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Employer Insurance and Obamacare
Old 08-16-2013, 07:32 AM   #1
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Employer Insurance and Obamacare

My wife's employer offers medical coverage but she has never enrolled because I always included her on my employer's plan. I am no longer working and we are currently on COBRA that will expire on Dec 31st. My wife is afraid that her boss will fire her is she enrolls on their medical plan on Jan 1st. Would her "option" to enroll under these circumstances prevent us from qualifying for Obamacare? Also, how is the government informed that she is eligible for employer medical coverage?
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Old 08-16-2013, 08:09 AM   #2
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Not sure why you think she would be fired, that's probably illegal.

As I understand it, if you have employer provided HI offered then you are not eligible for subsidies but you can purchase a plan. Her insurance must be really bad if you choose COBRA over joining her plan, maybe more to the story ?
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Old 08-16-2013, 08:15 AM   #3
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My former employer paid for our COBRA coverage through year-end. I agree it's probably illegal to fire her but really don't want to get into a lawsuit. Nice guy, right...he is forced by company policy to provide medical but keeps cutting costs since he is responsible for his own profit center!!! In any event, that's the situation.
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Old 08-16-2013, 08:26 AM   #4
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I've been reading a lot of horror stories in the news recently, with employers getting away with firing people right-and-left with impunity, regardless of whether or not it's actually illegal, because many states are relaxing both regulations and enforcement against employers. So the OP's concern is justified.

However, I believe that loss of job is a valid reason for going to the exchanges for health coverage - at least it is here in MA, under our legacy "Romneycare" system.
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Old 08-16-2013, 08:33 AM   #5
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I agree that I could go the the exchanges...but wondering if my wife could as well in order to avoid the potential firing issue at her employer...
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Old 08-16-2013, 08:36 AM   #6
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Originally Posted by mtf1 View Post
I agree that I could go the the exchanges...but wondering if my wife could as well in order to avoid the potential firing issue at her employer...
Yes she can still buy a plan but probably won't get subsidies.

https://www.healthcare.gov/what-if-i...lth-insurance/
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Old 08-16-2013, 08:40 AM   #7
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You and your DW can get insurance on the state health exchange, the only conditions are you cannot be in jail and must be legal residents or citizens.

If you want premium assistance or tax credits to offset some of the cost you would need to provide information about your household income and also the insurance that is provided by her employer.

This first year they will verify the employer information in some cases, by random audit. Beginning in 2015 they plan to verify the availability and cost of the employer benefit for all cases.

More detail on this can be found here http://www.healthreformgps.org/wp-co...cation-8-6.pdf
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Old 08-16-2013, 09:05 AM   #8
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First, the stmt make no sense to me....

Presumably, you DW is doing some kind of work that is needed by the boss.... so, he will have to have someone in that role to do it...

If it is not your DW, then I would assume that the new person hired would be on the insurance in about a month...


I think the worry is unfounded....
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Old 08-16-2013, 09:35 AM   #9
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Originally Posted by bUU View Post
I've been reading a lot of horror stories in the news recently, with employers getting away with firing people right-and-left with impunity, regardless of whether or not it's actually illegal
Most states are at-will states, meaning you can be fired for any or no-reason at any time. Of course you can't be fired for "illegal reasons" - there's a list. That's up to the layers to prove.

My only experience with this was in a non-at-will state. It was very very difficult to fire someone. We spent years documenting their very bad behavior.
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Old 08-16-2013, 12:26 PM   #10
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What this boss has done in several instances is hire part-time people to replace the full-timers to eliminate benefit cost. In my DW's case (a full-time employee), he would likely hire 2 part-timers at lower hourly rates and not eligible for benefits. I know it's stingy, strange and unusual behavior, but it's also the likely scenario for us!
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Old 08-16-2013, 12:39 PM   #11
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Originally Posted by mtf1 View Post
What this boss has done in several instances is hire part-time people to replace the full-timers to eliminate benefit cost. In my DW's case (a full-time employee), he would likely hire 2 part-timers at lower hourly rates and not eligible for benefits. I know it's stingy, strange and unusual behavior, but it's also the likely scenario for us!
Unless the boss has documented interviews regarding poor performance (or other reason for firing) and signed by your wife as having been personally interviewed, I wouldn't worry about it. It would be a lawsuit waiting to be filed. What would happen if your wife had a baby and said she had to have insurance to cover herself and the baby as yours would not cover the baby? I'd be talking to an attorney to get more input on this scenario.
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Old 08-16-2013, 01:01 PM   #12
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I appreciate the comments from everyone...this is very helpful. I think we moved away a little from my original question of whether or not my DW would be eligible for the subsidies if we went to the marketplace instead of her employer's insurance, due to the concerns already addressed. Unfortunately, I suspect she will not be eligible. Can anyone make a case that she would be eligible? Thanks again.
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Old 08-17-2013, 08:01 AM   #13
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Originally Posted by mtf1 View Post
I appreciate the comments from everyone...this is very helpful. I think we moved away a little from my original question of whether or not my DW would be eligible for the subsidies if we went to the marketplace instead of her employer's insurance, due to the concerns already addressed. Unfortunately, I suspect she will not be eligible. Can anyone make a case that she would be eligible? Thanks again.
I think from what I've read about ACA is that she can buy insurance but not on the Exchange because I believe using the Exchange implies eligibility for the subsidy (even if you make to much money to get it). She is not eligible for a subsidy because her employer provides health insurance. As long as she is employed by an employer who provides health insurance, I believe she would have to buy it outside the Exchange. She cannot be denied for pre-existing conditions and is guaranteed to be able to purchase a policy.

Question not directed at OP - If the employer provides insurance that allows family coverage, does that make OP ineligible to purchase insurance on the Exchange?
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Old 08-17-2013, 08:54 AM   #14
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Almost anyone can use the state health exchange to buy insurance. A recent CRS paper (here) gives an excellent summary. To buy insurance, the requirements are

Quote:
• Citizen, national, or noncitizen who is lawfully present in the United States
• Not incarcerated, other than pending the disposition of charges
• Meets applicable state residency standards
Eligibility for premium assistance or subsidy is different. From the same paper:
Quote:
Advanced payment of premium tax credits

• Meets the criteria for eligibility for enrollment in a QHP through an exchange
• Not eligible for minimum essential coverage other than
—through the individual health insurance market; or
—employer-sponsored insurance that is “unaffordable” or does not provide “minimum value”
• Is part of a tax-filing unit
• Is enrolled in a QHP offered through an exchange
• Has household income that either
—is between 100% and 400% FPL; or
—is not greater than 100% FPL and is an alien lawfully present (but not eligible for Medicaid because of duration of U.S. residency)

Cost-sharing subsidies
• Meets the criteria for eligibility for enrollment in a QHP through an exchange
• Meets the criteria for eligibility for advance payment of premium tax credits
• Is enrolled in a silver plan through an exchange
• Has household income between 100% and 400% FPL
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Old 08-17-2013, 09:06 AM   #15
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Originally Posted by Buckeye View Post

Question not directed at OP - If the employer provides insurance that allows family coverage, does that make OP ineligible to purchase insurance on the Exchange?
To be eligible for premium assistance or cost sharing subsidy, the employer's insurance must either be unaffordable or not meet PPACA specs. Unaffordable means
Quote:
For the purpose of this provision, ACA considers an employer-sponsored plan “unaffordable” if the employee’s premium contribution to the employer’s self-only plan exceeds 9.5% of household income.
Not meeing PPACA specs
Quote:
An employer-sponsored plan does not provide “minimum value” if it covers less than 60% of total allowed costs (on average).
The situation presented by the OP is unique, not really considered in the regulations: an individual chooses to shop on the exchange even though the employer offers a health benefit that is affordable and compliant.

mtf1, you need to know the cost of her policy, expressed as a % of her income. You also need to know if the policy meets PPACA standards for actuarial value.
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