Questions on Health Care Exemptions. Need Help!

[MBSC]

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.

The Medicaid expansion state exemption applies to all income levels below 138% FPL, including below 100% FPL. You enter exemption code 'G' in Part III of IRS Form 8965.

In non-expansion states, being below 100% FPL does not automatically create Medicaid eligibility.

 

[Ann H]

The Medicaid expansion state exemption applies to all income levels below 138% FPL, including below 100% FPL. You enter exemption code 'G' in Part III of IRS Form 8965.

In non-expansion states, being below 100% FPL does not automatically create Medicaid eligibility.

Thank you for that information. If that is so, then getting an exemption for him should be relatively easy.

----------

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.

You may be correct. He did mention Medicare in 24 months, so it's likely that his disability benefit is Social Security.

----------

Sullivan86, if you will get me your contact information we can help you file the tax return and get the exemption. Don't be afraid that you will owe taxes. If your income is only the disability, then you can file your tax return and get the exemption even if your tax liability is $0.

 

[TN_agent]

The OP really needs to talk to MD Anderson about which exemptions they will accept, it may not be a blanket "get an exemption, any exemption" and we will pay tens of thousands of dollars for your treatment on the house.

There is a program similar to his in TN that I know of that requires exemptions, but will not accept some of the exemptions that are only reported on taxes. They would not accept the one AnnH is describing because MAGI is over 100% of FPL and he is subsidy eligible in TX. Their reasoning is that we aren't going to dedicate our limited resources to treating you for free when you can get affordable coverage with low premium and OOP max. You may not be able to go to our hospital, but you can see someone else for very little money in the grand scheme of things and we are saving our 50,000 treatment for the person who really is caught in the ACA Medicaid loophole.
Or, you opted into a Medi-share program that won't pay for whatever treatment you want to get for free from us, but you could have signed up for heavily subsidized ACA compliant plans that would have paid us for it. Etc.

That is the way some of the programs are starting to be.

OP, I don't mean to be heartless, I have sympathy for your situation and hope that md Anderson will take that exemption.

Kudos to everyone for being helpful to the OP.

 

[Ann H]

That is very valuable information, TN_Agent. Thanks.