ACA plan billing question. ACA removes person date of death, read on...

[yorkriver1]

My client is worried there will be ER/hospital charges beyond the date of death as the body was held at the facility for 2 days after the death. Sad sudden death of a client's spouse.
I don't think insurance companies pay or charge fees beyond the date of death. The client was refusing to have the spouse removed from the app for the last 4 months of the year, even though there would likely be claw back of the tax credits received for the deceased person for the time beyond the death date.
Correct?

 

[Yagents]

That's a tough one.

I would presume the claim coding will show death, and date of death. All claims would be covered, pre and post death.

Insurer will probably notify marketplace of death and retroactively remove from policy as of D.O.D

Tax credits will be clawed back at tax time

 

[DonP]

On the 2021 irs 8962 there’s a check box for did you receive unemployment in 2021 . I’m assuming in 2021 there’s no clawback of credits if you received even 1 week of unemployment? I know for 2020 there was no clawback of credits for anyone .

 

[yorkriver1]

That's a tough one.

I would presume the claim coding will show death, and date of death. All claims would be covered, pre and post death.

Insurer will probably notify marketplace of death and retroactively remove from policy as of D.O.D

Tax credits will be clawed back at tax time

I recall a tax break for clawbacks based on income, with this situation, likely the income will fall below the income for tax credit qualification. Note: this is my only case with a retro (or any) death removal, and the Marketplace has referred it to a higher case level for some reason. Update: the hospital has confirmed they don't bill past death date and standard health insurance practice is to end coverage as of death date.

Also, as I understand it, there was no extension of the excess tax credit forgiveness in 2021. The longer standing information about tax credit payback based on level of FPL is still in effect, just checked.
Here is the chart:
from: What Happens if You Overestimate Your ACA Subsidy? - HealthCare.com
Potential ACA Subsidy Repayment Caps for Fiscal Year 2021:
Maximum Clawback Repayment in 2022:

MAGI (Taxable) Income % of Federal Poverty Level Single Tax Filer All Other Filers (dual figures for single and married)
Less Than 200% $325 $650
200-299% $800 $1,6000
300-399% $1,350 $2,700
400%+ Entire Subsidy
Note: important to read the new subsidy rules for higher incomes. This should mean payback for the part of the tax credit owed back due to underestimated income, and not the total 400% cliff drop off from 2020 and prior years. The new higher tax credits also have been extended to higher incomes than 400% FPL for 21/22 tax years.

 

[Helpico_Insure]

My client is worried there will be ER/hospital charges beyond the date of death as the body was held at the facility for 2 days after the death. Sad sudden death of a client's spouse.
I don't think insurance companies pay or charge fees beyond the date of death. The client was refusing to have the spouse removed from the app for the last 4 months of the year, even though there would likely be claw back of the tax credits received for the deceased person for the time beyond the death date.
Correct?

Correct. We have health insurance and the coverage is until the person needs health services. Everything else might be subject to another type of insurance, like Life insurance. Whenever he removes the dead spouse, the system will ask for the date this death accrued and will calculate based on it. Their tax year probably will be the last one, and if he doesn't mark her death in their Marketplace file, it might go without problems for him, but no insurer will pay post mortal expense under this policy. I also believe that IRS considered such cases when building all related to form 1095. Whatever he does, the system will calculate everything by the rule under this law.

 

[yorkriver1]

On the 2021 irs 8962 there’s a check box for did you receive unemployment in 2021 . I’m assuming in 2021 there’s no clawback of credits if you received even 1 week of unemployment? I know for 2020 there was no clawback of credits for anyone .

In the end that is exactly what happened, once I was able to get through the deep grief and not wanting to deal with all this situation and give specific things needed. I felt bad even using gentle pressure, but it was going to be so much worse if not resolved properly. Once we had statements of the unemployment benefits for the household, yep, $0 premium. Will probably receive a premium tax credit refund for the time up to the death date also once they file the 2021 tax return.