The marketplace has taken away the subsidy given to me, the only one in my household with an ACA plan, because they claimed to not get the required paperwork/uploads they requested. The thing is: they DID get those things. three times over. Multiple uploads to the website, twice physical paper copies sent to the KY address. Because of these false claims and/or technical issues on THEIR end, I am facing a $275 increase in my premium. I filed an appeal, they sent me a letter detailing what they needed and when it was needed by, I provided everything I could -did you know, it is nearly impossible to prove you’ve had no income at all? Its a nightmare. All the forms they request do not exist for me. What do I do? They don’t care.- paper and form-wise for myself and my father whom I am a dependent of, sent registered mail with tracking and I KNOW They received the envelope! USPS tracking said so, I saved the record of it too!
The thing is, I’ve heard nothing since. Not a word. This all started March 16th. They already took my subsidy away immediately for April, and now May and now I owe my insurance company $857 to keep my coverage going. I’ve only had it since January 2015! I was so happy to get help to break the cycle of “not healthy enough to work, can’t earn to get insurance, can’t get healthy without insurance” but it’s turned into a complete nightmare right in the middle of it.
In Summary: How long do appeals take? What do you do to prove you have no income of your own and thus do not HAVE the forms they request? Do I have to get a lawyer to prove to them that I had no income last year?
You can appeal any HealthCare.Gov or state Marketplace decision in regards to coverage or cost. Typically the process will take 90 days at most.
You can appeal the following kinds of Marketplace decisions:
- Whether you’re eligible to buy a Marketplace plan
- Whether you can enroll in a Marketplace plan outside the regular open enrollment period
- Whether you’re eligible for lower costs based on your income
- The amount of savings you’re eligible for
- Whether you’re eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
- Whether you are eligible for an exemption from the individual responsibility requirement
Proving you have no income is tricky, as you'll lack most required documents. But since you need a household income, perhaps you have some documents from last year showing you had no income (were you claimed on someone else's taxes?)
You Can Prove Income With the Following Documents
- Tax return
- Wages and tax statement (W-2)
- Pay stub
- Letter from employer
- Cost of living adjustment letter and other benefit verification notices
- Lease agreement
- Copy of a check paid to the household member
- Investment fund statement
- Document or letter from Social Security Administration (SSA)
- Form SSA 1099 Social Security benefits statement
- Court records for alimony and records of agency through which alimony is paid
- Legal documents that establish amount and frequency of alimony
- Self-employment ledger
- Letter from government agency for unemployment benefits
- Document or letter from Social Security Administration
- Proof of tribal income
- Military Leave and Earnings Statement
- Proof of gambling winnings
- Bank statement
- Agricultural income certificate
- Financial Aid transcript form for current semester/school year
If you are in the process of an appeal and are not getting a satisfactory answer (such as in your case) you should stay in contact and continue to collect the paperwork to prove your side of things (like the USPS tracking info and delivery confirmations when you do your part).
Marketplace cost assistance is based on household income, so if your household income is between 100% and 400% of the Federal Poverty Level you should be getting assistance. This is true even if you have no personal income as so long as you are claimed under the tax return of someone who did. If you simply have no taxable household income then Medicaid would be the only option and Marketplace cost assistance wouldn't be.
Tax credits are offered in advance, but you still retain the right to claim them at full at the end of the year for the months you maintain your Marketplace plan. So the end result of all this should be you able to claim the assistance you deserve when you file taxes. The problem is then having to pay the full amount for coverage while this is all sorted out.
We don't have solutions for all the problems laid out here, but here are a few things to double check:
- Make sure you don't have affordable coverage through another families members employer (that could make you ineligible for cost assistance).
- Make sure your household income for this year will be in the 100% - 400% FPL range (if it's more or less you could end up not being eligible for cost assistance when you claim your taxes).
Lastly, you can request an expedited appeal.
"You can file a request for an expedited (faster) appeal if the time needed for the standard appeal process would jeopardize your life or your ability to attain, maintain, or regain maximum function.
Your request to expedite your appeal should specifically explain how a standard appeal would jeopardize your life or your ability to attain, maintain, or regain maximum function.
Your request to expedite your appeal will be processed as quickly as possible. A final decision must be made as quickly as your situation requires." - Learn more from HealthCare.Gov