn't have any bad habits. So we view it as a need in the event of a major health issue. I have not read the entire coverage document. I left that up to her. I am sure she will take advantage of the periodic checks that are part of the ACA policies.

I am on Medicare with a Plan F supplemental policy so I have the Holy Grail of health insurance for an old geezer....