Questions on Health Care Exemptions. Need Help!

[FLM2]

they tell me at md for the aid I NEED insurance or a health care exemption..(I have spoken with them)

I cant get either, and that puts me in the situation of not getting treat ment for stage 4 melanoma..

You aren't going to get an exemption from the Marketplace in less than 60-90 days, the time frame is most likely never.

You should be able to get a Special Enrollment Period from the Marketplace, if you live in Texas and there isn't an Exchange plan that covers MD Anderson then you have a big problem, unfortunately, but there isn't anyone on this forum (and most of us are very experienced) that can really help you.

The other option you have (and I never thought this would be in a post of mine) is to find a 'Navigator', they are government-funded outreach people who specialize in Medicaid and lower income healthcare. If you find the right one maybe he/she would spend tons of time cutting through the red tape for you.

 

[kgmom219]

You aren't going to get an exemption from the Marketplace in less than 60-90 days, the time frame is most likely never.

You should be able to get a Special Enrollment Period from the Marketplace, if you live in Texas and there isn't an Exchange plan that covers MD Anderson then you have a big problem, unfortunately, but there isn't anyone on this forum (and most of us are very experienced) that can really help you.

The other option you have (and I never thought this would be in a post of mine) is to find a 'Navigator', they are government-funded outreach people who specialize in Medicaid and lower income healthcare. If you find the right one maybe he/she would spend tons of time cutting through the red tape for you.

There are ZERO On Exchange plans in TX that include MD Anderson.

I'm sorry Sullivan, I know this isn't what you want to hear. Get the SEP from the Marketplace, enroll in a plan for 5/1 and find another provider. That's your best shot.

 

[Ann H]

No, no, no. You absolutely CAN get an exemption earlier. Only a handful of the exemptions must come from the marketplace. The rest can be given on the tax return. The "Unaffordable Exemption" and the "Income below the Tax Filing Threshold" exemption are exemptions he would qualify for if the disability benefit is not taxable, and they are claimed on the tax return. He needs to go to an Accountant now. The Accountant can determine if the disability benefit is taxable or not, can create a tax return, show the Exemption, and solve the issue. In an hour. Good luck finding an available Accountant on April 12th, but once you get into the Accountant, they can get the exemption in an hour.

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Near the bottom of this page is a list of exemptions, and it shows which ones are claimed on the tax return and which ones require the Marketplace.

https://www.irs.gov/Affordable-Care...al-Shared-Responsibility-Provision-Exemptions

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Sullivan86, is your disability benefit from Social Security or is it private (like an employer plan)? If private, did your employer pay the premium for your disability insurance, or did you? Did you even pay part of the premium through payroll deduction? Did you receive a tax form showing that it is taxable (like a W2 or 1099R)? All of those questions are getting at whether or not it is taxable.

If it's not taxable, you have this made in the shade. You go to an Accountant to file your tax return, and right there it shows that you are exempt. Since you are in TX, which did not expand Medicaid, your income is above 100% and below 138% of the Federal Poverty Level. On the link I provided, the list shows that your tax return is where you claim the exemption for being a resident of a state that did not expand Medicaid. You should be able to qualify for an exemption from the penalty for that, too -- very quickly. An Accountant can do this for you.

 

[FLM2]

No, no, no. You absolutely CAN get an exemption earlier. Only a handful of the exemptions must come from the marketplace. The rest can be given on the tax return. The "Unaffordable Exemption" and the "Income below the Tax Filing Threshold" exemption are exemptions he would qualify for if the disability benefit is not taxable, and they are claimed on the tax return. He needs to go to an Accountant now. The Accountant can determine if the disability benefit is taxable or not, can create a tax return, show the Exemption, and solve the issue. In an hour. Good luck finding an available Accountant on April 12th, but it can be done ASAP.

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Near the bottom of this page is a list of exemptions, and it shows which ones are claimed on the tax return and which ones require the Marketplace.

https://www.irs.gov/Affordable-Care...al-Shared-Responsibility-Provision-Exemptions

'

Ann, as always, you provide real insight.

I read through the exemptions and there is one for having income below 138% FPL in a state where Medicaid isn't expanded. Texas is one of those states and the exemption can be claimed on the tax return. His stated income is well below the 138% level.

Here is the specific language:
Resident of a state that did not expand Medicaid - Your household income is below 138 percent of the federal poverty line for your family size and at any time during the year you reside in a state that does not participate in Medicaid expansion under the Affordable Care Act. *

The simple solution is file a tax return online using a free provider (https://www.taxact.com/ is one of them) and the return should generate the exemption-take the exemption to MD Anderson and get them to cover it under their program.

 

[Ann H]

Thanks FLM2. You were typing while I was revising my post to include that 100-138% exemption for non-expansion states, too.

With all due respect, he needs a professional to see if his disability payment is taxable or not. It can show up on a W2, 1099R and sometimes another tax form. It doesn't sound like he has the knowledge base to do-it-yourself yet. He doesn't need a high powered CPA. H&R Block can do it.

 

[FLM2]

Thanks FLM2. You were typing while I was revising my post to include that 100-138% exemption for non-expansion states, too.

With all due respect, he needs a professional to see if his disability payment is taxable or not. It can show up on a W2, 1099R and sometimes another tax form. It doesn't sound like he has the knowledge base to do-it-yourself yet. He doesn't need a high powered CPA. H&R Block can do it.

Ann, thanks but it doesn't matter whether the disability is taxable or not, it counts as a Social Security benefit and he will not owe any taxes on it (I just ran the numbers using the H&R Block online calculator) because he has no other income.

He just needs to file the darn tax return, claim the exemption, and get his treatments started-he has a life threatening disease and every day counts

According to the IRS, Social Security disability benefits are treated as taxable (he won't owe any taxes on it, though): https://www.irs.gov/Help-&-Resource...bility-Benefits/Regular-&-Disability-Benefits

Regular & Disability Benefits
Question: I retired last year, and started receiving social security payments. Do I have to pay taxes on my social security benefits?
Answer:

Social security benefits include monthly retirement, survivor and disability benefits. They do not include supplemental security income (SSI) payments, which are not taxable. The amount of social security benefits that must be included on your income tax return and used to calculate your income tax liability depends on the total amount of your income and benefits for the taxable year.

To find out whether any of your benefits may be taxable, compare the base amount for your filing status with the total of:

One-half of your benefits.
All of your other income, including tax-exempt interest.

The base amount for your filing status is:

$25,000 if you are single, head of household, or qualifying widow(er),
$25,000 if you are married filing separately and lived apart from your spouse for the entire year,
$32,000 if you are married filing jointly,
$0 if you are married filing separately and lived with your spouse at any time during the tax year.

 

[kgmom219]

Just asking, but does it matter?

He posted that he doesn't file taxes.

How's any of this going to do him any good RIGHT NOW? He's got to call in, beg for the hardship exemption and get enrolled ASAP. And find a new doc.

I agree with everything you said, but thats a 2017 issue. He's at stage 4, his tax filing and whether or not his DI is taxable is the least of his concerns.

 

[Ann H]

Ann, thanks but it doesn't matter whether the disability is taxable or not, it counts as a Social Security benefit and he will not owe any taxes on it (I just ran the numbers using the H&R Block online calculator) because he has no other income.

He just needs to file the darn tax return, claim the exemption, and get his treatments started-he has a life threatening disease and every day counts

According to the IRS, Social Security disability benefits are treated as taxable (he won't owe any taxes on it, though): https://www.irs.gov/Help-&-Resource...bility-Benefits/Regular-&-Disability-Benefits

Regular & Disability Benefits
Question: I retired last year, and started receiving social security payments. Do I have to pay taxes on my social security benefits?
Answer:

Social security benefits include monthly retirement, survivor and disability benefits. They do not include supplemental security income (SSI) payments, which are not taxable. The amount of social security benefits that must be included on your income tax return and used to calculate your income tax liability depends on the total amount of your income and benefits for the taxable year.

To find out whether any of your benefits may be taxable, compare the base amount for your filing status with the total of:

One-half of your benefits.
All of your other income, including tax-exempt interest.

The base amount for your filing status is:

$25,000 if you are single, head of household, or qualifying widow(er),
$25,000 if you are married filing separately and lived apart from your spouse for the entire year,
$32,000 if you are married filing jointly,
$0 if you are married filing separately and lived with your spouse at any time during the tax year.

Yes, I know that Social Security benefit can be taxable in part or whole. And I know that it's included in MAGI for the subsidy. I also know that it is NOT included in MAGI for the Affordability Exemption.

Whether or not he owes taxes is not the issue. It's whether or not the benefit shows up on his tax return, and is part of MAGI.

Now that we have discovered that he lives in TX, everything changed, though. His quickest route to an exemption is to file his taxes for the Medicaid Expansion state exemption. The income he stated is between 100% and 138% of FPL. So, whether it's Social Security benefit or taxable private insurance, he should be able to secure that exemption.

If it's non-taxable private insurance he can't get the Medicaid Expansion state exemption, because his MAGI is below 100% (Medicaid eligible). So then he must use the Affordability exemption.

That is why it is absolutely imperative to know if the disability benefit is Social Security, or non-taxable private or taxable private.

He needs to go to an Accountant instead of using some online service.

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Just asking, but does it matter?

He posted that he doesn't file taxes.

How's any of this going to do him any good RIGHT NOW? He's got to call in, beg for the hardship exemption and get enrolled ASAP. And find a new doc.

I agree with everything you said, but thats a 2017 issue. He's at stage 4, his tax filing and whether or not his DI is taxable is the least of his concerns.

He can get an exemption in an hour from an Accountant. It will take 60-90 days from the Marketplace. He doesn't file taxes, but there are millions of people who don't file taxes. He should go get his Medicaid Expansion State exemption or Affordability Exemption ASAP, and an Accountant can do that in an hour.

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Okay, this is nuts. I just went to my husband and asked if he could do a charity case, and file this guy's taxes for him. To the Original Poster, send me a private message with your phone number. My husband is an Accountant and he can do taxes in the state of Texas. He will ask all the right questions to find out if it's Social Security, or private, taxable or not, and take the correct exemption (Medicaid Expansion state or Affordability Exemption). Dave has been an Accountant for more than 30 years, and knows his stuff. We can get this done for you.

 

[kgmom219]

Okay, this is nuts. I just went to my husband and asked if he could do a charity case, and file this guy's taxes for him. To the Original Poster, send me a private message with your phone number. My husband is an Accountant and he can do taxes in the state of Texas. He will ask all the right questions to find out if it's Social Security, or private, taxable or not, and take the correct exemption (Medicaid Expansion state or Affordability Exemption). Dave has been an Accountant for more than 30 years, and knows his stuff. We can get this done for you.

Dave and Ann are Rockstars!

 

[FLM2]

Yes, I know that Social Security benefit can be taxable in part or whole. And I know that it's included in MAGI for the subsidy. I also know that it is NOT included in MAGI for the Affordability Exemption.

Whether or not he owes taxes is not the issue. It's whether or not the benefit shows up on his tax return, and is part of MAGI.

Now that we have discovered that he lives in TX, everything changed, though. His quickest route to an exemption is to file his taxes for the Medicaid Expansion state exemption. The income he stated is between 100% and 138% of FPL. So, whether it's Social Security benefit or taxable private insurance, he should be able to secure that exemption.

If it's non-taxable private insurance he can't get the Medicaid Expansion state exemption, because his MAGI is below 100% (Medicaid eligible). So then he must use the Affordability exemption.

That is why it is absolutely imperative to know if the disability benefit is Social Security, or non-taxable private or taxable private.

He needs to go to an Accountant instead of using some online service.

----------



He can get an exemption in an hour from an Accountant. It will take 60-90 days from the Marketplace. He doesn't file taxes, but there are millions of people who don't file taxes. He should go get his Medicaid Expansion State exemption or Affordability Exemption ASAP, and an Accountant can do that in an hour.

----------

Okay, this is nuts. I just went to my husband and asked if he could do a charity case, and file this guy's taxes for him. To the Original Poster, send me a private message with your phone number. My husband is an Accountant and he can do taxes in the state of Texas. He will ask all the right questions to find out if it's Social Security, or private, taxable or not, and take the correct exemption (Medicaid Expansion state or Affordability Exemption). Dave has been an Accountant for more than 30 years, and knows his stuff. We can get this done for you.

Ann, this is a wonderful offer, I've assumed his disability is SSDI because he mentioned he has to wait 24 months for Medicare to kick in and that is the requirement when SSDI benefits start.