Live in gf and separate health plans

[NameRedacted]

I'm planning to retire in January and sign up for health care on the local exchange.

I've been with my gf for a long time now. She has no effective income and I claim her as a dependent on my tax return.

She has type I diabetes and requires a lot of health care. I on the other hand have been very fortunate so far and mostly have just one checkup a year and that's it.

Because of my gf's condition I think a platinum plan would make sense whereas I only need a bronze plan (I know - something bad may happen but the annual max out of pocket is about $7000 which would not break me).

Here are the monthly numbers:

Platinum couples plan $1133
Platinum single plan $563
Bronze single plan $320

or a difference of about $250. Now the question is, how do the tax credits work if people in the same household have different plans? If I file a tax return with her as a dependent can I just add together the costs of both plans or can I only claim the cost of mine?

Alternatively, even though her income is negligible, we could generate income for her as she has unrealized capital gains. So we could generate some income to take her over the qualifying limit and then she could file a return and qualify for the tax credit too.

However, when I look at the rules at the IRS web-site it talks about the total household income which I guess means that we would each need to count the others income.

It's difficult to run the numbers when I'm not completely sure of the rules of the game.

Also, on an unrelated note. I'm a little concerned about ensuring that we don't experience any gaps in coverage. Mostly because the law is in flux and I don't want an insurance company to deny coverage at some point in the future by pointing out that we had a gap of a week's coverage this coming January.

How quickly can you sign up for coverage? I've been playing around on the exchange and I thought I received an email the other day saying I need to be signed up by December 16th if I want coverage to start on January 1st. It's also possible that I imagined that because I can't find the email any more.

Any help would be much appreciated.

 

[Senator]

I've been with my gf for a long time now. She has no effective income and I claim her as a dependent on my tax return.

My situation is similar to yours. Quit claiming her as a dependent. That only saves $500 or so in taxes. Once she is 'on her own', she will get a 100% subsidized healthcare plan. It will likely include dental, pharmacy and vision too. In MN, you could get her on MinnesotaCare and pay nothing.

Even though we live together, we are two distinct households. You are in the same household as she is your dependent.

That is what I do. Neither one of us pays any premiums, or deductibles. Our healthcare is cheaper now than when we had a subsidized employer plan.

 

[MBSC]

Once she is 'on her own', she will get a 100% subsidized healthcare plan. It will likely include dental, pharmacy and vision too. In MN, you could get her on MinnesotaCare and pay nothing.

That option is for states that expanded Medicaid. In non-expansion states, a non-disabled adult under age 65 without a dependent child is not eligible for Medicaid at any income or asset level.

Because of my gf's condition I think a platinum plan would make sense...

If your household income is between 100% FPL (138% FPL in Medicaid expansion states) and 250% FPL, you are eligible for Silver Plan Cost Sharing Reductions (CSR) that reduce deductibles and max out-of-pocket. This can make Silver Plans with CSR as attractive, or more attractive, than gold and platinum plans. Just make sure any plan for her has an adequate provider network.

I've been playing around on the exchange and I thought I received an email the other day saying I need to be signed up by December 16th if I want coverage to start on January 1st.

Yes, in the vast majority of states 12/15/16 is the last day to enroll for coverage starting 1/1/17. A couple of states push the sign up out a few days longer. You then have until 1/31/17 (effective 3/1/17) to change plans.

She has no effective income and I claim her as a dependent on my tax return....So we could generate some income to take her over the qualifying limit and then she could file a return and qualify for the tax credit too.

If she is claimed as a dependent, you or your insurance agent create a household account on Healthcare.gov (or your state exchange). This is one application. You then create two 'groups' within the application. You go into one group and select an individual Bronze plan. She goes into the other group and selects an appropriate individual plan. The cost of both plans is compared to the 2017 household income estimate you provide to determine if you qualify for Premium Tax Credits (PTC). You may want to call a local, independent health insurance agent and have them run the scenarios for you to review.

 

[athena53]

Be careful about how the deductible would work if you're both on the same plan. When I joined an employer with a (relatively) high deductible plan and DH had two endoscopies within a few months of each other, I discovered the unhappy fact that all of the covered expenses of one person on the plan (even after they've met the per-person deductible) are protected only by the FAMILY out-of-pocket max. To pick some approximate numbers, we had a $1,250 pp deductible and a $2,500 out-of-pocket max. We ended up paying $2,500 out-of-pocket even though my medical expenses for the year were negligible. With deductibles on the exchange being much higher, you could be in for a lot of extra out-of-pocket on a family plan.

 

[MBSC]

With deductibles on the exchange being much higher, you could be in for a lot of extra out-of-pocket on a family plan.

As of 2016, ACA compliant family plans must contain an embedded individual MOOP when the family MOOP exceeds the individual limit.

Q. When I compare health insurance plans in the exchange for our family, they all show total family deductibles and out-of-pocket maximums (OOPMs). Does that mean we’d have to meet the full family out-of-pocket limit, even for just one person?

A. As of 2016, no.

Prior to 2016, family plans could have aggregate OOPMs, or they could have embedded individual OOPMs.

For 2016, the individual OOPM is $6,850, and the family OOPM is $13,700 (these are increasing to $7,150 and $14,300 in 2017, although many health plans will continue to have OOPMs lower than these amounts). Under the new rules, no single member of a family can be required to pay more than $6,850 in out-of-pocket charges in 2016, regardless of whether the rest of the family has incurred any claims. This includes people enrolled in family HDHPs, and HHS has clarified that this does not conflict with HSA and HDHP requirements.

If you’re browsing plans in the exchange, in many states they only show family deductibles and OOPMs on the multi-plan comparison screen if you enter information for more than one family member. So you may need to look a little further to see what the individual OOPM is. In 2016, it won’t exceed $6,850, and in 2017, it won’t exceed $7,150.

But as long as you have an ACA-compliant health plan, you can rest assured that if only one member of your family needs extensive medical care during the year, your out-of-pocket costs will be capped at no more than $6,850 in 2016, even if your plan has a family OOPM of $13,700.

Source: https://www.healthinsurance.org/faq...hat-full-deductible-even-for-just-one-person/

 

[athena53]

Glad they changed that- it was an unpleasant shock even with our relatively small deductible.

 

[NameRedacted]

Quit claiming her as a dependent. That only saves $500 or so in taxes. Once she is 'on her own', she will get a 100% subsidized healthcare plan.

Thanks - that hadn't occurred to me. I'll have to look at the numbers and see what works out best.

 

[NameRedacted]

Thank you very much. Lots and lots of useful info here.

If your household income is between 100% FPL (138% FPL in Medicaid expansion states) and 250% FPL, you are eligible for Silver Plan Cost Sharing Reductions (CSR) that reduce deductibles and max out-of-pocket. This can make Silver Plans with CSR as attractive, or more attractive, than gold and platinum plans. Just make sure any plan for her has an adequate provider network.

Yes I checked online and all her doctors are in-network on all offered plans. I plan to call them all tomorrow to confirm. I also plan to ask them confidentially if any are a pain to deal with. My gf is really sick and tired of dealing with Health "Insurance" companies so ease of use is also a factor.

I understand about the silver plans but I think the platinum may still work better for her. I'll redo the numbers closer to the time. It may make sense for me to switch to silver though.

Yes, in the vast majority of states 12/15/16 is the last day to enroll for coverage starting 1/1/17. A couple of states push the sign up out a few days longer. You then have until 1/31/17 (effective 3/1/17) to change plans.

So the thing is I don't want coverage to start on 1/1/17. The plan is to hand my notice in on 1/3/17. When I do that I expect one of three things to happen.

1. They say don't bother showing up tomorrow.
2. They accept my end date as is. I'm planning for that to be 1/20/2017
3. They ask me to stay a couple of extra weeks to train my replacement. I would not be averse to that. I want to leave on good terms and I suspect working out my notice would be easy money. Also, it occurs to me that I would be paying a much lower tax rate on any earned money and will get a refund on that when I file my 2017 taxes.

In any event, I won't know my end date until the first week of January, which probably means I can't actually apply until at least then, since technically even in the worst case scenario I have existing coverage for 1/1, 1/2 and 1/3.

If she is claimed as a dependent, you or your insurance agent create a household account on Healthcare.gov (or your state exchange). This is one application. You then create two 'groups' within the application. You go into one group and select an individual Bronze plan. She goes into the other group and selects an appropriate individual plan. The cost of both plans is compared to the 2017 household income estimate you provide to determine if you qualify for Premium Tax Credits (PTC). You may want to call a local, independent health insurance agent and have them run the scenarios for you to review.

Thanks this is exactly what I needed to know. So to be clear I would then include the costs of both plans when I file my 2017 taxes? I'm pretty sure this is what you are saying and it does make sense.

 

[EastWest Gal]

You're health coverage typically lasts to the end of the month. You need to sign up by the 15th of the month to have coverage the 1st of the following month. But you also must pay before the first if the month. Typically you pay the insurance company directly.

One of the previous posters was right. You can create separate groups, with you and your gf in different groups.

In states without expanded Medicaid there are a sizable number of people who can't get health insurance. Without expanded Medicaid, there is a asset test for a Medicaid. If a person's assets are too high, they don't qualify for Medicaid. But if they make too little income, they don't qualify for regular subsidized insurance and are directed to apply to Medicaid. But then there assets are too high to qualify for Medicaid. And they can't afford any plans not on the exchange.

Fortunately I see you at live in NY and that state has expanded Medicaid.

 

[MBSC]

So the thing is I don't want coverage to start on 1/1/17. The plan is to hand my notice in on 1/3/17. When I do that I expect one of three things to happen.

1. They say don't bother showing up tomorrow.
2. They accept my end date as is. I'm planning for that to be 1/20/2017
3. They ask me to stay a couple of extra weeks to train my replacement. I would not be averse to that.

In any event, I won't know my end date until the first week of January, which probably means I can't actually apply until at least then, since technically even in the worst case scenario I have existing coverage for 1/1, 1/2 and 1/3.

Depending on how the group plan is set up you will either lose group coverage on your last day of employment or the end of the month. If you lose group coverage on 1/3 or 1/20 and are eligible for COBRA, you can use the retroactive activation feature of COBRA to cover yourself for the remainder of January. This means if you get sick you send in the activation form and pay a January COBRA premium that covers you retroactive to the first day of unemployment. If you don't get sick, you don't submit the activation and don't pay a premium.

If you're not eligible for COBRA and are healthy, you could enroll in a non-compliant Short Term Medical (STM) plan for the remainder of January. You can go two full months without compliant coverage before incurring the penalty/fine.

So to be clear I would then include the costs of both plans when I file my 2017 taxes? I'm pretty sure this is what you are saying and it does make sense.

Correct.

In states without expanded Medicaid there are a sizable number of people who can't get health insurance. Without expanded Medicaid, there is a asset test for a Medicaid. If a person's assets are too high, they don't qualify for Medicaid. But if they make too little income, they don't qualify for regular subsidized insurance and are directed to apply to Medicaid. But then there assets are too high to qualify for Medicaid. And they can't afford any plans not on the exchange.

Each state has their own requirements. My state did not expand Medicaid and the income/asset tests only apply to the disabled, those over age 65, and those with a dependent child. You are disqualified before taking the asset test if you don't fall into one of these categories.

Mississippi: Adults without dependent children are not eligible at all (this is generally the case in states that have not expanded Medicaid) unless they’re disabled.
https://www.healthinsurance.org/mississippi-medicaid/

North Carolina: Childless non-disabled adults are not eligible for Medicaid.
https://www.healthinsurance.org/north-carolina-medicaid/

South Carolina: No Medicaid coverage is available for non-disabled childless adults.
https://www.healthinsurance.org/south-carolina-medicaid/

Georgia: Individuals who are elderly, blind and disabled. Parents with family income up to 35 percent of FPL.
https://www.healthinsurance.org/georgia-medicaid/

Alabama: Childless adults in Alabama are not eligible for Medicaid. https://www.healthinsurance.org/alabama-medicaid/

Tennessee: Because Tennessee has not yet expanded Medicaid under the ACA, eligibility guidelines are unchanged from 2013, and non-disabled, non-pregnant adults without dependent children are ineligible for Medicaid.
https://www.healthinsurance.org/tennessee-medicaid/

 

[NameRedacted]

Thanks ever so much. I think all my questions were answered.

 

[redduck]

Live in gf and separate health plans

Thanks ever so much. I think all my questions were answered.

Yet I have a question:

Does your gf have any extra wombs to rent?

 

[redduck]

Live in gf and separate health plans

FTFU

Does your gf have any extra wombs to [-]rent[/-] went?

That's much better.
Thanks.
No, thank you.