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Humanist_Activist

(7,670 posts)
Sun Mar 30, 2014, 04:17 PM Mar 2014

Question about Obamacare, could never get a straight answer...

ok, so I signed up, in January for employer provided health insurance, since it was right below(on average) the 9% threshold for me to go on the exchange and qualify for subsidies, I was SOL.

My fiancee is on Medicare, having been on disability long enough to qualify. We live an a state that did not expand Medicaid.

Well, we are thinking about having a child, and the real question is, should we have one before we are married, or after?

A couple of things, first off, adding people(a child) to my coverage through work would more than double my premium. My question is, would this be enough to allow me to opt out and go on the exchange and get subsidized(and cost sharing) coverage? If my fiancee and I get married first, will both our incomes be taken into account, therefore disqualifying us from subsidized coverage?

Our issue is this, last year I was uninsured, so no premium, and my fiancee was on unreliable Medicaid(no monthly premium), this year she has 100 dollars(almost 10% of her income) taken out for Medicare part B, and I get about 8% of my paycheck taken out for my premiums for myself. Also, her prescription drug copays have increased, though not too drastically, still, we are poorer than last year, so have less flexibility.

The other option was to have a child and then both mom and kid should qualify for medicaid without the need for a spend down, but we will have to remain unmarried. Not sure what to do, this is more curiosity than anything, we aren't planning on having a kid until next year at the earliest, and a lot of things can change in that time.

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Question about Obamacare, could never get a straight answer... (Original Post) Humanist_Activist Mar 2014 OP
This situation falls under what has been called the 'family glitch'... PoliticAverse Mar 2014 #1
Well fuck, I guess I can't get married if we want to start a family... Humanist_Activist Mar 2014 #2
As someone I know says "Don't get married until the kids demand you do". n/t PoliticAverse Mar 2014 #3
LOL, sounds like good advice, and we have family support for such a decision... Humanist_Activist Mar 2014 #4
Adding your child to your coverage wouldn't matter. subterranean Mar 2014 #5
It may be easy to insure the child Freddie Mar 2014 #6

PoliticAverse

(26,366 posts)
1. This situation falls under what has been called the 'family glitch'...
Sun Mar 30, 2014, 04:26 PM
Mar 2014

(the fact that whether your employer's insurance is considered 'affordable' depends on the pricing
of a policy for you individually).

Here's a recent article that discusses the issue: http://www.sacbee.com/2014/03/02/6195691/obamacares-kid-glitch.html

 

Humanist_Activist

(7,670 posts)
2. Well fuck, I guess I can't get married if we want to start a family...
Sun Mar 30, 2014, 04:40 PM
Mar 2014

even if we made, combined, 2-3 times more than we do now, we can't afford to get married, this fucking sucks.

 

Humanist_Activist

(7,670 posts)
4. LOL, sounds like good advice, and we have family support for such a decision...
Sun Mar 30, 2014, 04:57 PM
Mar 2014

I was talking to my Dad about our marriage and family plans, and all he said was that its not necessary to get married to have kids, I think he just wants more grandkids, my sister already gave him 2.

subterranean

(3,427 posts)
5. Adding your child to your coverage wouldn't matter.
Sun Mar 30, 2014, 05:02 PM
Mar 2014

As the link in the post above this explains, the 9.5% "affordability" threshold applies to coverage for the individual employee only, not for any family members. So if you added your future child to your employer's plan and your premiums double, it wouldn't make any difference. You still wouldn't be eligible for subsidies.

However, as you said, the child might qualify for Medicaid, depending on your income (assuming your state hasn't opted out of the Medicaid expansion). If not, he/she might be able to get subsidies.

I believe the only thing that would be affected by you getting married or not would be your child's eligibility for Medicaid or subsidized insurance. That would depend on your and your fiancee's combined incomes.

Freddie

(9,267 posts)
6. It may be easy to insure the child
Sun Mar 30, 2014, 05:34 PM
Mar 2014

Look into CHIP or whatever your state calls it. My married daughter has insurance thru her job, her self-employed husband was able to keep his non-compliant bare-bones plan and their child has CHIP which is totally free to them. They're not destitute either. This is PA where the asswipe Corbett declined the Medicaid expansion but they're good about covering kids. They would fall into the "family glitch" as well with covering her husband.

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