ACA and cliff

[ivinsfan]

In past years Healthcare.gov has consistently underestimated our subsidy eligibility, and we ended up getting refunds from the IRS as a result. I don't know why this year would be any different.

I don't use the government website. so I don't know how close it comes..I'm just saying that you will pay more money for the policy now that it includes only one of you.

If you think of it at filing time come back and share how much of the 200 was your net cost. I think a lot of posters are interested in this number for planning purposes.

If it's a real 200 dollars increase coupled with Medicare and supplement cost, the increased cost per month could be anywhere from 400 to 600 dollars.

 

[Mr._Graybeard]

I don't use the government website. so I don't know how close it comes..I'm just saying that you will pay more money for the policy now that it includes only one of you.

If you think of it at filing time come back and share how much of the 200 was your net cost. I think a lot of posters are interested in this number for planning purposes.

If it's a real 200 dollars increase coupled with Medicare and supplement cost, the increased cost per month could be anywhere from 400 to 600 dollars.

Yes, we'll surely pay more. Up to now in 2018 our ACA premium was covered 100% by the subsidy -- in fact, we left some subsidy on the table when we opted for a Bronze plan.

Medicare B is about $175 a month, Medicare D another $20, Medigap $115. So yeah, our bump in expenses looks like $500/month unless the IRS returns some of my ACA premium. I will let you know next spring.

 

[SecondCor521]

The household gets the subsidy not the person, you cannot spilt a subsidy. On the MN exchange everyone in the family unit must use the same plan/subsidy.

[nitpick]
For the general case I think you are right, and that may be the way it works in MN. But I recently became aware of Part IV of Form 8962 and the instructions for it, which seem to have something to do with splitting a subsidy across multiple plans. The allocation situation that most closely could have applied in my case was Case #3, because I could have been in a situation where I had a tax family size of four - me and my three kids - except my oldest is 23, tax-wise is an independent (lives in my house but had a full time job), and didn't want insurance.
[/nitpick]

 

[ivinsfan]

[nitpick]
For the general case I think you are right, and that may be the way it works in MN. But I recently became aware of Part IV of Form 8962 and the instructions for it, which seem to have something to do with splitting a subsidy across multiple plans. The allocation situation that most closely could have applied in my case was Case #3, because I could have been in a situation where I had a tax family size of four - me and my three kids - except my oldest is 23, tax-wise is an independent (lives in my house but had a full time job), and didn't want insurance.
[/nitpick]

It's not a nitpick because in some cases separate plans would be desirable, I had a in-law family in this situation. We did some reading that indicted you could have different plans but at MNSure signup were told no it's not an option.


I think Rodi did something like this on covered California but don't remember the details. Oh wait she enrolled thru the CC and paid full cost for her DH and got some money back when she filed her tax return.

 

[Dtail]

You probably will continue to pay more, I wouldn't count on getting it back. The household gets the subsidy not the person, you cannot spilt a subsidy. On the MN exchange everyone in the family unit must use the same plan/subsidy.

The subsidy is determined by

Household Income
Number of people in the household

and finally number of people in the household actually buying an exchange plan. The computer spits out a number and there you are. If you are wondering about your situation and possible changes go to a website and enter some numbers...the MN Sure site is very easy to use.

Just making sure I understand.
My DB and I are on ACA. We are on the same Silver plan in FLA. The calculation is on the combined household income. Each one of us is taking the full tax subsidy upfront and we will be filing separate tax returns.
However, I will be claiming head of household supporting him on my return.
Any issues you see?

 

[ivinsfan]

Just making sure I understand.
My DB and I are on ACA. We are on the same Silver plan in FLA. The calculation is on the combined household income. Each one of us is taking the full tax subsidy upfront and we will be filing separate tax returns.
However, I will be claiming head of household supporting him on my return.
Any issues you see?

So I'm talking about MFJ not single people so I suggest you consult an insurance broker. I have no knowledge about head of household.

 

[gauss]

Just making sure I understand.
My DB and I are on ACA. We are on the same Silver plan in FLA. The calculation is on the combined household income. Each one of us is taking the full tax subsidy upfront and we will be filing separate tax returns.
However, I will be claiming head of household supporting him on my return.
Any issues you see?

If DB is being claimed as a dependent on your return, then I don't believe he will qualify for any PTC on his own return. (ref Form 8962 line 1)

There may be limitations on the amount of repayment required by him however.

-gauss

 

[Dtail]

If DB is being claimed as a dependent on your return, then I don't believe he will qualify for any PTC on his own return. (ref Form 8962 line 1)

There may be limitations on the amount of repayment required by him however.

-gauss

That is interesting. He needs to be claimed by me, otherwise he doesn't qualify as a single (FPL minimum).
So why would the govt allow him to take the upfront tax subsidy, if he can't take in the end tax return wise?
I made it clear he is my dependent and they said he needs his own separate plan with his own premium.

 

[Sue J]

You probably will continue to pay more, I wouldn't count on getting it back. The household gets the subsidy not the person, you cannot spilt a subsidy. On the MN exchange everyone in the family unit must use the same plan/subsidy.

The subsidy is determined by

Household Income
Number of people in the household

and finally number of people in the household actually buying an exchange plan. The computer spits out a number and there you are. If you are wondering about your situation and possible changes go to a website and enter some numbers...the MN Sure site is very easy to use.

But MN has it's own exchange. If your state uses the healthcare.gov marketplace people in the same family can use different plans. The subsidy is determined by household income and number of people and then each person gets a portion of the subsidy and can choose to use it with any plan.

Example - DH and I get a subsidy for the household. We designate a "group" for DH and a "group" for me. The group term come from the way HC.gov wants you to divide your family in order to buy different plans.

Our subsidy is split in half, he chooses a silver plan and I choose a bronze plan. Our costs are reduced by our subsidy for each plan. We are in Ohio which uses the federal marketplace site.

We are dealing with ACA for just one more full year, for 2019. I will need it just for Jan 2020 and then I will start Medicare on 2/1/2020. DH will return to his retiree medical (subsidized) for Jan-Mar 2020 and then start Medicare 4/1/2020 with a retiree medical reimbursement allowance.

 

[ivinsfan]

But MN has it's own exchange. If your state uses the healthcare.gov marketplace people in the same family can use different plans. The subsidy is determined by household income and number of people and then each person gets a portion of the subsidy and can choose to use it with any plan.

Example - DH and I get a subsidy for the household. We designate a "group" for DH and a "group" for me. The group term come from the way HC.gov wants you to divide your family in order to buy different plans.

Our subsidy is split in half, he chooses a silver plan and I choose a bronze plan. Our costs are reduced by our subsidy for each plan. We are in Ohio which uses the federal marketplace site.

Yes I realize that....I think the federal plan has an advantage here, the question is if only one person is getting insurance instead of two how does the federal site do the subsidy. It gets confusing...

 

[gauss]

That is interesting. He needs to be claimed by me, otherwise he doesn't qualify as a single (FPL minimum).
So why would the govt allow him to take the upfront tax subsidy, if he can't take in the end tax return wise?
I made it clear he is my dependent and they said he needs his own separate plan with his own premium.

If DB is your dependent, then you are responsible for his health insurance. The idea is that you would pay the premium(s) for both of you and you would rthen receive any PTC on your tax return for both of you -- less any APTC paid to the insurance company to subsidize the premiums.

When you claimed DB as a dependent, were you aware of all the requirements that must be met to do this (ie his gross income limit must be less than the personal exemption amount (ie ~ $4,050 in 2017)? If this is not the case, then you may get a letter/audit from the IRS.

edit:Note that if DB claims his own exemption and you don't claim him, he may be able to still get PTC even if his income is less than 100% of FPL. If the marketplace predicted that his income would be between 100% and 400% and granted him APTC, then PTC would be allowed. See line 6 form 8962.

-gauss
aka "the ACA nerd"

 

[gauss]

That is interesting. He needs to be claimed by me, otherwise he doesn't qualify as a single (FPL minimum).
So why would the govt allow him to take the upfront tax subsidy, if he can't take in the end tax return wise?
I made it clear he is my dependent and they said he needs his own separate plan with his own premium.

I am not an expert on the front end of this but can anyone other than a taxpayer, his/her spouse and children under age 26 be on an ACA Family policy?

I would suspect that if the exchange knew that he would have low income he would have been steered to a Medicaid plan, assuming you live in an expansion state.

Since FL is not a Medicaid expansion state, DB would be between a rock and a hard place with respect to any premium subsidies. He would, on the other hand, qualify for an exemption (see form 8695) to the penalty (SRP) for not maintaining health insurance if his gross income is below the filing threshold (ie ~ $10,400 in 2017 if under age 65) and he were not claimed by anyone as a dependent.

-gauss

 

[golfnut]

My wife and I are covered by an ACA plan. 2/3 years ago, we explored getting our son (then 22 years old) covered under our plan, He was not allowed to because


- made too much money (approx. $12,000).


- Also a part time college student


He also could not get a solo ACA plan because his salary was below the ACA min.approx. $16,000.


His only alternative was Medicaid. We live in Illinois.

 

[Dtail]

If DB is your dependent, then you are responsible for his health insurance. The idea is that you would pay the premium(s) for both of you and you would rthen receive any PTC on your tax return for both of you -- less any APTC paid to the insurance company to subsidize the premiums.

When you claimed DB as a dependent, were you aware of all the requirements that must be met to do this (ie his gross income limit must be less than the personal exemption amount (ie ~ $4,050 in 2017)? If this is not the case, then you may get a letter/audit from the IRS.

edit:Note that if DB claims his own exemption and you don't claim him, he may be able to still get PTC even if his income is less than 100% of FPL. If the marketplace predicted that his income would be between 100% and 400% and granted him APTC, then PTC would be allowed. See line 6 form 8962.

-gauss
aka "the ACA nerd"

Yes, I am officially paying for his premiums, but he has a separate ACA plan as required by Florida Blue.
I am fully aware of the 4,050 income limit for him. My estimated household income for both of us is 24k. 20k for me, 4k for him. I am managing his monies so he doesn't go over 4k.
This above point leads into a different future post I will throw out there to the masses, but not yet. Suffice it to say for now, his main current investment income generation is from a Roth IRA. However his spending monies is passed through me. I run separate Firecalc and Fidelity calcs for him and he is fine. He doesn't have a TIRA in which I could manage his taxable income through a Roth conversion.

Thus as of now, I am claiming my DB as head of household and expect to either receive the tax subsidy myself or he will directly.
As an aside as one can calculate, my taxes as HOH will be zero.
Will respond to your other post separately.

 

[Dtail]

I am not an expert on the front end of this but can anyone other than a taxpayer, his/her spouse and children under age 26 be on an ACA Family policy?

I would suspect that if the exchange knew that he would have low income he would have been steered to a Medicaid plan, assuming you live in an expansion state.

Since FL is not a Medicaid expansion state, DB would be between a rock and a hard place with respect to any premium subsidies. He would, on the other hand, qualify for an exemption (see form 8695) to the penalty (SRP) for not maintaining health insurance if his gross income is below the filing threshold (ie ~ $10,400 in 2017 if under age 65) and he were not claimed by anyone as a dependent.

-gauss

I have checked out extensively and Florida Blue and the Healthcare exchange agreed with me that I can claim my brother as my dependent for ACA purposes. Florida Blue didn't even know how to fill out the form in that it was so unusual.

Yes, FLA is not a Medicaid expansion state and there lies the reason why I used this concept. My brother's main portfolio is in a Roth IRA, so he can't reliably generate taxable income over FPL in order to gain his own coverage.
So anyone in FLA who doesn't earn taxable income of FPL (~16k) and is not covered through an employer is screwed.
Even though he will be under ~10,400, at age 59 he has to have medical insurance, so I can't go the route of non regular type insurance for him.

 

[Dtail]

My wife and I are covered by an ACA plan. 2/3 years ago, we explored getting our son (then 22 years old) covered under our plan, He was not allowed to because


- made too much money (approx. $12,000).


- Also a part time college student


He also could not get a solo ACA plan because his salary was below the ACA min.approx. $16,000.


His only alternative was Medicaid. We live in Illinois.

Yes, since my brother lives in FLA, he can't even go on Medicaid, so I came up with my alternate plan.

 

[gauss]

Hopefully you will be able to claim the PTC for both of your policies on your 1040. The details will be in how the 1095-A(s) are issued.

-gauss

 

[Dtail]

Hopefully you will be able to claim the PTC for both of your policies on your 1040. The details will be in how the 1095-A(s) are issued.

-gauss

Yes, agree. I plan on meeting with my tax guy and calling Healthcare soon on this concept.
Thank you gauss for all your responses.

 

[rodi]

It's not a nitpick because in some cases separate plans would be desirable, I had a in-law family in this situation. We did some reading that indicted you could have different plans but at MNSure signup were told no it's not an option.


I think Rodi did something like this on covered California but don't remember the details. Oh wait she enrolled thru the CC and paid full cost for her DH and got some money back when she filed her tax return.

Covered CA has improved - but for the first several years all family members needed to be on the same insurance in order to get premium tax credits up front. So we, ahem, "overestimated" our income so we did not appear to qualify for the premium tax credit.... and paid full freight during the year.... Then got it all back at tax time since our MAGI at tax time was substantially lower than our 'original estimate'. The subsidies were by family - but the software didn't allow families with subsidies to be on more than one plan.

(My husband did not want to be on the same insurance as the kids and I because his doctor wasn't a Kaiser Permanente doctor.)

I complained about this each year - and was told they were working on it. They fixed it by enrollment for 2017.

2017 was the first year we didn't have this issue - my husband went on Medicare the beginning of 2017.

But I still have to 'overestimate' our income because Covered CA seems to think the kids are borderline qualifying for mediCAL (CA's medicaid). They don't - but it's a 2 months of proving that to them while the kids are in medical insurance limbo. It all works out at tax time... so it's all good.

 

[S103462]

My Personal Healthcare costs under ACA are $0 pm. premium due to my MAGI Management for the Silver plan with $10 PCP Copay and $35 Specialist Copay, with $2250 Max OOP. No Deductible.


With Medicare (Coming up Later this year) it goes up to about $350 pm. with a Part "F" Supplement. Not sure what deductibles or Copays or Max OOPs are when on Medicare, or even if there are any. That is a lot more than ACA. But it is what it is, at least it remains relatively constant and a lot less volatile.

Doesn't your Part "F" Supplement pay both your Part A & B deductibles?

 

[augam]

“Member of Household “ how is that defined. Must be income limits? Age? Kids attending college?

 

[HadEnuff]

I'm going through this right now. My Medicare eligibility starts 9-1, and DW is 4 years younger than I.

Our cost for her single policy (premium-minus-subsidy) will go up $90, for identical coverage, over what we paid for that coverage for the two of us.

In addition of course, I will now pay for Medicare Parts B, D and G. However, my deductible will decrease.

 

[aja8888]

With Medicare (Coming up Later this year) it goes up to about $350 pm. with a Part "F" Supplement. Not sure what deductibles or Copays or Max OOPs are when on Medicare, or even if there are any. That is a lot more than ACA. But it is what it is, at least it remains relatively constant and a lot less volatile.

Full Part F (not high deductible F) Supp pays all medical deductibles under A & B. Part D (drug plan) is stand alone.

 

[Dtail]

Hopefully you will be able to claim the PTC for both of your policies on your 1040. The details will be in how the 1095-A(s) are issued.

-gauss

Bumping up this thread.
Good news in that both my brother and I were issued 1095-A statements and each one of us will be able to claim the full tax subsidy on each of our returns.