ljwalters Posted January 25, 2015 Report Share Posted January 25, 2015 When I asked client if he had insurance all year he told me he had minimal insurance was included in his college tuition. I know when my daughter went to UOP insurance was required. The question is does this qualify for aca. Graduated end of May. got job middle of June. Insurance with job started Sept 1. (normal waiting period) No DD in box 12 of W2 Before June total income $878. Total income for the year $29,723 all earned after June Hard ship for first 6months WHY couldn't my first one be an easy straight forward one. Help Quote Link to comment Share on other sites More sharing options...
Jack from Ohio Posted January 25, 2015 Report Share Posted January 25, 2015 The question is: Does the coverage meet the standards of Minimum Essential Coverage? Quote Link to comment Share on other sites More sharing options...
Lee B Posted January 25, 2015 Report Share Posted January 25, 2015 Remember late last year, when the administration backed down and approved a number of policies as being ACA compliant only because the policyholders had been promised that they could keep any policy that they already had. I have have several clients that still have one of those policies. Quote Link to comment Share on other sites More sharing options...
jklcpa Posted January 25, 2015 Report Share Posted January 25, 2015 I don't know the answer, but this site might help with the question of whether or not the student health insurance is minimum essential coverage, or might help you to determine the follow up questions to ask your client about the particular student policy and its coverage. http://www.acha.org/Topics/Affordable_Care_Act/FAQs_for_IndividualCoverageClassification.cfm#Q2 Also, there is an exception to the penalty for a gap in coverage of up to 3 months. With these in mind, it might be that your client won't have a penalty, but you have to ask the questions about that student insurance. Quote Link to comment Share on other sites More sharing options...
Pacun Posted January 25, 2015 Report Share Posted January 25, 2015 The gap exceptions is only 2 months (not 3). 1 Quote Link to comment Share on other sites More sharing options...
Jack from Ohio Posted January 25, 2015 Report Share Posted January 25, 2015 The gap exceptions is only 2 months (not 3). I disagree. Cite your source... Quote Link to comment Share on other sites More sharing options...
Pacun Posted January 25, 2015 Report Share Posted January 25, 2015 The way I read it is less than 3 months. 1 Quote Link to comment Share on other sites More sharing options...
ljwalters Posted January 25, 2015 Author Report Share Posted January 25, 2015 (edited) I agree with Pacun on the less than 3 months. How ever as I mulled this over last night. The fact that is income was $832 for the first 6 months, there should be no penalties for those months coverage is unaffordable for 5 months and half of the 6th. Coverage eligibility was 60 days hiring and started first of the month after eligible (company rules). What do you think am I way off base here. And now how to input. Edited January 25, 2015 by ljwalters Quote Link to comment Share on other sites More sharing options...
jklcpa Posted January 25, 2015 Report Share Posted January 25, 2015 The gap exceptions is only 2 months (not 3). Pacun is correct, and I was in error when I stated the coverage gap could be 3 months and meet that exemption from the penalty. Sec 5000A and all the other places I've looked all state "less than 3 months". I found an example on the IRS website and after the words "less than 3 months", in parathesis it said "(for example January, February)" Quote Link to comment Share on other sites More sharing options...
Pacun Posted January 25, 2015 Report Share Posted January 25, 2015 I disagree. Cite your source... I guess now you will have to cite your source..... I am kidding. The wording on this regulation is weird but that's why we have this forum. Quote Link to comment Share on other sites More sharing options...
Lee B Posted January 25, 2015 Report Share Posted January 25, 2015 The key is what constitutes "minimum essential coverage" for a month. Example: Jill has coverage from Jan 1st thru May 1st and she is without health insurance thru August 30th a total of 121 days until she reacquires coverage on August 31st. By definition since Jill had coverage for 1 day of both May and August those months are not included in the coverage gap and her official coverage gap is two months. No penalty. Quote Link to comment Share on other sites More sharing options...
jklcpa Posted January 25, 2015 Report Share Posted January 25, 2015 The key is what constitutes "minimum essential coverage" for a month. Example: Jill has coverage from Jan 1st thru May 1st and she is without health insurance thru August 30th a total of 121 days until she reacquires coverage on August 31st. By definition since Jill had coverage for 1 day of both May and August those months are not included in the coverage gap and her official coverage gap is two months. No penalty. IF that is the fact pattern then I'd agree, but the OP stated in both of her posts that the employer coverage started on Sept 1st, the first day of the month following the 60-day waiting period, so this person did not have coverage for any day in August. Quote Link to comment Share on other sites More sharing options...
BulldogTom Posted January 26, 2015 Report Share Posted January 26, 2015 I agree with Pacun on the less than 3 months. How ever as I mulled this over last night. The fact that is income was $832 for the first 6 months, there should be no penalties for those months coverage is unaffordable for 5 months and half of the 6th. Coverage eligibility was 60 days hiring and started first of the month after eligible (company rules). What do you think am I way off base here. And now how to input. This is one of the strange things about the ACA. It does not look at affordability on a month by month basis. It looks at your entire household income for the year and compares it to the cost of the Bronze Level plan for a year to determine if you meet the hardship exceptions. You could have $800 of total income for 11 months, and hit the lottery in December, and have to pay the penalty tax because you had the money to pay for coverage. I know, this is a very extreme example, but it is not far off from the post above. Linda, you are going to have to go through the worksheet to get the right numbers for affordability. It is not fair, but it is the law. You will get the 60 day short term exemption. Tom Newark, CA Quote Link to comment Share on other sites More sharing options...
Gail in Virginia Posted January 26, 2015 Report Share Posted January 26, 2015 Or they can apply for an exemption on the HHS site. As far as I can tell, they actually have a lot of leeway to grant exemptions on an individual basis. If he lived in a state that did not expand Medicaid, and his income was less than $1,000 for six months I would think this would be a slam-dunk. BUT in looking at income for the first 6 months while he was in school, was he a member of his parents' household? If they could have had him on their insurance, and chose not to for some reason, he would have a harder time claiming hardship. Quote Link to comment Share on other sites More sharing options...
ljwalters Posted January 27, 2015 Author Report Share Posted January 27, 2015 Gail what is the HHS site? No he is 39yrs old and his mother died late in 2013. He has had health and other issues and just started getting his life together when he started College. He went to school on a full grant and scholarship. Only took student loans to pay living expenses. Quote Link to comment Share on other sites More sharing options...
Gail in Virginia Posted January 27, 2015 Report Share Posted January 27, 2015 I am referring to the Health and Human Services website, healthcare.gov. https://www.healthcare.gov/fees-exemptions/hardship-exemptions/ There are quite a few exceptions, and the last one is just you experienced any other hardship. I would at least try that avenue. Quote Link to comment Share on other sites More sharing options...
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