Affordable Care Act Questions
July 6, 2015 2:15 PM   Subscribe

I recently lost my healthcare coverage and would like to explore scenarios for obtaining coverage for my estranged wife and the rest of my family.

I am the sole earner in my family. My three children and my estranged wife were on my employer-sponsored plan. A replacement plan will be available shortly. However, I would prefer not to enroll my estranged wife (we have lived separately for 8 months, divorce proceedings have been going on for 15 months; there is no legal separation status in PA) in the new plan for various reasons.

I want to get a general idea of what the cost to her would be to enroll in a subsidized plan through ACA. Keep in mind that loss of coverage is a valid reason for enrollment outside the normal open enrollment period. If comparable coverage can be obtained for her on a cost-neutral basis, I will pursue that option. It is preferable that she be the responsible party for any medical costs she may rack up (even though it is understood that there is a chance that the courts will view such costs as marital expenses. I get it.).

Also, I would like to see if I can save a few bucks - I don't think I qualify for any sort of subsidy but would like to see how the numbers add up.

So what I need is a tool or resource or live human person who can help me sort out the coverage and cost options, in a general, actuarial sense. I will not reveal any personal information about my erstwhile spouse, but I would like to have reasonable estimates in hand when I propose this to her.

I have reason to believe that she will not undertake such investigations on her own, preferring to stay on my plan because it doesn't cost her anything one way or the other (I would cover reasonable subsidized costs of an ACA plan - it is important that she has health insurance).

Thanks in advance.
posted by Mister_A to Work & Money (6 answers total) 3 users marked this as a favorite
Response by poster: Clarification: this statement: Also, I would like to see if I can save a few bucks - I don't think I qualify for any sort of subsidy but would like to see how the numbers add up.

pertains to me and my children. I would like to see if we can save money on our coverage, separate from the ex's, by going outside of our healthcare plan. Probably not, just want to run the numbers and see.
posted by Mister_A at 2:16 PM on July 6, 2015

Best answer: This may seem like a patronizing question, but have you created an account and seen the list of options available to you on

If you have, and the results are confusing and/or overwhelming and you need a human to walk you through them -

Phone: 1-800-318-2596
In Person:

Oviously, the above are for the federal exchange. If you live in a state that has set up it's own health insurance exchange, it should have its own comparable help features.
posted by zakur at 2:45 PM on July 6, 2015 [1 favorite]

Best answer: As far as I know, if your wife is eligible for employer-based health insurance -- which she is as long as you are still legally married to her -- she will not be eligible for a subsidy on the exchange. We recently went through a similar situation, minus the estrangement.
posted by KathrynT at 3:17 PM on July 6, 2015

Response by poster: zakur - I have created an account but I'm trying to see what's available for my ex. KathrynT - You may well be right, unfortunately. I will contact the helpline zakur recommended. Thanks guys!

posted by Mister_A at 3:27 PM on July 6, 2015

Seconding zakur's suggestion of in-person (or phone) assistance by one of the local organizations receiving grant funds to help people with questions about enrollment and options.

Pennsylvania is one of the states using the federal Marketplace, so visit You can search by zip code for nearby assistance, and there may be an agency on the list that you already have some relationship with.
posted by Snerd at 7:34 PM on July 6, 2015

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