Questions on Health Care Exemptions. Need Help!

Apr 9, 2016

  1. Sullivan86
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    Sullivan86 New Member

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    From my understanding, for a exemption the cost of insurance must be over 8% of your income.

    the thing is this...
    Im 29, and a stage 4 cancer patient(melanoma). I was diagnosed last year about Feb. 20th. I didn't have any health coverage before if it makes a difference.
    I have now receive disability. but do not qualify for Medicare( I have not been on disability for 2 years, and also apparently make to much....)
    my only income is the disability(12,360 a year).

    now I have been receiving treatment at md Anderson in Houston under the hospitals own aid program(so I have no unpaid medical bills that I know of), despite not having insurance. the program require me a apply ever year. And this year one of the new requirements for the aid is you have to have a exemption... BUT... I don't qualify as I said before because I make too much.... yes despite the fact that I make 12360 a year.... I do qualify for a tax credit, the silver plan i think.. meaning ill only pay about 21 a month.. not bad.. until you remember i have freaking cancer! and ill be hitting that pay cap FAST.. its 2500 i think.. but that plus the 250 a year in monthly costs is a lot for me..


    to make things worse for me.. the date for the aid from md crept up on me and im now not covered.. im unable to get the treatments i need ( radiation of the brain and immunotherapy).

    basically i need coverage FAST... and ever week without it is another week my brain is infected by more cancer.. so trying for some other exemption and waiting weeks for a response is NOT a option..

    im not even sure what responses im expecting.. venting i guess
     
  2. timamr
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    timamr Guru

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    I doubt I can help you but feel free to private message me ur # (or u can call me)and I can hopefully point you in the right direction. However, $250/yr in premiums with an additional $2,500 max out of pocket aint a bad deal considering the insurance company is probably gonna spend 10's of thousands of dollars (if not more) to cover ur situation.
     
    Last edited: Apr 9, 2016
    timamr, Apr 9, 2016
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  3. TN_agent
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    TN_agent Guru

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    call the marketplace. they are whizzes at getting people things they aren't technically eligible for.
     
    TN_agent, Apr 11, 2016
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  4. Tkruger
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    Tkruger Guru

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    First off I'm sorry to hear about your situation.

    If you lost coverage then you do qualify to get a plan on MD Exchange.

    To put coverage costs into perspective think of it like this...at 29 the cost without any help (Tax Credit) the plan would cost you $ 300 + per month for that same silver plan...the Max out of Pocket would be $6,000 + for the year.

    So as was stated the $ 21 per month with a $2,500 max out of pocket is the best deal going.

    Remember that the $ 2,500 you can make installment payments on. Get covered, get health and worry about the Max out of pocket later.

    I hope your situation turns around soon.






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    I mistook the md as MD ie Maryland...my apologies. That said, you loss the coverage from the program from the hospital in TX. Contact the marketplace to find out if you can apply there. 1-800-318-2596
     
    Tkruger, Apr 11, 2016
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  5. Ann H
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    Ann H Guru

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    So sorry to hear about your situation.

    First of all, you need to get professional assistance, since the calculation of MAGI (Modified Adjusted Gross Income) is complicated, and differs dependent upon which part of the law you are talking about. This is a numbers game, and a professional can show you how you might get to the right number, legally.

    For the Affordability Exemption, it does NOT use Social Security Benefits. If your disability income is from Social Security, that is important. Secondly, even if your disability is from another disability plan, it is possible that it is not taxable, which is also important. You mentioned 8% as the Affordability threshold. Actually, it was 8% in 2014, 8.05% in 2015 and 8.13% in 2016. Go to an Accountant to help you see if you are within the Affordability Exemption, since that is the quickest route to keep your aid from MD Anderson.

    Next, you may be eligible for Medicaid. Your income of $12,360 is barely over 100% of the Federal Poverty level and a little below 138%. That is an important technicality. Depending on the state you live in, you might qualify for Medicaid. The calculation of MAGI for Medicaid includes Social Security Benefits, but you might have other "above the line" deductions.

    Next, I hope that you used an agent or called the Marketplace about that Silver plan, rather than figuring it out on your own using the website. The formula to calculate MAGI (Modified Adjusted Gross Income) for the subsidy includes Social Security Benefits, but you might have other "above the line" deductions.

    For all 3 (Affordability Exemption, Medicaid and Subsidy), you could easily get your income down if needed by "above the line" deductions like student loans, moving expenses, etc. You need an Accountant, Agent, or knowledgeable person to help you reach whichever goal is best for you.

    If you can get insurance, the hospital may pay that $2500 deductible for you under an aid program. Don't turn down insurance for $21 a month! There are many ways to fund that deductible.

    Good luck to you. I hope things turn out well.
     
    Last edited: Apr 11, 2016
    Ann H, Apr 11, 2016
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  6. Tkruger
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    Tkruger Guru

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    You tip toed into the Accounting side.

    Disability comp has tax consequences if you own a business? Read more here

    Owning even a very small business can affect your eligibility for Social Security disability insurance benefits (SSDI). This is because if the Social Security Administration (SSA) concludes that the work you put into it is substantial gainful activity, you could lose your benefits -- or you won’t qualify for benefits in the first place. Running a business includes any kind of self-employment, including providing services, like a bookkeeper, carpenter, gardener, or handyman; doing contract or consulting work; freelancing; farming; and landlording.

    Here's the rule for the countable income test: If your countable income is more than $1,130 a month, your self-employment will be considered SGA and you will no longer be eligible for benefits, unless you can show you are not providing significant services to your business. If you are not providing significant services, you can make over the SGA amount.

    Countable income. Countable income is that portion of your salary or profits that you earn from your business based on your own productivity. To determine your countable income, the SSA will deduct the following from your net earnings:

    the value of any significant amount of unpaid help given to you by your spouse, children, or other people impairment-related work expenses
    unincurred business expenses paid for you someone else or by an agency, and
    for farms only: soil bank payments (if counted as farm income).
     
    Tkruger, Apr 11, 2016
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  7. Sullivan86
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    Sullivan86 New Member

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    sorry for a slow reply.

    things just get worse and worse...

    I cant even buy insurance because the markets are closed...
    I don't qualify for Medicare because Texas didn't expand it.
    and im very confused.. I don't file a tax return since im on disability, therefore I don't need a exemption for health insurance... but for the aid from my hospital I need the exemption.....:goofy: but I cant get the exemption because I don't file a tax return....
    im totally screwed...

    I feel like I should just roll over and die..
     
  8. Ann H
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    Ann H Guru

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    How is that applicable to this situation, though? That excerpt is explaining that self employed people have a hard time proving they are disabled.

    The important issues for this guy's disability income is whether it is social security benefits or not, and whether any private insurance is taxable.

    If it is social security benefits, it works against him for the subsidy's MAGI, but not for the Affordability Exemption's MAGI.

    If it's private insurance the issue is whether or not the benefit shows up on his tax return. Employer paid premium means taxable benefit. Personally paid premium means non taxable benefit in most situations. If that private benefit is not taxable, it's not part of MAGI.

    Lowering MAGI will help him qualify for the affordability exemption (which is his first goal) or Medicaid.
     
    Ann H, Apr 11, 2016
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  9. Sullivan86
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    Sullivan86 New Member

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    ok I found a exemption I qualify for. A hardship exemption for states that didn't expand Medicare.(or what ever it is)

    to get it I must file for it when I file my tax... the thing is I DONT FILE TAX.....

    so how can I get the exemption then!!??
     
  10. Tkruger
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    Tkruger Guru

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    Ok, now you lost me. Based on the data in the original post it was sounding like you were trying to make sure you had coverage not duck the penalty for not having coverage.

    If you are trying to get an exemption in order to receive the state assistance regarding your situation then you must file regardless of if you are going to owe or not.
     
    Tkruger, Apr 12, 2016
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