Because of past fraud by rogue brokers, some Affordable Care Act policyholders may get an unexpected tax bill this season.<\/p>\n
But that isn\u2019t the only potential shock. Other changes coming soon \u2014 stemming from proposals by the administration of President Donald Trump \u2014 could affect their coverage and its cost. And sorting out related problems and challenges may take longer as federal workers are laid off and funding for assistance programs is cut.<\/p>\n
First up: Taxes<\/strong><\/p>\n Tax season is when some consumers learn they were fraudulently enrolled in an ACA plan or switched to a different one without their knowledge.<\/p>\n Those unauthorized enrollments or changes took off in late 2023 and continued through last year, drawing more than 274,000 complaints<\/a> in the first eight months of 2024 to the Centers for Medicare & Medicaid Services, mostly about rogue agents or call centers.<\/p>\n Tax problems can arise if those enrollments resulted in premium tax credits exceeding the amount the consumer should have received. In those cases, consumers may have to pay all or part of those credits back. The amount owed could range from a few hundred dollars to thousands, with some caps based on income<\/a>.<\/p>\n The first clue some people have is when they get a 1095-A form<\/a> in the mail.<\/p>\n Those documents are sent out by the state and federal marketplaces to the IRS and ACA enrollees, showing any tax credit payments made to health insurers on a taxpayer\u2019s behalf. Taxpayers use the premium tax credit information from the 1095-A when completing their return.<\/p>\n Returns can be held up if the IRS has information indicating the taxpayer has ACA coverage that they failed to report on their return, or if there are other discrepancies.<\/p>\n The Biden administration last year took steps to slow the fraudulent switching, including requiring a three-way call between the broker, client, and marketplace for some enrollment issues.<\/p>\n \u201cWhile we may be seeing less [fraud], we\u2019re still dealing with 2024 taxes,\u201d said Erin Kinard, director of systems and intake for the Health and Economic Opportunity Program at Pisgah Legal Services<\/a>, a nonprofit serving western North Carolina that offers both legal help and assistance with ACA problems.<\/p>\n Consumers who suspect they were fraudulently enrolled should immediately call their federal or state ACA marketplace, experts say. Some consumers will be referred to special federal caseworkers through the marketplaces. But some of those caseworkers are now part of the broad reduction in force<\/a> by the Trump administration.<\/p>\n In recent days, \u201cthey laid off two divisions on the Affordable Care Act side,\u201d said Jeffrey Grant, who oversaw ACA issues as CMS\u2019 deputy director for operations in the Center for Consumer Information and Insurance Oversight before leaving in February.<\/p>\n With fewer caseworkers, \u201cit will take longer to get problems taken care of,\u201d said Grant, who is now president of Schedule F Healthcare Strategies<\/a>, a consulting group that aims to help laid-off federal workers find new jobs. \u201cThe marketplace is twice as big as it was the last time the Trump administration was here, and now they are cutting caseworkers to less than were around then.\u201d<\/p>\n And these cases are difficult because the rogue brokers who enrolled consumers sometimes misstated their income so they would qualify for the largest tax credits possible. Other consumers have found they were enrolled even though they had affordable employer coverage, making them ineligible for ACA subsidies.<\/p>\n That\u2019s what happened to Anthony Akra and his wife, Ashley Zukoski, in Charlotte, North Carolina. They were enrolled in a plan without their knowledge in 2023, by a broker in Florida with whom they had never spoken. The couple had health insurance through Zukoski\u2019s employer. The broker listed an income that qualified the household for a large subsidy that fully offset the monthly premium cost, so the couple never received a bill. One day, a 1095-A form showed up in their mailbox.<\/p>\n \u201cI didn\u2019t know what the hell it was,\u201d said Akra, who said the form showed that he had been receiving hundreds of dollars a month in premium tax credits. He would owe a big chunk of that back unless he could get the plan retroactively canceled.<\/p>\n Because their pharmacy, part of a national chain, had switched them to the new plan, also without telling them, they had used the new coverage every time they filled a prescription. That inadvertent use of the policy complicated their efforts to get the fraudulent coverage revoked. Meanwhile, the IRS withheld more than $4,000 from their tax refund based on the information sent through that 1095-A form. Months passed, but with assistance from a \u201cnavigator\u201d program \u2014 a government-funded nonprofit that helps people deal with insurance problems \u2014 they were able to get the incorrect insurance canceled and a refund at the end of October.<\/p>\n It is not unusual for people to spend weeks or even months trying to sort out the mess, said Kinard, whose organization is similar to the one that helped Akra.<\/p>\n While navigator programs nationwide are still operating to help people sign up for health coverage or address issues, the Trump administration has targeted their funding for a 90% cut<\/a>.<\/p>\n Meanwhile, ACA enrollees may face a range of other surprises due to policy and budget steps proposed by the Trump administration.<\/p>\n More Potential Changes<\/strong><\/p>\n Congress must decide whether to extend premium tax credits that were enhanced during the covid pandemic<\/a>, which expanded eligibility for the credits and made them larger for many enrollees. Keeping them in place would be expensive, with the nonpartisan Congressional Budget Office and Joint Committee on Taxation estimating it would add $335 billion<\/a> to the deficit through 2034.<\/p>\n That debate will come amid another deficit-affecting decision: whether to extend tax cuts enacted during the first Trump administration, which would add trillions<\/a> to the budget deficit through 2034.<\/p>\n If the enhanced subsidies are not renewed, monthly premium costs would rise by an average of over 75%<\/a>, according to KFF, a health information nonprofit that includes KFF Health News. Premiums could more than double in some states, including many GOP-led ones, such as Texas, Mississippi, Utah, Wyoming, and West Virginia.<\/p>\n That could spark a political backlash. Additionally, the enhanced subsidies are seen as a main reason for strong enrollment growth, leading to more than 24 million people<\/a> signing up for ACA plans for this year. A recent KFF study<\/a> found the 15 states with the most enrollment growth since 2020 were all won by Trump in 2024.<\/p>\n A proposed rule<\/a> released last month by the Trump administration includes provisions to shorten the annual enrollment period, get rid of a special open enrollment period that allows low-income people to sign up year-round, and require stricter verification of income and other information when people apply for coverage. The administration says most of these steps are needed to reduce fraud in the system.<\/p>\n The administration estimates that 750,000 to 2 million<\/a> fewer people would enroll in coverage as a result of the changes.<\/p>\n The new rule, if finalized, will make it harder for people to enroll, said Xonjenese Jacobs, director of Florida Covering Kids & Families at the University of South Florida College of Public Health. Losing the year-round enrollment for very low-income people, for example, would affect people short on cash who move often to stay with relatives or friends, and those who have unsteady employment, making it hard to know when or where to enroll and what their income might be in the coming year.<\/p>\n \u201cThey don\u2019t have the same ability to plan,\u201d Jacobs said. \u201cIt\u2019s definitely going to make a difference for a lot of the individuals that we service.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n