Clawback and Unelegible for Coverage

[ameneses54]

I'm quite clear on the details of clawback if you overestimate your income, but not so on how the IRS handles clients who enrolled, were not asked for income verification and ultimately did not earn enough to qualify initially in Florida (under the FPL).

 

[bluediamond]

Nothing happens to that person, but the agent who gave them enough income to qualify for a subsidy will be placed in a cell next to Bernie Madoff in N.C. and you will learn how to pull off the perfect scam for the next 30 years. But you have to pay him for his daily lesson's.

 

[ameneses54]

Nothing happens to that person, but the agent who gave them enough income to qualify for a subsidy will be placed in a cell next to Bernie Madoff in N.C. and you will learn how to pull off the perfect scam for the next 30 years. But you have to pay him for his daily lesson's.

I appreciate your humor, but this has nothing to do with intensional misrepresentation. Many customers honestly state and prove their income to the marketplace and eventually will not meet the FPL to have qualified for Obamacare.

 

[MBSC]

The person keeps the APTC since the exchange accepted the initial income estimate.

§ 1.36B-2 Eligibility for premium tax credit.
(6) Special rule for taxpayers with household income below 100 percent of the Federal poverty line for the taxable year. A taxpayer whose household income for a taxable year is less than 100 percent of the Federal poverty line for the taxpayer's family size is treated as an applicable taxpayer if—
(i) The taxpayer or a family member enrolls in a qualified health plan through an Exchange;
(ii) An Exchange accepts the estimate at the time of enrollment that the taxpayer's household income will be between 100 and 400 percent of the Federal poverty line for the taxable year;
(iii) Advance credit payments are authorized and paid for one or more months during the taxable year.

 

[bluediamond]

I appreciate your humor, but this has nothing to do with intensional misrepresentation. Many customers honestly state and prove their income to the marketplace and eventually will not meet the FPL to have qualified for Obamacare.

It's intentional and I was just kidding.

I don't thing anything happens to that individual and no clawback, but the govt can always change the rules, not like they haven't before.

 

[ameneses54]

It's intentional and I was just kidding.

I don't thing anything happens to that individual and no clawback, but the govt can always change the rules, not like they haven't before.

Thanks for your reply.

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The person keeps the APTC since the exchange accepted the initial income estimate.

I was aware of this law, but what happens if the Marketplace asks for income verification as a result of the application,they are sent and accepted and eventually the applicant does not meet the eligiblity requieremtnts for income. Will the same law still be applicable?
My confussion arises regarding the statement "at the time of enrollment".

 

[MBSC]

I was aware of this law, but what happens if the Marketplace asks for income verification as a result of the application,they are sent and accepted and eventually the applicant does not meet the eligiblity requieremtnts for income. Will the same law still be applicable?
My confussion arises regarding the statement "at the time of enrollment".

Yes, the same rule still applies.

At the time of enrollment, the applicant does not know what their income for the upcoming year will be and provides an initial estimate. If the initial income estimate is immediately accepted or accepted after supporting documentation has been submitted, the person keeps the APTC if their actual income ends up being below the threshold.