Be aware of these requirements and procedures to avoid losing your government subsidy or paying back a huge amount when you file your tax returns:

  1. Often the method to make your first insurance payment (called the binder payment) for a Marketplace policy is different from the subsequent payments. This means you will receive an invoice every month unless you contact your insurance company and arrange for an automatic draft from your checking account, savings account, credit card or debit card. I’ve had several customers ignore invoices thinking they were on automatic bank draft when it had not been set up. Unfortunately, some did not realize the problem until they lost their insurance policy and could not re-apply again until Open Enrollment.

 

  1. Make sure you register on the website of your health insurance company.  Although you will have a customer service number, this will give you a chance to view your claims, payment history and find information without making a phone call. Also, sometimes these sites offer discount coupons.

 

  1. Read your Marketplace Letter carefully. The Marketplace sometimes requires you to provide additional information several weeks after your policy begins. The type of information can be proof of your income, citizenship, identity or proof that you are in the U.S. legally. Even if you are paying your insurance premiums on time, the Marketplace will stop your government subsidy if you do not comply with their requests. This information can be uploaded to their website or mailed. If you mail it, make sure you follow their guidelines and include the barcode in Marketplace letter. Normally your insurance agent can upload your documents on your behalf.

 

  1. When you apply for a government subsidy you provide an estimate of your Modified Adjusted Gross Income (MAGI). Your subsidy is based on your MAGI, age, zip code and household members. Every January the Marketplace will mail 1095 A forms to heads of households receiving a subsidy. The information on the 1095 A is used to complete the 8962 form, which is used to reconcile the estimated income that you provided to the Marketplace with your actual income. If you don’t receive the 1095 A form, you can retrieve it at Healthcare.gov, call the Marketplace at 1 800 318 2596 or contact your agent. Even if you are only on a Marketplace policy for a short period you are required to complete this form. Failure to do this can prevent you from obtaining a subsidy in the future. 

 

  1. If you have a change in circumstances such as a new job where you make a higher income or are offered health insurance, make sure you contact the Marketplace. A higher income needs to be reported because your new income could cause you to lose all or part of your subsidy. If your new job offers health insurance that is compliant with the Affordable Care Act, you are not allowed to receive subsidy unless your premium is more than 9.12 % of your Modified Adjusted Gross Income. Failure to comply with this policy could cause you to pay an IRS penalty.

 

  1. Do not call your health insurance company to cancel your health insurance policy. Instead call the Marketplace at 1 800 318 2596. Once the Marketplace receives your request, they will contact your insurance company and cancel your policy.

 

  1. Changes such as your marriage status, dependents or address should be reported to the Marketplace immediately since this can affect the amount of your subsidy, policies available and your premium.

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  1. If you plan a trip outside of the United States, make sure your policy will provide the medical coverage you need. You may need to purchase Medical Trip Insurance. 

 

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