HomeArticleObamacareShould I OVERestimate my income to qualify for an ACA subsidy?

Should I OVERestimate my income to qualify for an ACA subsidy?

Question by schrodinger_hated_cats: Should I OVERestimate my income to qualify for an ACA subsidy?
My hours got cut on my job to where I now make less than the Federal Poverty Level, and I lost my health insurance because I’m no longer full-time. I also injured my knee quite badly a couple of weeks ago and can’t find any way to get the care I need other than going to the ER, and I don’t think this is a real emergency. Been caring for it at home, but it isn’t getting any better.

I would ordinarily qualify for Medicaid under the Affordable Care Act, but I live in Texas. Texas did not expand Medicaid for the poor, and since I’m below the FPL, I don’t qualify for a subsidy to help pay for the costs of insurance, or the second subsidy to help with the deductibles and copays.

I saw this article where it says that due to a quirk in the law, your income is self-reported, and you are to ‘project’ your income through 2014 when signing up through the Exchanges. If I ‘project’ my income to be above the FPL, I can then qualify for a subsidy. It’s a very gray area because I ‘might’ actually get another job where I would qualify for help or I might not be able to find any more work. The article which explains all of that is here… please check it out.


Excerpt from article… “Some of the millions of poor people expected to lose out on Obamacare coverage next year because their states are not expanding Medicaid might have a way to get help, but the strategy carries risk.

Experts say the key is for them to project their 2014 income to at least the federal poverty level, about $ 11,500 per person or $ 23,500 for a family of four.

That would entitle them to federal subsidies that would cover nearly all the cost of private coverage sold on new online insurance marketplaces set up by the federal health law. The subsidies are available on a sliding scale to people making between the poverty level and four times that amount.

Everyone applying for subsidies must estimate their 2014 income. For the poor, the difference between qualifying — or not — could be $ 1,000 or less a year. Since many rely on hourly or seasonal work, their incomes often fluctuate by a few thousand dollars each year. That’s one reason why people often lose eligibility for Medicaid, the state federal insurance program for the poor…”

I have been trying for over 2 weeks since the injury to find help, only to be turned away. The low cost clinics aren’t equipped to diagnose or treat the kind of injury I probably have– ligament, meniscus, etc. They don’t have X ray machines or MRI, and they don’t have orthopedic doctors. This is beyond a simple sprain, I am certain. I’ve had many knee injuries and a surgical history so I really need an orthopedic doc to examine me. But I can’t get that kind of help without Medicaid or insurance, and I can’t qualify for either program because Texas refused to expand Medicaid to people like me. My church doesn’t have the funds to help right now, either. I’m in a lot of pain.

Would it be wrong for me to ‘guesstimate’ my income to be in the range where I can get these subsidies if I don’t make enough now to qualify? Is this lying? Is it unethical, or is it just a last-ditch effort to get myself the care that I obviously need? One side says it’s wrong. The other side says that if I get my knee fixed by whatever means necessary, then I can return to productivity and then I’ll be able to buy insurance the right way.

What do you folks think?
FPL= Federal Poverty Line. If you are below 100%, you get Medicaid and don’t qualify for the subsidy. But if your state, like Texas, didn’t expand– then you get NOTHING. You fall through the cracks, or you pay full price for everything like the premiums and deductibles. ‘No soup for YOU’
Marcus, I HAVE a job. I WAS full time and had insurance, and would have been able to pay for my own care. My hours got cut way back recently and I LOST my insurance because I’m no longer full time. ALL of us full-timers got cut back and lost insurance.

I am LOOKING for another job, but I got badly hurt. Even so, I’m trying to keep working and I’m still looking, but I HAVE to get my knee fixed. This is a SERIOUS knee injury… probably a ripped ligament or two. I can’t even walk right now. I’ve exhausted all of my other options. I live in Texas, Texas didn’t expand Medicaid, and our remaining options are very few. If I lived in another state that DID expand Medicaid, I’d be able to get help that way. If the subsidies were granted to everyone who is below the level that was set, including those eligible for Medicaid, I could pay for insurance. I am one of the millions who is falling through the cracks. I want to pay. I can’t, and the subsidy doesn’t
exist for people like me. Why don’t you hire me for a second job so that I CAN pay, instead of being a twit?
People who have incomes below the FPL and live in states like Texas that didn’t expand Medicaid do NOT qualify for the subsidies. Poverty for one person is $ 11,490 per year. I got cut below that level. Thus I do NOT get a subsidy of any kind. Read here… http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?pagewanted=all&_r=0 and here… http://articles.philly.com/2013-09-02/news/41665222_1_medicaid-expansion-health-insurance-minimum-wage
I repeat, I do NOT want to go to the ER. I can’t afford an urgent care like Priamcare at $ 120 a pop, plus X ray costs. I’m trying to get on the county health plan but my appointment is in 3 months, the soonest I could get. County Urgent care w/o the plan is $ 85 which I don’t have. I can afford a $ 25 copay, which is what it would be once I get on the county plan IN THREE MONTHS. If I need surgery, that would be covered. That is 3 months from now. Oh but LEGAL IMMIGRANTS below the poverty line can get subsidies. Illegals can get Medicaid for giving birth, for their kids. Citizens below the FPL CANNOT.

Best answer:

Answer by Abu Bakar Siddik

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