Author Topic: jersey care  (Read 181044 times)

Offline S209

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Re: jersey care
« Reply #940 on: December 19, 2018, 02:36:06 AM »
I haven't followed the Lakewood story so closely, but I will not be surprised if it was big headlines with a big Chilul Hashem, but in reality might have all been 100% legal - but the media would never report that.

A real estate investor could have millions in positive cash flow, but if his tax return shows an AGI that is below 138% FPL, he is LEGALLY eligible for Medicaid ever since Obamacare was enacted.
From the small amount of research Ive done and speaking to one of the (former) defendants personally (I daven in Lutzk occasionally, so I know a few of them ;) ), it seems theyve dropped all charges against most of the couples already. For the few remaining, charges are dropping slowly and quietly.. good luck getting the MSM to report that, though.

Offline S209

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Re: jersey care
« Reply #941 on: December 19, 2018, 02:38:20 AM »
I haven't followed the Lakewood story so closely, but I will not be surprised if it was big headlines with a big Chilul Hashem, but in reality might have all been 100% legal - but the media would never report that.

A real estate investor could have millions in positive cash flow, but if his tax return shows an AGI that is below 138% FPL, he is LEGALLY eligible for Medicaid ever since Obamacare was enacted.
Not only is he eligible, but hes ineligible to purchase insurance on the marketplace and for subsidies, thus forcing him to pay an exorbitant amount for his monthly insurance or take Medicaid.

Offline ExGingi

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Re: jersey care
« Reply #942 on: December 19, 2018, 07:16:15 AM »
Fresh story within the last 24 hours.. you can look at app/nj.com/patch/jerseyshoreonline etc yourself..

..Or you can just Google "Lakewood man $10 million insurance fraud...
I Googled that story, and it has nothing to do with what @aygart or I  were saying.

There was no suggestion to open a sham business, definitely not in a state where you have no nexus. What @aygart was saying was that a business has a different set of rules, and can purchase insurance at times other than Federal open enrollment. I added that (since the enactment of Obamacare) in order for the business to qualify for a business plan, it must have at least one non-owner employee enrolling.

it isnt just the expenses. business plans are able to offer far better insurance
Correct. But as mentioned, you need to qualify.

After inquiries from a DDFer, I did find an association plan that might help sole proprietors. But they medically underwrite in order to be accepted to the association. If accepted the plans are excellent, similar to large business plans.
I've been waiting over 5 years with bated breath for someone to say that!
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Offline ExGingi

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Re: jersey care
« Reply #943 on: December 19, 2018, 08:43:27 AM »
Not only is he eligible, but hes ineligible to purchase insurance on the marketplace and for subsidies, thus forcing him to pay an exorbitant amount for his monthly insurance or take Medicaid.

That's not accurate.

I don't have that much experience with the Healthcare.gov exchange, but I would assume that similar to the NY Exchange one can indicate that they don't want help paying for insurance, and then all income questions are skipped.

The other way, and I will let others decide whether it's ethical or not, is to project a higher income that will put him over 138% FPL. I don't really know what will happen if such individual elects to take APTC, but I would assume that at tax time such individual would qualify for a tax credit and won't need to pay back any ATPC. The issue would come up when he enrolls in subsequent years, and they say that based on his income he qualifies for Medicaid. I don't know what would stop anyone from projecting a higher income again (Though in NY in many cases Medicaid provides better coverage and access to Doctors than Qualified Health Plans that are available on the exchange).
I've been waiting over 5 years with bated breath for someone to say that!
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Offline aro123

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Re: jersey care
« Reply #944 on: December 19, 2018, 09:49:54 AM »
That's not accurate.

I don't have that much experience with the Healthcare.gov exchange, but I would assume that similar to the NY Exchange one can indicate that they don't want help paying for insurance, and then all income questions are skipped.

The other way, and I will let others decide whether it's ethical or not, is to project a higher income that will put him over 138% FPL. I don't really know what will happen if such individual elects to take APTC, but I would assume that at tax time such individual would qualify for a tax credit and won't need to pay back any ATPC. The issue would come up when he enrolls in subsequent years, and they say that based on his income he qualifies for Medicaid. I don't know what would stop anyone from projecting a higher income again (Though in NY in many cases Medicaid provides better coverage and access to Doctors than Qualified Health Plans that are available on the exchange).
I think if you end up below 100% of poverty level U are not eligible for any subsidy and must pay back all u got

Offline etech0

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Re: jersey care
« Reply #945 on: December 19, 2018, 09:50:46 AM »
I don't have that much experience with the Healthcare.gov exchange, but I would assume that similar to the NY Exchange one can indicate that they don't want help paying for insurance, and then all income questions are skipped.
You can purchase directly from the insurance company (eg: Horizon BCBS) and pay full price.
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Offline ExGingi

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Re: jersey care
« Reply #946 on: December 19, 2018, 11:41:25 AM »
You can purchase directly from the insurance company (eg: Horizon BCBS) and pay full price.
I would assume that the off-exchange price is the same as the on-exchange price without subsidies. That's the case in NY.
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Offline ExGingi

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Re: jersey care
« Reply #947 on: December 19, 2018, 11:41:42 AM »
I think if you end up below 100% of poverty level U are not eligible for any subsidy and must pay back all u got
Source?

ETA:

I don't think your claim isn't 100% accurate (how does the IRS prove "intentional reckless disregard for the facts", unless it's a multi-year pattern).

See: https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit

Quote
30. I enrolled in a qualified health plan with APTC based on a Marketplace determination or assessment that I was ineligible for Medicaid or CHIP coverage. Subsequently, I was determined eligible for Medicaid and was enrolled for several months while I was enrolled in the qualified health plan. Am I treated as eligible for Medicaid and therefore ineligible for the premium tax credit for these months?
 
Generally, no. If a Marketplace makes a determination or assessment that an individual is ineligible for Medicaid or CHIP and eligible for APTC when the individual enrolls in a qualified health plan, the individual is treated as not eligible for Medicaid or CHIP for purposes of the premium tax credit for the duration of the period of coverage under the qualified health plan (generally, the rest of the plan year).  Accordingly, if you were enrolled in both Medicaid coverage and in a qualified health plan for which advance credit payments were made for one or more months of the year following a Marketplace determination or assessment that you were ineligible for Medicaid, you can claim the premium tax credit for these months, if you are otherwise eligible.  The Marketplace may periodically check state Medicaid data to identify consumers who may be dual-enrolled, and direct them to return to the Marketplace to discontinue their APTC. If you believe that you may currently be enrolled in both Medicaid and a qualified health plan with advance credit payments, you should contact the Marketplace immediately.

And

Quote
4. What happens if my income, family size or other circumstances changes during the year?

The actual premium tax credit for the year will differ from the advance credit amount estimated by the Marketplace if your family size or household income as estimated at the time of enrollment is different from the family size or household income you report on your return. The more your family size or household income differs from the Marketplace estimates used to compute your advance credit payments, the more significant the difference will be between your advance credit payments and your actual credit. Other changes in circumstances, such as marriage or divorce, may also affect your credit amount.  If your actual allowable credit on your return is less than your advance credit payments, the difference, subject to certain repayment caps, will be subtracted from your refund or added to your balance due. If your actual allowable credit is more than your advance credit payments, the difference will be added to your refund or subtracted from your balance due.

Notifying the Marketplace about changes in circumstances as soon as they occur will allow the Marketplace to update the information used to determine your expected amount of the premium tax credit and adjust your advance payment amount. This adjustment will decrease the likelihood of a significant difference between your advance credit payments and your actual premium tax credit. Changes in circumstances that can affect the amount of your actual premium tax credit include:

  • Increases or decreases in your household income. Events that could result in a significant increase to household income include:
  • Lump sum payments of Social Security benefits, including Social Security Disability Insurance
  • Lump sum taxable distributions from an individual retirement account or other retirement arrangement
  • Debt forgiveness or cancellation, such as the cancellation of credit card debt.
  • Marriage
  • Divorce
  • Birth or adoption of a child
  • Other changes to your household composition
  • Gaining or losing eligibility for government sponsored or employer sponsored health care coverage
  • Moving to another address

And most definitevely, from the instructions for IRS form 8962:


« Last Edit: December 19, 2018, 12:01:49 PM by ExGingi »
I've been waiting over 5 years with bated breath for someone to say that!
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Offline etech0

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Re: jersey care
« Reply #948 on: December 19, 2018, 12:11:51 PM »
I would assume that the off-exchange price is the same as the on-exchange price without subsidies. That's the case in NY.
I think so (NJ).
Workflowy. You won't know what you're missing until you try it.

Offline ExGingi

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Re: jersey care
« Reply #949 on: December 19, 2018, 12:56:16 PM »
I think if you end up below 100% of poverty level U are not eligible for any subsidy and must pay back all u got

Additionally, if income entered qualified applicant for Cost Sharing Reduction, AFAIK there is no repayment on that even if actual income is higher or lower. In NY that is mostly inapplicable, as income levels that qualify for CSR would generally qualify one for the Essential Plan.

http://workingamericahealthcare.org/how-do-cost-sharing-reductions-work
I've been waiting over 5 years with bated breath for someone to say that!
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Offline greatdeals

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Re: jersey care
« Reply #950 on: December 20, 2018, 08:50:25 AM »
I got new id cards in the mail don't know why but on mine it says NJ alternative benefit plan and on the
kids it says NJ familycare A. What is  NJ alternative benefit plan?

Offline iwlw2

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Re: jersey care
« Reply #951 on: December 20, 2018, 11:49:03 AM »
Isn't there something that if you know you're eligible for Jersey care they can pay for bills during the application process?
I think I heard that on the lrrc phone system.
Once you're approved, so long as you were eligible during the time the service was done, you can ask them to retroactively give you coverage up to 3 months earlier than your approved month to cover those bills.

Offline aygart

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Re: jersey care
« Reply #952 on: December 20, 2018, 12:20:43 PM »
Source?

ETA:

I don't think your claim isn't 100% accurate (how does the IRS prove "intentional reckless disregard for the facts", unless it's a multi-year pattern).

See: https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit

And

An easy example would be someone on a salary who underreports
Feelings don't care about your facts

Offline ExGingi

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Re: jersey care
« Reply #953 on: December 20, 2018, 12:48:53 PM »
An easy example would be someone on a salary who underreports

The discussion was about overreporting on the application in order to be disqualified for Medicaid. Not sure how doable that is when all a person has is salaried income, that gets reported quarterly. Whereas with inconsistent business income (which is the topic of discussion), the actual reconciliation between what's on the application and actual taxable income would only take place many months later, and could be just a bad estimate.
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Offline Definitions

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Re: jersey care
« Reply #954 on: January 17, 2019, 01:36:05 AM »
Any recommendations for a primary doctor in Lakewood that accepts UHC?

For an adult
« Last Edit: January 17, 2019, 01:39:16 AM by Definitions »

Offline S209

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Re: jersey care
« Reply #955 on: January 17, 2019, 02:07:13 AM »
Any recommendations for a primary doctor in Lakewood that accepts UHC?

For an adult
Dr. Kassover from CHEMED, Dr Preschel.

Offline greatdeals

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Re: jersey care
« Reply #956 on: February 14, 2019, 09:13:17 AM »
I just got a letter that my spouse and I and child over 19 (rest of kids are fine)
are going to be terminated because I make to much (around $200 a month over, I recently started a new job after my my old place closed down and was out of a job) I get paid twice a month but they don't count it times two otherwise I would be fine. The lady at the board of social services asked if anything is deducted
like 401k then that would be ok. I was thinking of joining the 401k plan at my work does anyone know if that will help?

Offline ExGingi

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Re: jersey care
« Reply #957 on: February 14, 2019, 09:28:51 AM »
I just got a letter that my spouse and I and child over 19 (rest of kids are fine)
are going to be terminated because I make to much (around $200 a month over, I recently started a new job after my my old place closed down and was out of a job) I get paid twice a month but they don't count it times two otherwise I would be fine. The lady at the board of social services asked if anything is deducted
like 401k then that would be ok. I was thinking of joining the 401k plan at my work does anyone know if that will help?
Are you paid bi-weekly or semi-monthly?
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Offline greatdeals

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Re: jersey care
« Reply #958 on: February 14, 2019, 09:42:15 AM »
I am paid every 2 weeks

Online avromie7

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Re: jersey care
« Reply #959 on: February 14, 2019, 09:44:29 AM »
I am paid every 2 weeks
That's more that twice a month, you're getting 26 pay checks a year instead of 24. They multiply it by 2.167.
I wonder what people who type "u" instead of "you" do with all their free time.