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Varying health premium subsidy amounts under health care law worry consumers

By Kelli Kennedy

Associated Press

Published: Thursday, July 24 2014 11:13 a.m. MDT

An applicant, second from right, is given assistance during a health care enrollment event at the Bay Area Rescue Mission, Monday, March 31, 2014, in Richmond, Calif.

Eric Risberg, Associated Press

Enlarge photo»

MIAMI — Linda Close was grateful to learn she qualified for a sizable subsidy to help pay for her health insurance under the new federal law. But in the process of signing up for a plan, Close said her HealthCare.gov account showed several different subsidy amounts, varying as much as $180.

Close, a South Florida retail worker in her 60's, said she got different amounts even though the personal information she entered remained the same. The Associated Press has reviewed Close's various subsidy amounts and dates to verify the information, but she asked that her financial information not be published for privacy reasons.

"I am the kind of person the Affordable Care Act was written for: older, with a pre-existing (condition) and my previous plan was being cancelled. I need it and I'm low income," said Close, who has spent more than six months appealing her case. "The government pledged to me that original tax credit amount. It's crazy."

Government officials say Close — and other consumers who have received different subsidy amounts — probably made some mistake entering personal details such as income, age and even ZIP codes. The Associated Press interviewed insurance agents, health counselors and attorneys around the country who said they received varying subsidy amounts for the same consumers. As consumers wait for a resolution, some have decided to go without health insurance because of the uncertainty while others who went ahead with policies purchased through the exchanges worry they are going to owe the government money next tax season.

These difficulties faced by Close and others are unfolding separately from the legal battle that flared this week when two federal appeals courts issued contradictory rulings on the subsidies in states that rely on the federal health exchange. The Obama administration says policyholders will keep getting financial aid as it sorts out the legal implications.

The government said consumers who received multiple subsidy estimates or disagree with their subsidy amount can appeal. The government hopes to resolve most of the appeals paperwork this summer. It's unclear how many people received or appealed varying subsidy amounts.

Still, Centers for Medicare and Medicaid Services spokesman Aaron Albright said consumers "should feel confident that they received an accurate determination based on the information they provided in their application."

Federal health officials ruled on Close's appeal last month, giving her yet another subsidy estimate, which was within a few dollars of the one she is currently receiving, her attorney said.

Subsidies are important to making premiums under the new health care law affordable. About 87 percent of the more than 8 million people who signed up for coverage under the law received subsidies, which are paid directly to the insurance company on behalf of individual consumers, according to data from federal health officials. Consumers pay the difference directly to the insurance company each month just as they do with private insurance.

Dallas insurance agent Jo Ann Charron said the different estimates her clients received varied as much as $100 a month.

"Some of them got more of a subsidy, some of them got less," she said.

Since consumers aren't required to use the entire amount, Charron said she encouraged her clients to accept at least $50 less than the highest subsidy quoted to give them a financial cushion in case the government ultimately decides that the lower amount applies.

The differing subsidy calculations are part of a mountain of data conflicts affecting at least 2 million people who signed up for coverage in the new health insurance exchanges. Most of the discrepancies involve important details about income, citizenship and immigration status — which affect eligibility and subsidies.

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