How to prove retirement Health care is "unaffordable"

[VanWinkle]

I am currently applying to the Healthcare.gov site for health Insurance. My wife is coming off of a cobra from my work and is getting subsidies and cost sharing. I have a retirement insurance plan that I pay the premium of almost 1000 per month. I have run out of credits to pay this premium, and now want to access the ACA for insurance. With my reported income, the retirement plan would qualify as unaffordable and I should be qualified for subsidies and cost sharing also. However, after checking the application, there is no place to input the premium to prove unaffordable. Anyone else run into this problem and give me some tips? I have called HC.gov and after 40 minutes yesterday and no answers to the question, I was disconnected.

I will call them again but thought maybe someone here had run into the same problem.

Thanks for any info.

VW


Problem solved------YES

 

[bingybear]

try an ACA insurance broker. They should be able to help you sort it out.

How did you figure your wife's subsidies? I would think in most cases you and your wife's earnings info would go into the calculations.

 

[VanWinkle]

try an ACA insurance broker. They should be able to help you sort it out.

How did you figure your wife's subsidies? I would think in most cases you and your wife's earnings info would go into the calculations.

Thanks for the reply. Yes I was at the broker for 1 hour yesterday and he was unable to figure it out. He was the one on the phone with HC.gov when he was disconnected after 40 minutes.

Yes both incomes were used for all of the calculations- we are both retired.

VW

 

[Rianne]

there is no place to input the premium to prove unaffordable

I'm not sure what you mean. We've been on the ACA since 2014. I applied the first year by myself with a little help from phone rep. You do not input the premium, once you put your income, plans should appear and show you the amount of the subsidy you are allowed. The plans show you the premium for each plan, and all the other cost saving information for those plans. My friend's income is about $20K less than ours. We have a LLC, so the income verification was the hardest part for us. My friend had different plans offered to her than we did.

This year we used a broker, just to get it done with little hassle. The broker was paid by the insurance co.

 

[cathy63]

Are you trying to enroll for coverage that starts December 1, 2017, or January 1, 2018?

If you want coverage for next year, then there's no need to prove that your retiree coverage would be unaffordable. We are in the open enrollment period and you are allowed to choose not to re-enroll in your retiree plan and instead purchase coverage on the ACA marketplace. Your cost sharing and subsidies will be calculated based on your current income. Whatever the previous plan's premium was is irrelevant.

If you are trying to claim that you should get a special enrollment period so you can buy insurance coverage for December of this year, that's a different question, and I don't know how that works.

 

[pb4uski]

The snippet below from the healthcare.gov website suggests that you don't necessarily need to have it be unaffordable to get subsidies... it suggests to me that you are eligible for subsidies if you simply chose not to enroll, but if you do enroll in your employer retiree plan then you are not eligible for subsidies. YMMV

If you have retiree health benefits

If you have retiree health benefits, you’re considered covered under the health care law. You don’t have to pay the penalty that people without insurance must pay.

If you have retiree coverage and want to buy a Marketplace plan instead, you can. But:

• You can’t get premium tax credits and other savings based on your income. This is true only if you’re actually enrolled in retiree coverage. If you’re eligible for but not enrolled in retiree coverage, you may qualify for premium tax credits and lower out-of-pocket costs based on your household size and income.
  
• If you voluntarily drop your retiree coverage, you won’t qualify for a Special Enrollment Period to enroll in a new Marketplace plan. You won’t be able to enroll in health coverage through the Marketplace until the next Open Enrollment period.

​

Bolding is theirs, underline is my emphasis added.

 

[jim584672]

If you want a catastrophic policy, which is usually for under age 30 yo, you can prove policies are unaffordable and get an exception so you can buy it.

 

[pb4uski]

If you want a catastrophic policy, which is usually for under age 30 yo, you can prove policies are unaffordable and get an exception so you can buy it.

However, unless you live in a state that prohibits or restricts age rating, the premiums for a catastrophic policy are about the same as a bronze policy so it isn't worth the effort.

 

[MBSC]

With my reported income, the retirement plan would qualify as unaffordable...

You need a new broker. The affordability clause does not apply to retiree plans. The section you are thinking of applies to current employment plans. See post #6. Retiree plans are voluntary and you can drop it during ACA annual enrollment to enroll in an exchange plan. Keep in mind that some retiree plans become Medicare supplement plans with drug coverage at age 65 and you may lose this feature if you drop it.

A job-based health plan covering only the employee that costs 9.69% or less of the employee’s household income is “affordable.” To find out if your employer’s plan meets the affordability standard, ask your employer.

Reference: https://www.healthcare.gov/glossary/affordable-coverage/

 

[VanWinkle]

The snippet below from the healthcare.gov website suggests that you don't necessarily need to have it be unaffordable to get subsidies... it suggests to me that you are eligible for subsidies if you simply chose not to enroll, but if you do enroll in your employer retiree plan then you are not eligible for subsidies. YMMV



Bolding is theirs, underline is my emphasis added.

Update: Your bold is exactly correct. The broker did not understand this part of it. I got a rep on HC.gov, and she explained that as long as I drop the retirement Insurance effective 12-31-17, I can get subsidies and cost sharing on 01-01-18 for healthcare through the market place. I am now set with a policy for my wife and I for 2018 with subsidies.

Thanks all for the answers you provided- the crisis is over!!!!!!

 

[VanWinkle]

Update: Your bold is exactly correct. The broker did not understand this part of it. I got a rep on HC.gov, and she explained that as long as I drop the retirement Insurance effective 12-31-17, I can get subsidies and cost sharing on 01-01-18 for healthcare through the market place. I am now set with a policy for my wife and I for 2018 with subsidies.

Thanks all for the answers you provided- the crisis is over!!!!!!

 

[pb4uski]

Update: Your bold is exactly correct. The broker did not understand this part of it. I got a rep on HC.gov, and she explained that as long as I drop the retirement Insurance effective 12-31-17, I can get subsidies and cost sharing on 12-01-18 for healthcare through the market place. I am now set with a policy for my wife and I for 2018 with subsidies.

Thanks all for the answers you provided- the crisis is over!!!!!!

I think you mean 01-01-18 and not 12-01-18... right?

Glad that it worked out for you.

 

[VanWinkle]

I think you mean 01-01-18 and not 12-01-18... right?

Yes my mistake. Thanks pb4uski!!