People caught in the coverage gap seek ways to earn more income to be eligible for subsidies

February 01, 2015

The New York Times reports that many low-income, working adults who are eligible for neither federal subsidies nor Medicaid because they live in states that have declined to expand the program are taking second jobs or working extra hours to increase their incomes, hoping to become eligible for assistance that will enable them to afford marketplace plans. All told, four million adults in nearly two dozen states fall into the gap, and Texas has the most, nearly one million. Though it is impossible to know how many of these people are trying to bolster their incomes, enrollment counselors around the country say they routinely help people think through whether they can scrape together extra income to qualify for financial help. Everyone applying for subsidies has to estimate his or her 2015 income, which can be tricky for people whose earnings fluctuate. If the estimate is more than 10% higher than the income listed on the applicant's most recent tax return, the federal marketplace may ask for documentation. If someone who gets a subsidy ends up earning less than the poverty threshold, he or she will not have to pay it back under the current rules, according to an enrollment program director at Families USA. Although the law requires most people who remain uninsured to pay a penalty, those who earn less than the poverty level in states that have not expanded Medicaid are exempt. Instead, they fill out a form to get a so-called hardship exemption.