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Does the government actually check if you qualify for Obamacare subsidies?

T

Tommy2000GT

Golden Member
Obamacare only cares about if the employer offers affordable health insurance plans to employees and not their families (which is a bunch of BS, search for family glitch. Thanks Donald Trump for working on repealing this fiasco)

Say if your employer offers a health insurance that affordable for you but not affordable for the family. The individual plan is less than 9.66% of your income but the family plan is more like 30% to 50% of your income.

Just because the fact that your employer offers you the family plan, even if it's ridiculously high, that disqualifies you for the subsidies. If you still sign up and claim employer coverage is not affordable, will the government actually check?
 
I'm pretty sure that they check. Actually what happens is that the government charges the employer a $3,000 penalty (or whatever it's indexed to now) for any of their employees who goes out there in the exchange and gets a federal subsidy because the employer care is unaffordable. So there's a lot of incentive for both your employer and the government to make sure that this whole process is working properly.
 
The goal was for you to get insurance from your employer and your family from their employer.

I am no expert, but a quick search shows that you file form 8965 with the IRS and claim an exemption from the requirement for having health insurance. The IRS will respond with what you can and can not do. https://www.irs.gov/uac/am-i-eligib...e-an-individual-shared-responsibility-payment They have a Q/A help on that website (click "Begin") that just takes a few minutes to find out what to do.

Then you can either not buy insurance, or you can use the marketplace to get immediate subsidies, or you can buy any insurance you want and get the subsidies when you file your taxes. The subsidies are checked when you file your tax return the next year. Yes, the IRS may legally go after you if you lied and are not qualified for the subsidies that you claimed (but generally you just pay it back when you file your taxes).
 
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zinfamous said:
What employer family plan is costing you 30% to 50% of your income?

I gotta see this.
Click to expand...

My employer covers 90% for employees. For dependents they are like 25%. Even at 90% coverage for employees, apparently it's hurting the company because the rates have gone through the roof.
 
yuchai said:
I'm pretty sure that they check. Actually what happens is that the government charges the employer a $3,000 penalty (or whatever it's indexed to now) for any of their employees who goes out there in the exchange and gets a federal subsidy because the employer care is unaffordable. So there's a lot of incentive for both your employer and the government to make sure that this whole process is working properly.
Click to expand...

My employer talked about not offering coverage for all employees when our plan expires in April. They feel it will save a bunch of money for themselves and also for employees with the penalty applied.
 
zinfamous said:
What employer family plan is costing you 30% to 50% of your income?

I gotta see this.
Click to expand...

I wouldn't be shocked too much if it was true.
When I started my current job, outside of the principal owners, I was the only employee that would be taking family insurance (lots of young employees). When I got the insurance numbers I laughed at them and pointed out that my plan would literally cost me 1 paycheck per month. They never even looked at the numbers but once I pointed it out to them, they went back to the plate and adjusted it for me.

That's 10 years ago. Nowadays, they offer great coverage for single people and families but employee+spouse is still through the roof...
 
dullard said:
The goal was for you to get insurance from your employer and your family from their employer.

I am no expert, but a quick search shows that you file form 8965 with the IRS and claim an exemption from the requirement for having health insurance. The IRS will respond with what you can and can not do. https://www.irs.gov/uac/am-i-eligib...e-an-individual-shared-responsibility-payment They have a Q/A help on that website (click "Begin") that just takes a few minutes to find out what to do.

Then you can either not buy insurance, or you can use the marketplace to get immediate subsidies, or you can buy any insurance you want and get the subsidies when you file your taxes. The subsidies are checked when you file your tax return the next year. Yes, the IRS may legally go after you if you lied and are not qualified for the subsidies that you claimed (but generally you just pay it back when you file your taxes).
Click to expand...

That form is only for exemption in penalties or reduction in penalties if you don't have health insurance for the tax year. It does nothing for the subsidies.

Right now I pay $1200 per month for the family plan. I was told by my employer it's projected to increase by 50% and I should look to get coverage for my family separately elsewhere.

I checked the CoveredCA website and I would be paying like $550/mo for the sliver family plan with myself included after $750 subsidy.

It does not make sense what my company and I are paying right now. But due the "family glitch", we get screwed.
 
Tommy2000GT said:
My employer talked about not offering coverage for all employees when our plan expires in April. They feel it will save a bunch of money for themselves and also for employees with the penalty applied.
Click to expand...

If they don't offer anything, they pay a penalty of $2,000 (indexed) for each employee. Here's a flow chart that helps understand all of this from an employer's perspective.
http://kff.org/infographic/employer-responsibility-under-the-affordable-care-act/

While it's likely cheaper for them to pay the penalty versus offering coverage, it's going to be a big take away for most employees (think the single employees with the 90% subsidy right now with a high enough income that won't qualify them for subsidies in the exchange anyway). One thing they can do is to re-allocate some of the money to another area of compensation, but because there's favorable tax treatment for providing health coverage for employers, it's usually not a good deal to do that either.

If both employers & employees can "win" as they claimed by doing this, you'd have seen a lot more companies that already did this. The rules are defined in a way that strongly encourages employers to keep offering the coverage.
 
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Homerboy said:
I wouldn't be shocked too much if it was true.
When I started my current job, outside of the principal owners, I was the only employee that would be taking family insurance (lots of young employees). When I got the insurance numbers I laughed at them and pointed out that my plan would literally cost me 1 paycheck per month. They never even looked at the numbers but once I pointed it out to them, they went back to the plate and adjusted it for me.

That's 10 years ago. Nowadays, they offer great coverage for single people and families but employee+spouse is still through the roof...
Click to expand...

It was $20/mo for employees and $50 for families a few years ago. When Obamacare came into law, it made the rates jump so much and it's still going up a lot year to year.

Obamacare took care of poor individuals with what they offer. But they screwed the middle class with families.
 
Tommy2000GT said:
It does not make sense what my company and I are paying right now. But due the "family glitch", we get screwed.
Click to expand...
$1200/month was fairly typical pricing for family insurance before Obamacare, and it is still fairly typical after it. So, yes, it does make sense.

You are supposed to get individual insurance through your employer. Your wife through hers. Your kids through individual insurance or through your wife's insurance whichever works best for you. If that is unaffordable, then bargin with your employers or file the form I linked above and skip coverage without penalty.
 
Tommy2000GT said:
It was $20/mo for employees and $50 for families a few years ago. When Obamacare came into law, it made the rates jump so much and it's still going up a lot year to year.

Obamacare took care of poor individuals with what they offer. But they screwed the middle class with families.
Click to expand...
Pricing before and after has barely budged for families (between $10k and $20k year before and after). Your employer may have chosen to cover less of the costs, but that has nothing to do with Obamacare.
 
Tommy2000GT said:
It was $20/mo for employees and $50 for families a few years ago. When Obamacare came into law, it made the rates jump so much and it's still going up a lot year to year.

Obamacare took care of poor individuals with what they offer. But they screwed the middle class with families.
Click to expand...

I'm not talking about the ACA at all. Notice where I said "That's 10 years ago"
 
Tommy2000GT said:
It was $20/mo for employees and $50 for families a few years ago. When Obamacare came into law, it made the rates jump so much and it's still going up a lot year to year.

Obamacare took care of poor individuals with what they offer. But they screwed the middle class with families.
Click to expand...
That's interesting, I had family plan from 2007-2012, and when Obamacare was implemented, my rates stopped going up.
 
Tommy2000GT said:
That form is only for exemption in penalties or reduction in penalties if you don't have health insurance for the tax year. It does nothing for the subsidies.
Click to expand...
To see if you qualify for the subsidies when you file your taxes (you pay in full during the year and get your subsidy when you file taxes), go here:
https://apps.irs.gov/app/IPAR/investigate/IPAR_1/en-US/Attribute~ACAPTC_interview_complete~global~global/qs$s2@TLC_ACAPTC_Development_Screens_ACAPTCLanding_xint$global$global?user=guest

I guessed the answers (based on what you posted here) and I think you qualify. But I don't know your income, nor number of children, nor the state you live in. So, it is possible that you do not qualify.
 
At tax time, they do.

And you can back-owe claimed subsidies if your income rises above certain thresholds.

It's really not much, in the below $30k income range it can get out of whack fast if you suddenly make more money with a new job or something.

Its really quite alot of paper work for not alot of money.

It is a tax-time nightmare for hairdressers, waiters, etc. You'd think they're doing taxes on day trading.
 
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