Need an ACA Pros Opinion....

[just some f.e.llow]

So, health insurance isn't my wheelhouse at all, but I have an FE client wanting insight. I said I'd try.

She's 60, with no income. Lives with her 22 year old daughter, who makes 12,000 a year. Easily medicaid eligible here in Ohio.

Here's the problem: they don't want to be "those people" who get government health care for free.

To counteract this, my only idea is that they could overestimate their income above the medicaid threshold. Then, they get a subsidy for on exchange health coverage.

Here's the question: at the end of the year, when they file taxes, it'll show they didn't reach the income threshold they reported, and should have been covered under state medicaid. What happens? Are they going to have to return the total subsidy amount they received during the year, since they technically "didn't qualify" for subsidies (gawd, it would be about $8,000)? Is is it no big deal?

Thanks in advance for any insights, ladies and gentlemen!

 

[Yagents]

She doesn't want a free handout, but taking $8000 is ok? Medicaid would be cheaper to the taxpayers. Claiming false higher income is illegal. In legal situation, no claw back in given scenario

 

[just some f.e.llow]

She doesn't want a free handout, but taking $8000 is ok? Medicaid would be cheaper to the taxpayers. Claiming false higher income is illegal. In legal situation, no claw back in given scenario

Agreed, an odd and arbitrary line they are choosing to draw.
Thanks man!

 

[Lakshmi]

"those people"?...a subsidy is a government "freebie" so to speak. So, they are still "those people".

What's the big difference really if they pay $240 or whatever small amount a year for a subsidized health plan, or nothing a year for Medicaid?

I know what you meant, but smh. I don't really get the logic sometimes. Just sayin...

 

[Yagents]

Other option is to pay full price for off exchange plan

 

[TXINSURANCE]

So, health insurance isn't my wheelhouse at all, but I have an FE client wanting insight. I said I'd try.

She's 60, with no income. Lives with her 22 year old daughter, who makes 12,000 a year. Easily medicaid eligible here in Ohio.

Here's the problem: they don't want to be "those people" who get government health care for free.

To counteract this, my only idea is that they could overestimate their income above the medicaid threshold. Then, they get a subsidy for on exchange health coverage.

Here's the question: at the end of the year, when they file taxes, it'll show they didn't reach the income threshold they reported, and should have been covered under state medicaid. What happens? Are they going to have to return the total subsidy amount they received during the year, since they technically "didn't qualify" for subsidies (gawd, it would be about $8,000)? Is is it no big deal?

Thanks in advance for any insights, ladies and gentlemen!

Wrong

First that's illegal.

Second they will want you to prove the income.

Third that's insane to even consider such a thing as a licensed agent. I.e. breaking the law.

Fourth this is not a valid prospect. Run. Don't walk. Run away.

 

[just some f.e.llow]

Wrong

First that's illegal.

Second they will want you to prove the income.

Third that's insane to even consider such a thing as a licensed agent. I.e. breaking the law.

Fourth this is not a valid prospect. Run. Don't walk. Run away.

I appreciate your candor.
Again, it's not a prospect. It's a current client looking for advice. Nobody is "considering" anything. This is a question. Needing advice.
Additionally, healthcare.gov states that when income is listed that is greater than the previous years reported income, it is auto approved, they do not ask for further documentation or proof of income, so that's not correct either.
Just wanted advice from someone who's dealt with this before.
Thanks again.

 

[TXINSURANCE]

I appreciate your candor.
Again, it's not a prospect. It's a current client looking for advice. Nobody is "considering" anything. This is a question. Needing advice.
Additionally, healthcare.gov states that when income is listed that is greater than the previous years reported income, it is auto approved, they do not ask for further documentation or proof of income, so that's not correct either.
Just wanted advice from someone who's dealt with this before.
Thanks again.

They will ask for proof of income within 90 days or they will lose subsidy in over 70% of cases. And then when the taxman cometh that's another unknown situation.

Jeeze take medicaid. Enjoy the great program I pay for.

 

[just some f.e.llow]

Jeeze take medicaid. Enjoy the great program I pay for.

Hehehe. I agree totally!!

 

[sales_Wolf]

I can understand where they are coming from. However in a situation were Medicaid is expanded its a provision that they need to take that option if available. If they were in another state were Medicaid is not expanded then the no claw back provision is in place for that type of scenario. When the client can prove their decline for Medicaid and you put there income on the APP higher than expected. That would stick, But not in expansion states.