ACA Open enrollment frustrations

[SecretlyFI]

wow.....thats a lot to digest!


His insurer , Horizon, does have his medical card showing on the site now and indicates coverage starts 1/1/26

I'm assuming that means hes covered right? the Get Covered NJ site , however, still says his application is "pending"

He’s not out of the woods yet. The Horizon site had all my info and I had gotten a welcome letter last week in the mail and the insurance cards. They are happy to have us and everyone is approved for coverage, since it’s open enrollment season.

Horizon wasn’t the issue. State of NJ/GetCovered had the issue and my application showed pending until it was resolved today. What was actually pending wasn’t the coverage, it was the eligibility for subsidies and that’s with the State, not Horizon.

The first letter I received in the mail explained it. Our subsidy eligibility was “conditional” pending their receipt and approval of documentation for our 2026 income estimate. The letter stated if the documentation wasn’t approved by mid-Feb, the subsidies would be cancelled and we’d owe the full amount every month and retroactively for January.

 

[SecretlyFI]

…and at the end of today’s call, the status on GetCovered changed from “pending” to “completed”, so that’s what you’re looking for.

 

[aaronc879]

I just had the pleasure of an hour and 41 minute call with GetCovered NJ! The good news is, my issue is resolved, but this is after several calls, re-submissions, etc. since my original application on November 19.

Some background and tips from my experience:
My issue, not surprisingly, was that the estimated 2026 income on my application was very different than prior income that the state had. Since I just retired this year, that was expected. First they notified me by mail that I needed to submit documentation proof for the income estimate on my application. I contacted my broker and they said no problem, we'll take care of that for you. They submitted an "attestation letter" (I didn't need to write it) confirming that no other proof of income exists, and it will be sourced from future capital gains/dividends, and these transactions have not occurred yet.

That attestation letter was rejected by GetCovered. I called GetCovered on 12/5 and had a lengthy conversation where they said an attestation letter is considered a "last resort" document and they need other proof instead like 1040, 1099, W2, SS documents, etc. I explained that none of those are applicable since I'm retired. And no proof exists for my investment income since the transactions haven't occurred yet. They said no problem, I have until Feb 17th to submit the proof. I said that doesn't help because the transactions still will not have occurred - first quarterly dividend won't be till end of March. They documented all this in "my account" including that I just retired so future income will be very different and no other proof exists. They said now the broker should re-submit the same attestation letter and it will be accepted.

So I contacted the broker and they re-submitted the same attestation on December 5. I waited till today and contacted GetCovered to see if it's been resolved and they said the 2nd submission was rejected again with the same explanation, that I need to submit other proof -1040, 1099, etc. . After an hour of me explaining that this doesn't make sense and the rep saying it will get approved if the attestation is just re-submitted (for a 3rd time), and me asking for a supervisor and them not transferring me to a supervisor.... By the grace of God I happened to ask the right question: what do I do if it's rejected again? The rep said then I can call back and they can escalate the case. AAAAHHH the magic word is not "supervisor", it's "escalate". So I said I wanted it escalated NOW.

That did the trick. She transferred me to the escalations department. They explained that everything I was previously told was wrong! The way it works is, they need one of their "acceptable" documents, like a 1040, to be submitted first - even when you know it won't match your 2026 income estimate. Then that document will be rejected AND THEN you can submit the attestation letter and it will be accepted. She sent me a link to access my GetCovered account (previously only my broker was accessing it). She stayed with me on the phone while I setup access, then I took photos of my 2024 1040 and uploaded them to my account. She refreshed her screen and reviewed it and rejected it for not matching. Then she had me conference in my broker (she even told me how to do that on my iphone ) and she explained to him to upload the attestation letter again. He did that and she went in and accepted it and I was able to refresh my screen and see "completed".

So this all took almost 2 hours today, but was finally successful and I'm all set for 2026.

TLDR: ask GetCovered to escalate your case so you can get a person on the line who can actually resolve things. Good luck!!!!!

It was already 50th or close to 50th on my list but this is yet another reason I will not be moving to NJ. What a cluster....

 

[FREE866]

He’s not out of the woods yet. The Horizon site had all my info and I had gotten a welcome letter last week in the mail and the insurance cards. They are happy to have us and everyone is approved for coverage, since it’s open enrollment season.

Horizon wasn’t the issue. State of NJ/GetCovered had the issue and my application showed pending until it was resolved today. What was actually pending wasn’t the coverage, it was the eligibility for subsidies and that’s with the State, not Horizon.

The first letter I received in the mail explained it. Our subsidy eligibility was “conditional” pending their receipt and approval of documentation for our 2026 income estimate. The letter stated if the documentation wasn’t approved by mid-Feb, the subsidies would be cancelled and we’d owe the full amount every month and retroactively for January.

He never got a letter.

When I go to the NJ Get covered website it says:

You have successfully enrolled in health plans. If you'd like to enroll in Dental Plans, please click on the 'Continue Shopping' button below.


But below it says:

Your Health Plans​

Horizon Blue Cross Blue Shield of New Jersey
OMNIA Silver Value B ($0 Horizon CareOnline Virtual Care, $0 Select Insulin, No Referrals)For 1 member

Pending



I left a message and emailed them today to get confirmation

 

[GenXguy]

I use healthcare.gov and it’s a breeze, assuming you understand that the monthly amount you enter will be annualized and is an estimate for the following year.

No. I used healthcare.gov the last two years, and that is NOT what happened, either year. See my example on my initial eligibility form that I screenshotted above where it shows "this month's" income as $300 and estimated 2025 income as $30,000. The $300 for the month getting annualized would have been $3600 for estimated annual income, which the screenshots clearly show didn't happen. I had entered separately independent amounts. I do remember being given an option to annualize a monthly amount, which I didn't use when I submitted my initial applications for 2024 and 2025.

Screenshot reference: ACA Open enrollment frustrations

The key thing is to make sure your "this month's" income alone is above the medicaid threshold, despite what you enter for annual income.

 

[SecretlyFI]

He never got a letter.

When I go to the NJ Get covered website it says:

You have successfully enrolled in health plans. If you'd like to enroll in Dental Plans, please click on the 'Continue Shopping' button below.


But below it says:

Your Health Plans​

Horizon Blue Cross Blue Shield of New Jersey
OMNIA Silver Value B ($0 Horizon CareOnline Virtual Care, $0 Select Insulin, No Referrals)For 1 member

Pending



I left a message and emailed them today to get confirmation

I think you're ok then. My dashboard shows the same "you have successfully enrolled..." message. Also below that, under "Overview" it shows: Your application status: 2026 application for 2 members Complete.
And below that under "Your Health Plans" it lists the plan type, like yours above (Omnia....). Next to the Omnia bit, it says pending. But that's only because it's not Jan 1 yet.

If you hover over the "pending" word, it says "Enrollment complete. Awaiting payment confirmation from the carrier". I asked about this on the phone with GetCovered today, since I made my 1st payment with the application in November. She said it stays like that until right before the effective date (Jan 1). The insurance companies will activate everybody right before/on Jan 1 and the updated info, including payment confirmation, will flow back to GCNJ.

 

[FREE866]

I think you're ok then. My dashboard shows the same "you have successfully enrolled..." message. Also below that, under "Overview" it shows: Your application status: 2026 application for 2 members Complete.
And below that under "Your Health Plans" it lists the plan type, like yours above (Omnia....). Next to the Omnia bit, it says pending. But that's only because it's not Jan 1 yet.

If you hover over the "pending" word, it says "Enrollment complete. Awaiting payment confirmation from the carrier". I asked about this on the phone with GetCovered today, since I made my 1st payment with the application in November. She said it stays like that until right before the effective date (Jan 1). The insurance companies will activate everybody right before/on Jan 1 and the updated info, including payment confirmation, will flow back to GCNJ.

Right.....just got off the phone with them......it says "pending " on the NJ site because Horizon , for whatever reason, hasnt processed the payment. So then I called Horizon and they verified coverage and the actually payment will process shortly...he will get his ID card sometime in the next 10 days......glad thats over......thank you for your help.....

 

[GenXguy]

Their system first checks your application amount against prior submitted tax returns and when it’s way off, it triggers them to require documentation explaining why.

Interesting. When I first signed up on healthcare.gov, my most recent tax returns showed income from working full time all year. My estimate on the application was a fraction of that. I had to answer a question by selecting an option that said something about no longer receiving income for a job or something like that. I wondered if it would trigger any documentation, but it didn't. And the same thing was true a year later - the most recent tax filing was when I had worked a large part of the year. And finally this year, my most recent tax filing is about $7000 more than my estimate for next year's income, but it auto-submitted. My estimates are legitimate - I'm been making moves to lower MAGI the last couple years.

 

[SecretlyFI]

Interesting. When I first signed up on healthcare.gov, my most recent tax returns showed income from working full time all year. My estimate on the application was a fraction of that. I had to answer a question by selecting an option that said something about no longer receiving income for a job or something like that. I wondered if it would trigger any documentation, but it didn't. And the same thing was true a year later - the most recent tax filing was when I had worked a large part of the year. And finally this year, my most recent tax filing is about $7000 more than my estimate for next year's income, but it auto-submitted. My estimates are legitimate - I'm been making moves to lower MAGI the last couple years.

The NJ site didn’t have a question on the application to allow you to select a reason for why the income was different than prior years. The person on the phone today said it does the comparison to prior tax return and if it’s off more than 50%, the documentation marathon begins.

 

[TripleLindy]

No. I used healthcare.gov the last two years, and that is NOT what happened, either year. See my example on my initial eligibility form that I screenshotted above where it shows "this month's" income as $300 and estimated 2025 income as $30,000. The $300 for the month getting annualized would have been $3600 for estimated annual income, which the screenshots clearly show didn't happen. I had entered separately independent amounts. I do remember being given an option to annualize a monthly amount, which I didn't use when I submitted my initial applications for 2024 and 2025.

Screenshot reference: ACA Open enrollment frustrations

The key thing is to make sure your "this month's" income alone is above the medicaid threshold, despite what you enter for annual income.

That screenshot is from after you entered your income. What I’m saying is that I didn’t enter actual income for the month (which would have been $0 in my case). Instead of entering actual income as you appear to have done, I entered my estimate for 2026 divided by 12. I just ignored that it was asking for the current month’s income because that didn’t make any sense in my case.

I never got to the screen that you attached and I also never entered an annual amount. Could be because you entered a very low monthly amount that triggered something that I didn’t encounter.

Regardless, I found the federal exchange quite simple to use. I went through the income entry multiple times this year because I was playing with various income estimates to see what that did with the subsidy.

 

[GenXguy]

I never got to the screen that you attached and I also never entered an annual amount. Could be because you entered a very low monthly amount that triggered something that I didn’t encounter.

My application still had inputs for both the month's income AND the estimated annual income when I updated the application AND the previous year, and the monthly income was at or near the 1/12 of annual in both those cases, so it wasn't a low monthly income that triggered the option for the annual income. However, it gives you an option to accept the 12X figure, which I actually did on my updated application a year ago. But the other two applications I submitted, I did not accept that 12X figure and input my own. Then this year, the state converted to its own marketplace, and it automatically generated an application based on last year's estimate and selected a new plan and enrolled me in it (old insurer no longer available), so I didn't have to deal with any of that this year, unless I had chosen to edit my application.

One thing to note - the screenshot is the eligibility results notice from using healthcare.gov, not something that appeared during the application process. The eligibility results on the new Illinois marketplace don't look anything like that and don't show the month income.

I just checked the state marketplace, and saw this:

I hadn't heard about that until just now. I've been enrolled since the first day when I was auto-enrolled. But maybe this means I could still change plans if I wanted. I've already received my insurance card from BCBS with my co-pays. I had already decided to stick with the plan they chose for me.

 

[BobsYourUncle]

You are correct, I went on and it did get to the estimated yearly income that it derived from the monthly income I entered for December for my wife and myself. I got approved not trying to pick a plan. AmBetter looks like the best option, but has terrible reviews online.

I just completed application the other night and it still said you had complete by Dec. 15th for January 1st coverage. I have not received a notification that it has been extended, maybe that's just your state.

Update: I just logged into HealthCare.gov and did not see any notice or alerts, but when I went to the "Pick Your Plan" step it now shows the option to pick by Dec 31 for Jan 1 coverage.

Also I hadn't paid attention to the first line "You have a Special Enrollment Period because of a life change.", I'm guessing that is because I did tell it I would lose coverage before 02/01/2026.

 

[googily]

I applied for the ACA for the first time this year, and Wyoming uses healthcare.gov. Like others above, I got asked first my November 2025 income, which was only about $1400. Then I got asked for my estimated 2026 income, which I put in as $35,000 (I think it will be a little less, but I wanted to give myself some room, and will just fill in my income up to that level if needed at the end of the year).

There was a huge Washington Post story yesterday about the crazy increases in Wyoming ACA costs--a family in Teton County (aka Jackson, the wealthiest place in Wyoming) that will now pay $43k a year in premiums.

https://www.washingtonpost.com/health/2025/12/21/obamacare-monopolies-subsidies/

It must ramp up wildly and I assume is dependent on the economics of individual counties, because as a single in my county with $35k income, they showed me getting around $1,900/month in subsidies, so just for the heck of it I went with a gold plan for $32 a month (BCBS). This is the only year I will have no income other than dividends (in 2027 I'll start my SS survivor benefits), so I figured I'd do whatever I could to bottom out. I will also be able to sell a small amount of highly appreciated stock and pay 0% CG, for I'm sure the only time in my life.

 

[PlayinwithFIRE]

I worked up to April this year.

For Healthcare.gov, I took that 4 months of income and spread it over 12 months. There is a section (atleast on healthcare.gov) where it asks if you expect large changes in monthly income. I tried using this a few times but found it lacking and then just averaged myself over the year.

pwf

 

[SecretlyFI]

There was a huge Washington Post story yesterday about the crazy increases in Wyoming ACA costs--a family in Teton County (aka Jackson, the wealthiest place in Wyoming) that will now pay $43k a year in premiums.

https://www.washingtonpost.com/health/2025/12/21/obamacare-monopolies-subsidies/

It must ramp up wildly and I assume is dependent on the economics of individual counties, because as a single in my county with $35k income, they showed me getting around $1,900/month in subsidies, so just for the heck of it I went with a gold plan for $32 a month (BCBS). This is the only year I will have no income other than dividends (in 2027 I'll start my SS survivor benefits), so I figured I'd do whatever I could to bottom out. I will also be able to sell a small amount of highly appreciated stock and pay 0% CG, for I'm sure the only time in my life.

I couldn’t read the article, since it’s behind a paywall. But, this is nothing unique to Wyoming. Yes, it “ramps up wildly”, which is why it’s referred to as a subsidy cliff. Go $1 over and you get 0 subsidy. Where I live, for 2 people, with income $85,000, which is just over the subsidy cliff, the un-subsidized annual premiums range from $21,031 - $76,824.

Your situation is also not unique. Based on the numbers you posted, with a low income of only $35,000 you’re at just over 200% FPL - and nowhere near the cliff of 400% FPL. So it makes sense that you’re getting a large subsidy.

 

[Fermion]

Make sure you are actually saving money with the gold plan. If your income is low enough, the silver plans have cost sharing which actually makes them better than the gold plan. It is confusing.

 

[googily]

Make sure you are actually saving money with the gold plan. If your income is low enough, the silver plans have cost sharing which actually makes them better than the gold plan. It is confusing.

Both the deductible and the out of pocket max are much lower on the gold plan, though I guess the copayments are higher. I also don't have any medical issues that are requiring on-going care (other than some cheap prescriptions), so I figured that this is more like catastrophic insurance for this year.

 

[MarcusAurelius]

My main source of income (95%) comes from dividends/capital gains distributions, almost all come in the last 3 weeks of the year and have varied from $35K - $90K for the last 3 years. I'm in PA using Pennie and I put down $40K as estimated income. There's a mandatory reconciliation on federal tax form if I'm lower or higher, so it's essentially a interest free loan either from or to me for a few months. If the prior year income was underestimated, then I wind up with higher estimated taxes in the current year, so it's probably a wash either way.

 

[EastWest Gal]

I was on Pennie and their calculation a few years ago was way under what we should have paid. It's easy to go back and make and adjustment in your monthly premium so you don't get whacked the following April. Or you can just adjust your quarterly estimated payments.

 

[2retireearly]

The reality is that the premium tax credit you end up getting is based on the federal income tax filing for that year. The numbers you are providing are to get the advance PTC roughly correct. But the questions they ask don't align with lumpy income. So just do what our Vulcan friend suggests and divide the projected annual by twelve.

Just do this. it all settles out in the wash at the end of next year's tax filing. so you can put in any number you want. to guestimate your income for a subsidy. if any, and to keep you out of Medicaid. We all know that December's income could have zero relationship to next year's income.

 

[GenXguy]

Just do this. it all settles out in the wash at the end of next year's tax filing. so you can put in any number you want. to guestimate your income for a subsidy. if any, and to keep you out of Medicaid. We all know that December's income could have zero relationship to next year's income.

One thing that doesn't settle out in the wash is if you are getting a silver plan and qualify for CSR. I went over my income estimate for 2024, putting me over 200% of FPL, but I didn't have to pay any out of pocket costs I would have had to pay based on my actual income. I only had to pay back some PTC of $950. Saved me a nice chunk of $ in 2024.

 

[perinova]

- Call them and ask them for the form used to submit an affidavit stating your estimated income for 2026.
- This year you have a special enrollment period. For the rest of us:

 

[orbops]

My DW and I have been on the ACA since 2018. The estimated income needs to be above around $25K/year so that you don't fall into Medicaid. In terms of being accurate on your monthly or yearly income, don't worry about it. If your estimates are too low at the end of the year, they'll simply bump up your tax payment due when you file by reducing the subsidies that you were supposed to receive. If your income is variable, the biggest problem is that if it jumps up towards the end of the year, then ACA assumes your income was that high for the entire year.

 

[meleana]

I'm currently still working but would like to retire soon as I can get ACA coverage, so that I have no gap in health insurance coverage. Along with that I plan on taking a distribution this month that I will use in the next 4 years to keep my MAGI below the 400% threshold.

So going through the enrollment process, it asks for my and my wife's current month's income (December 25). Will we are both currently working and I'm looking at the distribution that would technically count as income for this month. I assume they are just using this month's amount to estimate next years MAGI and adjust premium and subsidies. Of course if I put my current income plus distributions I will be well over the 400% if they multiply by 12 months, however I plan on keeping my MAGI below 400% in 2026. So should I just put an income amount for December 2025 for my wife and I that keeps it below the 400% threshold? Why don't they just ask your estimated 2026 income?

Several years ago when I was applying I got frustrated and so I went through a broker who handled the whole thing for me.

Easy peasy. Then when I transitioned to Medicare - for the supplement I also went through him.