ACA ?? Young man just turned 19 year old, still in high school . . .

[Yagents]

If the young man has a denial letter from Medicaid, you can call the marketplace call center and request an exception to enroll in a fully subsidized plan.

And what would be the "exception" reason since you seem to be part of Agent Pipeline?

https://www.agentbrokerfaq.cms.gov/...glish&utm_medium=email&utm_source=govdelivery

What if a consumer's income is below 100% of the federal poverty level (FPL) using their annual income and too high for Medicaid eligibility using their current monthly income?

Feb 9, 2024•Transitions in Coverage
ANSWER
When a consumer applies for help paying for Marketplace coverage, the Marketplace calculates their household income using modified adjusted gross income (MAGI) methodology. This dollar amount is then converted to a percentage of the FPL to determine eligibility for the following programs:

• Advance payments of the premium tax credit (APTC)
• Cost-sharing reductions (CSRs)
• Medicaid/Children's Health Insurance Program (CHIP)

In cases where someone's annual income is below 100% of the FPL but current monthly income is too high for Medicaid eligibility, Medicaid agencies are required to use a household's projected annual income to determine eligibility. The consumer may need to provide evidence such as a signed contract of employment, or a clear history of predictable fluctuations in income, in this instance.

 

[DonP]

Or he does what 50% of the unemployed people I run into weekly do. Nobody knows what there future income will be .He's just estimating his income . If he makes zero he still files a return and pays nothing back . Phone reps are doing this left and right . When you see green card immigrants that have lived here 1 yr getting free health insurance . Immigrants bringing there 75 yr old parents who never paid a dime of taxes to the us and they get free aca . This type of unfair insane system causes massive anger and cheating across the board . The thinking is " if Juan who never paid a dime of taxes and wasn't even born here gets it free I'm sure as hell getting it free " . It's like the multi millionaire amd billionaires paying no taxes . If they pay no taxes why should I . Unfairness in anything causes anger and cheating .

 

[Chazm]

Or he does what 50% of the unemployed people I run into weekly do. Nobody knows what there future income will be .He's just estimating his income . If he makes zero he still files a return and pays nothing back . Phone reps are doing this left and right . When you see green card immigrants that have lived here 1 yr getting free health insurance . Immigrants bringing there 75 yr old parents who never paid a dime of taxes to the us and they get free aca . This type of unfair insane system causes massive anger and cheating across the board . The thinking is " if Juan who never paid a dime of taxes and wasn't even born here gets it free I'm sure as hell getting it free " . It's like the multi millionaire amd billionaires paying no taxes . If they pay no taxes why should I . Unfairness in anything causes anger and cheating .

Who would you put as an employer and what do you show when they ask for proof of employment verification ?

 

[DonP]

Who would you put as an employer and what do you show when they ask for proof of employment verification ?

Self employed landscaping, housekeeper etc . On low income people the marketplace rarely if ever asks for verification of income . If they do agents have an excel spreadsheet that's lists the 12 months so you put $1500-Jan, $1500 Feb etc . I write quite a few self employed people who own landscaping businesses . I have to do this occasionally as they have no w-2 to show . Is it any different than the 1000's of agents lieing on the sep saying " loss of coverage " as the govt no longer asks for proof of loss of coverage . On the aca Facebook groups all the agents push that . See the system is littered with massive fraud . I'm stunned weekly running into at least 5 kids of my Medicare leads that have been unemployed for yrs that say I have Ambetter or Anthem. Many have been sold a worthless zero premium bronze on the phone when they could have gotten a $30 a month silver . But the guy selling them on the phone wants his commission for the yr and knows the client probably won't pay the $30 a month .

 

[Chazm]

Self employed landscaping, housekeeper etc . On low income people the marketplace rarely if ever asks for verification of income . If they do agents have an excel spreadsheet that's lists the 12 months so you put $1500-Jan, $1500 Feb etc . I write quite a few self employed people who own landscaping businesses . I have to do this occasionally as they have no w-2 to show . Is it any different than the 1000's of agents lieing on the sep saying " loss of coverage " as the govt no longer asks for proof of loss of coverage . On the aca Facebook groups all the agents push that . See the system is littered with massive fraud . I'm stunned weekly running into at least 5 kids of my Medicare leads that have been unemployed for yrs that say I have Ambetter or Anthem. Many have been sold a worthless zero premium bronze on the phone when they could have gotten a $30 a month silver . But the guy selling them on the phone wants his commission for the yr and knows the client probably won't pay the $30 a month .

I have maybe 20 ACA clients. It was a legitimate question that I had. I tell people that aren't working that they will pay full price. Several times I told people that they needed to send me proof of income as it was requested or they would lose coverage.

 

[Yagents]

It's a question of agent ethics at this point. Do I put my name on as AOR or have then call the Marketplace.

The marketplace no longer requires proof of loss of coverage. Anyone can now play the "wait til I get sick" game.

I Have 500 ACA policies, actively renewed 300 of them. Not 1 of them required proof of income This year.

Biden basically opened the doors to massive fraud, agents are leveraging it, and consumers are starting to learn the loopholes.

 

[DonP]

And if you want do a 3 way call with marketplace and they can tell marketplace what they want . It's all recorded . I do have a little regret I didn't divert much more of my attention to aca the last 3 yrs . I got around 150 on books with just taking help on demand calls , people I run into and referrals. Honestly I'm stunned how few calls I get for service .

 

[LostDollar]

worthless zero premium bronze

Could you explain a bit what you mean there?

I never saw a zero premium bronze plan in KS when we were looking at them.

I never thought of bronze plans as worthless.

But my experience of ACA is one annual purchase in one state.

 

[Yagents]

Could you explain a bit what you mean there?

I never saw a zero premium bronze plan in KS when we were looking at them.

I never thought of bronze plans as worthless.

But my experience of ACA is one annual purchase in one state.

Any insurance (bronze) is better then no insurance. The question is what's better for the client or what's best for the agent?

A $0 premium with $9400 OOP, or a $25 premium with $1500 OOP maximum?

 

[DonP]

Any insurance (bronze) is better then no insurance. The question is what's better for the client or what's best for the agent?

A $0 premium with $9400 OOP, or a $25 premium with $1500 OOP maximum?

Could you explain a bit what you mean there?

I never saw a zero premium bronze plan in KS when we were looking at them.

I never thought of bronze plans as worthless.

But my experience of ACA is one annual purchase in one state.

As Yaagent said . These are very very low income people. The $9400 deductible bronze plan can't be used till you hit $9400 of bills . For poor people that might as well be $10 mil . They can't even find $100 extra . Everytime they go to dr that's $150 bill out of pocket .