I have googled and googled, and I think I understand what is going to happen next January for people around the poverty line or a little higher, and for people who are multiples of the poverty line and do not have any access to health insurance, but I’m still mystified as to what will happen for families like mine, that have access to workplace health insurance that is too expensive.
We are family of four with income at right about 200% of the federal poverty line; my wife is a teacher who is covered herself fully with no premium. But to add the family to her policy would cost about 15% of our gross income. If we had no access to workplace insurance at all, it appears we would be charged about 6% of our gross income after rebates to get insurance from one of the exchanges. The law says people with workplace insurance or access to workplace insurance are not eligible to buy from the exchanges and are not eligible for a subsidy unless the premiums would cost more than 9.5% of their income.
Everything I have read is maddeningly vague as to what happens if, as in our case, the premiums are in excess of that 9.5%. Do we get rebated down to 9.5%? Or do we end up paying 6% as we would if we were on an exchange? (Still a difficult expense to pay–I sure wish we had single-payer.) If the former, how in the world did anyone think it would make sense to penalise both employee and employer for having a workplace policy? (If that last question is off-topic for general questions, please ignore.)
I have no factual basis on which to make this wild-assed guess:
Couldn’t you just waive insurance coverage from your employers and participate in your state’s exchange, if in fact, it turned out the premium cost was less?
I don’t think so. All the things I’ve read refer to “access to workplace health insurance” or workplace health insurance “available”. Whether one actually subscribes to it or not does not seem to be relevant.
We are in the exact same situation: we pay about 13% of our gross income for crappy coverage ($1200 deductible each, so in years when we have anything medical actually happen, it’s an even larger percentage) but I am so used to just rolling with that that it never occurred to me that we’d be in a different situation post-January. We just pay it. Honest to god, if they could just stop the upward creep it would help.
I have found that the Kaiser Family Foundation is a good source for this sort of information. At least from this on their site, those between 133% and 400% of poverty level would be capped between 2% and 9.5%. So, I’d bet you would be capped at less than 9.5%.
I wish Obamacare had done more to address costs, but at least those who could not buy insurance can now do so (with some subsidies) and there is no chance of being dropped without cause (fraud or non-payment). This alone is a big change.
Holy shit. That applies to us. I never even thought about it.
Ok, a follow up question, if you don’t mind: I pay 13% of my gross income for the crappy coverage, with the before mentioned $1200 deductibles and only 80% coverage after that. If I were to switch to the decent package, it would be more like 20% of my income. If, either way, I am getting rebated back to 9.5%, what possible incentive is there NOT to opt for the better package?
But see, the Kaiser link is the same ambiguity I keep running into over and over:
The employee premiums for us are 15 percent of our income; but our kids will soon be eligible for CHIP after they go six months without coverage (in March). However, I would then be the only member of the family without coverage and I would like to be covered!
The impression I got is you don’t get a rebate if you can get coverage from your employer no matter what percentage you pay, the rebate is only for policies bought on the exchanges.
I’m in the same boat. Single breadwinner, family of 3. PandaKid and MrPanda are uninsured because it’d cost about $550 a month to add them to my insurance at work. If forced to buy insurance, I’m fucked. I can’t afford an extra $50 a month much less $550.
Assuming $550 is over 9.5% of your income and you make less than 400% of the poverty level ($76,360 for a family of 3 in most of the US), you’ll be eligible to shop on the exchanges for coverage that will not cost more than 9.5% of your income. That’s probably more than $50/month, but hopefully much less than $550 (especially considering that whatever you are paying now for yourself counts toward the 9.5% cap. Furthermore, expanding Medicaid/CHIP means your kid might more easily be eligible for coverage with an even lower cap.
I’m reading this as saying if the employer plan is over 9.5% of income, you can buy on an exchnage instead with subsidies. Depends what “there is an exception” means? Exception to eligibility to buy on exchange instead, with subsidy?
And this:
This brochure is maddeningly ambiguous about whether the family rate is available for rebates; just that the employer is not penalized if the employee’s personal coverage costs less than 9.5% (OP says it does). So I’m seeing this as “family cost exceeds 9.5%, employee can go to the Exchange instead. Employer does not pay penalty because individual cost is not 9.5%” - That looks like a cheap way for the employer to escape no-coverage penalties if I’m reading this right.
It does suggest the employee/family could still go to the Exchange if they cannot afford the employer plan.
This makes the escape hatch for employees on family subsidies even more explicit.
It suggests that -
If the employee income vs. personal MEC cost is less than 9.5% - no tax penalty for employer.
If the employee household income vs. family MEC cost > 9.5% then the family switches to the Exchange (with subsidies) and the employer gets off scot-free, still no tax penalty.
The article also says this regulation is in direct contradiction with the law as written. (meaning, I assume, expect it to be “fixed”).
The logic is good - an employer can’t predict what household income is or family size, so total MEC percent is not known ahead of time, so why should they be hit with a surprise $3000 penalty because of that?
Yeah, I’ve been trying to figure out this problem as well. Basically my health care is covered 100%, but adding my wife would cost around 9% of our gross income. But if we qualified for the exchange, we’d get a subsidy so that we’d only pay ~6% for both of us. So if md2000 is correct, we’re just completely out of luck. (Thanks for the research, btw.)
And then there’s the added complication that I’m a grad student, so whether I count as an “employee” or a “student” in a given situation depends on what’s cheapest for the university…
Serious question: Could you leave your wife on the policy she gets from her work, and then just get a separate policy from an exchange for you and the rest of the family? It essentially means making your family two entities - one with employer provided health insurance, and the other without. Is this allowed?
This mainly deals with eliminating the voucher program, but definitely suggests the employee has the choice to switch from the employer plan to the Exchange.
From what I’m reading, the “limited to personal income, personal coverage” only figures in whether the employer is penalized. The subsidy appears to apply if the total cost of the employee-selected (family) coverage would exceed 9.5% of HOUSEHOLD income, and the employee elects to go to an Exchange instead.
Whether you can mix-and-match - good question. That would maybe depend on whether the addition of family itself is 9.5% or greater? Actually, it depends on what the rules are clarified to be…
I appreciate so many people grappling with this. It underlines, though, why I’m so confused by all of this because it appears the answers are not very clear cut at all. One of the things I’m still really wondering is if a family like mine would get a 6% of income premium cap if we were just completely uninsured, but will only get rebated down to 9.5 percent if we have employee insurance available.
Stated that way, it doesn’t sound like a huge difference; but it’s a more than 50% increase in the amount of money paid towards premiums and would make a huge difference to us ($375 a month we currently don’t spend while living paycheck to paycheck, vs. $250). it also just seems backward, perverse in its incentives. (Unlike the poster above though, I have great admiration for the president and it is regardless a huge improvement compared to the status quo.)