Prosthetic Coverage Under Obamacare
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Prosthetics are covered on most ACA plans, but replacements and adjustments aren’t considered an “essential health benefit”, thus services can be limited.
Questions
Are Tax Credits Annual or Monthly?
Tax credits are based on annual income, not monthly income. This doesn’t do much to help people between jobs when income is low, but it’s important to understand to avoid repayments of tax credits. Repayment limits are based on annual household income too.
Can I File Separate From Family If We Got Tax Credits?
Tax credits are based on household income, anyone in the tax family can join a family plan (coverage family) and share tax credits. The problem here is that everyone is filing separately, but sharing a family plan.
How Do I Claim Ineligible For Medicaid Exemption?
To claim the exemption for being ineligible for Medicaid write code “G” in column “C” of the 8965 – health care exemptions form. You don’t need to apply for the exemption to the Marketplace with the rejection letter if you live in a state that rejected Medicaid (although you can do this to get a ECN and qualify for special enrollment).
Is the Marketplace Granting Exceptions?
Between there Marketplace and IRS there are over 20 different exemptions from the fee, some trigger special enrollment, others short exemptions, some full year.
Why Not Adopt a TRICARE model Rather Than ACA?
TRICARE is government run healthcare, the benefits being a lack of middlemen. ACA is quasi-private (private insurers and public subsidies) plus expanding public Medicaid.
How Are Only 0.2% of Businesses Affected By the Mandate?
5.8 million of 6 million firms have over 50 employees. Only 0.2% of small business who have over 50 don’t already provide coverage (or about 10 thousand firms).
Will Medicaid Take My Estate?
Medicaid will use estate recovery and liens to recover certain Medicaid benefits for individuals 55 or older, this only applies to Medicaid.
If I’m Not Eligible For Medicare Can I Use the Marketplace?
If you don’t have access to Medicare then you can use the Marketplace and get cost assistance as a US citizen.
Can I Get Covered Until I Find a Job?
The Marketplace offers coverage to those without employer coverage, when you get a job that offers coverage you can simply switch to the employer plan.
I Need Special Medical Treatment, Will I be Covered?
All necessary treatments are covered under all major medical insurances up to an allowed amount. Number of treatments may be limited and are subject to cost sharing.
How to Average Hours over 12 Months For ACA?
An employer can use a standard initial measurement period of between 3 and 12 months to determine full-time status for the employer mandate.
Why Did Social Security Payments Reduce Tax Credits?
Social Security benefits count toward household income or the purposes of tax credits, so if you claim more SS tax credits go down, claim less and they go up.
Why Is ObamaCare So Expensive For Low Income?
Many states rejected expanding Medicaid. This means those with low incomes are priced out of Marketplace cost assistance, but make too much for Medicaid.
Do I Have to Take Secondary Health Insurance?
If you have two options for health insurance through two employers, you can take one and reject the other, or can take both and use one as a secondary plan.
What Are Disability Requirements for MAGI?
Social Security Disability payments count as income for MAGI. Medicaid doesn’t count this income, but the Marketplace cost assistance does.
Why Did My Insurance Premium Go Up?
Your rates didn’t go up because of legislation directly increasing premiums, some who had lower rates before saw rates go up as a response to new protections
Can An Employer Only Offer Coverage to Some Employees?
As a small business if you offer group coverage to one full-time employee you must offer to all, same with part-time. Employers have to offer group coverage and not just reimburse individual coverage to get the tax benefits.
Can Care or Claims Be Refused Until Bill Is Paid?
Private care providers can refuse non-emergency care, public hospitals can’t. Insurers can refuse to pay claims after 30 days of non-payment of premiums.
Can I Get Supplemental Medicaid Coverage?
Medicaid is different in every state and region, some regions have better coverage and networks. Typically there is no supplemental Medicaid coverage
Can I Keep my Health Insurance if I Move?
When you move whether or not you keep your coverage depends upon your plan type and if you have more than one residence.
How Do Exemptions Work When Moving Back to US?
When you move back to the US use the 330 day presence test to claim an exemption the 12 months before you move back, then use special enrollment to make sure you are enrolled in a plan
Can My Employer Reimburse Individual Coverage?
Typically under the ACA an employer must offer a group health plan instead of reimbursing individual coverage.
Why Do I Have to Pay Back ObamaCare Subsidies?
If you projected a higher annual household income then you claimed, you may owe tax credits you received in advance up to the repayment limit for your income when you file 8962 at tax time.
TN Visa Health Insurance and Penalty?
Typically on a VISA you can’t get cost assistance, but can get minimum essential coverage (typically through work). If you file taxes in the US you’ll need to have coverage, or pay the fee for each month you don’t have coverage, or get an exemption.