Need an ACA Pros Opinion....

[rzzr]

Good notes following up on your post, let's see if we can summarize everything.

Your 60yo client has no income. How does she get by? No income as in no wages? What about SS, pensions, etc?

She lives with her 22yo daughter on 12K AGI. Does this mean that the 22yo claims the 60yo as a dependent? Or does she provide help with daily living / costs?

These are questions that can facilitate possible options. From the basic details provided best course of action would be for 60yo single to get on Mcaid - as she would qualify for the services provided. The 22yo daughter on the other hand may qualify for a substantial TC herself to assist with premium assistance. I would recommend her to shop around for a plan before the end of OE @Feb 15th.

As towards your question regarding income - after applying on the FFM income will be asked to be verified. You do not want to manipulate or modify someone's income, higher or lower, for any reason. When applying for health insurance with premium assistance consumer testifies against prosecution of perjury that all information provided is true to the best of one's knowledge. Someone's AGI is what it is and attempting to alter it can lead to a point where you hurt your client instead of help. There are mechanisms in place regarding the reparations of TC's but these are intended for consumers who fall into special situations by way of life events - not for those actively seeking these situations.

To answer your question however the cap on the amount of advance credits that an individual must pay back if their income is <200% of the FPL is $300 or $600 for family.

 

[yogooglethis]

So, health insurance isn't my wheelhouse at all, but I have an FE client wanting insight. I said I'd try.

She's 60, with no income. Lives with her 22 year old daughter, who makes 12,000 a year. Easily medicaid eligible here in Ohio.

Here's the problem: they don't want to be "those people" who get government health care for free.

To counteract this, my only idea is that they could overestimate their income above the medicaid threshold. Then, they get a subsidy for on exchange health coverage.

Here's the question: at the end of the year, when they file taxes, it'll show they didn't reach the income threshold they reported, and should have been covered under state medicaid. What happens? Are they going to have to return the total subsidy amount they received during the year, since they technically "didn't qualify" for subsidies (gawd, it would be about $8,000)? Is is it no big deal?

Thanks in advance for any insights, ladies and gentlemen!

If she truly doesn't want to be " one of those people" explain to her that needs to commit to earning at least 11, 800.00 in 2015 to qualify for a full ACA subsidy by taking one of those low paying jobs that will hire anybody.


If she says she can't work because of health issues then she maybe can apply for SS disability but if she says she doesn't want to put forth the effort to earn 11,800.00 but still wants subsidized healthcare then maybe she is " one of those people"

I understand you are just trying to help. I run in to " these type of people " all the time.

 

[rayluk]

People do not want Medicaid, or medi-cal in my case often is not just they do not want a handout, but something more practical such as forcing a change of care providers. I can think of one client who refuses to go to Medi-cal because she is in the middle of cancer treatment. The specialist she is seeing does not take Medi-cal. How would you feel if you are in her shoes?

There are two sides of each story, and this is one mess up law.

 

[MaryDallas]

They do not have enough income; period. Texas did not expand Medicaid so these people fall through the cracks. They are not eligible for Medicaid and they are not eligible for marketplace. Just another brick in the wall.

A lot of people 'hide' income: they may babysit, do something for cash money, clean houses, sit with the elderly, run errands, repair cars. If they are willing to pay taxes on that cash money they 'may' qualify. It is a borderline situation at best but you would be surprised at how many people make thousands in cash money.