Tuesday, October 28, 2014

Reader: Can I swap workplace coverage for Obamacare?

Reader D.C. Tomlin has a timely question:  "Even if your workplace offers health care insurance can you still price the costs of the Affordable Care Act and perhaps qualify if it is cheaper?"

It's timely because many of us are getting 2015 health insurance packets from our employers and learning that premiums will rise.  But while it can't hurt to check out HealthCare.gov  (the site says  "window shopping"  info on 2015 rates is coming in early November),  it's unlikely you'll find a better deal.

If your employer's insurance meets the federal government's standards for affordability and value  (read details here),  you aren't eligible for a subsidy,  which is what keeps ACA premiums low for many low-  and moderate-income people.  You can still opt out of your employer's plan and pay full price on the exchange,  but if your employer is covering part of the premium you're likely to end up paying more.  And if you're going that route,  you'd do better to look at a wider menu of private-pay offerings  (only three companies will offer ACA policies in North Carolina in 2015,  and some counties have fewer options).

Families like mine face another twist.

As the only full-time employee,  I've got my husband and 25-year-old son on my Observer policy (the ACA requires employers to offer coverage until children turn 26). 

Our son works two part-time jobs,  neither of which offers health insurance.  His income would likely qualify him for a hefty tax credit.  But I was initially told that because the ACA makes him eligible for my plan he can't claim that aid.

"Having an offer of adequate, affordable employer coverage prevents those family members from accessing financial assistance in the marketplace.  This is known as the 'family glitch,'  "  said Madison Hardee,  a Legal Services of Southern Piedmont lawyer and health insurance navigator.

However, Donna Elliott Grissom,  executive director of HealthNet Gaston,  found a link indicating he does have that option.  Because he pays his own taxes,  rather than being listed as our dependent,  HealthCare.gov says he is eligible for subsidies  (Hardee agrees that's a crucial distinction).  But that's true only if I don't sign him up  --  and the Observer's enrollment ends before the ACA exchange opens for 2015 enrollment on Nov. 15.

I'm glad we have options,  but it does make for complex choices.  And in North Carolina,  the calculation has to include whether his 2015 income might dip below $11,670,  plunging him into the coverage gap in which he would no longer be eligible for aid.  That's an issue in states that have declined to expand Medicaid,  which was supposed to fill that gap for low-income adults.

Grissom,  who has young adult children of her own,  says she was also unclear on how this works until she started digging.  "We both learned something new today,"  she said.  "And like everything else ACA-related – it’s complicated!"


Archiguy said...

Just another example of why we need a universal single-payer health care plan in this country - think Medicare for Everyone - like every other civilized country on earth has already done.

Just like we let the NRA, it's lobbyists, and its bought-and-paid-for conservative politicians craft firearm policies and regulations, we let the private insurance industry perpetuate this horribly inefficient and disastrously expensive health care system in this country. A full third of all our health care costs are a direct result of the massive bureaucracy involved with all these private insurance companies and their executives' million dollar salaries.

Obamacare was necessary to get a few million more Americans some degree of coverage, but is woefully inadequate to deal with the out-of-control costs of health care. Only a single-payer plan with a rigid schedule of values and cost controls brought about by universal coverage can do that.

When will we elect politicians with the guts to tell the private insurance industry thanks, but your time is done? It needs to go away and be replaced with Medicare for Everyone. Every other country on earth has already figured this out. When will we?

Anonymous said...

So, even if your 25 year old son was on his own (assuming he lives with you based on your comments), he can't use the ACA simply because he is under 26? So, parents are essentially forced by ACA to cover their ADULT children up until age 26. Ridiculous. The government is forcing us to coddle our kids up to 8 years into their adulthood...sad.

Ann Doss Helms said...

9:34, I've updated this -- another sharp reader found an explanation that young adults who aren't listed as their parents' dependent (our son is not) DO have the option of applying for subsidies on the exchange.

Of course, you can then debate the philosophy of parents' insurance vs. federal subsidy. Obviously the ideal would be he'd have a great job with his own insurance ... but that's just not reality for a lot of people. As is, he's one of those "young invincibles" who takes almost nothing out of the system, but I'm glad there's something in place so our family won't go broke if he does encounter a major medical expense.

Anonymous said...

@Archiguy..I don't want the government controlling my health care. Single payer will not work in this country. This is the land of the free. The government should only take care of the needy. I can get out here and work for mine.

Anonymous said...

The government is not forcing parents to cover their children until age 26. ACA requires employers to OFFER the insurance coverage and employees decide who will be covered under their insurance. Most parents elect to cover their children until they are in a position to afford their own insurance.

Wiley Coyote said...

...Grissom, who has young adult children of her own, says she was also unclear on how this works until she started digging. "We both learned something new today," she said. "And like everything else ACA-related – it’s complicated!"

Sorry, but I find that comment comical.

It goes to show just how short of a memory many people have including some who might be liberal Democrats.

Remember this ditty?

"We Have to Pass the Bill So That You Can Find Out What Is In It"... Nancy Pelosi

We still don't know what's in the bill.

You get what you vote for and you voted for this mess.

Kimberly Hillman said...

Do the ACA plans provide coverage for dental and eyes? Or are going to have blind and toothless youngsters?
I have not looked into ACA plans. I (we) have coverage through my husbands employer, but was interested in this because of my 23 and 21 year old children.

Ann Doss Helms said...

ACA plans must include pediatric dental and vision coverage, but it's optional in adult plans.

Link on dental: https://www.healthcare.gov/coverage/dental-coverage/
Link on vision: https://www.healthcare.gov/glossary/vision-or-vision-coverage/

Archiguy said...

Anon 10:16 - So, you're going to refuse Medicare when you're eligible? Because, and this may come as a shock to you, that's a single-payer government-run health care plan, the kind you say "won't work in this country".

And it's paid for by younger workers, many of whom have no health benefits in their own jobs, and who are thus paying for the gold-standard health care of their elders while receiving no care themselves. Then, when a catastrophic illness or accident strikes, they show up at the ER door. Who do you think pays then?

The Affordable Care Act was designed to help remedy that situation and, for 10 million Americans (and growing every day), it has.

Funny, I haven't heard any staunchly conservative, free-market lovin' seniors offering to give back their Medicare cards on principle. And since it works quite well for them, your comment that "single payer won't work in this country" is silly.

What part of "we pay more and get less for health care than any other place in the world" don't people like you understand? Single payer is inevitable. And since we already have a well functioning example of it with Medicare, we might as well start now. It is the only thing that will keep the whole system from eventually melting down.

Archiguy said...

Wiley - the only reason the ACA is so complicated is because of the involvement of the private insurance industry. That was the price the President paid to get their support.

Medicare works quite well on about 2% overhead, and its executives manage to live on G-series salaries. The private insurance industry accounts for 35% overhead tacked on to basic care, and their executives make hundreds of millions in compensation. And that's where the complexity comes from.

What the President and most Democrats wanted was a single-payer system. But Obama knew that was a non-starter because of the lobbying power of the private insurance industry. So he adopted the GOP's OWN plan as the centerpiece of his plan.

He could never have predicted, no sane or rational person could, how the Republicans would then attack their own plan, originated in the Heritage Foundation, as the greatest threat to freedom since Pearl Harbor, just to oppose the President.

And before you mention yet again about "voting for a bill before we know what's in it", I have just two words for you: Patriot Act. We knew far more about the ACA than ANYone did about that.

Anonymous said...

Your situation is a classic example of what we want to be as a country. It goes to the heart of all of these 'subsidies". The reality is this - should your 25 year old son pay for his own health care OR should you pay as his parent OR should your neighbor pay. Correct? There is no 'free' health insurance or 'free subsidy'. To be honest I'd have to look at his budget. If he is working 2 part time jobs (assuming $7.25 min wage and 20 hours per week) he is earning $290 per week. That is $1160 per month. What is he purchasing with his money? Is what he is buying more important than health care? If so - it is his choice. If not - then why isn't he purchasing health care? The better public police is to give him a tax credit and let him purchase insurance - but that wouldn't allow the politicians to control us - so it won't happen.