Healthcare.gov: You don't qualify to purchase health coverage through the Marketplace: Is There A Problem Here?: Healthcare.gov: You don't qualify to purchase health coverage through the Marketplace

20131111

Problem ID: 753549263362712114
Entered by: Ben Simo

Healthcare.gov: You don't qualify to purchase health coverage through the Marketplace

Hooray! I finally got a Healthcare.gov insurance marketplace application all the way to the end -- without getting blocked or having my application prematurely processed.

The celebration comes to a sudden stop as I read the eligibility results. It says "Based on your application, you don't qualify to purchase health coverage through the Marketplace." It also goes on to explain that I don't qualify to tax credits or subsidies, or for Medicaid or CHIP. I directs me to go to community health centers for medical care.

I was not surprised that it said I was not eligible for subsidies, Medicaid, or CHIP. However, I thought nearly anyone could purchase insurance from the Marketplace. It says I do not qualify to purchase insurance from the Marketplace.

The letter said nothing about why I am not eligible.

I then went to the Learn side of the site in search of information on the requirements to purchase insurance from the Marketplace.

I find three requirements for purchasing insurance through the Marketplace: (1) live in the US, (2) be a US citizen, and (3) not be incarcerated. I meet all of these requirements. My granddaughter, for whom I'm trying to purchase insurance, also meets all these requirements. So, why am I not eligible to purchase insurance in the Marketplace?

I called Healthcare.gov customer service and asked this question. They instructed me to download an appeal form and mail in an appeal.

The appeal instructions suggest I consider involving an attorney in filing an appeal. I should not have to hire an attorney to purchase health insurance for my granddaughter.

Edit

33 Comments:

Comment ID: 1377247335988710485 Written by: Anonymous: I just tried signing up for this and got the same thing. There were a few things towards the end I clicked "decline" on though, like submitting to purgery, or allowing the government to use my data for 5 years. Maybe you just clicked a wrong button somewhere and didn't realize, or read a question wrong and didn't realize. Or maybe it's just a glitch...rumor has it that the website is a mess. :D
Comment ID: 8860648366294884789 Written by: Anonymous: I too got the same message saying I am not eligible. Called the HealthCare.gov site and the navigator could not tell me why and neither could her supervisor. Told me to file an appeal. So much for that help. Then I look at local DHHR and called and asked them who I could get locally to help me with problems of eligibility for ACA. They have a contract worker through the Insurance ……..Providers and I went in to see her She said there were quite a few people getting the same response and that when a person applies for insurance through ACA, they are going back to past 3-5 years and looking at income and basing it on that, and that since what I put as estimated income for 2013 as opposed to last 3-5 years was so different (DH retired and our income was 3x more when he was working) that there was too much descripancy in income amounts and it red flagged me. Anyway, long story short. She helped me file for Advanced Resolution which was supposed to give me an answer in 3-5 business days…….that did not happen. I am calling on MOnday and filing another appeal. Hopefully this will take care of it and I will have insurance starting Jan 1st, 2014; time will tell.
Comment ID: 2684444990319002632 Written by: Anonymous: I am clearly considered low income and I was disqualified from purchasing marketplace health coverage. I am so confused as to how I am disqualified and furthermore have no clear instructions to getting this issue resolved without a lot of red tape. I am definitely not going to hire an attorney to purchase insurance that I am being forced to purchase.
Comment ID: 8359580664432572773 Written by: Unknown: I too received a denial of tax credits even though I clearly fall within the income brackets for both the premium reduction and the out of pocket expense reduction chart on Healthcare.gov.

On November 16 I submitted my written appeal to London KY. On December 14 I received a call from the government contractor, Maxus. They instructed me to either: 1) log onto Healthcare.gov and delete my current application and reapply or 2) have a human at the Healthcare.gov call center do this for me. I asked the Maxus contractor what roll they played in the appeal process. She stated that their job was to simply process the letter I sent and then direct me back to Healthcare.gov. In other words I wasted nearly a month so I could go back to square one and reapply.

I let a human delete my existing application, then I went through the application process all over again for the 4th time. Believe it or not, the website doesn't save even the most basic information for a person. You know the simple stuff like name, address, DOB, SSN, telephone #. How inefficient is that.

By this time I'm two hours into the phone call after all of the waiting to be connected to a human. The application is completed and submitted. I get the same results, no tax credits. I asked the "customer service" person why I didn't qualify. She said that she didn't know and that I could file an appeal. Really, wow that means I'll right back to square one in a month. I told her that wasn't acceptable and I wanted to speak to her supervisor. Another 15 minutes of waiting.

Finally I got a supervisor. I explained what I had been through since November 16th and asked why I didn't qualify. She researched for a while, then put me on hold and researched some more. After 15 minutes of research she asked me for my appeal number. I don't know. She asked me which of the two applications was valid. Huh? One of them is supposed to be deleted isn't it? I asked if the applications had dates on them. Nope. Finally she was able to determine which one was the correct application. More research. She didn't have an answer. I directed her to the chart on Healthcare.gov with the income brackets. I asked her if based on what she saw there would i qualify for tax credits. She said yes. I asked her to explain why the system was denying me. I knew the answer was a programming glitch and I wanted her to say it too. Eventually she came back and said that she would be happy to escalate my question to the escalation department. In other words she was ready to dump me off. Been there done that, not going through that BS again. I asked her to connect me to them. Sorry they don't work on weekends. The deadline is 9 days away and they don't work weekends. My tax dollars hard at work. I asked her how long it would take for the escalation department to get back to me. 2-5 business days. Wow. December 23 is 6 business days away. I wonder if I'll get a call back in time? Probably not.
Comment ID: 2717158257488660556 Written by: Anonymous: Family of 4, 2 parents filing tax jointly, children 19 and 25 one filing as full time student dependent (over $400 in self-employment income requires 1040), one filing independently living & working in another state. Add the incomes, we are 120% of poverty level for family of 4, should be eligible for subsidy. I've been trying about 4 hours/day since Oct.1 to get signed up. Dec.16th now, application instructions are still poor and self-contradictory, no joy from results that make little sense. Not even an acknowledgement from paper application mailed Nov.4th. Difficulty getting ID verified. Each application takes 45min, even with practice, due to inefficient entry process. Trying to correct errors introduces more - even logging out & back in changes answers to incorrect - so, DELETE and start again from scratch. I am self employed, can't work because struggling with this application. Getting somewhat desperate need insurance for Jan.1 required by student's school.
Comment ID: 362163997276475919 Written by: Anonymous: my wife and i have four children (ages 6, 4, 2, and 6 months). she and i are eligible to to buy from the exchange by the kids have the "you don’t qualify to purchase health coverage through the Marketplace." how is it that both adults are eligible but 4 dependent children are not? at this point I am more educated than the people on the phone. anyone found out why this is?
Comment ID: 1348887551217425712 Written by: OrganicMama: I am having this exact issue! Only on my application (which I deleted and resubmitted 3 times with similar, thought not the exact same) results! Some, but not all, of my children are not eligible! My husband and I are, but not my young children!

I keep getting told different things by each different representative... and no one can help me!

If anyone can figure out how to get this fixed, please help! I am in tears! Our insurance is canceled in a few day!!!!
Comment ID: 2572225023430777378 Written by: Anonymous: Do you all live in Texas or one of the other states that are not participating with the health care?
Comment ID: 7364503701150863206 Written by: Anonymous: We've had the same experience as other posters. My husband and I qualify to purchase through the marketplace, and it says that one of my kids "might be eligible" while the other should seek health care at community health centers. The kids are 3 and 6 years old. We're a family of four making about 65k through 4 different income sources. (self-employment and part time employment). We were told at one point that on our application, it appeared that the same social and birthday was entered for each family member, which of course it wasn't. This has to be the glitch. We were told to delete the application, and start again, and have done that about five times, always getting the same results. I guess an appeal will follow.

At the last moment, our insurance company decided to allow us to continue on our current policy for a year. The policy is terrible and expensive, and I was hoping for better by Jan 1. Now I just am thankful that at least we can carry something until this complete MESS is sorted out!
Comment ID: 8588779449783585945 Written by: Anonymous: I actually got through on the second try and bought a bronze plan with Geisinger. But I have the same problem in that the site deemed me as not eligible for a tax credit. I filed the appeal and mailed it to Kentucky as instructed. I got a phone call from somebody saying that I should apply again. I asked if I should first delete my application and the person said she did not know, that I should call Healthcare.gov and ask. So I called there and waited on hold for an hour. Meanwhile I was reading that I really cannot delete my application without deleting the coverage I have purchased. Oh dear. The one thing I think is that I have a year to work this out when I do my taxes for 2014, right?
Comment ID: 4796283068348962751 Written by: Anonymous: We too have had the same problem. We have 3 children ages 13, 15, and 17. I spent from October to December trying to get my application done online. When I finally got it done, received letter that stated hubby and I qualify for tax credit and marketplace insurance but none of our 3 kids are eligible to purchase insurance through marketplace and not eligible for Medicaid. I called. Told to appeal as well, which I sent certified mail. This has got to be a computer glitch.
Comment ID: 2501938184781841474 Written by: Anonymous: Most states have Medicaid insurance available for children up to 300% of the poverty limit. If your family income is under 300% of the poverty limit the exchange will not accept your kids. You probably thought you were going to get a great tax credit for your family and this is not going to be the case. If you want your entire family on one policy on the exchange then your income will need to be over 300% of the poverty limit. At that income the tax credit is very small if any. You can hope that when you file your taxes in 2015 and your income is below that you will get some of it back but the IRS may disqualify since your kids quality for Medicaid. Your best option would be to take out insurance for you and your spouse on the exchange and then take out a catastrophic policy for your children off the exchange. The only reason to use the exchange is if you want a tax credit. The exact same plans without tax credits can be purchased off the exchange.
Comment ID: 662362661617267696 Written by: Anonymous: ^^ What is the exchange? ^^ We're having the same problem. I do not know what our poverty percentage is, but my husband & I qualify and our 3 young kids don't. We're being forced to put them on CHIP. Our insurance company says we could put them on their own individual plan as an option. How is it that a 1 year old can have his own health plan but can't be put on a plan with his parents? They said we could appeal but it sounds like that is just a waste of time. If so many people are not eligible for it, then why are we being forced to have it?
Comment ID: 2710551635402692983 Written by: Unknown: My daughter has the same issue she does not make enough to be able to buy insurance on the marketplace and they tell her that she doesn't qualify for KS medicaid either because she makes too much but on the marketplace says she makes too little to buy it through them. She mad a whole $9300 this past year because her daughter has had medical issues and cannot work fulltime. She has not recieved any child support since mid-summer and he says he rather go to jail then pay. She doesn't qualify for the subsidies either because she is poor does that make sense. How is this alright for a single Mom or anyone to have to go through this.

We have been through a crazy mess ourselves with the market place this is all just wrong. You know after dealing with the marketplace now for over 3 months, I wish that I could escalate them right to Obama. This morning I spent hours again on the phone trying to get them to send the right policy for Randy over to the Blue Cross Blue shield and they can't even do this without an escalation. We have 4 escalations in for the same thing. I have supposedly talke with the manager of the call center but her boss doesn't take phone calls which I know is BS. If they would stop doing all the escalations and do their job and learn it better they might get somewhere. I would like to see Obamacare work but if they don't fix the marketplace and the people working there it wont work. There is so much with this story of what we have been through with them that I can't explain it all on here. It is frustrating and it's even more frustrating watching our people that work in Washington not working together to fix all this. I hope somehow this makes it to them and Obama but I doubt it. If I only had a way to sit with somebody that mattered to discuss the issues.
Comment ID: 8456829741855752677 Written by: Anonymous: Okay I have read these blogs and I am an agent/broker and have a lot of your answers yet much to my dismay what I am trying to find out was not in any of these blogs.. This system is a two fold problem.. maybe not a problem but an equation.. What your income before Uncle Sam gets his cut and B= how many people consume life's bare essentials out of the check. IE Food, Gas, rent, mortgage, (ok you get the point) so there is the equation A-b=C. (C being the tax credit). A good base Formula is to start at around 11,600 for 1 person.. From there add 4,000 for every additional person. if you are above these amounts you should get a credit. Be weary a new feature in the eligibility results has a code(usually in the second box) it will be an 06,04,05... These codes were not on the earlier results before January 01. There is an out clause in which the Government can take away your Tax credits leaving you with no insurance again.. Now my quest is on if someone can shed some light on what these codes really mean .I am sure they did not design this to have epic failure.. I think the perfect resolution to this problem is to let the IRS handle any financial disparities in 2015 when the projected income is cross referenced to actual income. It seems simpler and less burdensome than the way it set up now.
Comment ID: 6159370929830930775 Written by: Anonymous: We live in Louisiana and my 26 year old son is a full time college student and works part-time. He is no longer eligible on my work health care as a 26 year old dependent. So he applied for the Affordable Health Care and was denied subsidies because he did not make enough money last year.
I believe he has to make @ $15,000 to qualify. He made @11,000 last year. He cannot afford to buy health insurance without subsidies, so he is currently uninsured. Any suggestions?
Comment ID: 2412630316460946463 Written by: Anonymous: my wife and I has similar problems, but it says she may qualify for Medicaid so she can't buy on the marketplace, and I don't qualify for a tax credit. Since we file taxes jointly and have the same income, how can our eligibility be different? Moreover we meet all the stated criteria for the tax credit. The really cool thing is that, even though the eligibility notice says I'm eligible to purchase through the market place (even though I don't qualify for the tax credit), and states that the "next step" is to choose a plan and make first month's payment, the website will not allow me to select or even view any plans.
Comment ID: 4691634280031893001 Written by: Anonymous: Yes, your son and all others in this type of situation should demand that the Republican legislators in your states allow Medicaid to be expanded. Your 26 year old son would most likely qualify, as would many others who fall into these grey areas. That was the original plan for the ACA(Obamacare, as many like to call it), all states were given the option of expanding their Medicaid program to cover many of the people who usually make too much to qualify for such programs, but that do not make enough money to purchase insurance from the healthcare exchange or on their own. This is a good plan, because the states would not have to pay for expansion. Federal government would pay 100% for first 3 years, then continue to pay 90% after that always. But alas, Republicans in certain states, including Louisiana, have decided that their own illogical & selfish party politics are more important than helping to make sure Americans have health insurance. Most falling into this category are working class, poor or disabled people, the ACA is a good thing as we all need healthcare coverage. It's just common sense. No surprise that the wealthiest 1% of citizens in this country are the ones that Republicans in these states are fighting to protect, while they fight to keep the other 99% of us from decent health insurance! If you don't believe all of this, please do your research on these matters, thoroughly. Read a variety of info from a variety of sources. A recent case in state of LA involved Moveon.org being sued by Gov. Bobby Jindal for refusing to take down a billboard they bought and put up in support of demanding he listen to his citizens and expand Medicaid. Research that case to see how hard some are working to keep your loved ones from healthcare. Thanks, and apologies for ranting
Comment ID: 7427753042925033398 Written by: Anonymous: I have a daughter who was covered on my spouses insurance (or so we thought) until we went to file a claim and it was denied. My daughter is 21 and apparently as of 12/31/13 her mother dropped her insurance (she is a nurse so she had better coverage than I did). Here is the problem, her mother didn't inform us that she dropped her insurance coverage and according to the insurance company they sent her notifications to her mother's address which she didn't forward on to our daughter. Since my daughter is out of her 60 grace period to be added to my insurance we decided to look at the marketplace. We found that since she filed her own tax return (with me claiming her as my dependent on my tax return) for the earned income of $4k she has working PT while going to college FT, I could not get a policy and add her to it. We were also told that since she doesn't make $11k she doesn't qualify for getting an insurance plan herself. WTH, I thought this was exactly the kind of person the marketplace was supposed to help get insurance. And now to top it off, since I can't add her and she can't get any insurance I will be subject to the fine for her not having coverage based on hers and my incomes. Talk about a bunch of BS! In the meantime we are getting her Short Term health insurance just so she has coverage until open enrollment starts again for my policy at work.
Comment ID: 361679204919777651 Written by: Anonymous: Initially, when I applied online at Healthcare.gov, I qualified for subsidies. But I was trying to apply when the site was slow and crashing all the time and wasn't able to complete the process. So near the cut off date for applying, I called Healthcare.gov customer service and went through the application process again with a live person. This time I was told I didn't qualify for subsidies because of my filing status on my federal tax return: married filing separately! I explained that I have no other choice but to file that way because my husband and I have been separated for 16 years, he is a foreign national living overseas, I don't know anything about his income or other financial dealings and therefore do not benefit from his income and rely solely on mine which qualifies me for subsidies. None of this matters apparently...
Comment ID: 189819393379115363 Written by: Anonymous: My cobra is up on 07/31/14 and I have been trying to get this going for 2 weeks now. I enrolled my wife and three children months ago when her Cobra plan was up. Now, their system flagged ONE of my THREE children for possible eligibility for the CHIP program in IL.. Basically Medicaid for kids... I said I do not want my kid in Medicaid and I want to enroll them into my family plan...

I am then told that if I choose to decline that Medicaid coverage then my entire family is ineligible for any savings or subsidies from the exchange... At this point I am so angry I cannot see straight.. I have had 2 agents tell me that is wrong and they have been told by their advanced teams that we can decline that coverage and we are still eligible and I have had 2 agents tell me that to decline that "help" we have to say no to the first question of the survey about receiving assistance or savings.... HOW IS MEDICAID HELP? NOT ONE OF MY CHILDRENS DOCTORS ACCEPTS MEDICAID!!!! How is declining Medicaid and wanting to enroll my child in the GOLD PLAN we selected a BAD THING???

I have asked all agents what the criteria is for a child being found eligible for Medicaid.. Why would all three not be? I really really believe this is a way that they can come back and decline any monetary savings for anyone they choose.. Medicaid is the lowest for of healthcare out there... And to say sorry, but you have to decline ALL federal assistance in order to roll my son into the Gold plan we chose in order for him to be accepted into that gold plan..

WTF is that? There have to be so many people out there that are just an enraged about this as I am... Totally unbelievable how blatantly obvious to me this whole process is at targeting those that they WANT to qualify for subsidies and those who they do not want to get them... Quite tragic...
Comment ID: 1166789146811828975 Written by: Anonymous: If what you say is correct, it sounds like Fed. Govt wanting state Gov. (medicaid) to pay part of your family ins. cost before Fed. Govt. gives any discounts for family ins. via the marketplace. Just a guess and many states are refusing to expand their medicaid coverages as the Fed. Gov't has asked. The fight ensues and your in the middle...
Comment ID: 5897793733657982153 Written by: Call center worker: Thanks for this post! It's really interesting to hear a perspective from the other side of the phone call.
Comment ID: 5887098861460075393 Written by: Anonymous: My son has had a drastic income reduction from 19,000 to 9,000 in 2015...He doesn't qualify due to too little income...Medicad not an option, were in N.C....Help...
Comment ID: 8769768757042560120 Written by: Anonymous: Having the same issue my wife and I qualify for the Marketplace and they want my kids to go on Medicare. Now that there are more questions than answers about this system, and no one that seems to have or want to answer them. I really hope this situation inspires people to get off their Darrrieres and Vote! It is interesting that I see many problematic situations with a similar theme and zero real help or answers! That is what we need, ANSWERS!

Some additional thoughts if anyone really cares. I thought Medicare was designed and passed to care for the very poor and needy?! Now they want to use it to care for the most vulnerable, not needy, (a new definition) kids in society under 18 years of age with parents that earn less than 130k a year. This is about the government controlling more dollars from each of us. I can see it now in the proverbial Washington back room with both DEM and REP attending, what if we could cash in on just 5% of the dollars going through our health care system? People this is not about helping us it is about CASH. That said; This is more than an economic issue it is another opportunity for the government to get one more step toward breaking up the family. Most plans on the marketplace are subtitled “Adult Only” when I asked an agent what this meant the reply was that children could not apply for this plan by themselves. Now I know that it means children are not to be included if your kids are on the marketplace they have a special plan for them; Medicare. What happen to the Family Plans? You go through the laborious process required by the marketplace, select a plan only to find out we have to leave our kids behind with sub-par health care that many doctors are not accepting. It feels like they are trying to take our kids and care for them as they see fit rather than giving us the choice to provide the best health care available. Go read the true Pipe Piper story; sounds familiar? There are too many comparisons in society today where the government is trying to tell us what is best for our kids and us. That would be a waste of reader’s time to call them out one by one. I agree after spending 16 hours over three days talking to people hire by the Marketplace that are very good at saying I'm sorry, I wish I could help you… that they don’t know and intentionally have not been trained to have real answers because there would be such uprising if people really knew the truth about this plan.
What I do know is that my previous insurance plan has been cancelled. I need protection for my family! As a result, my insurance cost will now more than double, my deductible will triple and the annual cost if I want to give my children real healthcare protection and not send them to the free clinics or doctor that may or may not take Medicare is that my costs will be more than my house and car payments combined. Oh and did I mention that I am considered to be in the middle upper income bracket? I made less than $70k last year. I will be voting will you?
Comment ID: 4854757723539712659 Written by: lookingfortruthandaccuracy: the employer mandate will disqualify people who fall within the income limits for a subsidy. It doesn't matter how much you have to pay for your coverage through your work. If your insurance expense for premiums for an individual plan coving just you is less than 9% of your whole household income, your are disqualified from a subsidy. It doesn't take your whole household expense for health coverage into consideration but it does take the whole household income into consideration. I'm sick of everyone acting like the republican's not expanding Medicaid is the only major problem with this stupid law. Like every other government program this one penalizes hard working lower middle class families The premiums and deductibles are a huge problem. How come the deductibles are not considered as part of your health care expense when applying for a subsidy? Not everyone without insurance issues qualifies for Medicaid - Maybe we should all quit our jobs :(
Comment ID: 6388265724221254168 Written by: Anonymous: This comment has been removed by a blog administrator.
Comment ID: 4135557125794992029 Written by: Anonymous: I am a Broker's Assistant. I cannot tell you the frustration dealing with healthcare.gov that I have experienced. I literally get sick to my stomach at the thought of having to call them AGAIN!!!! The people answering phones no absolutely NOTHING. Explain to me why after a Consumer applies on-lone and application shows submitted and accepted; and then the Consumer gets a letter explaining that they may qualify for Medicaid, only due to the fact they neglected to enter their income. So you would think that the Consumer could log in to their healthcare.gov account and add their income, right???? Wrong!!! At this point they have to either submit an appeal or start over. Oh, and if they just try and go in to existing application to add their income it starts the whole application process over again with a later effective date.

Healthcare.gov has literally created a mess for themselves.

Sorry.... I just needed to vent. I can't deal with this crap anymore.
Comment ID: 1822426203608214257 Written by: Punitor: I am an attorney. Last year, the Marketplace inadvertently inverted 2 digits in my husband's social security number, and denied him, like everyone else, WITH NO EXPLANATION. It took me hours on the phone to figure out THEIR error. We switched plans for 2016, and they again booted my husband from coverage. Having already provided them our 1040 and his driver's license, we received the same BS form letter with NO EXPLANATION of what the problem was. Turns out, this year, someone in the Marketplace put my year of birth in the place of his. GREAT. Still on hold, agent is talking with a supervisor. This is time consuming, stress-inducing, and wasteful.
Comment ID: 6971892902915762783 Written by: Shazeel Parwaz Rajput: dsadsdsdsad
Comment ID: 5971909429475134370 Written by: Unknown: Is there any way of keeping your children on a subsidized family plan? We're lower middle class, operating a family business, and just got denied group health renewal thanks to the definition of an "eligible employee" no longer allowing for a husband-wife run small business. We're forced into the individual market now, where for 2017 nearly all insurers have pulled out for private plans. So I go to healthcare.gov to be told my kids have to be on Medicaid, which is absurd. We aren't in poverty, we were able to afford our now defunct compliant group plan. No subsidy similar individual plans are running $500 a month more, and the subsidized plan is only $200 a month less than what I did have, but ONLY if I toss my kids into Medicaid,
Comment ID: 4785979264210424564 Written by: Bernard T Williams: I agree Punitor. This is time consuming and wasteful. I understand that all systems need support but the lack of explanations in these situations always increases the stress.
Comment ID: 7908548065283160049 Written by: Birthday Wishes: We too have had the same problem. We have 3 children ages 13, 15, and 17. I spent from October to December trying to get my application done online. When I finally got it done, received letter that stated hubby and I qualify for tax credit and marketplace insurance but none of our 3 kids are eligible to purchase insurance through marketplace and not eligible for Medicaid. I called. Told to appeal as well, which I sent certified mail. This has got to be a computer glitch.

Is There A Problem Here?

20131111

Healthcare.gov: You don't qualify to purchase health coverage through the Marketplace

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