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WC effect on ACA eligibility or tax credit
#1
Does anyone have knowledge or advice on the following scenario? I'm in GA but that probably doesn't matter to this question.

Last December I signed up for a health insurance plan for this year under the Affordable Care Act. With the earnings estimate based on my job at the time I qualified for a good premium subsidy. Then I was injured in mid-February and have been on TTD since; no release for work yet. It just occurred to me to wonder about how this may affect my ACA situation now and/or at tax time next year.

I understand that the WC wage replacement payments plus expense reimbursements such as for mileage - as well as lump-sum settlements - are not taxable income. Thus it seems likely I'll have difficulty reaching the minimum income level for ACA subsidy/tax credit. Is my understanding correct; am I right to worry about the tax implications? If so, is there anything I can do now or later to help the situation?

I wanted to ask this forum before possibly contacting the federal Marketplace folks. If anything is unclear, or more info would be useful, please let me know. Thanks.
 
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#2
I suspect the rules for subsidy eligibility vary by state and how Georgia may handle your sudden loss of income may be different then other states. what qualifies under IRS as earned income may be different for georgia ACA insurance exchange.
I also can't think it would be a significant problem as it should be anticipated that those with ACA health coverage may eventually have a serious medical condition that would affect earnings.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
Mileage reimbursement should not be considered as any type of income anywhere. I do not think you need to mention the mileage.

When you contact the marketplace please know some of those folks have more knowledge than others. If you are having difficulties then I would call back and speak with another representative.

I don't know if they would consider TTD income. It depends on their policy, if it reads income from workers compensation, for example.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#4
I thought this would be determined by federal rules, rather than state. Georgia did not set up its own exchange so I worked thru the fed's healthcare.gov site.

Now I've just heard about a court decision which could invalidate the subsidies if not provided specifically through a state exchange. Yikes! Will have to see how that plays out.

I don't mean for this to stray off the subject of WC. Will update again when I learn more. Thanks for your responses.
 
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#5
Yup the Halbig case may go to the supreme court as the fourth circuit court upheld the subsidies.
if Halbig is sustained, states like georgia that did not set up their own exchanges will no longer be subsidized.
there are about 36 mostly republican controlled states whose citizens would be denied ACA subsidies.
you may have to move to Kentucky to get your tax credit.

it may take a couple years to get a supreme court decision.
http://www.businessweek.com/news/2014-07...are-debate
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#6
http://www.whitehouse.gov/share/medicaid-map

On another note, here are a list of states that refused Medicaid expansion. Remember this when voting. Limiting Medicaid expansion is hurting and killing people who cannot get access to healthcare, and who would have qualified for this.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#7
I didn't expect to take so long, but things in my actual WC case intervened (for one, the insurance company is going out of business).

A Marketplace rep told me that indeed WC payments are not counted as income for ACA purposes. (Doesn't seem fair to me since I would be working but for the injury.) Though she could not point me to written, final rules, this page on their website says:
Estimating your income
You’ll need to estimate if you’ll be making more or less than a certain amount in the year for which you want coverage.
This amount should include income for:
• You and your spouse, if you are married and will file a joint tax return
• Any dependents who make enough money to be required to file a tax return
For each of these sources, estimate the amount of income you’ll make in the year for which you want coverage and how often you’ll receive it:
• Income from your job: Enter the amount that’s shown on your pay stub before taxes are taken out. If the amount of your wages changes each week, enter how much you expect to earn for the whole month, or enter the average number of hours you’re working right now. Count all tip income here, even if it’s not reported to your employer. Include all jobs, even if they’re part-time or you’re paid in cash. You can add each job separately by selecting “Add a new source of income.
• Net income from any self-employment or business (generally the amount of money you take in from your business minus your business expenses)
• Unemployment compensation
• Social Security payments, including disability payments -- but not Supplemental Security Income (SSI)
• Alimony
Other items to include when estimating your income are: retirement income, investment income, pension income, rental income, and other taxable income such as prizes, awards, and gambling winnings.
Don't include these:
• Child support
• Gifts
• Supplemental Security Income (SSI)
• Veterans’ disability payments
• Workers’ compensation
• Proceeds from loans (like student loans, home equity loans, or bank loans)


All year so far I've received significant premium subsidies. If my income were to end up being below the minimum level to be eligible for that, no doubt I'd be in a pickle come tax time. Thus what I really need is more taxable income. Unfortunately, at my wage rate before injury it would take 40 hrs/week every single week from late July to Dec 31 to get there, so I'm already behind. Plus I'm not even released for work yet - should be soon, but then time has to also be taken for another surgery and more therapy too.

Ah well, keep calm and carry on, etc, etc.
 
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#8
When I had applied for the ACA, they told me that my TTD would be considered as income.
My cost for insurance was going to be 600/month so they told me to apply for medicaid. Applied there and were were over the poverty line by 300/month. Go figure......must be a government office as it appears they have different answers when you talk to different folks.
 
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#9
(07-22-2014, 07:51 PM)California_Help Wrote: http://www.whitehouse.gov/share/medicaid-map

On another note, here are a list of states that refused Medicaid expansion. Remember this when voting. Limiting Medicaid expansion is hurting and killing people who cannot get access to healthcare, and who would have qualified for this.

Yep. And we just happen to be in one of them.
 
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#10
(08-13-2014, 09:37 PM)Scooter123 Wrote: When I had applied for the ACA, they told me that my TTD would be considered as income.
My cost for insurance was going to be 600/month so they told me to apply for medicaid. Applied there and were were over the poverty line by 300/month. Go figure......must be a government office as it appears they have different answers when you talk to different folks.

Since you were told differently, I called again to try to confirm which is true. This time the person started off saying it would count, but when I said I've heard it both ways she went off to check again and came back saying it would not. When asked if she could point me to something in writing she gave that same page I referred to in my post yesterday.

I've continued to dig around on healthcare.gov and irs.gov, without finding anything more definitive. The best I've come across is this page which near the bottom under More Information has:
• Final regulations [their link does not work on Safari; direct path is here] on the rules for individuals who enroll in qualified health plans through Marketplaces and claim the premium tax credit.
That document is from May 2012 and seems to have no mention of workers comp, though there are some interesting tidbits found when searching on 'income'.

That's all I've been able to come up with so far.
 
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