What to do if the Marketplace ends your tax credit in the middle of the year

By Sadie Tuescher

Every year, a few clients of ours go through a loss of their tax credit because of processing errors from the Marketplace. These are people who have been honest and done everything right, and I have ample proof of this. They have sent me their proof (such as proof of income or immigration status) and I have uploaded and mailed copies of their documents, keeping proof of my uploads and what I sent on their behalf. I have checked the status of these uploads repeatedly and seen no processing. I've called and spent hours on the phone with Marketplace representatives who either cannot or will not help. 

This happens to thousands of people every year. They do everything they were asked to do, and yet the Marketplace still pulls their tax credit for failure to provide proof of something or another. 

As an advocate for my clients, I track their applications and, if given permission, upload proof on their behalf. I know we're doing it right. We're going above and beyond. When the worst happens and the Marketplace unjustly decides to cut them off, we appeal. We wait for the appeal to come to a judge. In the meantime, the client has to pay the full cost of their premium, sometimes upwards of $2000 per month, to keep their coverage. If they fail to pay, the insurance company ends their coverage. And there's no getting it back that calendar year. 

Over the past few years, with each of these cases, I have virtually met a handful of judges. All my clients in such a situation have won their cases with my help. All the judges have quickly ruled in our favor and expressed the ridiculousness of the situation. Once the client has won,  the judge sends their ruling to the Marketplace. The Marketplace then sits on the decision for up to 90 days. During which time, my client has to somehow come up with the money to pay the premium they will eventually get refunded. 

It is a very frustrating situation. I can only imagine the number of people every year who do not work with an advocate and don't know how to fight their case, so they lose their coverage. If you buy insurance without the help of a broker, my best advice is to closely and repeatedly check your application (under the section titled Application Details) if you've been asked to prove something such as income or your Social Security Number. Keep screenshots of the proof you sent.

The bottom line is that you (or your advocate) should keep copies of everything, write down dates, and pay attention to your notices. Appeal any decision you think is wrong or unfair, and present evidence with your appeal. This is something we do on behalf of our clients for no cost (or for non-clients for a small fee). The most important advice Mary and I can ever give you is this, though: read your notices and take action! Like with any branch of the federal government, the Marketplace is unforgiving, and it will be an uphill battle to win your case. But it's worth fighting. 

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