ACA - additional info required?

[Willers]

I signed up for ACA insurance recently. Because we just retired we got the message that income verification is required. I'm getting mixed advice on how much detail I should send. Some say to keep it really simple and others say give them details.

Have any of you run into this? Can you give me any advice on what has worked for you and what level of detail is enough?

Thanks for any help you can provide!!!

 

[MRG]

I've sent in brokerage statements with projected interest and dividends. Short letter stating I no longer work and that's all our income should be. Worked flawlessly, they provide a list of suggested docs, I gave what I had and explained away the items I couldn't provide.

 

[ziggy29]

This link shows how to resolve "inconsistencies" in a Marketplace application, including the type of documentation they are likely to want for income verification:

https://www.healthcare.gov/help/how-do-i-resolve-an-inconsistency/

For 2015 income you won't have the tax return or tax documents (W-2s and/or 1099s) but maybe the last pay stubs and bank/brokerage statements for 2015 will show your approximate income in 2015. If your income isn't much changed from 2014 to 2015, your 2014 tax return may be useful as well.

 

[MBSC]

For 2015 income you won't have the tax return or tax documents (W-2s and/or 1099s) but maybe the last pay stubs and bank/brokerage statements for 2015 will show your approximate income in 2015. If your income isn't much changed from 2014 to 2015, your 2014 tax return may be useful as well.

The ACA Marketplace has access to your 2014 tax return. You get the request for more info when your forward looking 2016 income estimate varies substantially from the actual 2014 tax return.

 

[ziggy29]

The ACA Marketplace has access to your 2014 tax return. You get the request for more info when your forward looking 2016 income estimate varies substantially from the actual 2014 tax return.

I guess this wasn't all in place in late 2013 when first enrolling for January 2014.

My 2012 tax return (the latest available at the time) would have shown income over $120K, but I estimated something like $42K in 2014 income (I was laid off from my higher-paying IT job in 2013). This never triggered any red flags and I don't recall being asked to furnish more information about current income. I was asked to verify American Indian status, but that was it.

 

[MRG]

The ACA Marketplace has access to your 2014 tax return. You get the request for more info when your forward looking 2016 income estimate varies substantially from the actual 2014 tax return.

All I sent in this year was my 2014 tax return and my November 2015 brokerage reports on income and dividends. Our projected 2016 was less than $500, difference from 2014 and 2015. I can't say what triggers the RFI. Other than in my case there wasn't much of a change.

 

[scrabbler1]

I have had some weird and inconsistent experiences with income verification and the premium subsidy in the last few years dealing with my state's (New York) Marketplace (Exchange).


In early 2014, I was often asked to provide income verification and I uploaded annual statements from my main investment company (Fidelity) which showed my investment income. I had no other types of income such as unemployment, Social Security, pension, or W-2. Still, none of what I sent was good enough and they kept asking me for more.


However, I was not claiming any advance premium subsidy because I knew it would be pretty small so I planned to my "overpayment" of HI premiums as a sort-of backhanded tax withholding. After speaking to some NY Marketplace reps, they told me what I was doing was okay and to ignore future income verification requests. I claimed the subsidy on my 2014 federal IT return which was used to offset income taxes owed and all was fine. I am doing the same thing for my 2015 IT return and I didn't receive and income verification requests so I guess they finally figured that out.


But I just changed insurance companies for 2016 so when I reapplied and entered my projected 2016 income, I suddenly qualified for an advanced premium credit which is now lowering my monthly premium. I sent in no income verification and the Marketplace hasn't bothered me about it. I checked with my new insurance company to make sure it was okay to pay the reduced amount (I don't want to get bit in the ass later for underpayment of premiums and get the policy canceled).


I will end up having to complete a few more lines on the IT form to account for the advanced premium subsidy being received during the year but that's no big deal. I will no longer have the subsidy available to offset taxes due but that is no big deal, either.


Pretty strange set of opposite events regarding the premium subsidy, huh?

 

[MBSC]

I guess this wasn't all in place in late 2013 when first enrolling for January 2014.

Correct, they only audited a "significant sample" for the initial 2014 enrollment.

All I sent in this year was my 2014 tax return and my November 2015 brokerage reports on income and dividends. Our projected 2016 was less than $500, difference from 2014 and 2015. I can't say what triggers the RFI. Other than in my case there wasn't much of a change.

Sometimes the system does not receive a return value (income) from the IRS. The system also randomly selects applications to audit. These, along with other factors, can lead to RFI requests when income has not changed.

Back to the OP who is recently retired, you may want to review the following threads for ideas.
http://www.early-retirement.org/forums/f38/aca-submitting-income-documents-79798.html

http://www.early-retirement.org/for...age-inconsistency-big-drop-in-magi-74843.html

 

[MRG]

Correct, they only audited a "significant sample" for the initial 2014 enrollment.

Sometimes the system does not receive a return value (income) from the IRS. The system also randomly selects applications to audit. These, along with other factors, can lead to RFI requests when income has not changed.

Back to the OP who is recently retired, you may want to review the following threads for ideas.
http://www.early-retirement.org/forums/f38/aca-submitting-income-documents-79798.html

http://www.early-retirement.org/for...age-inconsistency-big-drop-in-magi-74843.html

Thanks. That makes sense.

 

[Willers]

Thanks everyone for the info and the links. It almost seems that it depends on who reviews the document and what kind of mood they are in that day.

I'm leaning toward the simple approach a try and see how it goes. Here's what I'm thinking:
- A short statement saying that we are both retired and that our income will be interest, divs and cap gains and listing 2014 actual MAGI, expected 2015 MAGI and forecasted 2016 MAGI (no calcs or spreadsheets)
- Our 2014 1040 page 1 showing the actuals
- 2014 schedules (B, D)
- December 2015 brokerage statements

Think that is enough?

 

[MRG]

Basically what I've provided for a couple of years. I don't send in more than the minimum they ask for, auditors taught me that, indirectly.

 

[heeyy_joe]

I sent them a letter to state I retired and sent along a copy of my COBRA offer from my former employer. Worked like a charm!

 

[Taxman59]

I retired in 2015, and called BCBSNC for help getting the ACA insurance. They took my info for my projected 2016 income, and signed up for the silver policy (1400 total OOP, 400per month premium). The notice I received made no mention of any additional information needed. I called the Marketplace help line to confirm that no information was needed, and she said I was good to go with no proof required!


Have the day you deserve, and let Karma sort it out.

Sent from my iPad using Early Retirement Forum

 

[Willers]

Basically what I've provided for a couple of years. I don't send in more than the minimum they ask for, auditors taught me that, indirectly.

Thanks. That's the direction I'll go. I guess they can always ask for more.


Sent from my iPhone using Early Retirement Forum

 

[Willers]

Thanks everyone. I'm sending the bare minimum and we'll see how it goes.


Sent from my iPhone using Early Retirement Forum

 

[Fermion]

I just didn't check the box that allows them to even look at our tax return. Worked so far.

 

[sengsational]

Think that is enough?

For me, if I uploaded that to the hc.gov site it wasn't enough. Once they sent the paper letter and I sent back the same document I'd been uploading along with their cover sheet, only then did they accept it.

 

[ShokWaveRider]

I just came across this.

I (we) had no such problem with info. But WE did not go directly to the Healthcare.gov site to get our ACA plan. We use a local insurance broker.

Wohoaaaa some of you may be thinking........... Calm down....

I checked the WebSite got some education, THEN called 3 local Insurance brokers that claimed to help with ACA applications. NOT official ACA Navigators, proper insurance brokers.

Well it turns out that the insurance companies PAY these folks to help navigate the system. While this sounds like a conflict of interest, and it can be, it actually worked to our advantage.

Here is how, I approached it:

I checked the healthcare.gov site, we are in FLA and for us FloridaBlue is pretty much the only game in town. there are others but their plans are VERY expensive. So I chose a plan and put it in my back pocket. Wrote down the main details, Deductible, MOOP, Etc... and started calling.

Broker 1 was and independent and their prices were silly, plans not what I wanted.

Broker 2 was ONLY FloridaBlue and comparable to what I found.

Broker 3 was affiliated with another company and too expensive.

We went with Broker 2:

I spent about 1 hour on the phone she (Judy) took all my info, no hard copies. Then said she would get back to me.

Judy emailed me 3 options of which one was the one I selected, BUT she had access to a direct line to the Insurance company (Different Website than the Healthcare.gov, although it is registered / linked to it)

The one I wanted had lower deductibles and things than those I had got. I asked her how she got paid and she was honest and explained that she was compensated by the company NOT form my premiums. This was correct I check.

We now have ACA healthcare, that we could NOT have got on our own and are very happy with it.

This may be different for folks in other states, but it worked for us. We did everything by phone.

If it was NOT for the ACA I could not get insurance with my heart condition (Pacemaker).

 

[boog]

Shokwaverider, I had a similar experience here too in Florida. I haven't signed up yet (planning to RE in April and start ACA insurance in May). There is a broker's office a couple of miles from where I live so I went over for a visit last week. Actually had a pleasant experience as the agent was quite friendly and seemed very knowledgeable. In my county there are only two providers - FLA Blue Cross and United Healthcare. The broker only represented Blue - agent said if they offered Blue, they had to be exclusive. The medical practice we use is not in United Healthcare's network anyway.
Wonder if your situation involved premium tax credits? If so, did the agent help you validate income for the subsidy, or are you forgoing the subsidy for a tax credit next year?

 

[MRG]

...snip..

We now have ACA healthcare, that we could NOT have got on our own and are very happy with it.

This may be different for folks in other states, but it worked for us. We did everything by phone.

If it was NOT for the ACA I could not get insurance with my heart condition (Pacemaker).

I'm probably confusing myself. Are you saying that the broker found plans that were not available through the exchange? Or ACA made it possible to now buy insurance due to pre-existing conditions? Thanks.

 

[ShokWaveRider]

Wonder if your situation involved premium tax credits? If so, did the agent help you validate income for the subsidy, or are you forgoing the subsidy for a tax credit next year?

Yes and No, I told her the number. We are fortunate where we can control our income. We get $1100 in Credits.

 

[ShokWaveRider]

I'm probably confusing myself. Are you saying that the broker found plans that were not available through the exchange? Or ACA made it possible to now buy insurance due to pre-existing conditions? Thanks.

Not exactly, however, The ACTUAL plan the agent found was the same as shown on the Gov site BUT the terms were different.

Plans from FLBlue have numbers Like say for Example: 1477

The Gov site showed me the 1477 Plan BUT the Agent found a derivative of it, that seems to be only available to agents to choose from. Say 1477c.

In my case this made the deductible $0, lower office visit co-pays, and OOP $4000 less for my family, with a nominal $3 increase in Monthly premium and the Co-insurance went from 80% to 70%. Although the Co-insurance was higher, the Max OOP was significantly lower and off set the difference IMHO.

From what I understand the Agents do not ACTUALLY use the GOV site but the Insurers version, not available to us lay people. However, when my agent set it up I could see it on the GOV site.

It surprised me too.

Does that make sense?

 

[MRG]

Not exactly, however, The ACTUAL plan the agent found was the same as shown on the Gov site BUT the terms were different.

Plans from FLBlue have numbers Like say for Example: 1477

The Gov site showed me the 1477 Plan BUT the Agent found a derivative of it, that seems to be only available to agents to choose from. Say 1477c.

In my case this made the deductible $0, lower office visit co-pays, and OOP $4000 less for my family, with a nominal $3 increase in Monthly premium and the Co-insurance went from 80% to 70%. Although the Co-insurance was higher, the Max OOP was significantly lower and off set the difference IMHO.

From what I understand the Agents do not ACTUALLY use the GOV site but the Insurers version, not available to us lay people. However, when my agent set it up I could see it on the GOV site.

It surprised me too.

Does that make sense?

Hum maybe. Did you actually enter your income in healthcare.gov or just use the list price of the plan? I'm wondering if the agent entering your income brought subsidies and cost sharing into the picture? If you entered the same data I would expect the same results, but I'm then again, I'm frequently wrong.

 

[MBSC]

We do not have access to hidden plans. On-exchange Silver Plans come in four versions based on income. The exchange and broker access the same version.

1) The base plan with no cost sharing reduction (1477).
http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477.pdf
2) Cost sharing reductions for 200-250% FPL (1477a)
http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477a.pdf
3) Cost sharing reductions for 150-200% FPL (1477b)
http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477b.pdf
4) Cost sharing reductions for below 150% FPL (1477c)
http://www.bcbsfl.com/DocumentLibrary/SBC/2016/1477c.pdf

Brokers use a WBE as a back door to the exchange.
eHealth | Consumer

List of authorized WBE's (HealthSherpa is often mentioned on this forum):
https://www.cms.gov/CCIIO/Programs-...nloads/Public_2015_WBE_List_August-Update.pdf

 

[ShokWaveRider]

Hum maybe. Did you actually enter your income in healthcare.gov or just use the list price of the plan? I'm wondering if the agent entering your income brought subsidies and cost sharing into the picture? If you entered the same data I would expect the same results, but I'm then again, I'm frequently wrong.

As I said, I did NOT use Healthcare.gov. The Agent did it all. I only used HC.Gov to look at the plans.