I wonder if that title will get cut off. My boss swears that the following is true:
His job offers health insurance, for which he is currently enrolled.
His wife’s job offers health insurance, for which she is currently enrolled.
Obamacare will not permit him to take anything other than the insurance provided by his company, also, he may not purchase his own insurance in lieu of employer provided insurance.
He is barred from joining his wife’s plan.
As I understand it, employers will no longer be *required *to carry spouses, however there is nothing saying employers MAY NOT carry spouses, whether said spouse is eligible for insurance at his / her job already.
I also see nothing which states that 3 or 4 are true. His wife’s employer may refuse to pick him up, but I don’t believe it’s a legal barrier placed on him.
A: What’s the skinny?
B: Any good sites (other than the 15 partisan opinionated non-factual chicken-little articles/blogs/info sites) that have information relating specifically to the changes that I as an employee will face?
It’s not something mandated by Obamacare. Employers have never been required to offer spouse or family coverage, at least at the federal level. However, because of certain cost shifting functions, many employers have adopted “working spouse” exceptions which make spouses with their own employer-provided coverage ineligible. This is not a legal barrier.
He may be conflating Obamacare with the HSA/HDHP requirements which have been in place for a long time, though. If you are covered by an HDHP (high deductible plan) and have a health savings account (HSA), you cannot enroll in a non-HDHP plan. Well, you can, but any further contributions to your HDHP become taxable.
So what does the employer’s plan typically say? Can you decline coverage or is enrollment a condition of employment?
Remember that ACA provides penalties for employers who do not offer coverage to every employee (some terms and conditions and other details) and applies penalties if too many emloyees are on the subsidized exchanges. The employer may demand that you accept coverage?
Then, what does the spouse’s insurance plan require? It may require you to show proof you have exhausted your own coverage before the spousal coverage kicks in (at least that’s how it works here in Canada for things like private prescription coverage benefits). Depending on the wording, the spouse’s plan may not cover you if you don’t take advantage of plans available to you first?
All of which would be due to terms from the insurance company, not ACA.
There’s a flaw in ACA that the employer’s compliance is assessed on the cost of the individual, not his family insurance. An employee can decline employer insurance, IIRC, but if the offered “Single” insurance is within guidelines, he does not qualify for a subsidy to buy instead on the Exchanges, even if family insurance through the employer is far too expensive. Based in the single-only price, the employer is not penalized for an unaffordable plan.
Perhaps this is where your misinformation comes from - you can quit your employer’s plan, but if the singles price is within guidelines, you don’t qualify for a family subsidy on the Exchanges?
Point #3 is definitely incorrect given that one feature of Obamacare is that employees can shop the exchanges and that if an employee chooses an exchange plan when the employer-offered plan is “not affordable” then the employer may be penalized. I put not affordable in quote because the law has a specific way of defining that term that doesn’t always match the plain-English definition of not affordable.
Do you have any cites that speak to the specifics of “not affordable”? How can I determine if my employer’s plan fits the legal definition of “not affordable”?
It certainly seems like I could easily get a more affordable plan shopping for myself…because I’ve got redonkulous co-pays and high premiums…but I can still *technically *afford it.
As long as the plan is expected to pay for 60% of covered charges, it’s a qualified plan. And as long as the premium for single coverage is not more than 9.5% of your household income it’s “affordable”.
Note that affordable isn’t based on co-pays or other out-of-pocket cost. It’s based on the amount of premium. If you’re looking at affordable from the employer side, it’s whether single-only coverage premiums paid by the employee are less than 9.5% of employee gross wages. If you’re looking at it from the employee side, it’s whether the premium for the whole policy is less than 8% of household income.
If that sounds like a confusing mess… why, yes. Yes it is.
Note the bit about “minimum essential value”. From what I’ve read variously, there are likely to be certain requirements for the coverage, and limits to how much co-pays etc. can be although the exact rules are not definite from what I can find. I.e. “you pay all costs under $5000 and half of anything over that” probably (you hope) won’t qualify as a valid health insurance offering for ACA. But as pointed out in the article, exactly what these standards are /will be is not definite.
one commentator explained it this way: Any such complicated and confusing large bill is going to be chock full of errors and contradictions and obvious flaws. Nobody can keep track of thousands of pages of details.
Normally, as happened with similar bills in years gone by, there would be a flurry of clarification amendments passed to settle any issues arising. However, the Republicans are refusing to make any changes to ACA - they will only accept complete repeal; the Democrats are not going to postpone the implementation significantly, they want a fait accompli too hard to unravel by the 2016 presidential election. meanwhile, they use departmental regulations to clarify the ambiguitis.
Both sides are hoping that if any major screwups can be blamed on the other side.
“See, they passed a piece of junk that would not work.”
“They refused to make the simple changes needed”
For example:
-what happens if halfway through the year, you get a big raise and no longer qualify for a subsidy? Do you have to repay the subsidy from the first half of the year?
how is an employer supposed to know what his employees’ “household income” is for calculating affordability. That need was changed by regulation, IIRC.
ther are dozens of questions like these not answered by the bill.
The insurance subsidy is paid based on expected income, but your tax return for the year recalculates the subsidy based on actual income. If income went up, you will owe back part of the subsidy (capped at 1,250). If income went down, you will probably have a tax credit for the amount of subsidy you could have received.
As for the employer, there is never a need to know the household income. The employer’s definition of affordable is solely based on employee gross wages and the amount the employee pays for single-only coverage. If the employee’s share of single-only coverage is more than 9.5% of their gross wages, it is “not affordable.” Since the employer knows all of these numbers, there is no problem there.