Marketplace Payment

Open enrollment has come to an end – January 15th was the final day to enroll for coverage for 2022. Remember, that you do need to make your payment by January 31st. It is important to make your first Marketplace payment to ensure that your insurance will go into effect. February 1st will then be your first day of coverage.

What happens if you chose a plan, and on reflection, have decided that you don’t like it? Unless you have a special enrollment circumstance during the year, you cannot switch plans. You can cancel it, which I strongly don’t encourage because you need some kind of coverage. But if you have a job change, family size, change in marital status, or you had coverage through a spouse and now you no longer have coverage, those all count as special events that allow you another 60 day time period to sign up for healthcare. So that’s a plus, and if you’re unsure, you can always check with me on the details. I can go through the questions with you and make sure everything makes sense.

Another thing that I want people to realize is that throughout the year, you can adjust your income as reported to the Marketplace. Why is this important? Because when you signed up for coverage, we put your expected gross income for 2022 into the Marketplace. If you’ve had a major increase in salary or decrease in salary, we need to adjust that because that could affect your subsidy. You cannot change your coverage, necessarily, but it will affect your subsidy. And why do I bring this up? Because I actually saved someone last week from owing the IRS $5,000!

In short, a couple wanted to change the way that they were insured. The wife has insurance from her employer, and the husband was a private PPO. They did not want to put the husband on his wife’s employer plan as it was very expensive. They were recommended to contact an agent who could get them “super cheap insurance”. But, she filled out the application incorrectly. Thankfully they called me,  to ask me a question about some other things. And I started asking questions and I looked at the Marketplace, was able to pull in the application. Not only did they incorrectly state, the income, but they also put it all to the spouse and did not appropriate it correctly between the wife and spouse. They marked that the husband who was getting the Marketplace plan was not eligible for employer-sponsored health care. He is eligible for employer-sponsored health care through his wife, he chose not to take it. So if the person who had enrolled them had gone through all the questions and asked them all the questions, they would have realized their mistake.

The problem with this mistake is that when you go to do your taxes in 2023, and the IRS finds out you had employer-sponsored health care, guess what you’re going to owe all that subsidy back. I did the math in this case, and it was $5,000 plus interest. Plus potentially a penalty if they put that in place. $5,000.

So this is one thing I tell people to make sure you know who you’re dealing with.

“I got a friend.” Well, who’s the friend, and how much did they know about health insurance?

You know, it’s okay for new agents to do this. There’s a system in place to prevent you from making a mistake.

If you’re unsure if the right subsidy was put in place for your Marketplace Payment, please make an appointment on my calendar, I’m happy to look at it. I can pull your application in, make sure it’s all correct. We can make corrections to the income if we need to. We do want the information to be correct.

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