2022 ACA Exchange Experiences

[PaunchyPirate]

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Originally Posted by EastWest Gal PA only launched its own exchange last year. It seems it still has to work out its kinks. We haven’t started this year’s application. Remember you have until the end of December to make the first payment. If I recall, we paid the first payment with a paper bill in the mail, then set up autopay thereafter.

It’s all been figured out. Highmark can’t accept payment until they generate an invoice. That takes a few days. Apparently, Pennie isn’t set up for that delay. Highmark eventually generated that invoice and notified me that I could pay it anytime. I’m all paid up. Pennie acknowledges that I’m paid up. And I have limited access to my account on Highmark’s website. I’m good to go!

[GTFan]

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Originally Posted by agh1 My subsidy fell because new insurance companies entered the market and are offering cheaper Silver plans. Since the subsidy is based on the 2nd lowest priced Sliver plan the subsidy went down. IMO the new plans are junk with no decent hospitals or doctors in their very narrow networks so I will be paying higher premiums in 2022. The cost of my current plan is also rising due to both age and rising premiums. In addition the copays and out of pocket amounts are also increasing.

Yep, seen that here - the new lowest cost Silvers have very restricted networks. But I don't mind paying $175/mo. in 2022 for a decent network plan, with low OOP costs. A whole lot cheaper than the rack rate of $1800/mo.

[djsander]

I’ve got a headache and gave up. I went through the application and it asked for income and put in what I think was this years and estimated for next year. I did the same for the wife and it has her being considered for Medicaid even though next years projected income for her is above the threshold. Not sure why it isn’t using household income. It is very convoluted. I finally stopped and found a broker listed on their website and left them a message. I think they prefer on Medicaid or no subsidies.

[sengsational]

^I put in zero for my wife and one annual number for what I'm targeting. Are you on hc.gov or a state portal? And you must file jointly.

[Dtail]

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Originally Posted by djsander I’ve got a headache and gave up. I went through the application and it asked for income and put in what I think was this years and estimated for next year. I did the same for the wife and it has her being considered for Medicaid even though next years projected income for her is above the threshold. Not sure why it isn’t using household income. It is very convoluted. I finally stopped and found a broker listed on their website and left them a message. I think they prefer on Medicaid or no subsidies.

I use a Healthcare Exchange rep on the phone to sign up each year. They are very competent with no issues.

[Go Bolts]

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Originally Posted by USGrant1962 You really shouldn't worry about getting a health insurance subsidy. There is only a tiny segment of the population that is NOT subsidized and that is not based on income/wealth. Basically only those who are upper income and retired and under 65; and maybe those who stay on unsubsidized COBRA between jobs. I guesstimated one time it is maybe 1% of the population, though probably less now with the elimination of the subsidy cliff. About 11 million are on ACA plans, or 3% of the population, and I've seen somewhere that 85% of those are subsidized. Everyone else is subsidized in one way or another. Examples: Warren Buffet, Charlie Munger, Bill Gates, Steve Ballmer, Michael Bloomberg and 61 million others - 65+ on Medicare, subsidized Elon Musk, Mark Zuckerberg, and 156 million others - employer provided, business expense deduction and not taxed on personal income taxes, subsidized Small business owners/self-employed - business expense deduction and not taxed on personal income taxes, subsidized The poor - Medicaid, subsidized Me - can deduct health insurance against my consulting income on Schedule C, subsidized The whinging that people under 65, unemployed, and with assets should be the only ones to pay full freight is silly, especially because it is a rounding error in the nation's health insurance bill.

Exactly!

A tax credit is a tax credit is a tax credit.

That’s all you need to remember. [emoji106][emoji383]

[djsander]

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Originally Posted by Dtail I use a Healthcare Exchange rep on the phone to sign up each year. They are very competent with no issues.

It’s a state exchange and the state for 2022 is running their own exchange. The exchange rep was no help. Called an agent and we worked through it and she called the rep. Still not very good as the agent called me back and said she went through three people and to the escalation desk and none could give any good answers. They are all new and it seems not well trained. I worked my way with through and got to sign up for a plan, but now they want proof of income which they don’t tell us what that is. What makes it more confusing is the way they ask for income during the interviews. They ask for your income and in one place they says it’s for the year you are applying, however the follow up questions are asking is this the income you will make in 2022 implying the first question is the present year. I answered every way conceivable and still had the could not electronically verify my income and I would have to send in proof of income. None of the reps that I talked with or the agent spoke with knew how to answer these questions. The other thing it threw my wife into a Medicaid review by the state. They said it shouldn’t do that based on our income, but that the state will reject it. Anyway, now we wait for another email that the exchange is supposed to send about income. This is definitely a government program.

[Dtail]

Quote:

Originally Posted by djsander It’s a state exchange and the state for 2022 is running their own exchange. The exchange rep was no help. Called an agent and we worked through it and she called the rep. Still not very good as the agent called me back and said she went through three people and to the escalation desk and none could give any good answers. They are all new and it seems not well trained. I worked my way with through and got to sign up for a plan, but now they want proof of income which they don’t tell us what that is.

Sorry to hear that. Didn't think about the state exchange concept.

[djsander]

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Originally Posted by Dtail Sorry to hear that. Didn't think about the state exchange concept.

Thanks, They give examples of income, but they really don’t tell you what they are looking for or if it is really current year or what it’s all not relative as you know all you can do is estimate for 2022.the good thing is we got a gold plan for $0. My wife goes on Medicare in March so even if it becomes a train wreck and they push us to the full cost for inadequate information which by their clock is mid February so we would start paying in March it would be just for me. We can come out of pocket and then claim the money in 2023, but don’t think we should. I’m guessing they have a set process that they have to go through. My DW and I have answer for this kind of convoluted mess. It’s the government what do you expect!

[PaunchyPirate]

Quote:

Originally Posted by djsander Thanks, They give examples of income, but they really don’t tell you what they are looking for or if it is really current year or what it’s all not relative as you know all you can do is estimate for 2022.the good thing is we got a gold plan for $0. My wife goes on Medicare in March so even if it becomes a train wreck and they push us to the full cost for inadequate information which by their clock is mid February so we would start paying in March it would be just for me. We can come out of pocket and then claim the money in 2023, but don’t think we should. I’m guessing they have a set process that they have to go through. My DW and I have answer for this kind of convoluted mess. It’s the government what do you expect!

I was also asked to "justify" my 2022 income estimation. I sent them my completed 2020 federal income tax return and added a comment that "My only income is derived from investments. I estimate my 2022 income will be approximately the same as shown on the 2020 tax return I have attached". This was accepted by the Pennsylvania exchange without further information provided. If your income is going to be different from your most recent tax return, I would still send it in and explain why it will be different. If they follow up, you may need to provide a copy of bank, brokerage, pay stubs, etc. whatever actually will give an idea of the income you are estimating. There is no one answer that fits all people.

They usually aren't too aggressive with this, because you will have to eventually pay the excess subsidy back at tax time if you underestimate your income.

[Methos1979]

First post although been lurking awhile now. Wife and I (58/60) retiring at end of year and went to try to sign up for ACA through NH portal. Filled everything out honestly. They asked about current salaries and access to healthcare and future salary (low) and no healthcare. But when submitted it came back saying we didn't qualify for reduced rates based on this year's earnings. Next year we'll be living off a very meager retirement (probably $35-$40k) so by the website estimates we thought we'd get the break. Any ideas why? We were looking at a very basic bronze Anthem policy.

[PaunchyPirate]

Quote:

Originally Posted by Methos1979 First post although been lurking awhile now. Wife and I (58/60) retiring at end of year and went to try to sign up for ACA through NH portal. Filled everything out honestly. They asked about current salaries and access to healthcare and future salary (low) and no healthcare. But when submitted it came back saying we didn't qualify for reduced rates based on this year's earnings. Next year we'll be living off a very meager retirement (probably $35-$40k) so by the website estimates we thought we'd get the break. Any ideas why? We were looking at a very basic bronze Anthem policy.

I think I would call the Help line and ask them to look at your application and assist you. It sounds like you must have misinterpreted one of the questions, which would be easy enough to do. I had to have help on my first year because of confusion like this. The Questions just aren’t set up for early retirees with a sudden, dare I say, intentional drop in income.

[Aerides]

Quote:

Originally Posted by Methos1979 First post although been lurking awhile now. Wife and I (58/60) retiring at end of year and went to try to sign up for ACA through NH portal. Filled everything out honestly. They asked about current salaries and access to healthcare and future salary (low) and no healthcare. But when submitted it came back saying we didn't qualify for reduced rates based on this year's earnings. Next year we'll be living off a very meager retirement (probably $35-$40k) so by the website estimates we thought we'd get the break. Any ideas why? We were looking at a very basic bronze Anthem policy.

different states have different portals, but the federal one asks for only your expected earnings. If yours doesn't permit that, you will see the reduction at tax time after the first year on the ACA, once your real incomes drop.

So it will even out in the wash.

[DayDreaming]

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Originally Posted by Methos1979 First post although been lurking awhile now. Wife and I (58/60) retiring at end of year and went to try to sign up for ACA through NH portal. Filled everything out honestly. They asked about current salaries and access to healthcare and future salary (low) and no healthcare. But when submitted it came back saying we didn't qualify for reduced rates based on this year's earnings. Next year we'll be living off a very meager retirement (probably $35-$40k) so by the website estimates we thought we'd get the break. Any ideas why? We were looking at a very basic bronze Anthem policy.

My state has it's own exchange and website - where it asks for various forms of income, I have to choose annual, monthly or weekly next to each number. I accidentally left it as monthly instead of annual, and only realized that later when I didn't qualify.

[SecondCor521]

Quote:

Originally Posted by Methos1979 First post although been lurking awhile now. Wife and I (58/60) retiring at end of year and went to try to sign up for ACA through NH portal. Filled everything out honestly. They asked about current salaries and access to healthcare and future salary (low) and no healthcare. But when submitted it came back saying we didn't qualify for reduced rates based on this year's earnings. Next year we'll be living off a very meager retirement (probably $35-$40k) so by the website estimates we thought we'd get the break. Any ideas why? We were looking at a very basic bronze Anthem policy.

Like others have said, when they asked for your income, they're really wanting to know what your income and health insurance availability will be in 2022.

If you answered honestly but gave answers to those two items based on now in 2021, then that will mess up the application.

Generally speaking, the questions can be hard to answer right because they can be poorly phrased.

If you want to get the monthly subsidies, you should be able to modify your application to give them estimated 2022 income and health insurance availability, and then you should get approved for the subsidies.

[explanade]

Insurers supposedly made out in 2020 because people and medical groups put off most procedures as health care resources were mostly consumed for covid.

So where are the rebates or premium reductions?

MLE has to come into play right?

[RetiredHappy]

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Originally Posted by explanade Insurers supposedly made out in 2020 because people and medical groups put off most procedures as health care resources were mostly consumed for covid. So where are the rebates or premium reductions? MLE has to come into play right?

What does MLE stand for?

I did get a rebate of about $150 from my private individual off-exchange plan because they did not spend the stipulated amount for patient care for 2020 (COVID year).

[COcheesehead]

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Originally Posted by explanade Insurers supposedly made out in 2020 because people and medical groups put off most procedures as health care resources were mostly consumed for covid. So where are the rebates or premium reductions? MLE has to come into play right?

There’s a difference between “put off” and cancelled. The charges will still likely happen. So we get a spike in ‘22. It all evens out.

[USGrant1962]

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Originally Posted by explanade Insurers supposedly made out in 2020 because people and medical groups put off most procedures as health care resources were mostly consumed for covid. So where are the rebates or premium reductions? MLE has to come into play right?

We got a check. And a lot of posters here mentioned the same.

[PaunchyPirate]

I just received an email to participate in a paid market research survey related to my signing up for health insurance with Highmark BC/BS here in Pennsylvania. It's done by a firm hired by Highmark. They asked a few questions in a web survey asking about my demographics and my 2021 and 2022 insurance choices.

After answering those, I "qualify" for an additional 1-hour Zoom video survey with a live interviewer. If they select me, I will get $75.

I agreed to all of this so I can, hopefully, voice my opinion on whatever it is they want to know. Interviews are Dec. 1-10, so we'll see where this goes.