So, You Received a Letter About Your ACA Health Insurance

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ACA Compliance

Is the letter 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 “Healthy You” discussing the benefits and some of the potential problems with Obamacare (ACA).  In May, this article addresses subsidies, Medicaid and areas where this writer sees people running into confusion and problems.

The Marketplace sends out letters when they do not have enough information or if that information is conflicting with their records.  So, if you changed jobs, got a raise or get a second job last year, you may get a letter from the 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 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 and if you do not answer the 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 situations 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 (advanced tax credit), push a person into Medicaid and require the payment back of any ACA subsidy paid toward their health insurance.  So, 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 enroll into ACA plans.  Therefore, agents may need to be less involved in this process or charge a consulting fee to assist people. Navigators and Marketplace government employees are not to give advice, only help process your wishes.  Remember, everyone with individual health insurance has an open enrollment period between 11/1 and 2/1 each year.  Most insurance transactions are done in this 90 day window.   Therefore, does the government hire “seasonal” employees from 11/1 -2/1 and perhaps some are better trained than others; or does ACA employee all of these people year around and know they will have 9 months of much less work available and idle  time?

Qualifications for Medicaid were increased under ACA from 100% of the Federal Poverty Level” (FPL) in Illinois to 138%.  Therefore, Illinois shifted thousands of people to Medicaid coverage.  The logical question is: how is that being paid for?  The only answer, in this writer’s option, is to better manage medical care.  That means setting up people with primary care doctors (PCPs).  Guiding people toward their PCP for non-emergency situations and away from emergency rooms for primary care.  In addition medical testing and procedures can be more managed which will mean less waste.  This is a huge change in the philosophy of some people from the way they are receiving care now.  There is no doubt, there are huge challenges ahead.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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