HealthCare.gov and Inconsistencies

[nico08]

Hi. I am confused in regard to the healthcare.gov website. I am currently enrolled in an Affordable Health Care Plan. However, I periodically receive emails saying that my health insurance may be in jeopardy. I have included some of the language that I see on the website in regard to my health insurance application below in bold. In one area it states that I need to supply additional documentation and in another area it says that the documentation has been submitted. I uploaded my 2015 federal income tax return as support/proof/evidence of my income.

I was diagnosed with cancer in 2014 and I was treated for it in 2014 and 2015. Two weeks prior to being diagnosed, I was terminated from my long term employment with mega-corp and I have not returned to work since.

When I have called the marketplace, they concede that the website is confusing. They state that what the website intends to communicate is that my 2015 federal tax return has been submitted, but not yet reviewed. But if you look below, based on the list of eligible documents, it appears that my 2015 federal income tax return is not a sufficient document to prove income?

I would rather not provide any more information to the marketplace than is necessary to confirm my eligibility, but based on my health situation I don't want to risk losing coverage.

Do they need a written statement from me affirming that I am not employed in 2016 and that I am living off of my savings? Do I need to give them some redacted version of my investment portfolio accounts and my bank account?

Have any of your remained in what appears to be limbo status concerning your eligibility for health insurance coverage? I just want some kind of confirmation so I dont have to worry about enrollment. I have enough to worry about. Thank you for your advice.

Qualified Health Plan eligibility

You have unresolved inconsistencies. You need to provide additional documentation.
Verify Steven's yearly income

Submit before 5/18/2016

SUBMITTED
(Select to upload another document)

Verify your yearly income
You need to send the Marketplace proof of your yearly income for 2016. Examples of documents you can send include:

Wages and tax statement (W-2)
Pay stub
Letter from employer
Cost of living adjustment letter and other benefit verification notices
Lease agreement
Copy of a check paid to the household member
Bank or investment fund statement
Document or letter from Social Security Administration (SSA)
Form SSA 1099 Social Security benefits statement
Self-employment ledger
Letter from government agency for unemployment benefits

 

[Ian S]

I would provide a summary of what you expect for "income" in 2016. This could include withdrawals from savings, IRAs, pension benefits, SS, etc. Then provide supporting documentation for those sources e.g. account statements, SS and pension statement, etc.

 

[bingybear]

I'm likely going to go through this shortly as COBRA will be running out. I guess a question I have... are you planning/trying to get a APTC or cost sharing? I would expect that they will be requesting documentation for that. If you can afford to pay the full premium ... quote the income above the subsidy level and just get the PTC when you file.

I'm not sure I would use "pulling X dollars from savings" as income, because it is not, put pulling from a TIRA would count as income.

I have heard about some that have provided copies of brokerage accounts to support the "distribution income" that they are claiming. I believe they are looking for supporting data to show the MAGI you will have.

If you don't have thing like employment income... then specifically state that. If they see nothing in an area... they are going to ask. I have seen on other threads where some have used a sworn document stating what there income is.

 

[Ian S]

I'm likely going to go through this shortly as COBRA will be running out. I guess a question I have... are you planning/trying to get a APTC or cost sharing? I would expect that they will be requesting documentation for that. If you can afford to pay the full premium ... quote the income above the subsidy level and just get the PTC when you file.

That's fine as long as you're not expecting cost sharing. IIRC, you won't get the latter unless you file for upfront for the PTC.

 

[jim584672]

"Income" does not include draw downs from savings. MAGI has a legal definition that should be referred to.

The OP may have very little income. Hopefully his state expanded Medicaid so he doesn't fall into the coverage gap for having too little income.

 

[ExFlyBoy5]

Anything .gov MEANS inconsistency, right?

 

[Ian S]

"Income" does not include draw downs from savings. MAGI has a legal definition that should be referred to.

Yes that's why I put income in quotes. Depending on the OP's situation, there may be a dramatic change in income that could be questioned as being unrealistic if the person is for example expecting to rely on drawdown of savings. While not income for MAGI purposes, explaining the use of savings to support your living standard could be useful if the healthcare.gov folks continue to question the application.

 

[gauss]

If I understand correctly you had very little taxable income in 2015. Have you done your 2015 income taxes yet? Is your AGI line 37 over $15,000? Did you have any Social Security income shown on lines 20a,20b?

If all answers are no, then you will likely not qualify for an ACA subsidy but rather offered expanded medicaid -- Are you still living in NJ as your profile shows? NJ did expand Medicaid.

-gauss

 

[pb4uski]

What I would do is to write them a letter and provide a table with the components of your 2014, 2015 and estimated 2016 Obamacare MAGI. Assuming that you do not have any of the elements reconciling from tax return AGI to MAGI you can also indicate that the 2014 and 2015 MAGI agree to your tax returns as filed and you do not have any differences for tax-exempt income etc.

You could provide page 1 of your 2014 and 2015 Form 1040 (redacting your SS number of you would like) and then comment on any significant differences between the 2016 estimate and 2015. For example, the table would show earnings in 2014 but not 2015 and you can explain that you ended your long-term employment about the time you were diagnosed with cancer.

Try to put yourself in there shoes of trying to verify that the 2016 income estimate that you provided is reasonable. For 2016 I suggest that you just use your judgement as to what supporting documents to provide. If the components of your 2016 estimate are reasonably close to your 2015 return then there should be little need for explanation.... if they are significantly different then more explanation and supporting documentation would be prudent.

 

[CRLLS]

Well, I got off the phone myself today. This is the 2nd time I've gotten notice that I need to provide more of what I think I already provided. When I called the first time, 3/14/16, they told me they didn't know what more they needed, just that what I originally submitted was not enough. HUH? I originally sent in 2015 tax return, a statement of expected income from self employment and how this year would be different from last year for both me and DW. Maybe I should send another statement of expected income and a statement that my DW was not employed, So I did that a statement signemd by me, a statement signed by my DW and a copy of my billing for Jan/Feb to the company I do some work for under a 1099, on the same day. I received an email yesterday stating that what I submitted did not match their records. I might loose coverage if I didn't send in more documentation. No more than that. So I called today and sat on hold for over 20 minutes. Finally got someone and explained my situation. She looked up my file. From that, she could tell that they have not reviewed or acted on my 3/14 submittal yet. She put another statement in my file that I called and tried to rectify what I thought was a threatening email. But they automatically send out "reminders" every 30, 60 and 90 days. They are very busy. I'd guess they are, since they send out these "reminders" before they review any submitted info.


Based on my 2 phone calls, if I were to call again next month, if I get my 60 day "reminder" I will get some other unspecific answer and suggest I do something different.


Keep good records of time and date and person you talked to etc just in case. But I think they are working at a normal Government Agency rate.

 

[gerntz]

Anything .gov MEANS inconsistency, right?

+1. Beat me to that one.

 

[bingybear]

That's fine as long as you're not expecting cost sharing. IIRC, you won't get the latter unless you file for upfront for the PTC.

I agree, but I did not catch that the OP was going for cost sharing.

I would supply an item or line for every item on the list. Indicate "not applicable" for items that do not exist.

For investments... they say they want income, so show what income is derived from your investments... redact the rest if necessary.

 

[MBSC]

(snip) She looked up my file. From that, she could tell that they have not reviewed or acted on my 3/14 submittal yet... But they automatically send out "reminders" every 30, 60 and 90 days. They are very busy. I'd guess they are, since they send out these "reminders" before they review any submitted info.

+1

This time last year I reported an income reduction to reflect the 2014 tax return I just completed and to start collecting APTC. I uploaded my two page 2014 Form 1040. I did not upload the schedules or any supporting documentation. I did get a green submitted button on the federal marketplace website.

For the next two months I received emails and snail mail stating I needed to submit documentation. I took no action since I had already submitted a document. The mail stopped when they finally got around to actually reviewing the document I submitted.

 

[xdafly]

When we completed our ACA application, initially we did not fully complete it and it resulted in a "..we need additional documentation.." status.

When we next did a whole session, all the way, including picking a plan and provider, the status changed to Completed and we received a BCBS Silver Plan membership, paid 1st month premium and that was that.

We still continue to get "... may be in danger.. " email reminders but they are likely from the earlier incomplete application(s). Our current status shows Completed so we're not going to lose sleep over this inconsistency.

 

[scrabbler1]

I, too, have seen some inconsistency about providing additional documents and how that relates to the APTC. Back in early 2014, when the exchanges first began, I was asked several times by my state exchange (New York Marketplace) to provide additional documentation relating to my income. I was not interested in receiving any reduction in my monthly premium because I knew the subsidy would be small (my MAGI is close to the maximum to receive a subsidy, so why bother?), opting to simply file for it when I completed my 2014 federal IT form a year later.


I did try, however, to send them what I had at the time. That included the latest monthly statement from my main investment company which included a year-to-date total of investment income. That wasn't good enough for them, even after I receive the annual statement a few weeks later in late January. I kept getting these email and snail mail requests so I called them up and explained my situation and how their list of options didn't seem to account for anyone who was living off his savings, not the more typical forms of income such as SS, wages, unemployment, etc. The phone rep told me to ignore the requests and they would go away without endangering my eligibility for the subsidy.


I received the 1095-A form and filed my 2014 FIT return and took the subsidy without any problems. Because I paid no taxes during the year, either through withholding or via estimated taxes, I used the subsidy as a backhanded tax withholding to reduce my tax liability.


I did the same thing for 2015 and did receive one of those "we need more documents...." and ignored it again. This time, on my 2015 FIT return I just completed, the subsidy nearly covered my whole tax liability.


But when I changed health insurance companies for 2016, I was told that my monthly premium would be reduced due to the APTC. And I never sent them any documentation! I just told them again, as in prior years, what I estimated my MAGI would be. Perhaps my state's exchange made some internal changes, I don't know.


Strange, when I told them more about my income, I was given a harder time getting the subsidy. But when I told them less about my income, I received the (advanced) subsidy. Go figure.

 

[MRG]

I agree, but I did not catch that the OP was going for cost sharing.

I would supply an item or line for every item on the list. Indicate "not applicable" for items that do not exist.

For investments... they say they want income, so show what income is derived from your investments... redact the rest if necessary.

Exactly what I did for 2015, and 2016 income estimates. I'm guessing it worked as they stopped sending mails.

Sent from my SAMSUNG-SM-G920A using Early Retirement Forum mobile app

 

[nico08]

Hi. I want to thank everyone for their feedback and for sharing their experience. To answer some of your questions, yes, I am seeking and receiving a premium reduction based on my estimated income for 2016. I am only 45, so I am not receiving social security or my small government pension yet. When I provided my estimated income for 2016, I relied primarily on my MAGI from 2015. The MAGI from 2015 was comprised of capital gains, dividends, interest and some unemployment income. Since I will not receive unemployment income in 2016, I just estimated that my MAGI for 2016 would be the same as my MAGI for 2015, less the unemployment compensation.

My estimated income for 2016, based on 2015's interest, dividends and capital gains, was about $21,000. I didn't see anywhere in the material that I received from healthcare.gov that I was eligible for medicaid.

If I was at a low risk of needing to make use of my health insurance, I think I would be a little less anxious about the inconsistent information I have received from the marketplace.

I think what I will do is upload a short sworn statement, explaining the difference in income between 2014 and 2015. I will also include reference to the cancer diagnosis and the employment termination, and how that affected my income for 2015 and beyond. And I can say how the following are not relevant or applicable to me aside from the bank or investment fund statements:

Wages and tax statement (W-2)
Pay stub
Letter from employer
Cost of living adjustment letter and other benefit verification notices
Lease agreement
Copy of a check paid to the household member
Bank or investment fund statement
Document or letter from Social Security Administration (SSA)
Form SSA 1099 Social Security benefits statement
Self-employment ledger
Letter from government agency for unemployment benefits

I can include account statements showing the capital gains, interest and dividends I have received in the first quarter of 2016.

I guess I have some "work" to do. Yuck, I hate that word "work", especially since I left the workplace in August of 2014.

I just entered into retirement in an usual way, so I am trying to roll with the punches. And I hope to have long term remission and be able to enjoy FIRE. I will tell you one thing, being diagnosed with a life threatening disease really reinforced how much I did not want to be a part of the corporate grind. We only have one life, we have to live it.

Thanks again for your feedback.

 

[DayDreaming]

I was also getting letters and emails stating that I needed to provide additional documentation.

Back in February, as soon as I finished my taxes, I uploaded my tax return via the healthcare.gov website. I also uploaded a PDF letter explaining that my 2016 income will be roughly the same, except that I won't be doing a ROTH conversion as large as in 2015, so my MAGI will be lower in 2016. (My only income is interest and dividends, a small self-employment income, and ROTH conversions).

On healthcare.gov, my status continued to show that I only had temporary eligibility and that additional documentation was needed.

So I snail-mailed in a copy of my tax return and that same letter. No change in my status on healthcare.gov, and I eventually got a letter saying it was my final notice and that I could loose my subsidy.

I called them a few days before the deadline, and spoke to a very helpful person who said she can see that I did provide some documentation so I did meet their deadline. They had not reviewed my file yet, but when they do, I would receive another letter either saying that I'm ok, or else it would explain what other information I need to supply. And it would not be a problem supplying additional documentation later, since I had met their original deadline.

About 2 weeks later I got a letter saying my documentation was accepted and my subsidy would not change.

 

[MrLoco]

The thing I don't understand is why do people need to submit:

"proof of income," "copies of tax returns", etc? The gov't. can simply cross reference your income with the IRS....isn't that why ACA subsidies are based on income and not net worth?

Then at tax time if you over estimated your income your refund increases.....if you underestimated your income...you owe. Seems pretty simple to me.

 

[bingybear]

The thing I don't understand is why do people need to submit:

"proof of income," "copies of tax returns", etc? The gov't. can simply cross reference your income with the IRS....isn't that why ACA subsidies are based on income and not net worth?

Then at tax time if you over estimated your income your refund increases.....if you underestimated your income...you owe. Seems pretty simple to me.

At tax time, yes they can. A year before, not likely. The IRS works after the fact. Do they know you're retiring? Do they know you just changed a job? Maybe they could know some of this.
As noted in this thread, tax returns are not considered required proof. I'm sure heathcare.gov has some data from previous tax returns and use that to question your estimates.

I you go for cost sharing... I don't think that is reconciled at tax time like PTC. Plus the govt likely does not want to give you a interest free loan for the year.
I would hope they only need to income from brokerage statements as PTC is based on income and not means.
All that said, is should be easier than what comes out in these posts. I expect I will just skip the APTC my first year and maybe second to make this process easier. But we'll see later this year how I handle it.

 

[GTFan]

When we completed our ACA application, initially we did not fully complete it and it resulted in a "..we need additional documentation.." status.

When we next did a whole session, all the way, including picking a plan and provider, the status changed to Completed and we received a BCBS Silver Plan membership, paid 1st month premium and that was that.

We still continue to get "... may be in danger.. " email reminders but they are likely from the earlier incomplete application(s). Our current status shows Completed so we're not going to lose sleep over this inconsistency.

We're in the same boat, a previously incomplete app was updated using the life change feature to let them check current income automatically (which resolved the income question) but we still get the occasional warning email that we could lose subsidy. The current app is showing complete and I have a full eligiibility letter on hc.gov so I just ignore the emails and nothing has happened.

They have some real issues with getting their communications to match the app status IMO, and the letters I got in mail from them were dated almost a month before I actually received them. They might have (mostly) fixed the website issues but their backend processing is still bad. I heard the same from Humana reps when trying to straighten out what our 2016 cost-shared Silver plan deductibles and OOP were supposed to be with the ACA app back in January. They conferenced in a hc.gov rep who said it could take weeks to resolve but fortunately Humana was able to fix it themselves.

 

[rodi]

That's fine as long as you're not expecting cost sharing. IIRC, you won't get the latter unless you file for upfront for the PTC.

I agree, but I did not catch that the OP was going for cost sharing.

I strongly disagree!!!! You CAN get the ACA tax credit at the time you file for taxes. I was forced into this situation because of a "feature" (feature=bug) in CoveredCA (California's ACA exchange). My husband insists on a different insurer than my kids and myself. CoveredCA will not offer premium reduction to reflect the tax credit if you are a family and have more than one insurer - it forces you onto the same insurer. Last year I spoofed the forms to show income above the MAGI premium tax credit to allow the selection of multiple plans. When I ran turbo tax I was able to claim the FULL tax credit, after the fact. The "feature" was still there during enrollment this year - so I did the same thing.

The key to claim the ACA premium tax credit at tax filing time is to purchase your insurance through an exchange. Only policies purchased through the exchange are eligible for the premium tax credit. The IRS does not care if you collect your premium tax credit along the way, or when you file your taxes. Sure, it's crappy for tax flow to pay the full freight along the way - but I set my retirement budget for full premiums to be conservative.

 

[Ian S]

I strongly disagree!!!! You CAN get the ACA tax credit at the time you file for taxes. I was forced into this situation because of a "feature" (feature=bug) in CoveredCA (California's ACA exchange). My husband insists on a different insurer than my kids and myself. CoveredCA will not offer premium reduction to reflect the tax credit if you are a family and have more than one insurer - it forces you onto the same insurer. Last year I spoofed the forms to show income above the MAGI premium tax credit to allow the selection of multiple plans. When I ran turbo tax I was able to claim the FULL tax credit, after the fact. The "feature" was still there during enrollment this year - so I did the same thing.

The key to claim the ACA premium tax credit at tax filing time is to purchase your insurance through an exchange. Only policies purchased through the exchange are eligible for the premium tax credit. The IRS does not care if you collect your premium tax credit along the way, or when you file your taxes. Sure, it's crappy for tax flow to pay the full freight along the way - but I set my retirement budget for full premiums to be conservative.

You're confusing the premium tax credit with cost sharing. The latter reduces co-pays, deductibles and maximum out of pocket costs for care you receive during the year. You have to qualify upfront and the income levels are different from the PTC. If you are not eligible for cost sharing because your income is too high, then it's fine to get your PTC at tax time. If you are eligible for cost sharing, then you would need to pre-qualify to get it.

 

[MBSC]

I strongly disagree!!!! You CAN get the ACA tax credit at the time you file for taxes.

There are two types of subsidies, premium subsidies (tax credits) and cost sharing reductions (CSR) that reduce deductibles and maximum out-of-pocket (MOOP). No one is challenging the statement that premium subsidies (tax credits) without CSR can be taken when you file your tax return. The conversation turned to cost sharing reductions.

The cost sharing reductions apply only to on-exchange Silver Plans for those with pre-approved MAGI below 250% FPL (300% FPL for federally recognized tribe Native Americans and ANCSA shareholders). The previous posters were saying that you cannot retroactively claim the CSR when you file your tax return.

Cost Sharing Reductions: Cost Sharing Reduction Subsidies (CSR) - Obamacare Facts

 

[nico08]

Hi. I just wanted to follow up and let you know that, in addition to the tax return I submitted for 2015, I also submitted a sworn statement and summarized my income for 2015 and my projected income for 2016. I supplied a response for every item on the list that they identified as documents addressing proof of income. I indicated "not applicable" for items that did not exist. I received confirmation from the marketplace that my application was accepted and that I am eligible for a tax subsidy base on my income.

Thank you for your advice.