2024 NY Essential Plan

[a60dan]

NY state residents:

Has anyone found the specifics (in writing) on what constitutes household income for the (non-ACA) Essential Plan?

Specifically:
Roth conversions
Capital gains


These items aren’t mentioned in what I’ve found.

Hoping to see which line on the 1040 is used so I can run scenarios this year.

Our friends have done Roth Conversions in December, reported it by phone, and still qualified the following year.

We think the income is reviewed on a monthly basis and they were told the one time income increase in the current month wouldn’t affect the following month.

My FA is encouraging me to start Roth Conversions but it makes no financial sense if we lose the no premium essential plan.

I just want to see the criteria in writing.

 

[GenXguy]

Good question for @jim584672

I would think Roth conversions and realized capital gains would both count.

 

[jim584672]

NY state residents: Has anyone found the specifics (in writing) on what constitutes household income for the (non-ACA) Essential Plan?

The Essential Plan is part of the ACA and ACA rules apply to it.

This is a good summary of what counts as income for the ACA:
https://laborcenter.berkeley.edu/wp-content/uploads/2021/03/2021-03-MAGI-Summary.pdf

Since the EP is not a QHP (Qualified Health Plan) subsidies do not apply to it. So there is nothing to reconcile at tax time if income comes in too high for the year. I don't know how they would handle that situation. I think the EP is like Medicaid and it has 12 months of continuous coverage once you get determined. NY has a waiver for 12 months of coverage. See slide 19,
https://info.nystateofhealth.ny.gov...or Training - Unwinding in NYSOH_Part One.pdf.

 

[a60dan]

Thank you for that presentation.

All I have been able to find is this:
http://https://www.health.ny.gov/health_care/medicaid/publications/docs/adm/10adm-5att1doccheck.pdf

There is much about “income” and no mention of Roth conversion or capital gain.

I can see that a capital gain is “income” because I have use of the money immediately without penalty, regardless of whether tax rate.

The Roth Conversion adds to my taxable “income” for tax purposes, but I’m not able to access the converted funds immediately per my understanding.

If I did the conversion once per year, the “income” that I can’t spend without penalty could be incurred in month 12, at the end of 2024 and my 2023 tax return (no conversion ) will be used.

I’m Medicare eligible 3/2025 and my wife 3/2026.

Based on our friends’ experience for 2+ years, I may take the risk and convert In December 2025 and again in 2026.

I never imagined that our medical insurance would be better than my employer plan, at no cost because my income was so low ��*

Medicare is beginning to look more costly…..

 

[jim584672]

Roth conversions and capital gains are definitely income. I am 100% sure about that.

If you are over 59.5 a Roth conversion is immediately available if you want to withdraw it.

Medicare will cost me much more than the ACA/EP/Medicaid ever did.

I found a Fair Hearing letter defining MAGI...

Applicable Law and Regulations
Modified Adjusted Gross Income
NYSOH bases its eligibility determinations on modified adjusted gross income as
defined in the federal tax code (45 CFR § 155.300(a)). The term “modified
adjusted gross income” means adjusted gross income increased by (1) any
income that was excluded under 26 USC § 911 for United States citizens or
residents living abroad, (2) tax-exempt interest received or accrued, and (3)
Social Security benefits that were excluded from gross income under 26 USC §
86 (see 26 USC § 36B(d)(2)(B), 26 CFR § 1.36B-1(e)(2)).
“Adjusted gross income” means, in the case of an individual taxpayer, gross
federal taxable income minus certain specific deductions, such as expenses
reimbursed by an employer, losses from sale or exchange of property, losses
from premature withdrawal of finds from time savings accounts, deductions
attributable to royalties, and certain retirement savings (26 USC § 62(a)). Living
expenses, such as rent and utilities are not an allowable deduction in computing
adjusted gross income

https://info.nystateofhealth.ny.gov...8_2017-10-13_Individual_Decision_Redacted.pdf