week, I fielded questions about the circumstances under
which people have to repay premium tax credits for
health insurance purchased on the marketplaces and about
Medicare coverage of dental services.
My 60-year-old sister lost her $45,000-a-year job in
2014, and she and her husband bought a marketplace plan
this year. They had estimated their annual income at
$22,000, but then she inherited $30,000 from our motherís
estate. If Iím calculating correctly, theyíll have
to repay $18,000 in premium tax credits. Are there no
allowances made for a death in a family or unforeseen
Fortunately for your sister, your calculations are
incorrect. There are special circumstances that likely
apply in her case.
premium tax credits that people receive to buy health
plans on the marketplaces are based on annual household
income. An unexpected increase in taxable income,
whether itís because someone gets a big raise at work
or a home-based business takes off, may change the
amount of tax credit people are entitled to. If your
income estimate was too low, youíll generally have to
repay some or all of the excess at tax time when your
estimate is reconciled against your actual income for
the year. The repayment amount is capped at $1,250 for
an individual if annual income is less than 400 percent
of the federal poverty level, or about $47,000 for one
not all types of income are counted when figuring annual
household income for premium tax credits. An
inheritance, such as your sister received, is considered
non-taxable income, says Judith Solomon, vice president
for health policy at the Center on Budget and Policy
Priorities. It isnít counted when determining
"modified adjusted gross income," the tax term
for the household income figure on which the premium tax
credits are based.
I qualify for a premium tax credit for marketplace
coverage in 2016. I will turn 65 in April, and Iíll
switch from my marketplace plan to Medicare. If I take a
part-time job after I switch and my 2016 income
increases, will I retroactively lose some of the monthly
tax credit I received for the time I was eligible for
marketplace coverage and have to repay it?
As discussed above, your premium tax credit is based on
your annual income, not just your income for the months
during which youíre eligible for subsidized health
insurance on the marketplace. If you think you might get
a part-time job after you drop your marketplace plan in
the spring, take that into account when you estimate
your income for your 2016 marketplace coverage.
should include what he expects to make [later on] in his
income estimate, and get it as close as possible,"
people take the premium tax credits in advance to help
them cover the cost of their monthly payments. But if
youíre worried about having to repay premium tax
credits, you could opt to pay the entire premium up
front every month while you have your marketplace plan
and take the premium tax credit on the back end when you
file your 2016 taxes.
I have an autoimmune disease called Sjogrenís syndrome
that attacks all my moisture-producing glands. Because
of my dry mouth, my doctor says I will eventually lose
every tooth I have. I desperately need dental care. I am
on Medicare, and it clearly states that it does not
cover routine dental care. I do have dental insurance
through the company that I retired from, but it doesnít
begin to cover all the care I need. I have spent all my
savings. Is there anything I can do?
You have a few options. Medicare only covers dental care
in very limited circumstances: for example, if someone
needs teeth pulled before receiving radiation to the jaw
or if someone is hospitalized and needs an oral exam
before kidney transplant surgery.
insurance typically covers a few thousand dollars worth
of care or less every year, and usually only pays half
the cost of major restorative work such as crowns or
like you, who have a medical condition that affects your
teeth, are in a tough spot, says Dr. Matthew Messina, a
consumer adviser for the American Dental Association who
practices in Cleveland, Ohio.
health care, "somehow the mouth got disassociated
from the rest of the body," Messina says.
"Oral health is a significant component of whole
Medicare wonít cover the care you need, check out
dental schools or community health centers in your area.
of community health centers provide dental services,
generally charging on a sliding scale based on income,
says Amy Simmons Farber, communications director at the
National Association of Community Health Centers. The
specific services offered may vary from center to