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Old 02-14-2020, 07:01 AM   #41
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You repay whatever APTC you were not entitled to receive, up to a limit.
And I am good with that, more than happy to pay my dues. I just prefer doing it at the end of the year, rather than monthly or up front. One still pays one way or another so I do not feel guilty.
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Old 02-14-2020, 07:11 AM   #42
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It is based on your zip code and family size (and maybe ages and tobacco use, not 100% sure on that).

You should be able to figure it out by putting your zip code and family information into your marketplace, shop for plans, then select Silver plans, then look at the second lowest premium. That should be it.

Theoretically if the insurance companies competing in the marketplace change their prices or enter or leave the marketplace mid year, then it could change, but I suspect that is not common.
I tried doing this in the first few years of the exchanges, sorting the Silver plans and using the second lowest. But what I used was never what I saw in the 1095-A form I got early the following year. Sometimes, it wasn't even close. So, I abandoned the estimate based on that.

I also called the NY Marketplace to try to get it from them before the 1095-A form came out. The phone reps had no clue (big surprise!), telling me to wait until the 1095-A form came out.

Now, I just take the previous year's and multiply it by 110%. Can't be any worse than any other guess.
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Old 02-14-2020, 07:52 AM   #43
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NY is unusual in that subsidies are from 200% to 400% FPL only. Under that and it goes to Essential Plan or Medicaid. This year I'm estimating 149% FPL to get a free Essential Plan. 150% to 200% FPL is $20 a month premium per person.
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Old 02-14-2020, 08:03 AM   #44
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Sent a letter explaining my income for the upcoming year and they accepted it without any questions.
I did that and got denied. All my data from the prior year and noted I would not be doing the roth conversion. I was 15 to 20 k under the cliff. I was denied . It was a good thing as I think the subsidy is not in my best interest.
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Old 02-14-2020, 08:10 AM   #45
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The weird thing about the 'cliff' and the forced into essentials / medicaid etc below certain FPL's, is that many people cannot know their income until AFTER the tax year is over.

This is the case for me as I have numerous real estate K-1's where they can be huge profit, or huge loss.

As such I just do the catastrophic plan where there is no subsidy, but it functions close in price / subsidy to a bronze plan around 399% FPL...atleast in my state.

One of the biggest changes I hope they make to ACA is to just cap premiums at 10% of family income regardless of income (lower percentages still under 400% FPL). To me this would be fair and not a give away, yet keep costs out of the stratosphere for people just over the cliff.

It would also mean you get the same subsidy whether in advance or in arrears.
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Old 02-15-2020, 09:20 AM   #46
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And I am good with that, more than happy to pay my dues. I just prefer doing it at the end of the year, rather than monthly or up front. One still pays one way or another so I do not feel guilty.
So you're good with estimating less than $25k income to get a max CSR Silver plan and actually reporting over twice that every year?

I wondered whether HHS would accept lowball estimates like that when actual reported is much higher year after year. Guess I know now they don't care, but this is the kind of stuff folks here rail about when they can't get subsidies.
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Old 02-15-2020, 01:02 PM   #47
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Loopholes, legalities, and ethics aside, the simple fact that the IRS is on the receiving end of the income estimate that I provide is enough to deter me from providing anything other than my best-faith estimate of what my actual income will be.
One always settles up at tax time...go over the cliff...simply repay any prior credits taken.

Claim significant credits but go under 100% FPL...repayment is limited...but note that would be relatively rare...the above is much more common.

In either case...still get to benefit from cost-sharing reductions.
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