ObamaCare Heads-Up – What Should You Be Watching?

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Obamacare Eligibility

Now that the Open Enrollment Period for 2014 has ended, about 7,000,000 people have enrolled in the Affordable Care Act (ACA) also called ObamaCare. If you enrolled, your involvement may not be done yet. Remember, people had the opportunity to enroll on or off the exchange. “Off the exchange” means that person enrolled directly with an insurance company (with or without agent assistance). (Note: off-exchange enrollment follows the same enrollment rules and time periods as on-exchange enrollment) Enrolling off-exchange, the enrollee would not receive tax credits, also called subsidies. On-exchange means the enrollee had enrolled through the governmental site, with or without an agent or navigator, where that person may have been eligible for tax credits (subsidies) and possibly cost sharing. So, the question becomes – if a person has an on-exchange plan, what do they need to monitor and report to the exchange?

First, income is one of the key factors for eligibility of a person for subsidies. If income rises a person may lose their eligibility for a subsidy. This subsidy (also called a tax credit) will be reconciled when a person files their taxes. If income decreases: a person, and/or children, may actually be eligible for Medicaid. If that becomes the case, the person would lose their eligibility for subsidies and may possibly be asked for repayment of the tax credits they have already received when they file their taxes.

During the calendar year, a person should notify the exchange:

  • if their income is different than projected: increases or decreases
  • income change could be the result of becoming eligible for Social Security payments
  • if they add or lose a dependent
  • if a dependent turns age 19 and was covered by Allkids
  • if they move out of a service area
  • if they marry or divorce
  • change jobs which affects income or group insurance eligibility.
  • gain eligibility for group insurance (with includes the mandated minimum benefits)
  • lose eligibility for employee sponsored group coverage
  • if a dependent turns age 26
  • if a person goes onto Medicare
  • if taxable money is unexpectedly taken out of an investment account

The aforementioned changes are considered Qualifying Life Changing Events. Be sure to notify the exchange for any of these. The 2015 Open Enrollment Period will be 11/15/2014 – 2/15/2015.

If you enrolled in a 2014 on-exchange ACA plan it is most important to view your “Eligibility Results” now. Go to www.healthcare.gov and then tab “Eligibility and Appeals” on left side of page for your eligibility and any additional information you must send to CMS (the exchange). You may send information by scanning and uploading files or by US mail. (by US mail, this writer would probably send certified).

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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