ACA for one Spouse but not the Other

[PaunchyPirate]

I’m curious about this situation. It’s about a family member...

Husband is employed by a decent-sized company. I assume he has employer-provided health insurance for at least himself.

Wife was just diagnosed with advanced breast cancer. She was advised by 2 close members who are in the insurance business to immediately quit her job, which I assume also had health insurance. Quitting the job was very much impacted by her need to dedicate all her strength to fighting the cancer.

I do not know whose insurance she was covered by prior to he leaving her job.

I assume her close friends are setting her up with a subsidized ACA plan. Their income isn’t very high even before she left her job.

My question: Does the ACA allow her to buy her own subsidized insurance via the exchange if it is possible for her to be added to her husband’s insurance instead?

I’m told the employer insurance is less beneficial than what the close friends can arrange for her.

I also suppose the friends may be lining her up with a full-price, more robust, off-exchange policy.

Thoughts?

 

[Aerides]

One would hope that those well-informed insurance friends have thought all this thru and asks those things for her but...

If she is eligible to go on the husband's plan, that's usually the first way to go. I don't think you can go on the ACA if you have other employer insurance available? Either way the costs and provider for her area are things to know and understand in all options. Does she want to stay with her doctor? Etc - all impacted by who insures her.

It can all get quite complicated and vary a lot from state to state, depending on the providers and state exchanges.

 

[PaunchyPirate]

One would hope that those well-informed insurance friends have thought all this thru and asks those things for her but...

If she is eligible to go on the husband's plan, that's usually the first way to go. I don't think you can go on the ACA if you have other employer insurance available? Either way the costs and provider for her area are things to know and understand in all options. Does she want to stay with her doctor? Etc - all impacted by who insures her.

It can all get quite complicated and vary a lot from state to state, depending on the providers and state exchanges.

I agree with all you say. That’s part of why I’m researching. The 2 close friends are also relatives of hers and they are very familiar with the doctors and networks, etc. In fact, within the last couple years they went thru this exercise with another family member who also had to navigate this all with breast cancer.

Perhaps the husbands insurance doesn’t cover spouses. Or do they all? I have no idea.

 

[cathy63]

If the husband's employer offers health insurance for him alone that costs less than 9.78%* of their annual household income, then that insurance is considered affordable. If the employer also offers insurance that would cover the wife, then she is not eligible for a subsidy no matter how much that couples plan would cost. It could be 40% of their income and she still wouldn't be eligible for a subsidy as long as the employee-only plan meets the definition of "affordable". She could enroll in an ACA plan or purchase coverage directly from an insurer if she wanted to, she'd just have to pay full price. This is known as the "family glitch" in the ACA law.

It may be that her quitting her job lowers their income enough so that his employer coverage is no longer considered affordable, and she/they could then get cheaper and/or better insurance on the exchange with a subsidy.

* that might be the 2020 number, google for the 2021 number

 

[PaunchyPirate]

If the husband's employer offers health insurance for him alone that costs less than 9.78%* of their annual household income, then that insurance is considered affordable. If the employer also offers insurance that would cover the wife, then she is not eligible for a subsidy no matter how much that couples plan would cost. It could be 40% of their income and she still wouldn't be eligible for a subsidy as long as the employee-only plan meets the definition of "affordable". She could enroll in an ACA plan or purchase coverage directly from an insurer if she wanted to, she'd just have to pay full price. This is known as the "family glitch" in the ACA law.

It may be that her quitting her job lowers their income enough so that his employer coverage is no longer considered affordable, and she/they could then get cheaper and/or better insurance on the exchange with a subsidy.

* that might be the 2020 number, google for the 2021 number

Thanks! I had seen references to the family glitch but didn’t know the details. This makes sense. I’ll learn more on their situation in the days ahead I’m sure. Thanks for the info.