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<p>Your subsidy is based on your income next year, so if there is any chance your income might be qualifying next year, buy on the exchange. If you bought an exchange plan, and then it turns out your 2014 income qualified for a subsidy, you get it retroactively on your tax return. But if you buy off-exchange, you don’t get a tax refund even if your income turned out to be subsidy-eligible.</p>
<p>COBRA grace is tied into the employer.</p>
<p>The subsidy is a tax credit. People who are fairly sure about next year’s income can get the subsidy as an advance tax credit-- that is, the subsidy is paid to the insurance company each month. People like you who are uncertain about next year’s income can get the subsidy as a tax refund.</p>
<p>You’re good, dstark. Always.</p>
<p>We couldn’t use 2012 income, nor 2013, so we projected 2014. I only had trouble, initially, projecting for my kids, since I couldn’t name an employer for D2, who graduates in June. I backed it out, flagged her as a student and added the $ somewhere else and was fine. YMMV. </p>
<p>You can google ACA and tax credit (aim for accurate info- healthcare.gov or explanations after Oct 1.) Also, it’s MAGI, not AGI. If actual exceeds the prediction (ie, you calculated for a higher subsidy than the final numbers would merit,) there is an adjustment. If you overestimated, also a adjustment. So yes, should wash out - BUT, that’s in 2015, when you file 2014 taxes. Also, you can call back in, during the calendar year and review- if, say, it looks like the you will earn more or less than you predicted.</p>
<p>The exchange will send some sort of form for use with your tax filing.</p>
<p>You can choose a subsidy or to wait for a tax credit, if you buy through the exchange.</p>
<p>Cobra offered me the same grace as BCBS- December’s bill is due 12/1 but you must pay by 12/31. My car insurance also has a grace (which I was told, years ago, is law-?) I don’t see why this is looping this discussion- if you rack up charges in a grace period and don’t pay, in most cases, they will come after you, per laws. </p>
<p>I don’t understand why some are looking for an endless stream of this sort of What Ifs. I can speculate.</p>
<p>It’s different because the providers are on the hook instead of the insurers. It’s also a longer grace period. The providers will be providing services to people they think are insured but aren’t, and will have to eat the cost. The insurers will know if the patients are behind on the premiums, but will the providers? During your auto insurance grace period, does the body shop have to eat the repair costs or the insurer?</p>
<p>Seems like the grace period is ripe for a legislative fix, especially if it becomes an issue in practice.</p>
<p>Not to mention that they can come back for more in the following year after using up grace period.</p>
<p>It doesn’t hurt to look for “an endless stream of WhatIfs” as complex as the law is, costing a lot, affecting everyone. If any of them has a merit, we can have a fix before it happens. An open discourse should be allowed without being subject to ridicules. If you are sound on your reasonings and have intellectual capacity, you wouldn’t be too quick to resort to cute comments. :)</p>
<p>**Moderator’s Note</p>
<p>This is not a thread to fix, improve, change, update, modify, or nullify ACA. </p>
<p>There are a lot of fixes that may be made. This thread is not for that discussion. **</p>
<p>The venting What Ifs distract us from sharing info and some advice. When they apply to a poster, we can do some good. Calmom ran us through her own What If’s re the tax credit. The situation for dstark’s son has What Ifs. Romani had some questions and a real life example of expenses. We learn from those and others. Maybe we can offer insights. That’s good.</p>
<p>To Coralbrook:</p>
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<p>The question is whether you will qualify in 2014. Not based on 2012 income, but based on 2104. You can sign up (and I think that you SHOULD sign up) via the exchange, unless you are on a grandfathered policy. Even if you don’t qualify for the advance subsidy payments, if your income comes up short in 2014, you’ll get the same money back in the form of a tax refund when you file in 2015. </p>
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<p>Not sure what you mean by “direct” insurance – either on or off Exchange you still are making payments directly to the insurance company, and are receiving a policy from them. The exchange simply facilitates the flow of the subsidy money. </p>
<p>I don’t think that in your situation that you can be sure of the ability to drop your existing insurance and enroll via the exchange outside an open enrollment period. A situation such as loss of a job can be the sort of changed circumstances that would allow someone to do it, but for you – it sounds like fluctuating income is business as usual.</p>
<p>If you forego the exchange this year, however, you will be able to buy on the exchange for 2015 during the next open enrollment period in 2014. That may make sense if you already know that you will have a short-term increase in income for 2014.</p>
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<p>You can analyze your own income however you want. Covered California asks you what you are currently making – probably because they need to screen for Medi-Cal based on current, not future, income. But you can fill in the online form with whatever information you fell is most appropriate. </p>
<p>Unless they have changed the site since I enrolled, Covered California asked the amount of earnings for the previous month. Obviously for someone who is self-employed with a fluctuating income, I think that is not going to work – so you have to adjust your numbers accordingly. </p>
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<p>To determine if you qualify for an advance subsidy, Covered California verifies the numbers you provide against numbers from your 2012 tax return. If you apply online, this is automated – Covered Cal transmits the figures to an IRS computer, which returns with a response that verifies whether the numbers are reasonably consistent, probably within 10% up or down. If the numbers verify, you are approved for a subsidy if appropriate; if not, Covered California will ask you for further documentation of income. </p>
<p>If the income you report is too high to qualify for a subsidy, it doesn’t matter – you can go ahead and enroll via Covered California to pay full price for a premium. If you have already checked policies and know what you want, I think there is a way to bypass the step of entering financial information if you check a box saying that you aren’t asking for the advance subsidy. </p>
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<p>Either way – your choice, if you qualify. </p>
<p>If you are unsure of 2014 income but have the funds available to pay full cost for insurance, I’d advise you apply via Covered Cal, waive the subsidy for now, and take whatever you are entitled to in the form of a tax refund next year.</p>
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<p>According to this, maybe you could. </p>
<p>On pg.14 of the link calmom posted in October with the regs/comments/responses </p>
<p><a href=“http://www.gpo.gov/fdsys/pkg/FR-2013-02-27/pdf/2013-04335.pdf[/url]”>http://www.gpo.gov/fdsys/pkg/FR-2013-02-27/pdf/2013-04335.pdf</a> </p>
<p>I found one of the “qualifying events” to trigger enrollment outside of the open enrollment period to be “an individual becoming newly eligible or newly ineligible for advance payments of the premium tax credit or experiencing a change in eligibility for cost-sharing reductions.” </p>
<p>That would be your situation.</p>
<p>Covered California reportedly getting swamped with enrollees:</p>
<p>[State</a> health exchange swamped with enrollees - latimes.com](<a href=“State health exchange swamped with enrollees”>State health exchange swamped with enrollees)</p>
<p>The call centers got more than 17,000 calls in one hour Wednesday, and they’ve got a 25,000 paper applications they haven’t even processed yet. Evidently a lot of people in California want coverage, which is good news for the solvency of the exchange plans. Bad news for people waiting in queues though.</p>
<p>The Whatif’s about a particular applications to an individual are useful – “what if” somebody figures out a way to cheat the system, is (I think) inappropriate and distracting. Cheaters and frauds will figure out a way no matter what the system – I justs read that a bunch of Russian embassy employees have been committing Medicaid fraud in New York, but that doesn’t mean we shut down Medicaid.</p>
<p>On a legal end of things, I’d argue that if a subsidized, insured person failed to pay premiums for 3 months, their insurance expiration would have to be at least pro-rated to account for the money the insurance company received from the government as a subsidy – so the grace period problem may not be as significant as thought. That is, if the premium costs $400 per month, and the government is paying $200 – then at the end of 3 months, the insurance company for the non-payer will have received $600 toward $1200 in premiums. That’s worth 45 days of coverage, so the insurer should still be on the hooks for those payments. (But the non-payer should be subject to clawback provisions at tax time).</p>
<p>I’d also note that I think that insurance companies currently pay on claims on a faster cycle than 90 days – so providers who submit claims promptly are likely to get paid even if the subscriber has fallen behind on payment. </p>
<p>Down the line, there will be more data to determine whether this is a trivial vs. significant problems. By “trivial” I mean there will be evidence as to whether or not this causes a significant loss that is any different from what providers and insurers already experience. If it turns out that this sort of problem leads to an average shortfall of 2% of claims that will be very different than if it is connected to a shortfall of 8%. </p>
<p>But I’d add that insurers not paying has historically been a problem before ACA. A few years ago my daughter got pre-authorization for a medical procedure covered on her college policy, but when it came time to pay, the insurance company balked, with all sorts of excuses. My d. was studying abroad at the time, so I ended up working to deal with it, and the insurance company was devious and lying to me about procedure codes - after several months I finally go the college benefits administrator involved, and he was able to work it out-- but the college changed its policy to a different company the following year. So I had small taste of the games insurers sometimes play about coverage. (Under ACA, there would be no question at all of coverage in that particular situation – so right there, the preventive care and essential benefits provisions give providers greater assurance of payment in many areas.)</p>
<p>The other game that insurers used to pay was to refuse payment on grounds that a given service or procedure was related to an excluded “pre-existing condition” – or by rescinding the insurance policy altogether on grounds that the the insured had failed to disclose a pre-existing condition when the policy was purchased, even if the policy has been in effect for many years. And of course, health care providers never had any way of knowing if a patient was about to use up the maximum benefits allotted under the policy. </p>
<p>So I think that when you look at the big picture, the impact of the new protections probably outweigh the issues that may arise at the fringes of the system. I also think that its far more likely that the nonpayers will be people who have run into financial problems that may allow them to be shifted to Medicaid, at least in the expansion states.</p>
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<p>Yeah, definitely - -I noted load problems with the web site this week, and for the first time ever I couldn’t get through by phone. (Usually in the past I would call, get a message that there was a long wait time, but hang on to the line anyway and get the call answered within 3 or 4 minutes - earlier this week I think I was probably on hold at least 45 minutes before I gave up).</p>
<p>California has opened a new call center, but I’d argue that being swamped by people wanting to sign up is a good sign. Better than a bunch of call center employees sitting on their hands, and nobody signing up.</p>
<p>I’ve seen more advertising for Covered California, including banner ads on this page.</p>
<p>This is interesting, and may be bad or good: people who have tried to sign up on the websites are not giving up. Pollsters reportedly can’t find people who wanted to sign up, got annoyed by all the problems, and stopped trying. </p>
<p>[It?s</a> hard to sign up for Obamacare. It?s much worse to be uninsured.](<a href=“http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/05/its-hard-to-sign-up-for-obamacare-its-much-worse-to-be-uninsured/]It?s”>http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/05/its-hard-to-sign-up-for-obamacare-its-much-worse-to-be-uninsured/)</p>
<p>This may signal that there is a pent-up demand, or only that there is a pent-up demand among people who are likely to make claims.</p>
<p>^Even small pieces of seemingly good news are welcome. Mostly, I’m taking a wait and see attitude. The priority was to wade through it and make our decision. I’ll be looking for the 1st quarter feedback. </p>
<p>Does it sound like the woman having the verification issue may need the “romani maneuver” - ie, just set up a new account?</p>
<p>The woman with the verification problem should definitely try the romani maneuver. For people who are having trouble, first they should try just removing their application, using the button that appears after they log in. If they reapply and still don’t succeed, or if they didn’t get as far as the application, they should just do a romani and start a brand new account.</p>
<p>I’ve participated in online discussions with people in verification hell. Some of them will say, I uploaded my documents and I’m still waiting, and then others will chime in with, Stop waiting and start a new account. The people who do try to start a new account seemingly always succeed, at least as far as I’ve seen.</p>
<p>Speaking of… Hanna, did you ever get through? (I think it was Hanna that was going to make a new account… I’m not looking through a few hundred pages to find out lol)</p>
<p>Also, I’m flattered to have something named after me. <em>beams with pride</em> 
LOL</p>