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My brother went to the marketplace to get insurance. He picked a plan and has paid on time every month.

Today he was told by his insurance that he owed an additional 1300 dollars. The marketplace had made an error. He doesn't have this amount and the insurance company is only giving him until the end of June to pay. What can he do?

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    Does he have something in writing telling him that the payments would be the amount he thought he was gong to pay? – DJClayworth Jun 17 at 16:53
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    How do you know it was an error on the Marketplace? What was the error? – David Taylor Jun 17 at 18:34
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The major issue with securing coverage from the exchange/marketplace is the calculation of the person's available tax credit. The tax credit is given based on an assumed eligibility.

I suspect your brother wasn't ultimately eligible for the entire assumed tax credit, his premiums likely changed as a result and he has been underpaying since.

I would understand whether or not the carrier will let him change plans. But be nice to the people you talk to on the phone, these are call center folks who don't have much authority; this probably was not a mistake.

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As DJClayworth says in his comment, does your brother have anything in writing saying this is the cost of the policy? Even a printout of the web page where he bought the policy. Best if he has a signed contract.

In general, if someone signs a contract agreeing to provide a product or service for a specified amount, declaring that you made a mistake when you signed the contract does not void it. If it did, contracts would be worthless. Anyone could sign a contract, see how things work out, and then if they decide they're not making enough money, just declare they made a mistake and the contract is no longer valid. What if he went back to the insurance company and said, "Oh, when I said I could afford to pay $500 a month (or whatever number), I made a mistake, and I can really only afford $400. So that's all I'm going to pay but I expect you to still provide the same service that you agreed to for $500" ... do you think the company would just say, "oh, okay, if you made a mistake ..."? Of course not. They'd tell him that he signed the contract and he is now committed. That's what contracts are for. A contract is a legal binding commitment, not a statement of what you think you might be willing to do if things work out.

If I was your brother, I'd get together whatever paperwork I can find saying that this is the price, and then tell them that if they do not live up to the terms of the contract, he will be contacting a lawyer to investigate suing them for breech of contract, and/or contacting law enforcement to make a fraud complaint. If they persist, I would contact a lawyer.

I'm assuming here that they really did advertise that they would provide this policy for the stated amount in writing or on a web site. If they said the price was $1000 a month and he's only been paying $800 a month and they've let it go but now they say the want the difference, different story. Or if the web site says it's $1000 a month but someone told him on the phone that he qualified for some special deal for only $800 a month, well, verbal contracts are theoretically just as binding as written contracts, but it's very difficult to prove what was promised.

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    It is almost certain that the insurance company says something like "policy is $x, your projected tax credit is $y so your net payment is $x-y." If the government subsequently says that your actual tax credit is less than y, the insurance company can hardly be expected to make up the difference. I would be shocked if the insurance company quoted a price of $x-y without boatloads of qualifiers. The odds of there being a contract between the policy holder and the insurance company for $x-y is almost nil. – Justin Cave Jun 18 at 12:27
  • @JustinCave Fair enough. If the issue is, "we estimated your tax subsidy at $X based on the information you gave us, but now the government is saying your subsidy is less than that", than yes. There's no indication in the original post that this is the issue, but that's possible. – Jay Jun 18 at 18:00

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