Continue on the Same Marketplace Plan

[ameneses54]

CMS has determined that customers that continue to pay their premiums have to do nothing for 2015 to keep coverage.
Considering that the federal poverty data has changed for the new open enrollment period, how will it affect customers who used the minimum income last year to be eligible for a subsidy? If they don't meet the requirements, will they be dropped or a re-adjustment and or clawback be appled in the 2016 tax ?

 

[RayNY]

I have a client on exchange who was just over the cutoff for 2014, but is below the 2015 cutoff. Been paying in full, on time, all year. (NY is a state run exchange, but it's pretty safe to presume the Fed run exchanges will handle this similarly).

Received a nice letter, direct from the exchange, stating:

"We cannot enroll you in your current health plan. You need to select a different health plan if you want coverage in 2015....You now qualify for health care coverage under Medicaid. This eligibility is effective Jan 1, 2015. You qualify for medicaid because federal and state data sources show your income is between $0 and $16,105. This is the allowable income range for medicaid based on your household size."

Tricky situation, nanny/actor, income varies wildly depending on whether she performs. She told me she expects to make $17.5k this year, so I'm rolling with it and updating her income to an eligible level.

 

[AllenChicago]

And if she ends up earning too little income for the subsidy $$ she'll receive in 2015, no recapture or claw-back. Nice job Ray!
ac

 

[RayNY]

My thoughts exactly AC. I can't see the harm in being optimistic with her income in this scenario, and she REALLY does not want to be on medicaid because the doctors she uses do not take it.

FYI, the letter is dated Nov 3, and I got a call on it Nov 10 (and a scanned copy). It says "all data is as of Nov 2". Pushing their luck with that 60-day notice, but I'd expect anyone who's getting this letter to get it this week.

 

[Nikita]

My thoughts exactly AC. I can't see the harm in being optimistic with her income in this scenario, and she REALLY does not want to be on medicaid because the doctors she uses do not take it.

FYI, the letter is dated Nov 3, and I got a call on it Nov 10 (and a scanned copy). It says "all data is as of Nov 2". Pushing their luck with that 60-day notice, but I'd expect anyone who's getting this letter to get it this week.

So what are the new poverty guidelines for 2015?

 

[G.Gordon]

I'm seeing some clients come in with quotes for their current plan, we run through the process, income remaining the same, can't come up with the same figure on any of those cases. It come out cheaper.

What's one to do if we're using the same information, now a year older, same plan comes up at a better deal on the h.gov site than the renewal notice?

 

[TxOnline]

Go to carrier's site to confirm the 2015 price IS correct.

Then, cancel the old 2014 plan....effective Jan 1st.
Give them 14 days to process the cancellation.
Buy a new plan next month....effective Jan 1st, 2015.

 

[RayNY]

I'm seeing some clients come in with quotes for their current plan, we run through the process, income remaining the same, can't come up with the same figure on any of those cases. It come out cheaper.

What's one to do if we're using the same information, now a year older, same plan comes up at a better deal on the h.gov site than the renewal notice?

TX's advice is probably right, but as for why they're different, I'd bet the carrier is still using 2013 FPL numbers, which would put them in a higher FPL bracket for the same dollar income, and result in smaller APTC's. Multiply their income by "1.0157" and see if the APTC's are equal.

Nikita,

http://www.accesscal.org/wp-content...Guidelines-for-2014-_-Covered-California-.pdf is Covered California's income chart. I verified it with my exchange and Medicaid figures and it all appears to be the same. You'll notice single 138% is $16,106 (the $16,105 figure I quoted, while single was raised from $11,490 to $11,670 at 100%)

 

[SamIam]

Does anybody have a chart for the new federal poverty level. I looked on Healthcare.gov and could not find it?

 

[Ann H]

Does anybody have a chart for the new federal poverty level. I looked on Healthcare.gov and could not find it?

Here you go - use this chart:

Federal Poverty Guidelines | Families USA

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Notes:

1. For Medicaid, you should be using 138% of FPL instead of 133%, because there is a 5% disregard. In non-expansion states, I believe you use 105% instead of 100%, but I'm not sure.

2. An easier way to calculate FPL is to use $11,670 for the first person, and add $4,060 for every additional family member. That gives you 100% of FPL.