Health Insurance - adult with potentially high costs (U.S.)
October 27, 2023 6:46 AM Subscribe
My adult daughter is going off my good health insurance at the end of this calendar year. She recently married and her husband has health insurance, but as best I can tell, it's not great. Does she have options other than going on his insurance (or in addition to)?
She has potentially expensive needs, e.g. regular shots that had to be preapproved and are not cheap, mental health medications and visits, historically ER visits for asthma although that's under control now.
It seems like if she is able to get health insurance through her husband, it's not practical to get it through healthcare.gov. She doesn't have a regular job.
She has potentially expensive needs, e.g. regular shots that had to be preapproved and are not cheap, mental health medications and visits, historically ER visits for asthma although that's under control now.
It seems like if she is able to get health insurance through her husband, it's not practical to get it through healthcare.gov. She doesn't have a regular job.
Best answer: Benefits are part of my job, we just kicked off open enrollment for the next plan year, and I have been breathing this stuff day in and day out for a while. If it would help, I'd be happy to take a look at her plan opinions her spouse has and see what might make sense. Hit me up on memail if you want.
posted by phunniemee at 6:51 AM on October 27, 2023 [10 favorites]
posted by phunniemee at 6:51 AM on October 27, 2023 [10 favorites]
Best answer: They just changed the rules -- the "family glitch" used to prevent dependents/spouses from getting ACA coverage and premium subsidies, but now you can shop on your state's exchange if the cost calculation shows employer-coverage is too expensive.
My wife did this last year -- my insurance at work is very good, but just to cover my wife I had to pay the Family Plan even though it was just one person, which was very expensive. Boom, rule change, so through the state of MN exchange she got good insurance -- the deductible was higher, but the amount we saved on premiums was more than the deductible, and her medications went way, way down.
States also provide free assistance from real insurance agents trained on the exchanges -- your daughter should talk to one of them, and if for some reason she doesn't qualify for exchange insurance they can tell her that, but don't just assume anything, ask a professional.
posted by AzraelBrown at 7:09 AM on October 27, 2023 [12 favorites]
My wife did this last year -- my insurance at work is very good, but just to cover my wife I had to pay the Family Plan even though it was just one person, which was very expensive. Boom, rule change, so through the state of MN exchange she got good insurance -- the deductible was higher, but the amount we saved on premiums was more than the deductible, and her medications went way, way down.
States also provide free assistance from real insurance agents trained on the exchanges -- your daughter should talk to one of them, and if for some reason she doesn't qualify for exchange insurance they can tell her that, but don't just assume anything, ask a professional.
posted by AzraelBrown at 7:09 AM on October 27, 2023 [12 favorites]
Response by poster: Thank you, phunniemee. memail sent.
She's aging out of my plan, which is why I'm trying to wrap my head around the options.
The info about the "family glitch" is very interesting.
posted by idb at 7:47 AM on October 27, 2023
She's aging out of my plan, which is why I'm trying to wrap my head around the options.
The info about the "family glitch" is very interesting.
posted by idb at 7:47 AM on October 27, 2023
Response by poster: phunniemee very graciously helped me work through some options and calculations, basically identifying the annual premium cost plus worst case OOP. Based on this, what I thought was the best option, was actually not.
I also was able to email a local advisor. The glitch option requires the cost of the premium of the lowest priced comprehensive plan of the employer to be more than 8.39% of the household monthly income.
posted by idb at 7:41 AM on November 28, 2023
I also was able to email a local advisor. The glitch option requires the cost of the premium of the lowest priced comprehensive plan of the employer to be more than 8.39% of the household monthly income.
posted by idb at 7:41 AM on November 28, 2023
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posted by saeculorum at 6:48 AM on October 27, 2023 [2 favorites]