By Steven Buttice, Founder and President, Living By Your Design, Inc.
Is the letter you received from the Healthcare Marketplace important? It seems complicated and unnecessary that ACA would ask for income verification when the IRS should already have that information, so many people ignore this letter. How will that work out for them?
Last month, this article coordinated with two radio programs on the weekly radio show “Healthy You,” hosted by Kim Brooks-Miller of Healthy Cells Magazine®. The episodes discussed the benefits and some of the potential problems with Obamacare (ACA—Affordable Care Act). We will now follow up by addressing subsidies, Medicaid, and areas where people may run into confusion and problems.
The Healthcare Marketplace sends out letters when they do not have enough information or if that information is conflicting with their records. If you changed jobs, got a raise, or got a second job last year, you may get a letter from the Healthcare Marketplace. In most cases, you must reply and provide them the requested information within 90 days or be prepared to lose any subsidy or tax credits you are receiving. This process is not forgiving, and the letter should be answered as soon as possible.
Remember, a subsidy is an advanced tax credit to assist you in paying part of your health insurance premium. Since subsidies are based on income, if you do not answer the Healthcare Marketplace requests, ACA may end your subsidy and ask for any advanced tax credits given to be paid back in the form of a returned tax return. Note: for those with employer-supplied group insurance, feel lucky: you do not need to go through this process.
There are a number of circumstances where people can find themselves in tough situations. If they get a raise or a bonus this year, the adjusted income they projected may be low. In this case, they could have their subsidy reduced or lose it completely. This could raise ACA premiums by hundreds of dollars each month. A person may lose a job or not make as much income as projected. This could totally remove the qualification for the subsidy, push a person into Medicaid, and require the payment back of any ACA subsidy paid toward their health insurance. That could mean losing your tax return money at the end of the year.
To complicate matters, most insurance companies are no longer paying insurance agents for their knowledge and advice in assisting people to enroll in ACA plans. Therefore, agents may need to be less involved in this process or charge a consulting fee to assist people. Navigators and the Healthcare Marketplace government employees are not to give advice—they only help process your wishes. Remember, everyone with individual health insurance has an open enrollment period between November 1 and February 1 each year. Most insurance transactions are done in this 90-day window. Therefore, does the government hire seasonal employees during the open enrollment period (and perhaps some are better trained than others), or does ACA employ all of these people year-round and know they will have nine months of idle time and much less work available?
Qualifications for Medicaid were increased under ACA from 100 percent of the Federal Poverty Level (FPL) in Illinois to 138 percent.
Therefore, Illinois shifted thousands of people to Medicaid coverage. The logical question is: how is that being paid for? The only answer is to better manage medical care. That means setting people up with primary care physicians (PCPs). The key is to guide people toward their PCP for non-emergency situations and away from emergency rooms for primary care. In addition, medical testing and procedures can be better managed, which will mean less waste. This is a huge change in philosophy for some people from the way they are receiving care now. There is no doubt that there are huge challenges ahead.
For more information, contact Living By Your Design, Inc. Living by Your Design focuses on the issues of the elderly: legal, financial, free guidance for residential placement, and healthcare issues. Call: 309-285-8088. Website: www.LivingByYourDesignInc.com. Location: 809 W. Detweiller Dr. in Peoria. To hear the podcasts of Steve’s radio show on “Healthy You,” go to www.healthycellsmagazine.com/Peoria.
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