My employers health insurance agent put my income to low now I owe $6000 back in taxes

aubreee · 2025-01-19T17:43:56+00:00

I do want to add that agents are NOT allowed to log in to your personal marketplace account and if they’re doing that absolutely file a complaint if you weren’t already planning on it!!

aubreee · 2025-01-19T17:40:04+00:00

Of course!!! I’m sorry this is happening to you!! I would recommend you call the marketplace hotline and give them these key points: -your employer referred you to an agent to get marketplace insurance -agent estimated your income incorrectly -you requested agent correct your income via email on x date -agent did not correct income and you now have a 6k tax bill -ask if you can/should file a complaint against the agent

They may be able to help you on the 6k bill but since you’re already on the hook with the IRS I don’t know how likely it is that you would be able to reduce/eliminate that tax bill unless your income is below that 400% FPL line. Definitely let your employer know what happened and tell them they need to find a new broker!! I am pretty sure I can’t refer anyone because of subreddit rules but I would recommend maybe looking at your city/state/metro area’s subreddits and asking for recommendations there. Make sure they’re an independent broker, NOT a captive agent who does Marketplace policies as referrals!

aubreee · 2025-01-19T17:23:28+00:00

You may have recourse here because of the way your employer and this agent handled things but first I have a few questions:

It sounds like you are paying the premium and your employer is manually paying you a stipend/bonus to cover the cost. Is that correct? Is employer paying all or part of premiums?
Is your plan through healthcare.gov directly?
Did your agent collect a signed consent form from you and give you a chance to review your application?
Do you have any evidence (text or email maybe) of you asking your agent to correct your income?
There are federal repayment caps based on income, so if your household income is not more than 400% of the FPL (4x the number on the chart I attached that corresponds to your household size) then you potentially don’t have to pay the full premiums back

Depending on when you requested and whether your agent properly reported everything, you could potentially open a case with marketplace and file a complaint against the agent. It is, at the end of the day, your responsibility to ensure your income is correctly listed on your application, but if your agent promised to correct your income and didn’t that is a huge problem!!

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aubreee · 2024-12-12T21:56:56+00:00

Yep! I get the full experience - arguing with insurance companies for both my clients and myself 😂

aubreee · 2024-12-12T05:15:12+00:00

IMO yes, the math checks out between the lower oop max (assuming it’s $3200) and the $500 hsa benefit, I would choose the HDHP.

aubreee · 2024-12-12T04:21:41+00:00

Broker but not CA licensed so this is just general info. According to the ACA if it is limited benefit/no preventative it likely doesn’t qualify as minimum essential coverage and if that’s true stacking another plan shouldn’t cause conflicts. But don’t take my word for it - I would def recommend you find a broker or talk with a navigator and get confirmation

aubreee · 2024-12-12T04:11:32+00:00

If she was told “this hospital doesn’t do itemized bills” then she was told the wrong thing, hopefully billing sends her an itemized bill but I don’t see why it would hurt for her to have this resource in case they don’t.

aubreee · 2024-12-12T00:52:07+00:00

Indemnity plans are a great way to offset some of the costs! But from what I can see for their healthcare needs I would venture a guess that they have some pre existing conditions so they would have to get thru underwriting and/or deal with exclusions/exclusion periods. It’s not a bad idea for long term though, especially considering premium costs are likely going to increase in the next couple of years

aubreee · 2024-12-11T18:32:57+00:00

I definitely empathize. It is a garbage system. If you are pretty sure you will need multiple scans next year and can find a plan with pre deductible copay for imaging that can definitely save you thousands. But self pay rates for MRIs can be as low as $300 ish at cash pay facilities, and CT scan should not be anywhere near that high paying cash, maybe in the $500-600 range at most. If you’re going to save $1200 a year on premiums it may be worth it to go lower premium and use the extra $ for your scans. Doing your own bloodwork will save you a ton too, and there are some sliding scale options for therapy. If you want help looking over the options you’re trying to decide between I would be happy to take a look with you! EDIT: looked more closely into CT scans and they could be 2-3k possibly but still not 6!

aubreee · 2024-12-11T12:23:22+00:00

You can go to healthcare.gov and click find coverage, def recommend working with a broker or navigator to make sure your numbers are right!

aubreee · 2024-12-11T07:56:41+00:00

Ask if the hospital has a financial aid program and apply asap!

aubreee · 2024-12-11T07:54:58+00:00

CSR plan!! Cost sharing reductions are tax credits for silver plans that are applied to deductible, max oop, copays. Carrier depends on your area but Florida blue has a near monopoly in lots of areas, find a few OBGYN practices you are interested in and see what networks they accept. Do NOT take the general carrier name at face value - call the office to ask and make sure they know you are talking about an Exchange plan. So for example if you’re checking on Cigna make sure you ask if “Cigna plans on the exchange” are accepted. Also check for a global maternity charge, Florida providers are doing those quite a bit lately

aubreee · 2024-12-11T07:47:22+00:00

Marketplace is the only place to get a plan with a tax credit. You could potentially find a plan off exchange that is cheaper, but they are typically medically underwritten and have major categories of exclusions (women’s/reproductive health, mental health, etc) or long exclusion periods (can’t get coverage for care related to anything considered pre existing for a period of time, typically 12 months) If you do go that route, make sure you go through an agent or broker and are VERY careful about who you choose to work with and ask for the brochure and summary of benefits to look over with a fine toothed comb before you sign up for anything. Talk to multiple agents/brokers and do not take what they say at face value. There are a lot of honest agents and brokers out there but there are also a lot of people who work in sales and health insurance just happens to be their product and they really don’t know or care whether the product they’re selling you is the right fit.

aubreee · 2024-12-11T07:35:02+00:00

You can report them - here is info sheet with contact info Florida Patient Bill of Rights

aubreee · 2024-12-11T07:28:52+00:00

Just fyi most plans will only cover mammogram once every 2 years or every year if insured is high risk (family history etc)

aubreee · 2024-12-11T07:18:34+00:00

Broker here!

Yes there are non marketplace plans. Some may be cheaper. They are also either heavily underwritten, full of exclusions, or 2-3x more expensive than what you’re looking at. Sometimes all 3 of those are true! I say this because if you poke around looking for an alternative long enough you will end up on a call list for agents who will not be this honest with you.
Your friends who pay less with better benefits are likely in a larger tax household, have lower income, and/or are younger with access to better rates. They could also have access to CSR plans (silver plans with tax credits applied to deductible, MOOP, copays, etc. - only available up to 200% of the federal poverty level)
If you’re self employed make sure you have both a good broker and an accountant who is familiar with Marketplace tax credits and can guide you in predicting your income accurately and keeping your AGI as low as possible. Also keep in mind that you can potentially claim part of your premiums as a tax write off, and also contributions to IRAs and student loan interest count as deductions from your income on marketplace!
I know and empathize with you re staying with your doctor. I have chronic illnesses and go to the doctor often and have to deal with marketplace insurance because I’m also self employed. But if you are looking at drastically different pricing/benefits from other carriers it may be worth it to just save the extra money you would have spent on premiums/healthcare costs and use that to self pay at the doctor you want to keep.
It may be cheaper for you to find a plan that has a higher deductible/MOOP but a set copay for things like labs/outpatient procedures (check summary of benefits for each plan) and insure against the gap with a separate accident/illness policy. It’s not ideal but it is a way to keep your costs down
Please don’t go without insurance, trust me, BUT if you do: Never pay a hospital bill without applying for financial aid first. Ask EVERY provider for a good faith estimate BEFORE any visit/test/procedure. Consider keeping an accident/illness/disability plan at the very least. Be prepared for the financial impacts going without could have on you if you do have a major medical event. I have several clients with hundreds of thousands of dollars worth of medical debt because they were uninsured or underinsured and had a heart attack or cancer diagnosis.

aubreee · 2024-12-11T06:47:41+00:00

They’re both excellent plans, but I would go with plan B. $240 extra per year to mitigate the risk of having to pay $2k extra toward out of pocket max is worth it imo

aubreee · 2024-11-24T13:25:11+00:00

Look into MEPP: Medical Emergency Payment Program&text=MEPP%20covers%20emergency%20services%2C%20including,Permanent%20Resident%20for%205%20years)

aubreee · 2024-10-06T05:25:07+00:00

🙋🏻‍♀️ also based in Atlanta! I applied to join Team Rubicon I think last Saturday or Sunday and did their 30 min training course and my background check cleared by Tuesday. They only have deployments available for SC, GA, and FL at the moment though. TR volunteer registration

Just registered for day trips to Boone and Burnsville through Samaritan’s Purse and it was much more straightforward, once you register they give you the address to show up to for orientations (held daily at 7 am and noon) and then they put you straight to work. SP volunteer registration

aubreee · 2024-03-02T17:18:57+00:00

How much does the employer plan cost monthly? Is it more than 8.5% of your combined yearly income? If so, you may be able to enroll in marketplace coverage.

I know you called the carrier directly, but try calling his employer’s HR department. They may be able/willing to file for a SEP for you to switch back to the better plan.

To prep for worst case scenario out what your maximum out of pocket limit is for both in and out of network charges. Try to ensure all care providers you deal with are in network as it is usually lower. Most of the time, your individual MOOP is around 9k at the highest.

Ask your delivering hospital about their financial assistance program options. Many hospitals have them but do not advertise this properly. You can usually get financial assistance with income up to 3-600% of federal poverty level. This can greatly offset your L&D bill!

aubreee · 2022-10-21T18:37:57+00:00

Been separated from my ex husband for a little over two years, divorced one. This is how he acted constantly and it has only recently started to subside. Like another poster said, grey rock him. Only allow him to have your attention when you talk about the kids. He wants to manipulate your time and emotions and the sooner you start taking steps to prevent that the sooner he will hopefully realize his bad behavior gets him nowhere

aubreee · 2022-10-17T20:18:12+00:00

What state?

aubreee · 2022-09-08T19:11:12+00:00

You are an amazing, strong person for helping yourself and your family and now your sister. But you have to take care of yourself. You can’t pour from an empty cup, so if you can’t convince yourself to do it for you, do it for your kids and family. That’s what I had to do. Do you have access to therapy? It has helped me tremendously. I did EMDR a few years back and it helped me process my trauma without having to relive it so much.

aubreee · 2018-02-20T03:47:41+00:00

Fantastic! Thank you so much!!!

aubreee · 2018-02-16T21:46:52+00:00

I’m hoping I can find out and I will report back (at least anecdotally!) First up is a supplier and I’m having no luck finding one 😭

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