Healthcare insurance – it doesn’t always add up

A gentleman came into the office of the Houston Home Journal Friday.

His name was John Doe. You might, after reading this, choose to refer to him as something more along the lines of “lifesaver,” or “champion,” or “guardian angel,” but he chose to use the name John Doe – Good Samaritan that he is.

Here’s what he had to offer.

Imagine you’re a single mom. You have one child. You’re 45 (we’ll just keep that between us). You are not pregnant. Repeat. You are not pregnant. (You’ll understand why I repeated that in a moment.). And your annual salary is $14,000.

Now, you take that information and you go to the healthcare.gov website (Obamacare Central). You create an account and you plug in all the information – including that about not being pregnant. And then you have to answer that question again on the website – the pregnant question – as if they want you to just double check. (“Now are you sure you’re not pregnant?”)

That done, you click on the next link and you’re off to view your wonderful, wonderful (sarcasm) “premium estimates” and “marketplace plans.” “Hmm. Let’s see … $287 a month is the minimum. $287 a month! Are they kidding! Did they miss the fact I only make $14,000 a year?!”

Oh, I suppose it could have been worse. You could have gone for top of the line. It was/is only $372 a month! (more sarcasm)

Now let’s try it a different way. (Note: “You’re welcome” for waiting for you to come to after previously passing out.)

Let’s say you’re the same person. (Hopefully, you’re still the same person and the aforementioned information didn’t prompt you to don a disguise and are now hiding out in Mexico.)

This time, however, Ms. or Mr. 45-year-old not pregnant person (hopefully in the case of “Mr.”), you enter an “expected” (this word is especially important and comes straight from the site) annual salary of $15,750.

Now you follow the link back to “premium estimates” and “marketplace plans.”

“Hmm. Let’s see what they have to offer me now. Better place a pillow down here on the floor in case I pass out again. Hmm. OK. Humana National Preferred Bronze plan. Well, it’s the lowest there is. Let’s see how much it costs. $0! It costs $0! $0! What in the world?”

That’s right, and you can scroll on down through six more plans, each one getting better and better, and your monthly premium is going to be $0!

How in the world?

Yes, how indeed. You’re making more money and yet paying less – “$0” – for healthcare.

And yet there it is.

I would have never believed it, and yet John Doe walked me right through it. Who is he? Some techno-geek? Nope. He’s … well, a John Doe. As he put it, just a guy who applied for insurance and his salary had him paying “$0.” Then he heard from his daughter-in-law and she was about to pay through the roof. (She’s the $14,000, 45, etc.)

So what makes the difference?

Apparently, it’s a monthly tax credit that kicks in based upon your annual salary. In the case of $14,000, it’s $0. In the $15,750 case, it’s $329 a month, that is, per the website, “applied to the plan.” Go figure.

What to do? What to do? Well, note again what the key question you’ll be asked is: What is your “expected” annual salary.

So, I guess you could lie and say it’s $15,750 or more. Oh no you didn’t! That’s not what this here man is endorsing, and I want to strongly go on record as advising against it!

Or, I suppose if your heart is really, really, really in the right place, you could do it with the intent of getting a part-time job that would give you that extra $1,750 ($15,750-$14,000). (Note: See “really, really, really in the right place,” and if that fails, see Rule No. 1: “really, really, really in the right place.”)

I was unemployed for two weeks prior to coming back to the Houston Home Journal. The state paid my unemployment based on “intent” – the honor system – that is: “I promise I’m out looking for a job (which I was). Now can I have my money?”

Maybe it’s me – usually is – but I don’t see a difference. Again, intent, to me, plays the biggest part. Are you trying to defraud the federal government? (Don’t do it!) Or are you a hard-working, honest person who is just trying to make ends meet for your family? And, “I really, really, really am going to find another job to make up the difference.” (Note: We have a person at the church who works two part-time jobs – counting the church. I’ve asked that person to figure up the combined salaries – the person just started working at one of the jobs. Believe me, if that person needs an additional $1,750 a year to pay $0 for health insurance, we’re going to do everything in our power to find $1,750. I would hope there are other bosses who would do the same.)

I suppose in the end the federal government is going to sort it out one way or the other. That is, if you put down $15,750 as your “expected” salary and you’re making $14,000 at the end of the year, you are probably looking at penalties, etc.

Of course, all this said, I’m not a lawyer.

Or even one of those very, very smart tax people who seem to be able to squeeze money out of a rock. (“Oh yes, Mr. burglar. You can deduct that rock provided that rock was used in the course of your business …”)

That – the take on the insurance, not the rock – could be the worst advice in the world, bar none. Probably is.

Then again, it may be the difference between $0 a month for healthcare and food on the table or $329 a month for healthcare and … well, you’re going to need it because now you’re not feeling so hot.

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