OK, I am now fairly freaked out about the ACA and the insurance exchanges.

[renie408]

I just went to the Kaiser Family Foundation subsidy calculator and it is telling me that insurance through the ACA exchange for the state of North Carolina will cost me $9,615 per year or $801.25 per month for THREE members of my family. My husband and I file separately with me claiming the kids on my taxes and filing head of household. I have a declared self employment income of just under $20,000 after deductions. I run a horse boarding/training farm in upstate SC and we live just across the state line in NC. I put me, my 22 year old son who is still in college and my 17 year old daughter on there. None of us smoke.

Is this right? How do they expect me to pay $800 a month with an income of $1666 month? WTF? It says that I do not qualify for subsidies because I make 92% of the poverty level and subsidies are only for people who make 100% to 400%. So, it is basically saying that I am too poor to be subsidized? Does that make sense?

As for the actual exchange, I can't get in there. I have been trying three times a day for the past three weeks and never get to the point of actually being able to see policies.

Does anybody know if these figures that I have been given are accurate?

[okaawhatever]

1. Doesn't sound right. They don't give something to someone who makes more than you and

not to you. It may mean that you qualify for Medicare with that income, I would try increasing your income to 100% of poverty level just to see what it would be then. Add 10 to 15% to your income and see what happens. I know the numbers aren't right.

[renie408]

4. I don't qualify for Medicare in NC because if you make more than like $3 a month,

you can't get Medicare here. Seriously, you have to make some ridiculously low amount of money. And wonderful NC, now that we have Republicans running things, elected to NOT to expand Medicare.

[Mojorabbit]

44. Did your state take the money for medicaid expansion?

In Florida our legislature did not and it is leaving a section of the public out.

[renie408]

46. NC did not expand MedicAID and that is why

when I put in the lower income I expected for 2013, I got the response I did. I fully believe my income will be higher in 2014, so that should bring it above the income level to receive subsidies. EXCEPT, we file separately, which will have to change.

Jeez, they wouldn't want to make this hard, would they?

[SharonAnn]

50. It is known problem with the ACA in those states without the Medicaid expansion.

The Medicaid expansion, paid for at 100% by the Fed. gov't for three years and 90% after that, was supposed to cover people like you. But the Supreme Court decided that states could opt out and NC is apparently one of them that opted out of the Medicaid expansion. Therefore, people in that low income/poverty category do not get the subsidy and they do not get Medicaid.

It's something that I hope will be fixed, but right now it has to be fixed by the state legislature or the state governor.

I'm so sorry that the Republicans want people like you to go without health insurance.

[Ms. Toad]

63. It is not a problem with the ACA -

but with the Republican leadership in those states. There is money under the ACA to pay for 100% of the Medicaid expansion - all those states have to do is accept it.

[NMDemDist2]

2. did you run the numbers including your hubby and his income? n/t

[NYC_SKP]

3. It doesn't sound right. I would keep trying healthcare.gov during the off hours, late at night.

We have a couple frequent posters from NC, maybe PM one of them.

Hang in there.

[Warpy]

6. Unless they are counting your husband's income

as family income, which they will do if you are married and living together, the figures are wrong.

[HereSince1628]

7. You are associated with states that didn't adopt the Medicaid extension

The ACA as written was intended to cover you under Medicaid, but your state legislature wants the ACA to fail...

[enough]

34. Right. Maybe people will realize eventually how much their Republican governors are

screwing them. Like mine here in PA.

[Hoyt]

8. I bet you are eligible for sizable subsidies at that income, and family size.

When you go to Healthcare. Gov are you clicking on Apply button/link, or the Info link under it. The Info button has worked perfectly every day since it was added.

Don't panic, and good luck.

[JanMichael]

9. I used an

Asheville zip code, and plugged in your age as 44... 2 kids, 20 grand a year...and came up with 400 a year.

[bullimiami]

11. NC killed Medicaid expansion so that may well be true.

http://www.newsobserver.com/2013/10/12/3272904/without-medicaid-expansion-no.html


Without Medicaid expansion, no insurance for 500,000 in N.C.

Published: October 12, 2013


Dont blame it on the ACA. Blame it on the NC State Legislature.

[renie408]

15. I might have to fudge my income for 2014, then.

I will declare less expense on my Schedule C or something.

[renie408]

12. Ok. something is wrong with the calculator.

I put in an income of $25,000 and my out of pocket goes down to $500 a year. It makes no sense that with an income of $18,000 I would pay 53% of my income, but when it goes up $7000 a year, I pay 2% of my income.

[okaawhatever]

24. I think the problem lies with the income being below poverty level. Since the exchange

serves multiple states, it may be that when you're below the minimum threshold for subsidies they can't give an accurate number since it varies state by state.

[lumberjack_jeff]

67. I assume you live in a state which didn't expand medicaid.

The ACA was written envisioning that everyone under 133% of fpl would have the option of medicaid and that everyone under 100% would be enrolled automatically.

The supreme court invalidated that part of the ACA, so states such as yours weren't required to accept the money to expand medicare, so you are only eligible for medicare through the preexisting state rules.

The ACA calculator is asking you to estimate your 2014 income. As the law exists today (and assuming that neither your state nor the federal government tweak the laws to correct this ridiculous donut hole) If your 2014 tax return that you send in in april 2015 indicates that your income is less than 100% of fpl, you are ineligible for the ACA tax credit (subsidy).

In practice you like all of us are only taking an educated guess at your 2014 income, I don't think it's implausible or indefensible to project your income will go up 10% in 2014, and if the law doesn't change, there are perfectly legal ways to assure that your income for 2014 is high enough to qualify (by exchanging lawnmowing-for-hire services with the neighbor, for instance).

[Warren Stupidity]

13. The federal poverty level for 2013 family of 3 is 19,530.

So something is wrong in your calculation. By your reported data, you qualify for a subsidy. However I suspect that filing separately is irrelevant, your total income likely includes both of your returns, which would put you well over the fpl. Your actual subsidy depends on how far over.

When I was self employed I was paying over 1200/month. Self employed people are some of the real winners under the ACA because of the rate regulations and the exchanges, and depending on income levels, the subsidies.

Now if only the stupid ass website worked.

[renie408]

20. We don't have to pay for the house we are living in...

So, while we are pretty damn tight all the time, we are not in what I would call poverty. Also, the cars are all paid for, etc, and we have zero credit card debt. And I can squeeze a nickel until it screams.

My husband used to have a fairly successful construction business, but that tanked hard in '08. He owes back taxes from that year, the reason we started filing separately. His income is a fraction of what it was five years ago and erratic. This month he will make a decent amount. Last month...nothing. Not one job the whole month. He will go out and do anything during times like that...clean gutters, anything. But for some reason, nothing came up in September.

[okaawhatever]

28. Well, when we say poverty level, they are using percentages of poverty level &

clearly your situation is unique, but if you think you're strapped, can you imagine trying to be a single mom with two kids making 19k per year?

[notadmblnd]

21. it's down this weekend for maintenence

[VanillaRhapsody]

14. and be sure you are using Adjusted Gross Income

[Barack_America]

17. "Modified adjusted gross income"

Which includes all household income.

[VanillaRhapsody]

31. true..

[madville]

16. If you need more income

Just have one of the kids "pay" you rent and claim it on your taxes. You need like $1500 more a year, charge them $125 a month rent and claim it as income.

[madville]

25. If the system doesn't work

Make it work, what is wrong with adjusting one's income to get out of the coverage gaps? It wasn't intended to be like that, with all the states that were able to opt out of the Medicaid expansion.

It would be wrong to claim less income in order to get a subsidy but I don't see the big deal about creating more income in order to get coverage.

How about get a small part-time job to make a couple hundred more a month? There is nothing wrong with that if it helps get the income level right to obtain subsidized coverage, especially since they screwed up the way the law was supposed to work originally.

[renie408]

22. I actually low balled the income because we moved to a new farm this year and

had extra expenses with fencing, etc, that I was going to declare. I just won't declare a lot of that expense and that should bring me up above where I need to be.

[Barack_America]

30. No, no, DO declare that for 2013!

The subsidies are based on an ESTIMATE of 2014 income.

Do not short-change yourself this year.

[renie408]

33. OH! Well, problem solved...LOL

The farm we moved to actually makes more money (lower lease rate), it just cost me a boatload of money for fencing when we moved in.

I was thinking about what I would declare on my taxes in January, not what I would be making in 2014. Duh. Thanks!!

[enlightenment]

18. Check the calculator again.

I think you're reading what the total (full) cost of the annual premium is - not what you will pay.

I guessed a few things you didn't qualify (your age, your zipcode) and came up with this, which is very close to what you quoted. Note the two bolded lines. The first is before the subsidy - the second is what your would pay per year, based on your criteria:


Household income in 2014:
102% of poverty level
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
2%
Health Insurance premium in 2014 (for a silver plan, before tax credit):
$9,685 per year
You could receive a government tax credit subsidy of up to:
$9,285 per year
(which covers 96% of the overall premium)
Amount you pay for the premium:
$400 per year
(which equals 2% of your household income and covers 4% of the overall premium)

[grantcart]

23. Funny I did it with your figures and came up with free insurance

If you chose Silver you would have had to pay $ 400 but at bronze it is $ 0

http://kff.org/interactive/subsidy-calculator/

North Carolina, Zip Code 27511, income $ 20,000


http://kff.org/interactive/subsidy-calculator/#state=nc&zip=27511&income-type=dollars&income=20000&employer-coverage=0&people=3&alternate-plan-family=individual&adult-count=1&adults%5B0%5D%5Bage%5D=21&adults%5B0%5D%5Btobacco%5D=0&child-count=2&child-tobacco=0

Because your income is equal to 102% of the poverty level, you may be eligible for tax credits in the exchanges. Tax credits are only available to people with incomes between 100% and 400% of the poverty level. The information below is about subsidized exchange coverage:

Household income in 2014:102% of poverty levelMaximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:2% Health Insurance premium in 2014 (for a silver plan, before tax credit):$5,767 per year You could receive a government tax credit subsidy of up to:$5,367 per year
(which covers 93% of the overall premium) Amount you pay for the premium:$400 per year
(which equals 2% of your household income and covers 7% of the overall premium) .
Other Levels of Coverage

The premium and subsidy amounts above are based on a Silver plan. You have the option to apply the subsidy toward the purchase of other levels of coverage, such as a Gold plan (which would be more comprehensive) or a Bronze plan (which would be less comprehensive).

For example, you could enroll in a Bronze plan for about $0 per year (which is 0% of your household income). By enrolling in a Bronze plan, you would receive $4,190 in subsidies, which would cover the entire amount of your Bronze premium. For most people, the Bronze plan represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a Bronze plan, you will face higher out-of-pocket costs than if you enrolled in a Silver plan.

I did find it strange it doesn't ask your age, which would have an impact.

[renie408]

27. I actually put in $18,000 the first time and that's when it came back

as costing $9615. I think it is what somebody else mentioned, that because NC didn't expand Medicare if my income is that low I fall into the 500,000 people who will not be covered by either the ACA or Medicare. I low balled my income because we had a lot of extra expense this year that I was going to declare on my taxes. I won't do that now.

[llmart]

37. Please stop using the term "Medicare".

Medicare is for people over 65. Unless you are 65 or older you do not qualify for "Medicare".

You are thinking of "Medicaid".

And your first figure of 92% of poverty level is wrong.

[renie408]

40. I am sorry, I always get those backwards.

When I initially ran the numbers, I put in $18000 as a guesstimate of what I would declare on my taxes for this year. You will have to argue with the Kaiser Family Foundation about what percentage of poverty it is. They say 92%. I was not thinking about my income for NEXT year, which will substantially higher given that the expense from this year's move will be over.

[Barack_America]

29. Do your kids work at all? Summer jobs? If so, add in their income...

Their income counts towards determining your subsidy because the Modified Adjusted Gross Income is used.

https://www.healthcare.gov/what-income-and-household-information-do-i-provide-when-i-apply-for-marketplace-coverage/

If they don't work, maybe they could plan on doing whatever babysitting, lawn work, etc. is needed to get you guys to 100% FPL.

[enough]

32. Is the $20,000 per year your entire family income?

From what I have seen on that calculator, the cost of insurance depends on the TOTAL FAMILY INCOME, even if not everyone in the family is applying for insurance.

So, if your husband, who is not applying (because he probably has insurance through work), happens to have a high income, that will affect your premium.

You can't separate out high and low earners within one family, apparently.

[renie408]

35. I should probably check all this out more thoroughly before I try to apply.

I was thinking I would put in what I file on my 1040. We file separately with me claiming the kids.

[Barack_America]

39. You don't add your husband if he files separately.

https://www.healthcare.gov/what-income-and-household-information-do-i-provide-when-i-apply-for-marketplace-coverage/

DON’T include:

Your unmarried partner who doesn’t need health coverage and is not your dependent
Your unmarried partner’s children, if they are not your dependents
Your parents who live with you, but file their own tax return and are not your dependents
Other relatives who file their own tax return and are not your dependents

[renie408]

42. Ok, thanks!

That is a big help!

[Yo_Mama]

43. I don't think married filing separately couples get a subsidy at all

I'm looking for the IRS reg on this right now.

If the OP otherwise qualifies, then they have to file jointly for 2013 to qualify for the subsidy.

For example, this is from the Congressional Research Service:
http://www.fas.org/sgp/crs/misc/R41137.pdf

Couples married at the end of the taxable year will have to file joint returns to be eligible for the
credit.

The final regulation includes special rules relating to the calculation and allocation of
credit amounts in response to changes in filing status (e.g., taxpayers who marry or divorce
during a tax year). The final regulation acknowledges that certain circumstances may make filing
jointly a challenge (e.g., domestic abuse, abandonment, etc.); it states that the IRS will propose
additional rules to address these kinds of circumstances.

[renie408]

45. Ugh. Looks like you are correct.

So, I think this means we can file the way we have been for 2013 and will have to file jointly for 2014.

[Yo_Mama]

47. No, you would have to file jointly for 2013 to receive the 2014 tax credit, I think

If you filed jointly for 2014, I think you could claim a retroactive tax credit for 2014 premiums, but if you need the advance tax credit in order to pay for the premiums, I think you are stuck filing jointly for 2013, ASAP. That would be a question to ask the Navigators, but some of this is up in the air.

Also, if your spouse is eligible for qualifying employer insurance, you cannot get the subsidy.

Best of luck - I hope this is doable for you.

[SoCalDem]

55. Yes, that's the way I understand it too. It's about HOUSEHOLD

and "family income" is what matters, so to correctly identify it, it's joint filing for married folks.. gotta get that AGI line # whatever amount into the computation.

It's about getting insurance to people who did not qualify before, or who made too little to afford a plan offered by an employer. If the employer offers coverage that fits within the affordability model, you cannot get a subsidy from ACA, and do not qualify for it.

If there is an affordable plan offered by husband's company, that will have to be the one taken.

[Barack_America]

60. And it only has to be affordable for the husband.

Doesn't matter if everyone else is charged $1000 a month each.

Another brilliant call by the IRS.

[Barack_America]

48. Drat. Wow, the government should be setting up H&R block type offices everywhere...

...just to help people navigate this minefield.

[Yo_Mama]

49. It is complex, and we don't have a lot of time to figure it out.

There were supposed to be hardship exemptions for the filing-separately thing, but I can't find any yet. Many of these regulations were issued this year, and supposedly there are "refinements" coming.

[PoliticAverse]

57. Right, she can't get a credit unless they file jointly...

From: http://www.irs.gov/uac/The-Premium-Tax-Credit

Eligibility

In general, you may be eligible for the credit if you meet all of the following:

buy health insurance through the Marketplace;
are ineligible for coverage through an employer or government plan;
are within certain income limits;
file a joint return, if married; and
cannot be claimed as a dependent by another person

[PoliticAverse]

56. She has to add her husband to her household income. You missed this right above

the part you quoted...

When filling out your application, DO include:

Yourself
Your spouse

Household income includes her spouse's income (and to get a credit they must file jointly).

See: http://www.irs.gov/uac/The-Premium-Tax-Credit

[Barack_America]

59. No, the site states otherwise.

Estimating your income
When you apply for lower costs in the Marketplace, you’ll need to estimate your income for 2014.

You can start by adding up the following items for:

You and your spouse, if you are married and will file a joint tax return

Any dependents who make enough money to be required to file a tax return....

The marketplace website and IRS website seem to contradict each other. However, given that it was left to the IRS to make many decisions about ACA implementation, so I would go with their requirements.

[PoliticAverse]

36. Does your husband have health insurance at his job?

When you add your husband's income to yours where do you fall on the % of poverty level scale?

[Shandris]

53. Let's hope not.

If they even offer him insurance - whether he takes it or not - they're not eligible for any tax credits at all. At 104% of the poverty level, my friend, a KFC employee, can't get the tax credit for ACA because his work offers insurance (the absolute worst insurance I've ever laid eyes on, at that) here in Indiana even though the credit would take his payments from $120/month to ~$200/year for the Silver-level plan as opposed to the vaguely-Bronze conglomeration they're offering him now.

[Chellee]

58. Is the premium more than 9.5%?

If his employer offers insurance, but it isn't affordable (less than 9.5% of his income,) then he can still buy insurance on the exchange and get the subsidies.

[Barack_America]

61. 9.5% only applies to the employee. There's no cap on dependent cost.

"Affordability" doesn't extend to family coverage.

[Shandris]

68. I didn't know that subprovision...

...but I just calculated and no...it's presently 9.02%. Good thought, though, and I thank you.

[Yo_Mama]

38. I am not sure whether you can get a subsidy.

Based on income you probably can. However it gets a bit complicated with your husband and you filing separately, and then if your husband is covered through work the family is generally ineligible for subsidies.

Try to do it through the exchange and see if you get a different result.

You won't have to pay a fine, though.

You can use this new page at Healthcare.gov to see insurance plans and premiums on the exchange in your area without the registration requirement. It also provides some basic information about incomes and subsidies.
https://www.healthcare.gov/find-premium-estimates/

There is a complicating factor with the filing separately issue, about which I have read varying stories.

You could also try calling a Navigator group and see if they can give you help.

Also try ValuePenguin to find more information - some of the insurance sites have very good calculators.
http://www.valuepenguin.com/

Update:
As a married person filing separately, my understanding is that you are not allowed to get a subsidy on the exchange even if you otherwise qualify and your spouse is not covered through work:
http://www.nytimes.com/2013/10/05/your-money/estimating-income-and-other-questions-on-the-health-care-plan.html?_r=0

I've read this in several places.

Can you get your husband to file jointly for 2013?

[renie408]

41. Thank you!

I think I will go ahead and call one day next week when I have some time and talk to somebody from the government about exactly what to put on the application.

[panader0]

51. Im going to wait until the last minute to get freaked out.

I'm on Social Security, $776 a month. Luckily, no bills and Jeannie has a good job. When I first got through on the net, the premiums were out of the question, and apparently, I'm too poor for subsidies (in Az). To be honest, I think the whole thing is going to need a shake up to make the process easier,
and more universal. To be sure, I think that this chaos will eventually lead to single payer.

[Schema Thing]

52. I'm pretty sure Arizona went ahead with Medicaid expansion.

Jan Brewer is even fighting the other repugs for it, if I heard correctly.

[Lex]

54. ***Try this link*** It is much better than Kaiser.

Maybe it will give you better results. It did for me when I was trying to estimate:

http://www.valuepenguin.com/ppaca/exchanges

[Ms. Toad]

62. You do know

that if you are living with your husband that you are not eligible to file your federal tax return as head of household, right?

[The Straight Story]

64. Mine showed 353/mo. Until I did the final enroll. Showed subsidies, $0/mo

I used that calculator as well before I enrolled, and it didn't show me as having any subsidies. I ended up with a decent silver plan at no cost.

[aznativ]

65. I just used it and the Kaiser site

Heres my results for income of $75k annually, me and the wife bot 44 y/o, 2 kids no smokers, zip code 85208

myCigna Health Flex 5100
Cigna Health and Life Insurance Company
Deductible $5,100
Coinsurance 40%
Out of Pocket Maximum $6,350
More Details
Monthly Cost
$875.36
Premium: $907.15
Subsidy: $31.79
- See more at: http://www.valuepenguin.com/ppaca/exchanges/az#sthash.HYgxjpZy.dpuf

Kaiser result:

Household income in 2014:
318% of poverty level
Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:
9.5%
Health Insurance premium in 2014 (for a silver plan, before tax credit):
$7,508 per year
You could receive a government tax credit subsidy of up to:
$383 per year
(which covers 5% of the overall premium)
Amount you pay for the premium:
$7,125 per year
(which equals 9.5% of your household income and covers 95% of the overall premium)

This one comes with a $12700 deductible btw.



Either case is much more than I pay now. I have no idea what I will actually get on the exchange as I still cannot get a legit quote. Ill have to quit my job to find time to do this.

The company I work for is dropping ins coverage because of the increased costs. There was lots of stuff they didnt cover, but it was stuff we didnt want anyway. Now my premium is doubling and the deductible is quadruple.

Hope the real thing is cheaper.

[dairydog91]

66. A suggestion.

I have a declared self employment income of just under $20,000 after deductions.

This isn't legal advice, but I believe that whether or not you can get a subsidy is determined by Modified AGI, not your taxable income. In other words, when you calculate your taxable income you might very well be using more deductions than you'd use when you calculate your modified AGI. Your "income" for purposes of getting the subsidy may be higher (For example, you might deduct the standard deduction in order to calculate your taxable income, but you would not do so in order to calculate your Modified AGI).

Look here for where I'm getting this.

[aznativ]

69. I'm not going to get any subsidies

The income I listed is the final income I am taxed on per my tax return....all deductions for mortgage interest, IRA / 401K contributions, tuition etc have been made. I don't get a subsidy or if I do, it is miniscule.

I dont need a subsidy, I just want to keep my current insurance which will not be happening.

I use my insurance all the time due to my health- or lack thereof. This new Obabmacare will destroy me with the deductible, or it would appear that will happen.

[BluegrassStateBlues]

70. The information I got from Kaiser compared to the official exchange...

Was way, way, way off the mark.

[Drew Richards]

71. Unfortunately nc screws the poor and middle class but...in your case you would need a ton

Of details and a good financial planner to see if there some other avenues of subsidies you can collect...the web sites cannot do that only an expert can.

I use www.valuepenguine.com to check basic calculations.