Affordable Health Care Exchanges - are we eligible?
July 11, 2013 11:08 AM Subscribe
I'm looking for good resources for information about the upcoming exchanges, especially concerning eligibility restrictions, specifically in Colorado.
I apologize for asking this as it seems like something I should have been able to find on Google, but I'm unable to navigate the wealth of crappy information available to find good resources to answer this question.
My husband and I are both uninsured 20-somethings and I want to correct that. His work offers a group plan, but we've previously opted out of it -- it's very expensive for practically catastrophic-only coverage, and they only offer individual or family, so insuring both of us through it would be outrageous. I've heard that you aren't eligible for the upcoming exchanges if you have access to an employee group plan barring certain restrictions, but I can't find actual documentation of what the eligibility requirements are. If you have any resources regarding the exchanges eligibility, I thank you in advance!
I apologize for asking this as it seems like something I should have been able to find on Google, but I'm unable to navigate the wealth of crappy information available to find good resources to answer this question.
My husband and I are both uninsured 20-somethings and I want to correct that. His work offers a group plan, but we've previously opted out of it -- it's very expensive for practically catastrophic-only coverage, and they only offer individual or family, so insuring both of us through it would be outrageous. I've heard that you aren't eligible for the upcoming exchanges if you have access to an employee group plan barring certain restrictions, but I can't find actual documentation of what the eligibility requirements are. If you have any resources regarding the exchanges eligibility, I thank you in advance!
Best answer: To clarify (not necessarily for you but for anybody searching in the future who might find the answer), the question isn't whether or not you're eligible for the exchange -- anybody can buy from it.
But if it's what it seems like you're asking -- whether or not you are eligible for the subsidized coverage (now "health premium tax credits" thanks to the runaround from last year) -- that's a more complicated issue.
If your husband's employer didn't offer family coverage at all, you'd be eligible as long as your family income wasn't above 400% of the federal poverty level (which is $62,040 for a family of 2 this year)
However, since your husband's employer does offer family coverage, your family's eligibility for subsidized coverage on the exchanges will depend on whether the employer's coverage is considered "unafforadable or inadequate under the law." If the cost for single coverage is more than 9.5 percent of your income or the policy doesn't cover at least 60 percent of your allowed medical costs, your whole family could be eligible for subsidized coverage on the exchange. But if the coverage available through the job meets those standards, your family won't be eligible for subsidized coverage.
posted by MCMikeNamara at 11:26 AM on July 11, 2013
But if it's what it seems like you're asking -- whether or not you are eligible for the subsidized coverage (now "health premium tax credits" thanks to the runaround from last year) -- that's a more complicated issue.
If your husband's employer didn't offer family coverage at all, you'd be eligible as long as your family income wasn't above 400% of the federal poverty level (which is $62,040 for a family of 2 this year)
However, since your husband's employer does offer family coverage, your family's eligibility for subsidized coverage on the exchanges will depend on whether the employer's coverage is considered "unafforadable or inadequate under the law." If the cost for single coverage is more than 9.5 percent of your income or the policy doesn't cover at least 60 percent of your allowed medical costs, your whole family could be eligible for subsidized coverage on the exchange. But if the coverage available through the job meets those standards, your family won't be eligible for subsidized coverage.
posted by MCMikeNamara at 11:26 AM on July 11, 2013
Best answer: The Colorado-specific info is scheduled to be posted on the state health reform website in September. I'm looking forward to getting insurance this way, too -- please feel free to get in touch if you want to talk about options when the time comes.
posted by asperity at 11:32 AM on July 11, 2013
posted by asperity at 11:32 AM on July 11, 2013
Best answer: The details are state-specific, but this calculator should give you a general idea of your possible subsidy rate if you qualify for subsidies based on your husband's employer's offer, as explained by MCMikeNamara.
posted by Mr.Know-it-some at 12:16 PM on July 11, 2013 [1 favorite]
posted by Mr.Know-it-some at 12:16 PM on July 11, 2013 [1 favorite]
However, since your husband's employer does offer family coverage, your family's eligibility for subsidized coverage on the exchanges will depend on whether the employer's coverage is considered "unafforadable or inadequate under the law." If the cost for single coverage is more than 9.5 percent of your income
Be careful. Is it 9.5% of his income or 9.5% of the family income? This is a gotcha that a lot of families with two workers could fall into. http://www.santacruzsentinel.com/localnews/ci_23578698/ask-emily-could-your-family-fall-into-affordable
posted by Gungho at 1:25 PM on July 11, 2013 [1 favorite]
Be careful. Is it 9.5% of his income or 9.5% of the family income? This is a gotcha that a lot of families with two workers could fall into. http://www.santacruzsentinel.com/localnews/ci_23578698/ask-emily-could-your-family-fall-into-affordable
posted by Gungho at 1:25 PM on July 11, 2013 [1 favorite]
This thread is closed to new comments.
posted by Jacqueline at 11:11 AM on July 11, 2013