Healthcare and ACA - very confusing!

[rmcelwee]

I've received better advice and information here than I have in 5 hours of phone calls today. So far I've been told by ACA that I cannot get a subsidy if I have income of more than $30K per year. That contradicts when healthsherpa told me I can save more than 50% ($1,000 per month) even with an income of $120K per year I've been told that the subsidy is in the form of tax credits and I have been told it was simply a lower monthly amount.

I've been looking for weeks trying to find somone who can tell me the correct info and I have found no one. Searching online has found not one person locally that is an ACA agent.

Very frustrating!

 

[RunningBum]

I've always found healthsherpa to be accurate, and gives the same numbers at the official site where you'll want to enroll, healthcare.gov. $1000 subsidy with $120K income sounds high but it depends on family size and the cost of the second lowest silver plan in your area.

It's a subsidy. You can choose to use it to reduce your monthly premium, or just get it back as a tax credit at tax time. And differences from your estimated income you used for your subsidy and actual income (MAGI) are squared up at tax time as additional credit or additional tax to pay.

 

[bloom2708]

Are you single or married? Your AGI/MAGI removes your standard deduction and pre-tax deductions.

~$62k AGI/MAGI was where the subsidies were best for Married Filing Jointly for 2022. If you make too little, you could end up on your state Medicaid.

Even the ACA helpers won't help with estimating your AGI. Use your past tax returns and a calculator to make the best guess. As mentioned, it all gets squared up when you file your taxes.

 

[SecondCor521]

If you want to doublecheck your numbers, you could also try the KFF subsidy calculator. I think it's accurate also.

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

Of course you have to enter accurate information to get an accurate subsidy estimate.

 

[EastWest Gal]

Have you looked at healthcare.gov?

You can browse marketplace plans and get subsidy estimates for plans in your area. You put in your household information (who is to be covered), age, estimated income, and zip code. It will look like you need to enroll on the page, but then scroll to the bottom and you can browse plans without enrolling. You will get an estimate of the tax credit and it will show you plans with the premium based on the information you put in.

I pretended to be a person in South Carolina in their 50s with a family of 4 and got an estimated tax credit of $1092, which is probably what healthsherpa told you. I could be wrong, but I'm guessing the $30K figure you were quoted was somebody referring to the upper limit of eligibility for Medicaid for a household of 4 which is indeed exactly $30K. Maybe there was an over-the-phone misunderstanding.

BTW, I think many of us using the ACA marketplace never went to a local agent. I just used healthcare.gov and then used my state's exchange starting in 2021. I've been getting insurance through the ACA from 2015-2017 and since the end of 2020.

So try healthcare.gov and see if that helps you. Then continue to ask questions as needed. You can also use healthsherpa to actually enroll, from what I understand.

 

[xlf11]

Find a local ACA agent to help you and it's free. You can look up through Healthcare.gov or get recommendation from your friends and/or coworkers who have used ACA. It also helps you to find the best plan in your local area, which might not have the most updated info on the Healthcare.gov.

 

[O2Bfree]

If you want to doublecheck your numbers, you could also try the KFF subsidy calculator. I think it's accurate also.

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

Of course you have to enter accurate information to get an accurate subsidy estimate.

This is the one I've always used, and it's always been accurate.

 

[rmcelwee]

See, I knew I would find better info here than "in the real world". I've got an account on the .gov site but was always afraid to go to far into it because everything seems like it is going to sign you up if you click the wrong button. I will take another look. Thanks!

 

[gauss]

I've received better advice and information here than I have in 5 hours of phone calls today. So far I've been told by ACA that I cannot get a subsidy if I have income of more than $30K per year. That contradicts when healthsherpa told me I can save more than 50% ($1,000 per month) even with an income of $120K per year I've been told that the subsidy is in the form of tax credits and I have been told it was simply a lower monthly amount.

I've been looking for weeks trying to find somone who can tell me the correct info and I have found no one. Searching online has found not one person locally that is an ACA agent.

Very frustrating!

Perhaps what you are seeing is the difference between the law as originally passed with a 400% of FPL ceiling on income that would prevent subsidies and the current law.

The current law removes the 400% of FPL ceiling on income to get a subsidy
through 2025.

After 2025, the 400% ceiling will return unless the law is changed again.

If you compare year 2022 IRS Form 8962, which calculates your actual subsidy, to the 2019 version of that form. The difference is visible in Part 1 of the form.


-gauss

 

[rmcelwee]

I also haven't found an answer to this:

Can I get my normal $1000 RRA refund from my ex-employer as well as get a subsidy from ACA? The person at my ex-employer told me NO but I don't necessarily believe everything she says.

I would hate to sign up for a plan and find out that the cost is going to be $800 a month more than I thought.

 

[SecondCor521]

I also haven't found an answer to this:

Can I get my normal $1000 RRA refund from my ex-employer as well as get a subsidy from ACA? The person at my ex-employer told me NO but I don't necessarily believe everything she says.

I would hate to sign up for a plan and find out that the cost is going to be $800 a month more than I thought.

It looks like the answer is no.

From googling, an RRA refund looks like it is from an HRA. If that is correct, the instructions to Form 8962 (where ACA subsidies are reconciled at tax time), says, in part:

"If you were covered under an individual coverage HRA for
2022, you are not allowed a PTC for your 2022 Marketplace
health insurance. Also, if another member of your tax family was
covered under an individual coverage HRA for 2022, you are not
allowed a PTC for the family member's 2022 Marketplace health
insurance. If you or a family member could have been covered
by an individual coverage HRA for 2022, but you opted out of
receiving reimbursements under the individual coverage HRA,
you may be allowed a PTC for your, and your family member's,
Marketplace health insurance if the individual coverage HRA is
considered unaffordable. See Pub. 974 for guidance on
determining whether an individual coverage HRA is affordable."

[Emphasis added.]

(The above paragraph is from the 2022 instructions, but should be the same in the 2023 instructions. See https://www.irs.gov/pub/irs-pdf/i8962.pdf)

 

[rmcelwee]

It looks like the answer is no.[/url])

Thank you! I was not able to find that info. This makes a HUGE difference in which plan I will select.

 

[SecondCor521]

Thank you! I was not able to find that info. This makes a HUGE difference in which plan I will select.

No worries.

You might want to check to make sure that what you've been using was a "individual coverage HRA". It sounds like it, but that would be a good thing to ascertain.