Opting Out of Employee Coverage

[Nikita]

I need assistance with the following:
Client says her employer coverage is not affordable. We filled out all the information on the marketplace but no where did it ask her to send in proof or a letter from her employer that she does not have affordable coverage. She was not given any subsidy at all, even though she is single and her income is only $22,000. Clearly she should get a subsidy. I called the marketplace rep and they said her only recourse is to appeal. This is nuts. There must be thousands of people who are opting out of non-affordable employee coverage. Are they all being denied subsidies and told to file an appeal? Can someone share with me the key to getting these apps through with the appropriate subsidy?

Thanks for all the great guidance this forum offers!

 

[HealthGuy]

sounds like those Marketplace Navigators can really assist huh. Great freakin insurance system. Works great

 

[bluediamond]

I need assistance with the following:
Client says her employer coverage is not affordable. We filled out all the information on the marketplace but no where did it ask her to send in proof or a letter from her employer that she does not have affordable coverage. She was not given any subsidy at all, even though she is single and her income is only $22,000. Clearly she should get a subsidy. I called the marketplace rep and they said her only recourse is to appeal. This is nuts. There must be thousands of people who are opting out of non-affordable employee coverage. Are they all being denied subsidies and told to file an appeal? Can someone share with me the key to getting these apps through with the appropriate subsidy?

Thanks for all the great guidance this forum offers!

Anytime I have answered the question yes to, does the employer offer coverage or words to that effect the applicant does not receive a subsidy, if you put no they will. If they are passed their open enrollment then technically they do not have coverage available to them, until next open enrollment.

 

[timsip]

Anytime I have answered the question yes to, does the employer offer coverage or words to that effect the applicant does not receive a subsidy, if you put no they will. If they are passed their open enrollment then technically they do not have coverage available to them, until next open enrollment.

Opting out of group coverage does not count. If it is truly unaffordable per IRS definition, she can opt out; if it is just unaffordable according to her budget, she doesn't get a subsidy.

 

[Nikita]

Opting out of group coverage does not count. If it is truly unaffordable per IRS definition, she can opt out; if it is just unaffordable according to her budget, she doesn't get a subsidy.

Timsip - can you please tell exactly what I need to do on her application to allow her to opt out and get a subsidy? She truly does have unaffordable coverage (using the ACA definition of affordability). Does she just answer "no" to whether or not she has employer coverage? This would technically be untrue, because the question as worded does not ask whether she has "affordable" coverage, it just asks whether she has coverage.

 

[Yagents]

If you say no coverage, she gets subsidy. If you say yes, u open up can of worms. She should have received a form from her employer, or can ask for it, stating the plan is over 9.5% of income (I THINK). If yes, then we arrive at same place government would, subsidized policy with proof.

 

[Nikita]

If you say no coverage, she gets subsidy. If you say yes, u open up can of worms. She should have received a form from her employer, or can ask for it, stating the plan is over 9.5% of income (I THINK). If yes, then we arrive at same place government would, subsidized policy with proof.

Yagents - she does have a letter verfiying that her employer coverage is not affordable. But the marketplace does not ask for this letter anywhere, they just don't give her the subsidy. What have you done in instances like this? Surely there must be agents on this forum who have figured out a solution to this problem? I have only done a small number of apps compared to some of the agents here who have done hundreds.

 

[Yagents]

All of my clients tend to be self employed or retired. Sorry, no direct experience with unaffordabity.

 

[G.Gordon]

My one case with unaffordable employer coverage. Where it asked if she was in or available, when you answer to the affirmative, then it should ask how much the coverage cost, then the program does the math and allows the subsidy.

 

[pahealthquotes]

All of my clients tend to be self employed or retired. Sorry, no direct experience with unaffordabity.

can I have your client list?