General Discussion

Beartracks

(12,821 posts) Sun Oct 6, 2013, 08:11 AM Oct 2013

ACA: Can I stay on employer-based plan but cover my spouse thru exchange?

This may be a dense question, but I just want to be fully informed and aware before I start anything.

I have an employer-based health insurance plan that satisfies or exceeds the requirements of the ACA, and for which my employer pays all of my premium. I am very happy with this benefit, and don't plan to change, since switching to an exchange-based plan would mean I'd be paying with after-tax dollars and would also lose the employer contribution. HOWEVER, my spouse is also on my employer-based plan, and THAT costs around $450 per month. Is there anything that would prevent me from getting an exchange-based individual plan for my spouse while I stay on the employer-based plan?

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8 replies

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ACA: Can I stay on employer-based plan but cover my spouse thru exchange? (Original Post) Beartracks Oct 2013 OP

Keep your wife in your employer paid plan, that is far, far less expensive for you. bluestate10 Oct 2013 #1

You really should not be making that assessment Ms. Toad Oct 2013 #7

Yes jberryhill Oct 2013 #2

Technically I don't think so but Freddie Oct 2013 #3

The spouse can buy a policy on the exchange but is not eligible for a premium subsidy. n/t PoliticAverse Oct 2013 #6

Your spouse would not be eligible for the subsidy unless she also works & doesn't get qualifying ins Yo_Mama Oct 2013 #4

No, but your spouse cannot receive a subsidy when buying a policy on the exchange. PoliticAverse Oct 2013 #5

A bit more info Beartracks Oct 2013 #8

bluestate10

(10,942 posts)

1. Keep your wife in your employer paid plan, that is far, far less expensive for you.

Reply to Beartracks (Original post)

Sun Oct 6, 2013, 08:17 AM

Oct 2013

Health insurance is expensive, even with the ACA in place. A low level Bronze level plan can run $300-$400 per month for your wife minimum, and she likely will not get the deductibles and out of pocket maximums that your employer coverage provides. Many people that have employer sponsored health insurance have NO idea of what the real cost of health insurance is.

Ms. Toad

(34,087 posts)

7. You really should not be making that assessment

Reply to bluestate10 (Reply #1)

Sun Oct 6, 2013, 11:32 AM

Oct 2013

without knowing the relevant factors: age, smoking status, and state of residence. (Income doesn't matter, because if a plan is available through work, subsidies aren't).

Insurance on the exchange may be cheaper, or it may not. Why tell someone to just stay with the employer plan rather than suggesting checking out the exchange prices?

jberryhill

(62,444 posts)

2. Yes

Reply to Beartracks (Original post)

Sun Oct 6, 2013, 08:36 AM

Oct 2013

If you can get a better deal, then you can certainly do so.

Freddie

(9,273 posts)

3. Technically I don't think so but

Reply to Beartracks (Original post)

Sun Oct 6, 2013, 10:02 AM

Oct 2013

If your coverage is "affordable" (less than 9.5% of your income) and you have spouse coverage available, regardless of the cost to you, your spouse is supposedly ineligible to buy from the Exchange. This is one of the major "glitches" that needs to be fixed ASAP. However, how are they going to find out if you tell a fib and say that your employer does not offer spouse coverage?
My daughter and her husband are in the exact same situation. He's self employed, she gets work coverage that would be very costly if she added him. Right now they have a catastrophic-only plan for him (he's healthy & under 30) which they plan to continue thru the exchange.

PoliticAverse

(26,366 posts)

6. The spouse can buy a policy on the exchange but is not eligible for a premium subsidy. n/t

Reply to Freddie (Reply #3)

Sun Oct 6, 2013, 10:35 AM

Oct 2013

Yo_Mama

(8,303 posts)

4. Your spouse would not be eligible for the subsidy unless she also works & doesn't get qualifying ins

Reply to Beartracks (Original post)

Sun Oct 6, 2013, 10:33 AM

Oct 2013

What happens is that since your employer is offering you qualifying insurance at no cost, she is ineligible for the exchange subsidy, according to the IRS.

But you can of course buy it - it just might not be that affordable for you. Check out the options and see what's best financially for your family.

Here's an article about it:
http://www.desmoinesregister.com/article/20131006/NEWS/310060059/1001/

PoliticAverse

(26,366 posts)

5. No, but your spouse cannot receive a subsidy when buying a policy on the exchange.

Reply to Beartracks (Original post)

Sun Oct 6, 2013, 10:33 AM

Oct 2013

The only requirements to be able to buy a policy on the exchanges:
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

Why spouses can't get a subsidy if they can be added to your affordable employer insurance:
http://thehill.com/blogs/healthwatch/health-reform-implementation/172765-healthcare-law-may-leave-families-with-high-insurance-costs

See also:
https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

Beartracks

(12,821 posts)

8. A bit more info

Reply to Beartracks (Original post)

Sun Oct 6, 2013, 06:52 PM

Oct 2013

Sorry, I guess I should have provided a bit more info. Spouse is on SSD, not working, non-smoker. I wouldn't expect a subsidy, since I do have the option to have her on my qualifying employer-based plan.

I was just wondering if it would be worth it to see if we could get a better deal just for her via the exchange, or if that was not even possible because, officially, I'm "supposed" to put her on my work plan...

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