ACA and Employer HC for DD

[Hermit]

I will be going on Medicare early next year. This year I am paying for retiree health care through my former employer for me and my two kids. Next year, they will be on their own for health care. DD works for a corporation that considers a lot of employees part time including DD. She works a minimum of 40 hrs per week. Their web site has a statement that health care for part time employees has been canceled for 2014 due to ACA.

I also have read that companies with over 50 employees are required to provide health care that meets ACA requirements for all employees working more than 30 hrs per week.

Does anyone have any insight on how to proceed in this situation for health care to cover the year 2015 and beyond? I need to get this straightened out before the enrollment period for my corporate health care plan next October. DS is still in college and I should be able to get him on the college student health plan.

 

[pb4uski]

How can your DD be part time if she works a minimum of 40 hours a week?

Your DD could purchase her own policy on the exchange and may even be eligible for a subsidy to help with the cost. You can go to the exchange for your state and get an idea as to gross and net costs for different levels of coverage. Generally speaking, someone who is in good health is best off with a bronze level plan but it might make sense to look at her net costs for bronze, silver and gold and then make a decision.

 

[MichaelB]

Does anyone have any insight on how to proceed in this situation for health care to cover the year 2015 and beyond? I need to get this straightened out before the enrollment period for my corporate health care plan next October. DS is still in college and I should be able to get him on the college student health plan.

If your daughter's employer does not offer her affordable health care insurance she will be eligible for a policy on her state exchange with the possibility of premium assistance. Page 5 of this document describes characteristics of the employer coverage http://www.fas.org/sgp/crs/misc/R41137.pdf

Not Eligible for “Minimum Essential Coverage”

To receive a premium credit, an individual may not be eligible for “minimum essential coverage,” with exceptions (described below). ACA broadly defines minimum essential coverage to include Medicare Part A; Medicare Advantage; Medicaid (with exceptions); the State Children’s Health Insurance Program (CHIP); Tricare; Tricare for Life, a health care program administered by the Department of Veterans Affairs (VA); the Peace Corps program; any government plan (local, state, federal) including the Federal Employees Health Benefits Program (FEHBP); any plan offered in the individual health insurance market; any employer-sponsored plan (including group plans regulated by a foreign government); any grandfathered health plan; any qualified health plan offered inside or outside of exchanges; and any other coverage (such as a state high risk pool) recognized by the HHS Secretary.

Exceptions to Minimum Essential Coverage Eligibility

ACA provides certain exceptions regarding eligibility for minimum essential coverage and receipt of premium credits:

• An individual who is only eligible to obtain coverage through the individual (nongroup) health insurance market may be eligible to receive a premium credit.

• An individual eligible for an employer-sponsored plan may still be eligible for premium credits if the employer’s coverage is either (1) not affordable; that is, the employee’s premium contribution toward the employer’s self-only plan exceeds 9.5% of household income; or (2) does not provide minimum value; that is, the plan’s payments cover less than 60% of total allowed costs on average.

• An individual who is eligible for limited benefits under Medicaid may still be eligible for premium credits (see “Medicaid” section below for additional information).

 

[Hermit]

How can your DD be part time if she works a minimum of 40 hours a week?

Your DD could purchase her own policy on the exchange and may even be eligible for a subsidy to help with the cost. You can go to the exchange for your state and get an idea as to gross and net costs for different levels of coverage. Generally speaking, someone who is in good health is best off with a bronze level plan but it might make sense to look at her net costs for bronze, silver and gold and then make a decision.

Its "on call" work. If there is work, she gets a call, but there is no minimum hours. The company does not consider any of the "on call" employees as full time. I would think they will still need to provide health care for those who average more that 30 hours a week. They also can't expect to keep their top employees if they don't allow them to work at least 40 hours.

If it turns out that she needs to go to the individual exchange, she will probably go with a bronze plan. I just want to make sure she understands the system well enough to have time to determine the best plan once enrollment for 2015 starts.

This whole idea of requiring a young person just starting out with a career to go through a complex analysis of how health care impacts her income tax seems rather ludicrous to me.

 

[pb4uski]

Keep in mind that she will also qualify for a cat plan if that meets her needs and she is willing to take a risk on the difference in co-pays and deductibles.

 

[Hermit]

Thanks MichaelB and pb4uski,

The info is quite helpful.

Hermit