If you sign up for Obamacare – You can’t get off

That is what has happened to this Gaston County resident.  Read his story from the Gaston Gazette below:

American taxpayers are essentially paying $875 a month to help insure David Carpenter and his wife. He no longer wants or needs all of the money, which is going to the couple’s health insurance company in the form of a subsidy to help pay the premium. But after more than a month, Carpenter hasn’t been able to stop or cut the payments. And worse, the hiccup could cost him thousands in the long run. Even with the help of an insurance agent who has spent hours on the phone trying to work out the kink, Carpenter has mostly met dead ends. They see it as wearisome evidence of the potholes that still exist within Obamacare, which they say still doesn’t have adequate resources to deal with unanticipated problems. “It’s been real frustrating,” Carpenter said. “Nobody at the marketplace seems to have a clear answer for us. We just want to do what’s right. But it seems like it’s been kind of unfair.” The marketplace is the online and telephone system the government put in place to help give Americans access to health insurance through the Affordable Care Act. Stephanie Sheffield, the Carpenters’ Gastonia insurance agent, said their situation is unlike any she’s ever encountered. “When there is something that needs to be changed on the policy through the marketplace, no one seems to know how to fix it — not people at the marketplace nor their supervisors,” she said. “There seems to be no wizard you can go to and say, ‘How do I do this?’”

One misstep

Carpenter, 64, and wife Sandra, 62, live on the Gaston County side of Kings Mountain. He was an Army medic during the Vietnam War, driving an ambulance and working in a dispensary. Carpenter didn’t apply for VA benefits for years because he and his wife both had health insurance through longtime jobs at Ultra Machine and Fabrication in Shelby. But after both of them were laid off within the last 14 months, they had to scramble. “Once you’re over 60, nobody wants to hire you in manufacturing,” he said. “We both drew our unemployment until it ran out.” Carpenter will qualify for Medicare later this year. But he needed additional health coverage in the interim, and his wife needs it longer. He applied for VA benefits in August, without knowing when they might be approved. A couple who file taxes together — and are applying for a federal subsidy through the Affordable Care Act — must sign up for insurance jointly. So the Carpenters did that in December through healthcare.gov. One question on the application asked Carpenter if he was receiving any other medical aid, such as VA health benefits. He answered ‘no’ because he didn’t think he was. The Carpenters enrolled in a Blue Cross Blue Shield plan and were approved to receive a subsidy to help pay their $1,555 monthly insurance premium. The subsidy they received meant the government would cover $875 of that per month, leaving the Carpenters’ monthly payment at $680.

Early last month, Carpenter received a packet of information about his coverage, along with a request from the marketplace to provide proof he wasn’t receiving VA benefits. He soon discovered his VA benefits had actually kicked in for 2014. “I guess I didn’t realize it,” he explained. “I don’t get a monthly check or anything like that.” He called Sheffield, who began seeking a solution. “We told them we had to get him off this plan because he’s getting VA benefits,” she said. That’s proven easier said than done.

Standing to owe thousands

Carpenter’s dilemma is that at year’s end, he’ll have to pay back any insurance subsidy he received during the time he was also insured by the VA. For his portion of the policy he obtained with his wife, that amounts to $680 a month, and $8,160 for the whole year. It seems logical the government would free Carpenter from the Affordable Care Act insurance plan, Sheffield said. Not doing so results in taxpayers footing the bill for him to be insured with two different plans. The 15th of each month is a red-letter date when it comes to Affordable Care Act plans. It’s the cutoff for making changes to policies in time for them to take effect the next month. Sheffield said she and Carpenter began trying to call the marketplace to work out their problem the first week of January. By Jan. 14, they were pleading with someone to help clear up the problem before the Jan. 15 deadline. “They told us they would have an upper-level support person call us back and tell us what to do that day,” Sheffield said. “We never got a phone call.” They kept trying for the next month, going through the Centers for Medicare and Medicaid Services, which oversees the marketplace. But they made no progress. Last Friday, on the horizon of the Feb. 15 deadline, they were again unable to iron out the problems in time, due to the agency’s computer systems being down. “I have spent so much time trying to get somebody to tell us what we need to do,” Sheffield said. “I have been hung up on by the marketplace so many times, I can’t even keep count.”

Insurance he doesn’t need

The ideal thing would be to terminate the joint Blue Cross Blue Shield policy, then start over with an individual plan for Sandra Carpenter, Sheffield said. Her husband could simply use his VA benefits. Sheffield said Blue Cross has been hesitant about making any such changes because the company representatives don’t believe they’re allowed to do that under Affordable Care Act rules. The Carpenters have been told there is no way to cancel the policy they signed up for. On Tuesday, Sheffield was able to alter the policy going forward. The portion of the $875 monthly subsidy tied to David Carpenter will apparently be dropped as of April 1. But as it stands now, he will still have to pay back the subsidy he received for the first three months of the year. In a best-case scenario, he will also have paid an insurance premium for three months of coverage he didn’t need. That’s money the Carpenters can’t just pull out of thin air. Sheffield made contact with the offices of Sen. Richard Burr and Rep. Patrick McHenry this week, and hopes they can help rectify the problem. But she also worries this situation is indicative of drawbacks — if not identical, then similar — that many others are experiencing across the country. “Somebody needs to know how to pull the switch on things like this,” she said. “But nobody seems to know how to do that. “We’re at their mercy at this point. The people of the United States are suffering here, and nobody seems to care.”

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