ACA Application with covered CA

[Alex The Great]

I applied for ACA coverage in 2024 today, for the first time. In application, I estimated projected income ~$23K for the next year. Obviously income was much higher this year since I've been employed all the way till September. After application submitted, I've been asked to select a health plan and it appears the premium subsidy (or credit whatever they call it) is just $1. Do they pull my tax record for 2023, in order to learn about the income? The application status is pending.
Did anyone have the same issue when applying for the first time?

 

[cathy63]

How many people are in your family? If you're below 138% of the federal poverty line, you don't qualify for an ACA subsidy in California because you do qualify for Medicaid. If there are two of you, change your income estimate to $27,214 or higher and see if that changes your results.

Otherwise, no they don't pull your tax return before approving your application (they would get the one for 2022 if they did). They may ask for more details and have you fill out an affidavit explaining that your income for 2024 will be much lower than it was in 2022.

 

[Alex The Great]

How many people are in your family? If you're below 138% of the federal poverty line, you don't qualify for an ACA subsidy in California because you do qualify for Medicaid. If there are two of you, change your income estimate to $27,214 or higher and see if that changes your results.

Otherwise, no they don't pull your tax return before approving your application (they would get the one for 2022 if they did). They may ask for more details and have you fill out an affidavit explaining that your income for 2024 will be much lower than it was in 2022.

I'm just one applying for ACA. The estimated income is clearly above 138% FPL. Indeed I may need to wait for a feedback from them. Thanks for the info!

 

[PaunchyPirate]

I'm just one applying for ACA. The estimated income is clearly above 138% FPL. Indeed I may need to wait for a feedback from them. Thanks for the info!

I would call them rather than wait for them to do something. Most of the exchanges have call centers with pretty knowledgeable employees helping get applications filled out properly. You can explain your situation and they can set up your answers properly to get you the maximum amount due.

 

[RetiredAndLovingIt]

When I first applied, I estimated too low and they tried to put me on Medi-Cal. I was able to call them and have them increase my estimated income but I think that number you give is good for a 1 person household.

 

[RetiredAndLovingIt]

California only ever gave me $1 but the government subsidy is much larger. How much do they say you qualify for? They should have given you 2 numbers and also if they want to put you on Medi-Cal it would say that you qualified for it.

 

[Alex The Great]

Yes it is a great idea to call. I just called them and indeed very knowledgable person explained my mistake. I erroneously selected Employer Health Coverage. I thought it is for this year and it appears they consider it for the next year. Anyway representative fixed everything and selected a plan for me. The only inconvenience would be to call Blue Shield in a week to establish an account and the type of payment as it seems cannot be done online. Otherwise, everything is taken care of. Thanks a lot for prompt help!

 

[Alex The Great]

California only ever gave me $1 but the government subsidy is much larger. How much do they say you qualify for? They should have given you 2 numbers and also if they want to put you on Medi-Cal it would say that you qualified for it.

No they did not give two numbers. It is just one. For Blue Shield Bronze PPO I will pay $435/mo, the price without assistance is $1,397/mo.

 

[cathy63]

Yes it is a great idea to call. I just called them and indeed very knowledgable person explained my mistake. I erroneously selected Employer Health Coverage. I thought it is for this year and it appears they consider it for the next year. Anyway representative fixed everything and selected a plan for me. The only inconvenience would be to call Blue Shield in a week to establish an account and the type of payment as it seems cannot be done online. Otherwise, everything is taken care of. Thanks a lot for prompt help!

Ah, that makes sense. Having employer health coverage is definitely one of the things that disqualifies you from subsidies. I'm glad you called them, because I don't think we ever could have guessed what was going wrong!

 

[jim584672]

No they did not give two numbers. It is just one. For Blue Shield Bronze PPO I will pay $435/mo, the price without assistance is $1,397/mo.

Something doesn't make sense, if your income is $23,000 for a house of one that is 157.75% FPL. The Silver benchmark should cost less than 2% which is under $38 a month after subsidies. And you would get generous cost sharing reductions.

 

[MC Rider]

I called them more than once. We ended up with Medi Cal and according to the insurance broker we have been talking to it is the same doctors as any other plan, at least in this small area. And the cost is almost zero.

 

[PaunchyPirate]

No they did not give two numbers. It is just one. For Blue Shield Bronze PPO I will pay $435/mo, the price without assistance is $1,397/mo.

I assume they discussed other plans with you and you chose one you wanted, right? Because as Jim says above, there are probably other, less expensive plans you might prefer instead. Some free if you preferred to go Bronze. I randomly picked a San Jose zip code and I see silver plans for less you mention above.

 

[Alex The Great]

Ah, that makes sense. Having employer health coverage is definitely one of the things that disqualifies you from subsidies. I'm glad you called them, because I don't think we ever could have guessed what was going wrong!

Indeed I would not be able to figure it out myself

 

[Alex The Great]

Something doesn't make sense, if your income is $23,000 for a house of one that is 157.75% FPL. The Silver benchmark should cost less than 2% which is under $38 a month after subsidies. And you would get generous cost sharing reductions.

I agree those PPO plans are terribly expensive but they are the only plans accepted by my doctors. Indeed there are cheap Kaiser plans available but useless for me at this point.
Though I'm not sure what is a benchmark you're talking about. These are three true PPO plans only available for zip code 95118 and these are the premiums for each with $23K annual income, 56 old person: Blue Shield Bronze 60 PPO $413/mo, Blue Shield Bronze 60 HDHP PPO $436/mo and Blue Shield Silver 87 PPO $752/mo.
Do I miss anything?

 

[jim584672]

I agree those PPO plans are terribly expensive but they are the only plans accepted by my doctors. Indeed there are cheap Kaiser plans available but useless for me at this point.
Though I'm not sure what is a benchmark you're talking about. These are three true PPO plans only available for zip code 95118 and these are the premiums for each with $23K annual income, 56 old person: Blue Shield Bronze 60 PPO $413/mo, Blue Shield Bronze 60 HDHP PPO $436/mo and Blue Shield Silver 87 PPO $752/mo.
Do I miss anything?

The cost after subsidy should be less than 2% of income, no matter what the price of the plan (for the second lowest cost Silver plan, the Silver benchmark). A Bronze plan would be even cheaper than a Silver, so probably free after subsidy.

 

[Alex The Great]

The cost after subsidy should be less than 2% of income, no matter what the price of the plan (for the second lowest cost Silver plan, the Silver benchmark). A Bronze plan would be even cheaper than a Silver, so probably free after subsidy.

Sorry but I don't understand. The premium cost I provided is after subsidy.
Of course as I mentioned there are other cheaper alternatives but those are HMO and EPO plans not accepted by doctors from Sutter Health/PAMF I currently use. May be after 1-2 years I'd consider to switch to Kaiser if the cost will raise with the same rate as before.

 

[jim584672]

Sorry but I don't understand. The premium cost I provided is after subsidy.
Of course as I mentioned there are other cheaper alternatives but those are HMO and EPO plans not accepted by doctors from Sutter Health/PAMF I currently use. May be after 1-2 years I'd consider to switch to Kaiser if the cost will raise with the same rate as before.

It doesn't make any sense at all. No way is a person making $23K is paying $400 something after subsidy. That is over 20% of income.

 

[Alex The Great]

It doesn't make any sense at all. No way is a person making $23K is paying $400 something after subsidy. That is over 20% of income.

Oh I see what do you mean and I completely agree. I think there is something special to my zip code that it does not comply with ACA rules. But changing it is even a greater challenge

 

[jim584672]

The KFF estimator says a 56 yo in 95118 with $23K would get a $962 a month subsidy, and the benchmark Silver would cost $6 per month.

https://www.kff.org/interactive/subsidy-calculator

Seems like the problem is you are picking the most expensive plans. I don't think it makes sense. Do you have a special reason, like an ongoing medical condition that requires your current docs? Seems cheaper just to pay them out of pocket if you ever need them, and save almost $500 a month. Also I would get the Silver with CSRs and not a Bronze.

 

[cathy63]

It doesn't make any sense at all. No way is a person making $23K is paying $400 something after subsidy. That is over 20% of income.

It's because his preferred doctors only accept Blue Shield plans and those are super expensive, with even their lowest bronze plan coming in much higher than the benchmark silver plan. There are other choices that are much less (even free), but don't include his doctors.

Entering his info at CoveredCA's Shop and Compare page, I get the exact same results. The benchmark silver plan is a Kaiser plan at $966.98 /mo, and his subsidy is $962.04. The unsubsidized premiums for the Blue Shield bronze and sliver plans he's looking at are $1375, $1398.24, $1714.41.

 

[teej1985]

See this post from TFB: https://thefinancebuff.com/aca-insurance-not-include-doctor.html

 

[PaunchyPirate]

It doesn't make any sense at all. No way is a person making $23K is paying $400 something after subsidy. That is over 20% of income.

More accurately, a person making $23k doesn't have to pay $400+ after subsidy for insurance. Unless they choose to.

You are correct in your math and reasoning. And indeed there are less expensive plans available for the OP -- including free ones. But that doesn't necessarily make them the best plan for him. I have also chosen more expensive plans than I had to in order to get better benefits.

 

[perinova]

No they will not pull your tax return from a previous year but request that you upload it yourself. You may have noticed already that they are requiring your to upload documents of your choice. I have been in your situation and in this case what you need to do is choose the Affidavit (aka Attestation) route. You will attest of your estimated income for next year.

23K income for a single filer should give you a very low premium and about $1000/month subsidy.
For 2 filers or more, you will be <138% FPV, they will route you to Medi-Cal (Medicaid): Insurance at No Cost to you!

The subsidy result may mention to you a $1 state subsidy, which is in addition to the Federal subsidy. NOT INSTEAD.

 

[perinova]

The attestation you need to use can be downloaded at the following link:

https://www.coveredca.com/pdfs/Attestation-Form-Income-No-Documentation-Available-English.pdf

 

[fh2000]

It's because his preferred doctors only accept Blue Shield plans and those are super expensive, with even their lowest bronze plan coming in much higher than the benchmark silver plan. There are other choices that are much less (even free), but don't include his doctors.

Entering his info at CoveredCA's Shop and Compare page, I get the exact same results. The benchmark silver plan is a Kaiser plan at $966.98 /mo, and his subsidy is $962.04. The unsubsidized premiums for the Blue Shield bronze and sliver plans he's looking at are $1375, $1398.24, $1714.41.

DW is on ACA with the same plan: Blue Shield Bronze 60 HDHP PPO. Our household income is $30K. We check the Shop and Compare tool. It shows her premium about $400/m. But, the CoveredCA agent on the phone who signed up for her, says it is $0. So we signed up with the plan with $0 premium. I do not know how that works and it is still $0 for next year.

So, I can only suggest to call CoveredCA to sign up for you, and ask what premium will be.