What Would You Have Done?

[cadylou]

I had a 28 year old today who is the son of one of my Medicare clients. I agreed to help him & when he was asked what he made, he told me $10000/yr. I told him, that's not enough to get the APTC.

He asked about that & I explained that we didn't do the Medicaid expansion in MO or KS and he'd have to meet the bottom threshold to qualify. He told me then - just say I make $12000.

At that point, I told him that I couldn't assist. He got upset. I explained that since I don't know him & this is federal money, I can't commit fraud.

His dad then called me & said he works for him (the guy is a doctor). I explained that the son never told me that - so how was I to know. Dad also said that son has income from investments that he didn't tell me about. I said ok - if you can vouch for that - I will help him.

The son didn't want to go forward - he was pissed. The father tried to get him to go through an agent (they like me), and I heard the kid say he'd just do it himself. It told his father - no problem, no worries - if the kid wants to go out there & do everything on his own I'm fine with that.

I felt bad about the whole incident, but explained to the father that when I asked the question & he so casually said "make my income this" - I felt uncomfortable and couldn't participate.

What would you have done?

 

[RayNY]

I just use a fact finder before I have a consult, and never would have seen him in the first place.

Name, contact info, estimated income for 2016, current coverage details, doctors/hospitals that are important to them.

When I saw $10k, I would have just told him "You don't need my help, you only qualify for medicaid, here's how you contact the exchange to enroll".

 

[FLM2]

Just explain the rules and tell him that the amount that is on the application is his number, not yours, end of story.

If the Marketplace asks for proof and he doesn't provide it the coverage will end.

 

[AllenChicago]

Just explain the rules and tell him that the amount that is on the application is his number, not yours, end of story.

If the Marketplace asks for proof and he doesn't provide it the coverage will end.

Exactly right. After explaining the APTC thresholds, showing how it affects the premium, and advising that proof may be needed in the future, I enter whatever income they tell me.

Like Ray, I do some fact-finding ahead of time. If Medicaid-eligible, I give the phone number and state website URL. They're on their own at that point.

 

[TN_agent]

I think in your case, I would have asked him how he intended to pick up the other $2000. Does he have any other income, etc. 10,000 is pretty close to 12,000. He would have said "I work for my dad, he can increase my hours".

Stating that he was asking you to commit fraud and that "you don't know him" was probably not the right way to frame it to him. In his mind, when he said "just put 12,000" he may have been thinking "my dad will increase my hours to get me to that, no problem", not "let's commit fraud on this federal application and lie about my income". Possibly he is a fraudulent liar, possibly he is someone confident in his ability to earn money.

This is all a guessing game anyway. None of us know exactly how much we are going to make next year. I could get hit by a bus tomorrow and be out of work for 6 months and my income could drop. Or I could hit the motherload of hot leads and double my income.

 

[houcoogster]

You said 12,000 right? That was $12,000 per year right?????????

 

[DS4]

I don't "ask" how much money they make, I have them fax or email me a copy of their last tax return.
Don't want to send me the tax return, click.
Next.

 

[houcoogster]

I don't "ask" how much money they make, I have them fax or email me a copy of their last tax return.
Don't want to send me the tax return, click.
Next.

That does tell you what they are currently making it could be a lot more or a lot less.

 

[Duaine]

Tell him that you don't look good in Orange:

 

[TN_agent]

I don't "ask" how much money they make, I have them fax or email me a copy of their last tax return.
Don't want to send me the tax return, click.
Next.

So you use 2014 income of 25,000 for a household of two..... and they proceed to tell you that even though they told you 25,000 wages on their 2015 app, they will be taking a 13,000 rental loss for the house that they usually break even on each year.... but this year didn't have renters for since the previous tenant trashed it and they had repairs. And if they can get renters in there in 2016 their income will be back up to around 25,000... but they don't know if they will... and every month without a renter is a loss of $800 how do they project that???

I tell them to talk to their accountant! But what do they do for insurance in the meanwhile?? Subsidy eligible in 2014, not subsidy eligible based on 2015.... but they might be in 2016.... subsidy will probably be yanked in 2016 once they file 2015 taxes even though they could have a renter by then and would be eligible in 2016...and then they would lose coverage and be fined if they didn't have the coverage that would cost $600 a month without subsidy that they are eligible for that Uncle Sam just yanked....