General Discussion

Spacemom

(2,561 posts) Sat Oct 5, 2013, 04:40 PM Oct 2013

Yet another ACA question

I've searched Healthcare.gov as well as other sites and can't find an answer.

My employer offers health insurance but my husbands employer does not. If I understand correctly, if my employer offers affordable coverage, then I'm ineligible for subsidies or to shop the exchange.

Do I have to cover him under my plan or can he buy coverage through the exchange?

Thanks for any help.

10 replies

= new reply since forum marked as read

Highlight:

Yet another ACA question (Original Post) Spacemom Oct 2013 OP

He can buy coverage through the exchange but he cannot get a subsidy. PoliticAverse Oct 2013 #1

Thank you for the help Spacemom Oct 2013 #2

This specific case has to do with the 'family glitch' which you can learn more about here: PoliticAverse Oct 2013 #3

Yes Spacemom Oct 2013 #4

Yes, that's the 'family glitch' case unfortunately. As long the insurance your employer is offering PoliticAverse Oct 2013 #7

You *can* still be eligible for subsidies provided that.... Roland99 Oct 2013 #5

Right but it's the premiums for the plan for her only, not her and her spouse PoliticAverse Oct 2013 #6

Are you sure it's what the premiums would be for a plan for the employee only? Roland99 Oct 2013 #8

Right, this is known as the 'family glitch' error in the PPACA. It needs to be fixed but that PoliticAverse Oct 2013 #9

These are issues that will be addressed and hopefully improved in the first round of corrections. kelliekat44 Oct 2013 #10

PoliticAverse

(26,366 posts)

1. He can buy coverage through the exchange but he cannot get a subsidy.

Reply to Spacemom (Original post)

Sat Oct 5, 2013, 04:54 PM

Oct 2013

You could also buy through the exchange (but also cannot get a subsidy, see:
https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/ )

The only requirements to use the exchange:
https://www.healthcare.gov/am-i-eligible-for-coverage-in-the-marketplace/

To be eligible for health coverage through the Marketplace, you:

must live in the United States
must be a U.S. citizen or national (or be lawfully present)
can't be currently incarcerated

Spacemom

(2,561 posts)

2. Thank you for the help

Reply to PoliticAverse (Reply #1)

Sat Oct 5, 2013, 05:15 PM

Oct 2013

I guess what I don't understand is why he wouldn't qualify for subsidy help just because I have access to employer coverage.

Without employer coverage, our income would otherwise qualify us for subsidy help.

PoliticAverse

(26,366 posts)

3. This specific case has to do with the 'family glitch' which you can learn more about here:

Reply to Spacemom (Reply #2)

Sat Oct 5, 2013, 05:45 PM

Oct 2013

http://www.usatoday.com/story/news/politics/2013/09/23/aca-family-glitch-issues/2804017/
http://www.oregonlive.com/health/index.ssf/2013/09/new_health_laws_family_penalty.html

One question, does your employer's plan allow your spouse to be added to your policy?

Spacemom

(2,561 posts)

4. Yes

Reply to PoliticAverse (Reply #3)

Sat Oct 5, 2013, 05:58 PM

Oct 2013

I can cover him on my plan, but the price goes up considerably.

PoliticAverse

(26,366 posts)

7. Yes, that's the 'family glitch' case unfortunately. As long the insurance your employer is offering

Reply to Spacemom (Reply #4)

Sat Oct 5, 2013, 06:11 PM

Oct 2013

to you alone doesn't cost more than 9.5% of your household income no one in your family can get
a subsidy if they buy a policy on the exchange.

Roland99

(53,342 posts)

5. You *can* still be eligible for subsidies provided that....

Reply to Spacemom (Original post)

Sat Oct 5, 2013, 05:59 PM

Oct 2013

the premiums for the plan from your employer are 9.5% of your household income or more.

If they are, you can qualify for subsidies.

http://kff.org/interactive/subsidy-calculator/

PoliticAverse

(26,366 posts)

6. Right but it's the premiums for the plan for her only, not her and her spouse

Reply to Roland99 (Reply #5)

Sat Oct 5, 2013, 06:11 PM

Oct 2013

together that can't exceed 9.5%.

Roland99

(53,342 posts)

8. Are you sure it's what the premiums would be for a plan for the employee only?

Reply to PoliticAverse (Reply #6)

Sat Oct 5, 2013, 06:19 PM

Oct 2013

I've interpreted it that the employee's portion of the premium (incl a family plan) cannot be more than 9.5% of the household income (obviously combined if there are two wage earners)

EDIT: Oh...I am in the wrong. Found this:

, if the employee's contribution toward his or her annual premium for individual coverage does not exceed 9.5% of the employee's current W-2 wages from the employer, the employer will not be subject to any penalties.

So I'm guessing that involves an employee getting subsidies, hence the employer being liable for penalties based upon the income/premium ratio.

PoliticAverse

(26,366 posts)

9. Right, this is known as the 'family glitch' error in the PPACA. It needs to be fixed but that

Reply to Roland99 (Reply #8)

Sat Oct 5, 2013, 06:53 PM

Oct 2013

isn't happening at the moment.

For more background on the issue:
http://thehill.com/blogs/healthwatch/health-reform-implementation/172765-healthcare-law-may-leave-families-with-high-insurance-costs

kelliekat44

(7,759 posts)

10. These are issues that will be addressed and hopefully improved in the first round of corrections.