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This Exchange stuff is getting complicated.
Old 08-03-2013, 02:40 PM   #1
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This Exchange stuff is getting complicated.

Background: Early this year, my wife started a job as a minister in a new congregation. Because I had good health insurance at my work, we didn't negotiate non-cash health insurance as part of the compensation package.

April 2013: I get kicked to the curb by Megacorp. Realizing we have options with both open enrollment through the church group plan (if we negotiated health insurance for 2014) and the coming exchanges, I took out a temporary policy for the rest of 2013 ($320 per month compared to $960 with COBRA) to bridge me until January 2014. Plus my loss of a good salary puts our income *way* below the 400% threshold for 2014 (probably closer to 200%).

So far, so good. I get it. But it looks like things will get really messy come September and October. For one thing, in August and September the church will get information from the group administering employee benefits (she already has her new 403B set up there) and we are to sit with council to determine whether they will offer a health plan to us for 2014, and whether (and how) it would affect how 2014 compensation is given. (There will be four plans in the new church program, ranging from the usual Bronze to Platinum with "Gold" being the recommendation from churchwide and the benefits team. IOW, sure, we could ask for a Cadillac plan, if we want to see her cash salary drop by several grand a year, so it may not be in our best interest to ask for the moon and stars.)

Also -- even if they did want to offer us a plan for both of us... as I read more into it, as a member of a federally recognized Indian tribe it appears that I (but not DW) could get a plan through an Exchange and not be subject to any cost sharing (copays or deductibles). So given that it seems like I really want to go to an Exchange since the church plan would come with cost sharing for me and cost us more (in reduced cash compensation, most likely).

But then... if it makes sense for the church to cover her but not me... then we can we even *do* that? A married couple where one uses the Exchange and one doesn't... and then, like tax issues with MFJ and filing separately, does that change how the formulas for calculating poverty line go?

Yikes, this is making my head hurt! I guess I'm not looking for answers here, but just sharing how convoluted this can be based on your personal situation. And yet, by late October, our church council has to report to the benefits agency which plan they will be offering (if any). So I have to know what we are doing there before anything else and before even seeing how (if at all) we (or just I) sign up for an Exchange plan.
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Old 08-03-2013, 03:03 PM   #2
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I don't know the answers to the questions (especially how the Tribe stuff since I didn't know that was treated differently).

I do know that a few months ago I read an article that talked about people working for companies where the coverage was deemed "affordable" for the employee - i.e. cost less than I think 9.5% a year of salary. In that case, the employee couldn't get a subsidy through the exchanges. The employee could buy from the exchange but wouldn't get a subsidy.

Anyway, the issue was what would happen if family coverage was more than 9.5% a year of salary (I think that is the percentage but not entirely sure). Would that be considered "affordable" or not "affordable". Anyway, I read that regs had been issued that only the employee cost was looked at. So if family coverage was more than the threshold but employee coverage was less than than the threshold, then the spouse and kids couldn't get a subsidy by going to the exchange.

Again, don't know if this has changed since then. A lot of people were critical of the reg, but doing it this way decreased the number of people on employee plans who could get subsidies. The problem, of course, is that some people can't afford to pay more than 9.5% a year for family coverage, but won't be able to get a subsidy since the employee's coverage is less than 9.5%.

The point is that you need to look into whether you would even be eligible for a subsidy if the church offers family coverage and your wife's cost of coverage was deemed affordable for her alone.

Again - These things are often changing rapidly so you need to look up more current information and keep updated on it.
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Old 08-03-2013, 03:09 PM   #3
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The point is that you need to look into whether you would even be eligible for a subsidy if the church offers family coverage and your wife's cost of coverage was deemed affordable for her alone.
As I understand it, this is determined at the congregational level. Her employer is this congregation, not the larger church body. So if the council decides not to offer it or budget for it, she's not eligible for employer coverage (or would have to pay WAY more than 9.5% of our income for it).
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Old 08-03-2013, 05:54 PM   #4
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I am seeing an opportunity for a Certified Health Insurance Adviser, (CHIA) ..

I wonder if I can use the catchy CHIA pet jingle for the ads
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Old 08-03-2013, 06:09 PM   #5
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Ziggy29, the stress level that you, and others are going through right now due to lack of specific information is simply beyond belief. How is someone supposed to budget for health care under the circumstances? I hope you get some answers soon.
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Old 08-03-2013, 06:34 PM   #6
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I am married. I get health insurance through my employer for myself and my children. My spouse gets different health insurance through her employer. I just write this because just because one is married and files a MFJ tax return does not mean the spouses have to have the same health insurance.
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Old 08-03-2013, 07:16 PM   #7
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Ziggy29, the stress level that you, and others are going through right now due to lack of specific information is simply beyond belief. How is someone supposed to budget for health care under the circumstances? I hope you get some answers soon.
One way or another, the cost will be manageable. It's just that there are SO many moving parts in our case that I've not been able to track down all the answers.

My best guess is that if DW got her insurance from the church and I went on the exchange, I'd still pay as much as I would if we were both on the exchange -- BUT I know they have a budget item for "pastor's benefits" (which we've barely used this year, only for 403B contributions) and I understand that if I were on the exchange, I would have no copays or deductibles because of American Indian status. So it *might* be best in my case, if the church paid for all of DW's insurance, didn't offer it to me and I went on the exchange with a "bronze" plan (no need to pay more if I have no cost-sharing), we might actually come out ahead.

But yes, SO many moving parts. It gives me a headache!

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I am married. I get health insurance through my employer for myself and my children. My spouse gets different health insurance through her employer. I just write this because just because one is married and files a MFJ tax return does not mean the spouses have to have the same health insurance.
I understand that. It's just that the law tends to err toward treating married couples as single economic units, and choosing to treat yourself otherwise often has significant financial impacts. That's the only reason I used that comparison.
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RIP to Reemy, my avatar dog (2003 - 9/16/2017)
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Old 08-03-2013, 07:19 PM   #8
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As I understand it, this is determined at the congregational level. Her employer is this congregation, not the larger church body. So if the council decides not to offer it or budget for it, she's not eligible for employer coverage (or would have to pay WAY more than 9.5% of our income for it).
Would it be any better if she were a 1099 "employee" (i.e. a consultant?). This way maybe the congregation could offer her additional pay in lieu of this health insurance, and you would (both) definitely still be eligible for the government subsidy payments. It could be a win-win (except for the taxpayer, but no sense in bringing that up here--you'd just be playing by the rules as they are written.)
They provide housing, don't they? That might prove to be a sticky wicket in this dodge plan.
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Old 08-03-2013, 07:22 PM   #9
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Would it be any better if she were a 1099 "employee" (i.e. a consultant?). This way maybe the congregation could offer her additional pay in lieu of this health insurance, and you would (both) definitely still be eligible for the government subsidy payments. It could be a win-win (except for the taxpayer, but no sense in bringing that up here--you'd just be playing by the rules as they are written.)
They provide housing, don't they? That might prove to be a sticky wicket in this dodge plan.
Yes, they provide housing and she is on W-2 and subject to withholding (including SS and Medicare taxes). Once she's ordained she would be self-employed for that purpose, but that's 2-3 years away.

Anyway, if we don't need their health insurance this coming year, we are free to negotiate so they can say "we don't offer it", give her more pay in lieu of benefits, and we'd both go on the exchange. Lots of moving parts, lots of sitting down with calculators...
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RIP to Reemy, my avatar dog (2003 - 9/16/2017)
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Old 08-04-2013, 07:18 AM   #10
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Yikes, this is making my head hurt! I guess I'm not looking for answers here, but just sharing how convoluted this can be based on your personal situation. And yet, by late October, our church council has to report to the benefits agency which plan they will be offering (if any). So I have to know what we are doing there before anything else and before even seeing how (if at all) we (or just I) sign up for an Exchange plan.
I find the most difficult parts to understand are employer rules and the options for household members when the employer offers coverage.

It's a great advantage that you and your DW can input and influence the coverage she / you will receive. Keeping her employer coverage "employee only" seems to be be best options, and also the least complicated.
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Ziggy29, the stress level that you, and others are going through right now due to lack of specific information is simply beyond belief. How is someone supposed to budget for health care under the circumstances? I hope you get some answers soon.
+1. I'm hoping he not only gets answers but finds a way to explain them in a simple manner here.
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Old 08-04-2013, 07:46 AM   #11
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+1. I'm hoping he not only gets answers but finds a way to explain them in a simple manner here.
Yeah, I hope so, too. It might be a useful case study for a complicated situation...
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"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
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