Not sure where to post this but I may be over the “NY essential health plan” by a few hundred dollars..

[momplus3]

I’ve had free health insurance for years and my 2023 gross income is just over the limit for essential plan. This was only because I had to fill in for a position at my job for 7 months getting 10 hours extra a week. It was supposed to be a 2 week thing but was threatened I’d be fired if I didn’t fill in so now they found somebody and I’m back to making lower income and I’ll be notified within a month if i qualify. It ends May 1st. I’m worried because I’m slightly over I won’t get insurance and not sure what my options are. I have made way less money since the start of 2024 but not sure if they go by my 2023 gross income which again is over by about 500 dollars.. do you think they well negotiate something with me if my current checks are lower again? I had free insurance for 9 years and can’t afford 300 dollars a month for health insurance. I’m helping my mother save her house and paying 1400 dollars a month and only making about 520 a week compared to 608 or something 7 months last year.. Anyone know what options there are. If I have to pay my doc 110 dollars for monthly visits and 20 dollars for scripts so be it but it’s messed up just because I was essentially forced into taking the hours that put me over.. my car is dying as well and just every financial burden happening at once. I just could use some advice here. Thank you.

 

[oceanwaves]

@momplus3 Is it determined based on gross income or adjusted gross income?

 

[momplus3]

@oceanwaves That’s the thing. I’m pretty sure it’s gross. A few honest insurance guys ran numbers and said I qualify. A few others tried to scam me into private insurance. I’m hoping I’m good like two of the said.

 

[oceanwaves]

@momplus3 I did a small bit of research, and it looks like it is based on MAGI (Modified Adjusted Gross Income). I don't know your overall financial situation, but I think this would make it harder to qualify in general as MAGI adds back some of the typical deductions that lead to AGI. My original thought was that if you were over, you could make an IRA contribution before April 15 and get your number down, but that won't work in this case.

If a pro is saying you qualify, you're probably good.

 

[momplus3]

@oceanwaves Either way i read they just passed a law where I can get the “essential plan”. Basically Medicaid with small copays. It’s crazy because it went from 200% poverty line to 250 and I’m at 201%. 1 percent over could of just lost my insurance altogether if a miracle law didn’t happen to pass on April 1st next month. I still don’t believe it. That is incredibly lucky to happen if the Medicaid falls through. I mean, it should. Covid restrictions are over and I make 13k more than medicaids limit. Have no clue how I had it this long. It’s like they aren’t paying attention or every single article on the internet is false.

 

[keke1223]

@momplus3 The Covid winddown for NYS of Health only happened recently. Spring of 2023 officially but depending on when you signed up, being disenrolled off of Medicaid was staggered out. They let people stay on Medicaid for years despite changes in income intentionally.

 

[rosevs]

@oceanwaves yea it’s definitely gross income… which makes no sense because obviously it shouldn’t count what you paid in taxes because that money wasn’t available to pay the premium with…yea marketplace is the only way to go unless you get it for free from work…. I don’t understand why healthcare is even a profit business, my Sister in law is from Canada and she thinks it’s so crazy that when she takes her kids to the doctor in the US they ask for money, she said it feels like a bribe lol

 

[jiffyette]

@momplus3 Even at 608/wk for the whole year, you'd qualify for ACA. Should be able to get coverage for $0. The NY State website (nystateofhealth.ny.gov) estimates you'd get 700/mo in advanced tax credit, which more than covers some bronze plans, and covers all but about $100 for some silver plans.

 

[momplus3]

@jiffyette Okay, good to know. I was making about 608 for 7-8 months last year and averaging around 500
The other months landing at 30.4 k in total. I had hours cut making like 480 a week until last week and I’ll be making 550 now weekly so by what you’re saying I should be good or at least have something affordable. These guys I got “quotes” from were calling me saying im screwed and trying to sell me 250-300 dollar a month insurance. One swore at me and said get my income up where 2 others were respectful and ran my numbers and said I have nothing to worry about and that the computer said I’m eligible. One even admitted they were trying to use me to sell. Rare to find an honest guy like that.

 

[jiffyette]

@momplus3 Skiip the agents. Go straight to the NY marketplace website. Sign yourself up.

 

[keke1223]

@momplus3 If you call NYSOH to update your income, they go based on the projections for the current year (2024). For some people, they just use last year's numbers if that would be accurate, but there's several ways to estimate your income. From my side, I can put in a yearly amount, a monthly amount, a biweekly amount, an hourly amount & how many hours etc.

A couple of things to note:

• NYS just released a new guideline where people with income 200% - 250% ($37,650) of the FPL are now eligible for the essential plan. This goes into effect on 4/1/2024 but you can already update your account to make sure you are enrolled for 4/1/24.
• You are able to update your income on your account at any time, so if your income is higher or lower than estimated, you can adjust accordingly and be placed in the proper plan at that point in time. Not all states are like this but NYS is.
• You should update your income within 30 days of any changes.
• If you for whatever reason end up still outside of the new guidelines for the essential plan, you most likely would be placed in a Tax Credit bracket. So if you were just $200 - $500 over the Essential Plan eligibility, you could get a tax credit that deducts a dollar amount off your monthly bill. This deduction is a sliding scale based on your income, so the lower your income, the higher the credit and the lower your bill and vice versa. I have people who pay as low as $1.00 monthly (but have high deductibles). There's definitely options out there.

 

[momplus3]

@keke1223 Thanks so much for the info. Luckily I found out about the new law and feel so lucky. Also, JUST got a big raise this week and will now make around 36k so essential plan will definitely work. I have no clue how I’ve been able to get Medicaid even pre COVID tbh.

 

[revchar]

@momplus3 Yeah, you’re ok!! Apply on the NYS marketplace based on your anticipated 2024 income and you’ll be all set. Don’t ever go to private insurance companies to get quotes. Go straight to NYS. CDPHP Marketplace has the best in-network plans.

 

[cleoi]

@momplus3 Does anyone know what to expect if I was switched from Essential Plan 4 to Essential Plan 3? I am really scared because I have a lot of doctor's visits

 

[rosevs]

@momplus3 Hey, I had the EXACT same thing happen to me, I freaked out cause i can’t afford 300 dollars for health insurance either… I got scammed after doing a search for health insurance quotes, some guy called and talked me into a private plan that covered everything with no co pays or deductibles and was $327 a month, and then after i paid for the first month i realized it was pretty much a scam… not real insurance, and my phone rang off the hook from other people from that same company…. i was super lucky to get a hold of someone and it was like pulling teeth to get my money back so DONT search anything on google for health insurance unless it’s from the the NY state of health website, you can’t trust it. My advice- when i called the NYSOH representative he told me that I can redo my application, based on what I am projecting to make this year (cause 2023 i had half a year of 50 hours a week) I filled out the application and sent it in. In the meantime i DID qualify for $458 dollars a month to put towards a marketplace plan. they aren’t as good as the essential plan, but i was able to find a silver tier Independent health plan for $676 a month, which meant i would pay 218. And the deductible wasn’t too crazy, and all my generic prescriptions , and my personal types of medical needs (like my primary doctor, psychiatrist, outpatient substance abuse and any Telehealth appointments) were all regular copays. Depending on how often you go to the doctors there are cheaper ones i saw for like $500+ that would have cost me like 50 dollars a month, but those plans are basically for people who rarely go to the doctor, and don’t take much medicine. In the mean time i tried to find things that i was wasting money on, and subscriptions to stuff, and i cancelled a bunch of them to help offset my new 218 premium. but then today i got an email saying that i have been reenrolled in my previous coverage under the essential plan based off my new application when i estimated what i would make in 2024, rather than going off my 2023 tax returns. so..
1) fill out your entire renewal application with your best guess of what you will make.
2) If you are not that much over the qualifying amount, then you will probably qualify at least for the $458 credit per month.
3) look through the plans because you can find something that not too too bad after the tax credit (that gets automatically applied, and you don’t have to apply for it separately)
4) keep checking for any changes regarding your eligibility for the essential, cause you may get reenrolled based on your projected income.
That obviously would be ideal, but of you still don’t qualify, start looking to choose a plan and apply your tax credit to it, If you are just looking for catastrophic plans that only emergencies, you can find plans on there that will be less than your tax credit and basically free, not great plans, or for like 150-250
a month there are some decent plans and you can compare them on the site and everything. I wish you the best and hopefully your projected salary will qualify you. don’t put your phone number on ANY “health insurance quotes” in still getting non stop calls from random numbers…

 

[momplus3]

@rosevs Thanks. Appreciated. I was speaking with many scam “insurance quoters” telling me I’m screwed. One even said swore at me about being a broke B word lol. I spoke with two others who were being honest with me and one told me I’d qualify for Medicaid if I made under 31k. I made 30.4 k last year but then she got disconnected. I spoke with another very honest, good man who told me they were just trying to sell me something and it’s his job to sell private insurance but he put in my info and said in my state I qualify for Medicaid based on the numbers I gave him and not to worry at all. He said 400 dollars over is ridiculous and laughed at them trying to scam me. What a good dude. It’s just odd because my Medicaid is through a company cdphp and their cutoff is 17k a year for Medicaid and 29.4 for essential plan on the website itself. This is why I’m confused the insurance people told me I qualify. Something about those numbers reflecting open enrollment and not renewal he said. Also, going by what you said then that’s an option as well. The one guy tried to convince me that If I spend 250 for private insurance for 3 months they might give me my Medicaid back seeing I can’t afford it. Another hung up immediately when I said I’m not interested in buying just looking for quotes to get an idea. So I’m still pretty confused but at least I feel a bit better that the one obvious honest guy told me not to worry and didn’t bother trying to sell me bs.

 

[saith]

@momplus3 I think when filling out the form it ask you to estimate your income for 2024, just estimate with your old numbers.

 

[momplus3]

@saith Yeah, good idea. It’s just crazy I read they are upping the poverty line for the nys essential plan from 200% to 250% April 1st. I’m literally 300
dollars over 200%..lmao I’m sure I’ll get a rejection letter in 2 weeks now that restrictions from covid are lifted but at least I won’t be screwed out of insurance thanks to a miracle law that just happened to pass 1 month before I lose coverage. I suppose I wait until April 1st and just grab that essential plan. It’s wild I could have lost health insurance over 300 dollars. I still got my fingers crossed though. I’ll be shocked if I somehow get Medicaid when I make nearly twice as much as the limit. I honestly have no idea how I’ve gotten it for 9 years in a row making over the limit.