Skip to content
Link copied to clipboard

They say they're paying for ACA misrepresentation

Myra Kodner has spent most of her career helping people qualify for programs such as food stamps and Social Security benefits.

Myra Kodner has spent most of her career helping people qualify for programs such as food stamps and Social Security benefits.

She knows qualifying people for a government program means submitting the right information in the correct format.

So when her husband, Don, lost his job in customer service - and with it the couple's health insurance - in March 2014, Kodner swung into work mode. She gathered the couple's information and called the Affordable Care Act's help line to buy insurance.

Myra Kodner, 60, who lives in Phoenixville, said she answered each of the customer service representative's questions - including the most important, an estimate of the couple's 2014 household income, a key factor in determining eligibility for a tax-credit subsidy.

The answer was $52,000, well within the $62,920 cutoff for a family of two. With that income, the Kodners qualified for a substantial subsidy.

But when the couple filed their 2014 income taxes, they were shocked to discover they did not qualify for a subsidy - and owed the government $8,000.

Kodner reported the couple's employment income but said she was never asked about income from unemployment insurance or retirement savings. The couple had tapped into their retirement savings to make up for lost income.

Officials with the agency that runs the marketplace say, however, that customer service representatives read questions from a script that clearly states all income sources must be included.

Now, with no way to prove what she says she was told, Kodner is fuming.

Asked about the Kodners' claim that they were misled over the phone, the Centers for Medicare and Medicaid Services (CMS), which runs the ACA program, said the couple's situation "does not represent any particular pattern or significant area of complaint."

The details of the Kodners' situation may be unique, but in March, a Kaiser Family Foundation report estimated nearly half of the households receiving a 2014 ACA tax subsidy would owe a repayment to the government when they filed their taxes.

The analysis, based on "historical patterns of income volatility among all households eligible for ACA premium subsides," found the average repayment was $794.

Myra Kodner has written letters to CMS' parent agency, the U.S. Department of Health and Human Services, and was recently contacted by a CMS representative. She said that person told her others had had a similar problem.

Kodner said when she applied, the representative "didn't ask the right questions or completely omitted" questions during the application process.

The representative did say that the government "reserved the right to look at our income tax."

"I assumed that they were looking at that to make sure they weren't giving [a subsidy] to people who could well afford [insurance]," she said.

Kodner said she was told unemployment payments did not count as part of household income. She said the representative never asked about money from sources such as an IRA or 401(k) plan.

But all those sources of income are considered when qualifying for a subsidy.

"They just asked if I could provide proof of income and I said yes. I sent them a month of wage statements."

In its e-mail, CMS noted that all of its customer representatives read callers questions from a script that lists income sources including investments, retirement, and pension funds (including IRA/401(k) withdrawals). An excerpt from the script reads: "The application will walk you through the types of income you should include and those you shouldn't."

Also in its e-mail, CMS said people who bought coverage in the marketplace were told they would have to reconcile their "advance payments of the premium tax credit with the actual premium tax credit" they received in 2014 when they filed their taxes.

"The premium tax credit you are allowed is based on your actual 2014 information, such as your actual household income and family size," according to the e-mail.

The CMS e-mail noted there were installment plans for people who have to repay the government some, or all, of their subsidy.

Both Myra and Don Kodner now have jobs with benefits. But the idea of repaying for what they see as's mistake doesn't sit well with them.

"I think they should have some type of forgiveness program," Myra Kodner said. "These are mistakes that they generated."

This article was written in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.