Long Wait for Employer Coverage, Tax Credit Eligibility Issues

Nov 21, 2015

  1. yorkriver1
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    yorkriver1 Guru

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    Two recent examples + one I am about to work on:

    1. Will be eligible for open enrollment in August 2016, and this was included on app, employer plan is not affordable, based on income vs. bi-weekly payroll cost. This one sailed through with tax credit.

    2. Will be eligible in 9 months during open enrollment, also entered cost and income, this one was not found eligible for tax credit. Not sure what I may have answered differently on app. Income and employer cost should have qualified.

    3. New employee, income qualifies, not group insurance eligible for a year, which comes up November 2016. HC.gov advised to just say not eligible for employer based coverage on app. Future premium may not be knowable.

    Your experience?
     
  2. G.Gordon
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    G.Gordon Guru

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    If they are not able to take coverage for the needed coverage date, Jan 1, for example. None of that other information is needed. They are not eligible and can't enroll in their work based plan NOW. They need to be told that when they are able they have to take it or keep their current plan sans the tax credit.
     
    G.Gordon, Nov 21, 2015
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  3. yorkriver1
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    yorkriver1 Guru

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    So that makes them like people who will become eligible for Medicare within the calendar year. They won't automatically be disenrolled from Marketplace, but had better do so unless they want to pay back any subsidy they get past their eligibility for other coverage, group or Medicare.

    They hate paying more on Medicare or group, I get it, but owing back the subsidy is worse. Calendaring on my end, don't want the issues.

    I do wonder, though, because the HC.gov app asks if they have employer coverage available even if it's at a future date. So not answering that they have employer coverage available later in the year is a work around?
     
    Last edited: Nov 22, 2015
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