Probably Qualifies for Medicaid, but Wants PPACA Plan, Clawback?

Aug 28, 2015

  1. Justin Bilyj
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    Justin Bilyj Guru

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    I don't do ppaca plans, just private exchange stuff. I had someone ask me about stating their income higher than they expect it to be, they really don't want to go on Medicaid. Is there such thing as a subsidy clawback but if they make less than their stated income?
    Also, will they ask for any income documentation for this? He has a SEP. What will happen later in the year for taxes if his income turns out lower? Will he be automatically put on medicaid if he's under 100%fpl next year?
    Appreciate any help on understanding this.
     
  2. Tkruger
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    No there is not a clawback under 100% FPL...however intentionally misrepresenting income to qualify for an APTC knowing they don't qualify for it is fraud and is not only punishable by fines and possibly jail but may very well cause them to be audited by the IRS.

    Also, will they ask for any income documentation for this?---Yes

    He has a SEP. What will happen later in the year for taxes if his income turns out lower?---He must report the reduced income trend.

    Will he be automatically put on medicaid if he's under 100%fpl next year?---Depends on the state. What make him so confident he will be forced to Medicaid?

    My advice is to distance yourself completely from this matter.
     
    Last edited: Aug 28, 2015
    Tkruger, Aug 28, 2015
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  3. Yagents
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    Yagents Guru

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    I rarely do thumbs up, but you earned this one Kruger. Nice response.
     
    Yagents, Aug 28, 2015
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