Qualifying for ACA subsidies

[InTheSticks]

Sorry, if this has been asked before. I searched the forum to no avail.

A friend of mine is considering retiring. She's 60 years old. Her husband works and she could go on his health insurance plan.

Can she elect to get health insurance through the ACA Marketplace and receive a subsidy?

She has received conflicting information from so called experts.

Thanks!

 

[Aerides]

Can she elect to get health insurance through the ACA Marketplace and receive a subsidy?

She may be able to enroll, but not receive a subsidy. If her husband's policy is deemed "affordable" she might not be eligible for a subsidy.
Probably worth her time to dig around on Health Sherpa.

 

[zinger1457]

If she applied for insurance through ACA she would also have to include her husbands income as part of the 'household income' when determining if she is eligible for a subsidy.

 

[SecondCor521]

If the husband's health insurance provides minimal essential coverage, then no. Most employer plans provide MEC.

See IRS instructions for Form 8962 at https://www.irs.gov/pub/irs-pdf/i8962.pdf:

"You can take the PTC for 2019 if you meet the conditions under (1) and (2) below.
1. For at least 1 month of the year, all of the following were true.
a. [...]
b. That individual was not eligible for minimum essential coverage (MEC) for the month, other than coverage in the individual market. An individual is generally considered eligible for MEC for the month only if he or she was eligible for every day of the month (see Minimum essential coverage, later)."

Later, under MEC:

"Minimum essential coverage (MEC). An individual in your tax family who is eligible for MEC (except coverage in the individual
market) for a month is not in your coverage family for that month. Therefore, you cannot take the PTC for that individual’s coverage for the months that individual is eligible for MEC. In addition to qualified health plans and other coverage in the
individual market, MEC includes:
• [...]
• Most types of employer-sponsored coverage"

 

[InTheSticks]

If the husband's health insurance provides minimal essential coverage, then no. Most employer plans provide MEC.

See IRS instructions for Form 8962 at https://www.irs.gov/pub/irs-pdf/i8962.pdf:

"You can take the PTC for 2019 if you meet the conditions under (1) and (2) below.
1. For at least 1 month of the year, all of the following were true.
a. [...]
b. That individual was not eligible for minimum essential coverage (MEC) for the month, other than coverage in the individual market. An individual is generally considered eligible for MEC for the month only if he or she was eligible for every day of the month (see Minimum essential coverage, later)."

Later, under MEC:

"Minimum essential coverage (MEC). An individual in your tax family who is eligible for MEC (except coverage in the individual
market) for a month is not in your coverage family for that month. Therefore, you cannot take the PTC for that individual’s coverage for the months that individual is eligible for MEC. In addition to qualified health plans and other coverage in the
individual market, MEC includes:
• [...]
• Most types of employer-sponsored coverage"

Thanks. That's what I thought. I have passed the information along.

 

[Dtail]

See below for the MAGI rules for calculating ACA income.

http://laborcenter.berkeley.edu/pdf/2019/magi.pdf