r/obamacare

ACA question for you FIRE experts.

I have recently retired in 2026, and our family is on ACA with substantial tax credits. We are family of 4 and plan to manage our income to around $90k.

My son is a full time college student and is taking a job making $25/hr for the summer and this job will offer health insurance. He will plan to continue working there likely during the fall/winter term if it is not too busy for him.

Are we good to keep him on our ACA health insurance without incurring any penalties or losing subsidies?

He will make under the $16,100 federal filing threshold for 2026. But, I’m concerned that since he will qualify for insurance through his job it will screw something up. I want to keep him in ACA for 2026 so that he is not flip flopping back and forth. There is a chance when school starts back up in September he won’t work the 30 hours a week to maintain benefits with the employer.

We knew this was going to happen. But still, it's upsetting. OBAMACARE and then the Dems federal expansion of medicaid (not available in many red states) is the best thing that happened to me.

For anyone who says the government cant deliver government insurance, come to WI. I will show you how good my coverage is. I would literally be dead if I l8ved in Florida. The GOP refusal to take federal funds to help people pay for much needed medical insurance/care would change my vote from red to blue in a heartbeat.

“NEW YORK (AP) — About 3 million fewer people in the United States had Affordable Care Act health insurance plans in February compared with the same time last year, according to new federal data.

In the report released Friday, the U.S. Department of Health and Human Services suggested the 13% drop in enrollment from 22.1 million people in 2025 to 19.2 million this year could be attributed to a federal crackdown on fraudulent or “phantom” enrollment. But health analysts said it was more likely related to the Jan. 1 expiration of federal subsidies, which caused a surge in plan costs that resulted in many people being unable to pay their premiums.”

From https://aspe.hhs.gov/sites/default/files/documents/f5f29954221d5b5713070ac2541fda8e/aca-enrollment-report-2026-final-version.pdf

> Unfortunately, improper, phantom, or fraudulent enrollment persists. Recent experience during and after the 2026 Open Enrollment Period strongly suggests ongoing and persistent fraud, waste, and abuse in the system. We estimate 2.6 million improper and phantom enrollments remain, including over 1 million enrollments without a social security number.

and

> Preserving the fiscal and programmatic integrity of the ACA Exchanges is key to safeguarding taxpayer-funded resources for those that truly need them.

When I signed up during open enrollment for ObamaCare in 2025 for 2026, I had a part time job that didn’t offer me health insurance because I wasn’t considered full time. I’ve been on Obamacare for years. So, I gave Obamacare my best guess for this year. I would have been very close. I told them $17,000 for the year. Well, after a short time (3 months this year) I lost my job. Only made $5,500.

I have not reported this to them because I don’t want to lose my subsidies. Without the subsidies, there is no way I can pay for health insurance.

I’m “too rich” for Medicaid and not old enough for Medicare. I will be 62 in 4 months and I plan on signing up for social security widow’s benefits. I could have signed up 2 years ago because I‘m a widow, but I decided to wait a bit.

My questions are: Am I going to have to pay back $12,000?? Also when I sign up during open enrollment will they even let me if I have no income and haven’t started collecting social security benefits yet?

So confusing, and so upsetting. I have a small IRA, but I don’t want to drain it to make up the difference between my projected income and what I actually made! 😢

I've had long-term neurological issues like neuropathy, muscle pain, and memory issues for nearly 6 years that neurologists in my state (and in Connecticut) haven't been able to definitively diagnose. I am on SSI for disability, which means I get Neighborhood Health Plan of Rhode Island as my primary insurance, with Medicaid as the secondary.

I was told by a neurologist I saw across the border in Connecticut recently (Some doctors in CT take my insurance it seems) that being seen at a bigger hospital like Mass General may lead to a definitive diagnosis. From what I was told by his office after they tried referring me to the hospital, Mass General/MGH is no longer accepting my insurance even with prior authorization, when a few years ago i was told by Mass General they were taking my insurance with those stipulations.

I was told by MGH's neurology department staff (who were very nice and compassionate about my situation, to be fair to them) that it's possible the hospital chose not to contract with my insurance this year, hence the change, and that because I am on Medicaid, I couldn't even choose to self-pay to go there. They said it's possible in the future the contractual issue could change, and they also told me to try contacting Neighborhood Health myself and explain the situation and see if they could somehow get me approved to be seen at Mass General. I will be calling them this upcoming week.

I was curious as to how often Americans are on health insurance plans that cover seeing specialists across state lines, how difficult it is for them to be approved to see specialists in different states, etc.

I find it frustrating that my insurance doesn't work across state lines considering this is the smallest state in the country. Not every specialist is going to be here. Logistically it seems to make sense to me that CT/MA should have a deal with RI insurance to cover people if they at least get prior authorization/approval.

As of right now Mass General wouldn't take me no matter what, which I find very concerning and depressing. I have had multiple neurologists say I should be seen in a place like Boston to possibly get a definitive diagnosis, why is that not enough to be seen there? That makes no sense to me.

Under the ACA, insurers in the state marketplaces and fully insurer plans were bound by the Medical Loss Ratio (MLR). They had to spend 80% to 85% of premium revenue on actual medical care, capping their administrative overhead and profit margins at 15% to 20%.

But this creates a massive perverse incentive. Because an insurer's profit margin is capped as a strict percentage the biggest way they can generate more total dollars for their company via marketplace plans is if the overall cost of healthcare goes up.

For example, if UHC aggressively negotiates lower baseline prices with a hospital network, their total premium pool shrinks. 20% of a smaller pool means fewer absolute profit dollars. Therefore, it is far more lucrative for them to act as mere pass-through entities: accept higher hospital prices, deny just enough individual claims to manage their margins, and then use those rising baseline costs to justify a premium hike the next year. How did framers of the ACA not see this inherent problem with the 80/20 rule, doesn’t this cause health insurance prices to go on a death spiral?

So I lost my main job this week. I do have a second little 1099 side hustle that’s good for about $400 a month which is only a little over half my mortgage cost and I have some savings I can dip into. My ACA premium ended up being my second highest monthly bill because I estimated my income higher and because of Trump screwing those of us that use the program.

My question is can I switch to Medicaid halfway through the without having to worry about paying back the subsidy? I’m applying for Medicaid today but obviously won’t have an approval decision before my premium is due on July 1st, so I will probably have to pay my July premium. It would hurt financially to have to keep paying this inflated amount for the premium till the end of the year when I’m no longer making anywhere near that but I don’t want to create an even bigger financial headache come tax time. Any insight appreciated thanks 🙏