What happens when ACA applicant OVERSTATES income?

[wehotex]

I receive referrals from a doctor's office that gives me patients who are already on ACA we th subsidy. These ACAs don't pay for much. What I find is that these people have overstated incomes, some with practically $0 income due to loss of job.

My understanding is that min income of about $13k/yr is required in Texas. It seems like somebody is lying for them to get the coverage?
What are the tax consequences when this person files their taxes?

 

[Yagents]

Yup, its a scam that many agents do.

I've never heard of a $0 income person having to pay back tax credits. Also, their is max threshold clawback levels for low income.

What Happens if You Overestimate Your ACA Subsidy? - HealthCare.com

 

[Yagents]

I receive referrals from a doctor's office that gives me patients who are already on ACA we th subsidy. These ACAs don't pay for much. What I find is that these people have overstated incomes, some with practically $0 income due to loss of job.

My understanding is that min income of about $13k/yr is required in Texas. It seems like somebody is lying for them to get the coverage?
What are the tax consequences when this person files their taxes?

Besides W2 income, they may have other income that qualifies for aca magi, like social security or rental income or iRA $

Modified Adjusted Gross Income under the Affordable Care Act - UPDATED WITH INFORMATION FOR COVID-19 POLICIES - UC Berkeley Labor Center

 

[Helpico_Insure]

I receive referrals from a doctor's office that gives me patients who are already on ACA we th subsidy. These ACAs don't pay for much. What I find is that these people have overstated incomes, some with practically $0 income due to loss of job.

My understanding is that min income of about $13k/yr is required in Texas. It seems like somebody is lying for them to get the coverage?
What are the tax consequences when this person files their taxes?

Depends in what state they are and also depends strongly on their personal situation. There isn't such thing they don't belong anywhere because of their income. They belong to a specific group for their health insurance needs.
1. Ask many questions about their income: unemployment, passive income, income from another country, etc. incomes. Use MAGI for help. They should be able to prove income. Are they dependent to someone else? Then use their income. You should identify the taxpaying body behind them (the family)
2. How the state they live in treats people with very low income? Is there Medicaid?
3. Ask about their immigration status. GC holders who are less than 5 years here and have low income, but not $0 for sure, they can't take Medicaid, so they stay with the Marketplace even they might have lower then min income.

You should ask many questions and see the last tax filing. People lie and they even don't know why.

And I'll say again: everybody belongs somewhere when it comes to health insurance. This is the good Obama did with this law.

 

[yorkriver1]

States with "Expansion" Medicaid are easy to fix, although no commission, but doing the right thing is important. Up to about 136% of FPL qualifies.
Often there are free clinics for non expansion residents and hospitals have a policy of paying bills for under 200% of FPL, not great but something.
I hated to tell people they didn't qualify for tax credits with income below 100% FPL before my state got expansion. Once the Covid emergency is over, some will have income for ACA, and have to requalify for where they fit.