Appeals Process If You Lost Your Subsidy

[Duaine]

While on the phone with a client who "forgot" to mail in the requested tax documents and CMS I learned that the client can make an appeal to reinstate the lost subsidy.

Now that the client "understands" that he/she should open mail sent to them form Uncle Sugar they are sending in the required tax documents and sending in the required form which is attached. (The forms can be different in your state so check healthcare.gov for the proper form.)

I've had about (5) of these this year who have lost their subsidy and been amazed and astounded about how much their premium really costs although I told them what the total cost was and how much the subsidy reduced their out-of-pocket.

Hope that this appeal process might help one of your clients.

 

[taterpeeler]

that's all great and good.... however...... client filled an appeal over something back in Nov. 2013.... yes, 2013. Client got letter from HHS stating her appeal would be heard via conference call one month ago... exactly a year and a half later.... we declined to attend the hearing as I fixed the problem months ago... I will pass on the appeal process

 

[FLM2]

that's all great and good.... however...... client filled an appeal over something back in Nov. 2013.... yes, 2013. Client got letter from HHS stating her appeal would be heard via conference call one month ago... exactly a year and a half later.... we declined to attend the hearing as I fixed the problem months ago... I will pass on the appeal process

Totally agree, just submit a new application under a change in income SEP, they go through every time.

 

[yorkriver1]

No barrier to re-doing app with subsidy:
Not knowing my prospect & looking to maybe reduce premium increase they thought was due to higher income, we called HC.gov. I thought, let's do a life change, as subsidy was not recalculated for 2015 by updating the app in December.
Turns out, subsidy had been lost for no proof docs submitted. I asked if the subsidy could be reinstated, answer, "yes".
We were walked thru the app, given a SEP, new subsidy. There was an income change from 2014, higher, so this was a help. I was surprised that no big deal over the subsidy loss.
No docs required this time, probably due to income matching 2014 tax return. Chose lower cost plan, also used new subsidy.

 

[kgmom219]

that's all great and good.... however...... client filled an appeal over something back in Nov. 2013.... yes, 2013. Client got letter from HHS stating her appeal would be heard via conference call one month ago... exactly a year and a half later.... we declined to attend the hearing as I fixed the problem months ago... I will pass on the appeal process

Thats hysterical!!! They are THAT far behind???

 

[Duaine]

I understand that with a call you can get them "re-instated" but what I was trying to bring out is that they can still appeal and get back the subsidy for the months that they lost it.

That's all....

 

[Yagents]

It will probably be quicker to get the refund at tax filing.

 

[taterpeeler]

I understand that with a call you can get them "re-instated" but what I was trying to bring out is that they can still appeal and get back the subsidy for the months that they lost it.

That's all....

file your taxes, be correct in your projected income... BOOM, subsidy back, its a feature AND a benefit of the law, ask Smarco

 

[yorkriver1]

I understand that with a call you can get them "re-instated" but what I was trying to bring out is that they can still appeal and get back the subsidy for the months that they lost it.

That's all....

Wrote in busy time, reinstating subsidy is a good thing to know about, thanks for the info.

 

[yorkriver1]

Now I have one, where they got bumped on income level and the real kicker for these folks is, a. the income proof was sent in b. they got kicked down a notch on cost sharing from 94% to 87%, so the appeal would be for cost sharing-- claims costs, if any.

Or, is this an appeal, since the forms were submitted?

I have already done an income change for 8/1/15, and CSR back to 94%, but any claims for May/June/July, not much luck. Info came to me slowly.
Good point about subsidy, just get back on tax return.