ACA/Medicaid nightmare, need help

[Golden Mean]

I have been using ACA in Nevada for 2 years. I applied/renewed in Nov. and was approved for 2025. I even paid my premium for Jan 2025.

Today I got an email that my ACA coverage is canceled and I'm not allowable for ACA. I tried to renew again and I cannot because they think I'm eligible to for medicaid even though my MAGI is $44k. I called the ACA people and they couldn't help at all. I am on hold for the Nevada Medicaid (I think) but don't think I'm contacting the right people.

Does anyone know who I should contact or what document I should create to tell the Nevada ACA people I'm eligible?

I'm freaking out right now and pretty sure if I get this fixed I still won't have health insurance for Jan 2025. Nightmare.

 

[SecondCor521]

Strange. Do they have your estimated AGI and family size correct in their records?

I would call the Nevada ACA marketplace and either repeatedly call or escalate until you get someone who can help.

I would probably stay away from calling the Nevada Medicaid people, because they're probably not likely to care if you're on Medicaid.

 

[Golden Mean]

Strange. Do they have your estimated AGI and family size correct in their records?

Yes. I was already approved Nov 15 with all the right info (nearly identical to the last two years). They just randomly canceled every think today (yesterday).

I would call the Nevada ACA marketplace and either repeatedly call or escalate until you get someone who can help.

There was no one to escalate too. The personal who helped me asked a higher up and they just said I need to apply for Medicaid and get denied before and use the document to re-apply for ACA.

I would probably stay away from calling the Nevada Medicaid people, because they're probably not likely to care if you're on Medicaid.

I don't want Medicaid, but I'm not eligible anyhow.

 

[Irishgirlyc58]

I would contact this office at the location that serves where you live.

2.General Information

dwss.nv.gov

This is for Nevadas Medicaid. See if there is any information about eligibility on there and if some new program is kicking you into Medicaid. Then if not -call ACA again and ask to talk to a supervisor. If the ACA system is kicking you into Medicaid when you are not eligible something was input in wrong.
I’m wondering if there are certain deductions to your income for next year that are making you Medicaid eligible?

 

[ivinsfan]

I would contact this office at the location that serves where you live.

2.General Information

dwss.nv.gov

This is for Nevadas Medicaid. See if there is any information about eligibility on there and if some new program is kicking you into Medicaid. Then if not -call ACA again and ask to talk to a supervisor. If the ACA system is kicking you into Medicaid when you are not eligible something was input in wrong.
I’m wondering if there are certain deductions to your income for next year that are making you Medicaid eligible?

Except the OP says he was already approved for an ACA policy for 25. And he got a bill and he payed the bill.

 

[Irishgirlyc58]

There was no one to escalate too. The personal who helped me asked a higher up and they just said I need to apply for Medicaid and get denied be

Oh for goodness sake’s!
It’s a little late in the year to be telling you that.
Try calling the Medicaid office- they may be more helpful.
If not try calling ACA again and asking for a manager. You need a better explanation than that given that it’s December 19.

 

[ivinsfan]

OP did your check clear? most likely this is an internal error in the system...so things aren't as grim as you think.

 

[Irishgirlyc58]

Except the OP says he was already approved for an ACA policy for 25. And he got a bill and he payed the bill.

True- which makes absolutely no sense. It should have kicked OP into Medicaid at the time of renewal- that’s how it works typically in California anyway.

 

[ivinsfan]

True- which makes absolutely no sense. It should have kicked OP into Medicaid at the time of renewal- that’s how it works typically in California anyway.

This doesn't help the OP but stuff like this is why you should use an insurance broker if possible.

 

[Marc]

So you have net worth of $3M and you are worrying whether you get subsidized insurance on the exchange or Medicaid?

 

[MichaelB]

Let’s please stick to the thread topic and assist a fellow forum member.

 

[disneysteve]

So you have net worth of $3M and you are worrying whether you get subsidized insurance on the exchange or Medicaid?

Net worth has nothing to do with it. ACA subsidies and Medicaid eligibility are based on income. And even if you don’t qualify for a subsidy you still buy your insurance through the ACA exchanges.

 

[SecondCor521]

There was no one to escalate too. The personal who helped me asked a higher up and they just said I need to apply for Medicaid and get denied before and use the document to re-apply for ACA.

Yes there was. "I'd like to speak to a supervisor please."

There's also the acronym HUACA which applies here.

Depending on where you live in Nevada and your daily schedule, you might also consider walking into an ACA marketplace office. In my state (not NV), it's part of the Department of Health and Human Services. Being face-to-face sometimes gets things resolved.

As a last ditch effort, you could contact your state or federal level congressional representative's office. They have constituent services that can address these sorts of things. I used this once on a tax issue and it did help.

I know it's frustrating, but when I've been in similar situations, "keep trying" is usually what works.

 

[Dash man]

Yes. I was already approved Nov 15 with all the right info (nearly identical to the last two years). They just randomly canceled every think today (yesterday).

There was no one to escalate too. The personal who helped me asked a higher up and they just said I need to apply for Medicaid and get denied before and use the document to re-apply for ACA.

I don't want Medicaid, but I'm not eligible anyhow.

Can you call your state representative’s office for assistance?

 

[Marc]

Net worth has nothing to do with it. ACA subsidies and Medicaid eligibility are based on income. And even if you don’t qualify for a subsidy you still buy your insurance through the ACA exchanges.

My point exactly.

 

[rodi]

I had something similar happen to me in both 2015 and 2016. Only difference was I was caught in California's Medicaid expansion for children... So my (then minor aged) kids were cancelled from the ACA insurance to be out on Medicaid... But really to be put in limbo... Both times I had to explain to the Medicaid person that I knew our family didn't, and shouldn't qualify because our income was too high. It took about 30 days both times

My solution after that was to claim higher income on the application, get smaller monthly tax credits, but get it back at tax time.

I estimated my income higher assuming larger withdrawals from an inherited IRA and or Roth conversions.

 

[Marc]

I had something similar happen to me in both 2015 and 2016. Only difference was I was caught in California's Medicaid expansion for children... So my (then minor aged) kids were cancelled from the ACA insurance to be out on Medicaid... But really to be put in limbo... Both times I had to explain to the Medicaid person that I knew our family didn't, and shouldn't qualify because our income was too high. It took about 30 days both times

My solution after that was to claim higher income on the application, get smaller monthly tax credits, but get it back at tax time.

I estimated my income higher assuming larger withdrawals from an inherited IRA and or Roth conversions.

So you lied to the State of California?

 

[jim584672]

Medicaid is current month based and ACA is calendar year based. So if they ask your current month income and it is under 138% FPL monthly it will put you in Medicaid, even if your yearly is way over 138% FPL. That is what I think happened. That is how it is designed and is not an error.

 

[EastWest Gal]

I had to do something similar when the state exchange finally started in PA in 2021. They routinely overestimated our tax credit, resulting in a large tax bill at income tax time. I didn't realize it the first year, and I had to pay a penalty. But by calling the state exchange I learned there was a way I could manually correct it.

The OP sounds like his problem is a glitch somewhere. Try exploring the state exchange website to see if you can change your inputs (like estimated income). If that doesn't work calling your state representative may be helpful as well. Last, perhaps an insurance broker can help with your problem.

 

[rodi]

So you lied to the State of California?

I estimated on the high side to avoid getting slammed onto Medicaid. It meant I paid more each month for health insurance (foregoing large premium tax credits) but there was a refund at tax time. So it was all a wash over the course of the year. I could have taken the larger withdrawal from the inherited IRA or done larger Roth conversion. But didn't need to this years. I just estimated a worst (highest) case income. You call it a lie... I say it was trying to avoid taking too high of a premium tax credit and trying to avoid public benefits that we didn't qualify for. It all came out the same when I filed my taxes.

The system is broken and a found a tax neutral way to have it work properly.

 

[simple girl]

Perhaps try contacting an ACA navigator. I believe they have them for every state.

 

[jim584672]

I estimated on the high side to avoid getting slammed onto Medicaid. It meant I paid more each month for health insurance (foregoing large premium tax credits) but there was a refund at tax time. So it was all a wash over the course of the year. I could have taken the larger withdrawal from the inherited IRA or done larger Roth conversion. But didn't need to this years. I just estimated a worst (highest) case income. You call it a lie... I say it was trying to avoid taking too high of a premium tax credit and trying to avoid public benefits that we didn't qualify for. It all came out the same when I filed my taxes.

The system is broken and a found a tax neutral way to have it work properly.

You don't have to go through all that, just never report under 138% FPL on a monthly or yearly basis and no more problem. You might be missing out on Silver plans CSRs by overestimating.

 

[Golden Mean]

Thanks for the info everyone. I think I've got things half way worked out. I'll give an update tomorrow.

 

[MBSC]

I had something similar happen to me in both 2015 and 2016. Only difference was I was caught in California's Medicaid expansion for children... So my (then minor aged) kids were cancelled from the ACA insurance to be on Medicaid...

You don't have to go through all that, just never report under 138% FPL on a monthly or yearly basis and no more problem. You might be missing out on Silver plans CSRs by overestimating.

California Medi-cal for children is below 266% FPL (322% FPL in 3 counties), according to this chart.

https://www.coveredca.com/pdfs/FPL-chart.pdf

 

[jim584672]

I have heard nothing but good things about Children's Medicaid.