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I have great news!  My friend was able to enroll in a very good health insurance plan  through the ACA federal exchange this afternoon!
Her income is only $1321/month. Last Saturday when we tried to sign-up, after finishing the application we went to see how much her subsidies would be, and the estimate came back showing that she was not eligible for subsidies.  Hence, I posted the first of this diary on daily kos last Saturday asking for help (thanks everyone). Turns out the reason her subsidy was coming out ZERO was that in the application they ask you if you will be filing a tax return in 2014, and she checked "no".  She checked "no" because her income is all from non-taxable Social Security.  However, apparently, to qualify for subsidies you have to file with the IRS; this must be the only way they can verify you income.  Anyway, so today, we went through the application process again, and checked "yes" for filing a tax return in 2014. (She checked with her tax person and she is DEFINITELY filing a tax return for 2014)  And viola! Instead of her paying starting Jan 1, 2014 $1100/month (keep in mind her SS income is only$1321) for her current insurance premium, plus a $1000 deductible, with her new insurance on the ACA exchange, her premium with a high-level Silver plan is $0 with $0 deductible!!  Keep in mind too that she has a lot of serious, pre-existing health problems.  She and I both started crying and jumping up and down!!  Thank you God!  And thank you PBO!!

Her co-pays for specialist dr  are $25, regular dr $5.  Prescriptions are $5, $30.
Maximum out-of-pocket is $1500/year.

She is so happy she can hardly believe it!!

ACA is definitely a good, good thing and we need to keep spreading the good news!

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Comment Preferences

  •  Happy news. Congratulations. And a rebuttal to (25+ / 0-)

    some of the nattering nabobs of negatism on DailyKos about the ACA (esp. computer glitches).

  •  Awesome. I'll add her to the Signups chart! (21+ / 0-)

    Well, actually, she probably won't show up until the January HHS report; the December one will likely only run through the end of November...

    http://acasignups.net/

  •  that's great news (12+ / 0-)

    it just goes to show that when something doesn't seem right that persistence pays.  

  •  Keep spreading this good news on FB and Twitter (6+ / 0-)

    The more the word spreads, the more people will be willing to sign up and enroll.

  •  Soooo happy for her ! (3+ / 0-)
    Recommended by:
    Lujane, Radiowalla, Aunt Pat

    Is anybody keeping tabs on the diaries relating to ACA, what people are getting/not getting, costs, etc?

    It would be interesting to have a graphic of some kind.

    I must be dreaming...

    by murphy on Tue Dec 10, 2013 at 08:31:01 PM PST

  •  I am very glad for her (4+ / 0-)
    Recommended by:
    liberte, Lorikeet, ybruti, Aunt Pat

    but she is very, very, close to falling off into Medicaid territory - and that's if MO expanded Medicaid.  If they haven't (and I've lost track of who has and who hasn't) she needs to pay close attention to these figures:

    1) Her SS income (and any projected - usually tiny - increases) in it for 2015.

    2) What the Federal Poverty Level will be set at for 2015.

    It is imperative for her (assuming no expansion of Medicad in MO by then) that she have an income of at least equal to 133% of the FPL for 2015.

    By the Third quarter of the year these figures start to be published.

    Now if MO expands Medicaid, she may or may not be pleased to have it.  It will be even cheaper but there are some issues around it, as well.

    And if MO expands Medicaid, she will need to have  an even slightly higher higher income (138% of the FPL) to stay in subsidized coverage territory because for the purposes of caclulating Medicad eligibility 5% of the income is "disregarded".  The disregard was established to protect people from losing all benefits over tiny amounts of extra income, but in the current instance it can wind up snaring people who are just barely over the line 133% - and want to stay there.

    The 133% of FPL for 2014 for one person is $15,282.  Her income (that you reported in your diary) is $15, 852. So she's good for now. If MO expands Medicaid, she will need an income of at least one dollar more than $15,856 and maybe a bit more to cover the expect expansion of the FPL every year.  If Medicaid is expanded she will have no other choice if her income falls below the 138% of the FPL.  So it would be worth her while, if she is able, to try to work out a way to add a couple of hundred dollar cushion in her income this year.  If she'd prefer to use Medicaid, if the expansion happens, then she could simply resign whatever little side job she has worked out and use that, but if she'd prefer private insurance on the Exchange then she needs to meet the income guidelines  to keep her options open.

    But tonight congratulations are in order.  I hope she truly enjoys a sense of well-deserved security and freedom from anxiety over health care costs.  Everyone should feel the same, and we must not stop demanding that until it is so.

    Araguato

  •  interesting changes in media narrative (5+ / 0-)

    thanks for posting!

    Has anybody noticed the deafening silence from the media over the past week or so regarding ACA?  It went from "doom-n-gloom/failed website/Obama in trouble" narrative to .... all quiet.  

    It seems they can't quite bring themselves to trumpet the good news.... but their silence speaks volumes.

    Let's make the MSM have no choice but to report on the continuing rise in ACA success stories!

    The world is a dangerous place to live; not because of the people who are evil, but because of the people who don't do anything about it. - Albert Einstein

    by ERdoc in PA on Tue Dec 10, 2013 at 10:35:07 PM PST

  •  The health insurance subsidy is not entirely (0+ / 0-)

    eleemosynary. Much like the Earned Income Credit, one of the objectives is to get people filing reports with the IRS, so the system can more effectively track what is going on.

    You'll recall that Brack Obama suggested during the first campaign that individuals getting less income than $25,000 would be freed from filing any returns at all. That proposal disappeared, for a good reason. If some entities are exempt from filing, then it is not possible to get an accurate picture of what is going on in the economy. It's for that reason that the exemption non-profits used to enjoy (no reports required, if the annual income and expense was less than $25,000) was actually rescinded (a Bush initiative, I believe) and now all non-profits have to send in returns, if they want to keep their non-profit tax-exempt status. In the case of the non-profits it is also likely that a considerable number will be found to have been prevaricating about their actual receipts. If they didn't file reports, how could the IRS determine whether their claim to be poor was valid?

    That said, let me suggest that requiring the information is entirely justified. If people want to do good works without being tracked, let them do it without using money. But, if people use money and rely on our currency to validate their activities, then they have an obligation to comply with the terms of use. It's the same principle that applies to electronic communications. If people don't want to be tracked or held to account for what they say, let them rely on face to face communications in their personal and secret locations. One can enjoy privacy in a public venue, but expecting it is a bridge too far.

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Wed Dec 11, 2013 at 04:40:38 AM PST

    •  This is not correct information. (0+ / 0-)

      I just checked the 2013 instructions for IRS Form 990, and the current exemption is $50,000 of income, up from $25,000 rather than eliminated. That is, charitable organizations with less than $50,000 of income (and less than $500,000 in assets at the end of the year) do not have to file an informational return with the IRS. There are a number of other exemptions, including religious organizations.

      So while your point about encouraging individuals to file tax returns and report all their income may be true for the ACA, the charitable organization example doesn't support that. (And people who now are working under the table and not filing returns may decide to keep doing that, so they fly under the radar of the individual mandate penalties.)

  •  Were you able to do the successful application (0+ / 0-)

    without the help of a navigator or a telephone consultant at healthcare.gov?

    The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

    by ybruti on Wed Dec 11, 2013 at 05:32:53 AM PST

    •  After we received the letter for her subsidies (0+ / 0-)

      we were going to go back later to study the different plans.  But the navigator was really interested (in Missouri they are called Certified Application Counselor Organizer) in seeing her completely enroll, so we stayed with her until we were completely finished!  It took over 3 hours to complete because the site would get over burdened (I am assuming because we were notified to come back) and kick us out.

      Do you know any thing about the millions (4 million I have heard) that had to switch plans because their current plan did not adhere to the requirements of the ACA?  I wonder also what % were able to go ahead and keep their current plan, if they wanted to,  for another year?

      •  I only know about California's concern for these (0+ / 0-)

        people, about 900,000.  They've set up a special call center just for them.

        The team is made up of 25 Service Center representatives getting customized training to handle questions from this specific group of enrollees. While 32 million Californians will keep their existing plans and another 4 million uninsured will get coverage beginning next year, it’s projected that about 900,000 Californians will be moved off policies that are discontinuing as of Dec. 31, 2013, because the plans don’t meet the minimum benefits of the Affordable Care Act.

        Of those, about 310,000 policyholders are expected to get premium assistance with their new plans. Another 590,000 may not be subsidy-eligible but could see comparable rates or slight increases in costs. A remaining small number of consumers could see premiums rise but will have options to buy lower-cost metal-tier or minimum coverage plans, or use tax planning strategies to reduce costs....

        Many of the questions received by this unit may require input or support from the health plan to address consumers’ detailed questions. Covered California representatives will be able to transfer consumers directly to health plan staff, or they can work with consumers on a three-way call.

        Representatives are trained to speak with consumers to understand their situation, educate consumers about the Affordable Care Act and their options, calculate consumers’ eligibility for premium assistance or an affordability exemption, remind consumers of deadlines for getting insurance so there are no gaps in coverage and transfer consumers to health plan staff or arrange for a three-way call.

        Covered California is also supplying information on helping these consumers to thousands of in-person assisters, including Certified Insurance Agents, Certified Enrollment Counselors and county eligibility workers.
        http://coveredcanews.blogspot.com/...

        In most other states, but not Minnesota or Washington, people are able to keep their policies for another year, as Obama requested, but the California board voted unanimously (5-0) not to allow non-compliant policies unless they were "grandfathered".

        The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

        by ybruti on Sat Dec 14, 2013 at 02:50:34 PM PST

        [ Parent ]

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