Family Affordability Glitch
ObamaCare’s family affordability glitch meant family members with access to employer coverage costing less than roughly 9.5% of household income per member can’t get subsidies on the Health Insurance Marketplace. It was a glitch because this could leave family members and families who would have qualified for cost assistance without access to the employer-sponsored plan in a gap where they couldn’t afford coverage and also couldn’t get cost assistance.
Luckily for some families, those with a low enough income and children of the right age still qualified for Medicaid / CHIP (still true). Also, luckily a rule was finalized in 2022 to fix the family glitch.
UPDATE 2022: President Biden fixed the family glitch. Instead of individual income being counted, family income will be counted and tax credits will be offered if an employee’s share of family coverage costs more than 9.5% (adjusted) of household income.
— NOTE THE REST OF THIS ARTICLE IS FOR HISTORICAL PURPOSES ONLY DUE TO THE GLITCH BEING FIXED —
Notes
The exemption amounts started at 8% and 9.5% respectively, and have gone up slightly each year. Consider this when reading the information below, and make sure to use the current numbers in practice (they can be found in the instructions for form 8965 each year).
We have offered the 2017 numbers as an example below. See Affordability Exemptions and the Family Affordability Glitch for 2017 Plans.
For 2017:
- If the cheapest employer plan costs more than 8.16% for self-only or family-member-only coverage, that family member qualifies for an exemption from the fee.
- If the cheapest employer plan costs more than 9.69% for self-only or family-member-only coverage, then that family member can use marketplace cost assistance (but must be approved from HealthCare.Gov first).
FACT: If two or more family members’ aggregate cost of self-only employer-sponsored coverage is more than 8% of household income, as is the cost of any available employer-sponsored coverage for the entire family. This grants a hardship exemption, but not eligibility for cost assistance.
Who has to be Offered Coverage?
Spouses don’t have to be offered coverage from an employer, but the employee and dependents do. If the spouse is offered coverage, or if a dependent is offered coverage, then the rules below apply to them.
Rules for Affordability
Under the ACA for insurance to be considered affordable it must meet the following criteria:
- For individuals without access to employer-based insurance. Coverage must cost no more than 8% of household income (for the cheapest marketplace bronze plan after subsidies).
- For families with access to employer-based insurance. Coverage can’t cost more than 8% of aggregate household income (for the cheapest marketplace bronze plan after subsidies). If it does they qualify for a hardship exemption.
- For employer-sponsored insurance. The cheapest employee-only coverage offered must cost no more than 9.5% of household income after employer contributions (for the equivalent of the cheapest marketplace bronze plan after subsidies). Typically employers use employee-only income as a safe harbor.
If insurance is not considered affordable a person may qualify for an exemption, and/or for catastrophic coverage through the marketplace.
Rules for Minimum Value
The coverage also must provide at least the cost-sharing of a Bronze plan sold on the Marketplace, meaning it must have at least a 60% Actuarial Value.
There are No Affordability Rules for Dependents of Employee
Even though an employee’s coverage has to meet minimum affordability guidelines, the coverage for other family members on the employees employer-sponsored plan don’t.
How The Family Glitch Affects Marketplace Coverage
If an Employer Offers Affordable Coverage Then Whoever Has Access Can’t Get Cost Assistance Through ObamaCare’s Marketplace.
Dependents Can Still Qualify For CHIP and Spouses Can Still Qualify For Medicaid
In a household with a low enough income a child and parents may still qualify for CHIP. CHIP eligibility levels are different for each state and depend age and income. In states that expanded Medicaid adults making less than 138% of the Federal Poverty Level may qualify for Medicaid. This is all true even if a spouse has employer coverage that is offered to the family.
The Result of the Family Affordability Glitch
As a result of the “glitch” a family member may have access to coverage through a household members employer that is only technically affordable by these guidelines, but costs much more than 8% of their household income for coverage.
If the plan costs 8% or more of household income for any family member it will exempt them from the fee for not having coverage and may qualify them for a catastrophic marketplace plan, but the law does little else to make the employer plan actually affordable to the family since the family loses access to cost assistance through the Health Insurance Marketplace by being offered coverage.
No Subsidies Can Mean Unaffordable Coverage
The main issue here lays in the fact that affordability in the workplace is determined by employee-only, where affordability for individuals and families is determined for each household member. The marketplace includes subsidies to curb the cost down below the 9.5% mark, while employer plans include only employer contributions and no additional rules for family affordability.
Learn more about affordable employer-sponsored coverage and the family affordability glitch.
Author: Thomas DeMichele
Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...
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Anna Marriott
Referring to this as a “Glitch” is the biggest understatement. If I were to insure my family through my work’s plan (or even based of the Health Exchange Rates), 30% of my income would go to insurance, but since the cost to cover JUST ME is considered affordable, we are unable to qualify for any subsidiaries. Why wouldn’t the entire family be taken into account when asking if the plan is affordable? Looking only at the cost for the employee seems to be irrelevant. This needs to be reevaluated immediately. If everyone in America is required to have insurance, then coverage should not cost 30% of one’s income – Period
CYNTHIA C HOLBERT
The cheapest available plan at my husbands job for he, myself, and our children is 240 a week. For a person that only makes 34K that insurance would be 32% of his annual gross income.
ObamaCareFacts.comThe Author
Yeah, that is insane. You can likely qualify for some if not all of the affordability exemptions… but not necessarily. It depends on who pays which premium.
Remember, next time someone howls and wails about how much we would pay in taxes for something like single payer, we need to consider that its offsetting costs like this.
Jack Tietjen
Here’s my problem. I’m on disability. Have been for 2 years. I have 5 people in my household. But, my son works, for minimum wage. After being on disability for 2 years one is forced to take Medicare. So now I’m paying $134.00 a month and I added vision, dental, and medicine’s and the cost went up to $174.00. My wife and I had a silver plan before I was forced to take Medicare. It was somewhat affordable. But, what they did now was make my wife, she doesn’t work, into a individual and charged my income to her, thus treating her as a single entity. So when you take my income, and her being treated like she’s single, she is forced to find a plan by herself. Well the only plan we can afford for her is the bronze plan. So, with my income, she can’t afford the silver plan. So now, instead of paying $196.00 a month, under the ACA, we are being charged $435.00 a month. Not to count the deductibles! Her plan doesn’t help until she until she reaches the $4,000 threshold! After you figure in our deductibles, we are close to $500. a month. The ACA doesn’t figure in assets. I know people that, when you add up their asset’s, they are a way richer then I am, and yet pay only $40.00 a month. Because they don’t have to show their asset’s. So they don’t work and show no income and get over. And why they don’t take into consideration of how many people live in my household, even though they ask that question, is ludicrous! We are being forced to take a very expensive health plan, which I believe, should be illegal, and it’s not affordable! You can’t eat a health plan. This is way to complicated and it’s a rip off. Totally illegal! And they, the government, are promoting it. The argument that they don’t want the government involved in medical care, don’t understand, they, the government, is involved in medical coverage. That’s what Medicare, ACA, or in my state, Medical, is.
Adele eldrisge
My spouse has our family covered thru her ins. My employer offers me free coverage with a high deductible just for myself. He will reimburse me the first 1200 in deductible charges. Should I take my employer ins as primary and use my wife’s plan as secondary
Media Goettel
I am on medicaid but the deductible went up to$2500 per month. I want to opt out of that and be covered under my husbands employer sponsored insurance but his employer won’t allow it because this is not considered a hardship. Can the employer refuse coverage for me?
Brian R
I’m a father of one child. He lives with his mother the majority of the time. I have health insurance through my employer and I want to cover my son because it offers more or a variety of coverage compared to the Affordable Care Acts Plan. She refuses to allow me to cover him. I was under the impression that AHC was for those who couldn’t get coverage through their employers. Do I have the right to cover him? Does she have the right to deny him better coverage?
Talkingrock
Can you help with these 2 common dependent scenarios? Like many others, I called HealthCare.gov several times and was told conflicting information.
Tim and Jane have 2017 Marketplace plans. They are unmarried adults, and Jane is Tim’s dependent. Tim qualifies for the Premium Tax Credit. Tim is offered a new job at $30,000 a year, with employer insurance:
1. The employer offers affordable insurance (under 9% of the household income) to Tim, but Jane has to pay full price (25% of the household income).
Tim takes the employee plan. But because Jane was offered a plan, though unaffordable, would they loose their Premium Tax Credit?
2. The employer offers affordable insurance (under 9% of the household income) to Tim, but does not offer to cover Jane. The employer covers dependent children, and direct family members only.
Tim takes the employee plan. Would the Premium Tax Credit still apply to Jane because she was not offered insurance?
Cindy
Me and our 3 kids are dependents of my husband’s ACA. I am not currently working but I have a plan to find job. If ever i will get a job are we still eligible for ACA? Or if ever i can have a separate health insurance is my husband still qualified for ACA with a 3 kids dependent?
Erin
If you are employed by an employer that offers you and your family employer sponsored insurance, you will likely not be eligible for the cost assistance on Marketplace Insurance. If an employer sponsored insurance costs less than 9.65% of the families income for the employee only, then it is considered “affordable” and you won’t be eligible for tax credits or cost assistance.
Holly Edis
I and my son have insurance through my employer. My husband who is retired (medically) does not have health insurance. I read that the penalty is a percentage of the household income. That being said, would it be better for us to file separate so that only his disability income and part time income are penalized?
Erin
No, if he is medically disabled and getting SSDI then he is entitled to Medicare (unless he’s still in the initial waiting period) and is wont be eligible for tax credits on Marketplace insurance. If he isn’t entitled to Medicare yet, then he is still eligible for coverage on your employers plan and this would make him ineligible for cost assistance on Marketplace plans. You could try applying for him for any disability based Medicaid programs in your state, but those programs vary state to state, so you’ll have to check to see what is available in your state. Also, the Affordable Care Act makes it difficult for married people to file separately to get tax credits for premiums.
Annette
My husband and I just found out that his company deducted $1200 from his pay checks this year for what they call an “alternative coverage fee”. It’s basically a spousal surcharge that the company charges to employees who’s spouses have been offered insurance by their own employers. As if insurance isn’t expensive enough!! But does anyone know if it still applies to me if I don’t work?
Erin
Employees and their families are not required under the Affordable Care Act to take an employer sponsored coverage that is offered to them. You are simply required to have minimal essential coverage or pay a tax and the employers are simply required to offer minimal essential coverage or pay a tax. The ACA also incentivizes employer coverage in that you can’t get tax credits through the marketplace if the employer coverage is considered “affordable”. Unfortunately, the ACA doesn’t prevent employers from requiring employees take their insurance as a term of employment and/or spousal surcharges. In theory the larger the pool of people in an insurance group, the more distributed the costs of covering everyone is. So declining coverage can higher premiums for those who remain in the employers plan, the surcharges are intended to create incentive for people to accept the employers coverage, but also to supplement the higher premium costs of having a smaller pool if many decline participation. Its also a loophole that allows employers to potentially take advantage of their employees and blame the ACA for requiring them to offer coverage that met a minimum standard. Perhaps this is something that will be addressed in future healthcare reform.
debra
im in a bad spot my husband employer offers insurance it would cost 95.00 every 2 weeks just to cover him but to cover me under family plan we would be out of pocket about 500.00 a month dont know what to do we cant afford a family plan this
obamacare is a joke
Dawn
Since this Obamacare Affordable care act came into effect, my husband has had insurance and me and my 3 children have not. Chip wanted $900 a month just to cover them. We are living paycheck to paycheck. We wouldn’t be able to afford $300 a month as a family. I have to shop with coupons and sales only just to put food on the table. We are being insurances to death. Our flood insurance, car insurance are killing us. Now my oldest is soon to be an upcoming driver. We are gonna be punished for that. What is wrong with this country when they make it so it’s a better option to get a divorce than to be married. Our country is set up to fail like this. Please mr. Trump, fix this mess! I have asthma that isn’t controlled because I can’t afford a doctor or prescriptions without insurance. My daughter hurt her shoulder at school and I can’t afford to have her x rayed to see what happened. Before the aca we have always been covered and never had these worries. These deductibles and copays are sooo high nobody can afford it. Please fix this!!
Dean Bilal
considering affordability on adding a spouse to an employer insurance program should not be based on total house income. It should based on the net pay after paying taxes, mortgage, and car lease and insurance. Those are expenses we have to pay monthly. I don’t want to sell my house and go to rent in cheap area just to be able to afford paying my wife insurance.
Tim Lawson
Ok I can get insurance through my work my wife recently changed jobs where she had insurance covering her and my two sons that are in college. I have looked into including them on my plan but the premium they want will mean I will be bringing home 150.00 dollars a week my wife and I together gross about 75,000 a year. Can we put her and my kids on a aca plan and I stay on my current plan or do we have to all be on one or the other.
Gloria Davis
My husband and I are currently covered under Obama Care. He is eligible for coverage through his employer on Jan. 1. He is able to add me to that insurance, but we’re wondering if he is required to do so under the Affordable Health Care Act, or if I will be able to choose between the two options, based on finances.
Amy
We fall into a nasty gap. I have a family of 6 (2 adults, 4 children), and I earn just over $2000/mo, pre-tax (take-home is approximately $1600). Our children qualify for Medicaid, but we don’t because our income is too high. My company offers medical for me only, but the absolute cheapest plan is just under $100/week. According to healthcare.gov, though, we do not qualify for an exemption, we do not qualify for any tax credits/subsidies, and we simply cannot afford nearly $100/week for insurance for me alone.
What are some other options that are available to my family so that we do not have to pay fines every year?
[email protected] Erin
Unfortunately no. If you have already tried applying for the many exemptions through healthcare.gov, then you have literally among the many frustrated working families stuck in this glitch. My suggestion is to write a letter to every single legislative representative you have and tell them to address this type of flaw in legislation.
AM
We fall into a nasty gap. I have a family of 6 (2 adults, 4 children), and I earn just over $2000/mo, pre-tax (take-home is approximately $1600). Our children qualify for Medicaid, but we don’t because our income is too high. My company offers medical for me only, but the absolute cheapest plan is just under $100/week. According to healthcare.gov, though, we do not qualify for an exemption, we do not qualify for any tax credits/subsidies, and we simply cannot afford nearly $100/week for insurance for me alone.
What are some other options that are available to my family so that we do not have to pay fines every year?
[email protected] Erin
You’re efforts to get insured are being limited by two different issues with how the ACA was legislated. First, your employer’s coverage for you only is $400 a month (if I’m understanding you right) and your family’s income is $2000 a month (roughly). That means the cheapest employer plan is 20% of income just to cover you. This would mean you could apply for an Affordability Exemption though Healthcare.gov. That would normally mean that you could use the marketplace and get cost assistance. However, to use the Marketplace you must make at least 100% of the Federal Poverty Level. This amount goes up with each household member, so the more children you have the more you have to make in order to be eligible to use the Marketplace and get cost assistance. This was a really poor way to design eligibility for cost assistance and it leaves low income families in states that did not expand Medicaid without a lot of options for health insurance. So despite actually overcoming the Family Affordability Glitch, you found yourself in a gap. You should still be able to qualify for an exemption from owing the fee for insurance because the cheapest options available for you and your spouse is more than 8.13%. If they denied it through healthcare.gov you may want to appeal that decision and make sure you are providing the requested documentation. There is another exemption that may also help you avoid the fee.
In states that did expand Medicaid all under 138% of the Federal Poverty Level. However, that means there is another option for you and your wife to at least get an exemption from owing the fee for not having insurance. If you apply for Medicaid in a state that did not expand Medicaid and get denied, you are eligible to be exempt. It also sends a message to your state that you need then to address the Medicaid Gap.
Brady
I am a single parent making $21000. My son (21 Yr.) is in college working full time making $26000. He will be offered coverage Jan. 1 through his job. I claim him as a dependant but this affects my income total being $ 47000 when I go to the exchange. Would I be better off not claiming him as a deduction on my taxes ? I just don’t understand how someones income counts on yours when they can get their own insurance.
Ava Williams
I need to know more about what the definition is of “offered coverage” because for some employees, the employer is offered coverage where the employer pays part of the premium and the employee pays an affordable premium. However, in some cases, the employer pays nothing towards dependent coverage and only allows the employee to add the dependent to their coverage at full premium for the employee. Example: Mom works and pays $150 a month for her premium but in order to add her daughter, she must pay over $500 a month, which is the full premium for that dependent. So in essence, the employer is not paying any part of the coverage for the dependent. In my opinion, this is different than the situation where employers have individual and family plans and pay a portion of the premium for everyone on the plan. So what is the definition of offered coverage?
Either way, this is a BIG glitch as many working middle income folks cannot afford coverage for their dependents, even though their own individual premium is affordable.These dependents are young and usually healthy so now we’ve excluded a lot of healthy young folks from the health insurance pool and driven up the cost of healthcare premiums.
Can someone clarify the difference between these two scenarios as far as being eligible for a subsidy?
ObamaCareFacts.comThe Author
So even if they are offered full priced coverage they are “offered coverage”. Part of the glitch is that the employer only has to cover 50% of employee premium.
I think we can expect some state-based fixes up the pike, but i’m hopping the next President makes the general glitch a property. In my opinion the simplest solution is just allowing families whose employer coverage totals more than 9.65% (as a family, not self-only) to use the exchange if their income is under 400% FPL. That said, even my basic ideas for a solution are more complex than that.
And, I agree with the rest of your point. It is bizarre to be sticking young healthy kids with big premiums.
Dave
ObamaCare is built for those to lazy to get a job, non legal citizens, and the insurance industry. Welfare free insurance. Illegal border crosser free healthcare. Insurance industry more forced customer more revenue more money for the CEO’s. American worker more out of pocket, less coverage, division of husband and wife, it is a crock. 9.5% for insurance 5.5% State retail tax 6% State Income Tax, 16% Federal Income Tax, 1.5% for Medicare, 6% OASDI (we probably will never see). Total 44.5% of gross income gone. Now lets not forget the special taxes Gas, Tire, Property, and ETC ETC ETC. Now lets remove premiums for eye, dental, disability (in case you get hurt), and life insurance so your wife and children are not totally screwed when you die from exhaustion. Retirement well why would you want to do that. Brought to you by Career Politicians, Pay to Play Government, and Big Corporation Lobbyists. I will most likely be black balled for this or punished some way but needed to vent. Nice knowing you all….
Ashley Elizabeth Bach
This “glitch” has destroyed our lives. We are a newly married couple who are now fighting all the time and unable to afford the children we wanted to have.. So we’ve made the decision not to have children. Because we could NEVER insure them. I just got pushed into a $500.00 a MONTH plan through my husband’s employer, who changed to an insurance plan which none of my doctors take and gave us TWO WEEKS to deal with this. The price went up $400 even though none of my doctors take the new plan, $200 or more on top of the $500.00 increase. I HAVE to stay on it. If I don’t, my penalty will be $500 and I will have to get unaffordable insurance from someone else which isn’t good insurance. Also, I’ll be penalized for the 2 months between now and Jan. This is a DISGRACE. I voted for Obama. I understand he tried to do something incredible for this country and the Senate has destroyed his vision and his hard work. It’s now Our problem. The gov’t has left us behind. I work hard, my husband works hard. We can’t afford to live our lives when between the two of us we work 120 hrs a week. Now, after this insurance problem, we will NEVER have a Christmas, take a vacation and now we can’t even pay our bills. Thanks. You ruined our lives. Does that feel good?
Extremely Frustrated
I believe I understand this correctly, but I want to confirm, because I have been told this by calling the healthcare.gov line as well as researching it myself online.
I am provided with health insurance through my job; it’s a good plan and provides good coverage. My wife is eligible to receive benefits under my plan, but at a very high cost, about $600 a month. She does not work, and we file taxes jointly, so to cover her would cost about 12% of our household income. My wife SHOULD be eligible for subsidized care and a lower monthly premium, but she is not. She doesn’t get any type of hell through the Marketplace.
If I am to understand correctly from what I have researched, the reason she does not qualify is because the affordability of the coverage is not based off of the percentage of our income that HER health care coverage cost would be (which would be 12% through my employer), but off the percentage of my income that MY health care coverage costs are; which is basically nothing. So even though is would cost me more than is considered “affordable” to cover her under my plan at work, she doesn’t get to receive any help through the marketplace, because MY coverage costs are “affordable”. For this reason, I am expected to pay full prices, through the marketplace, for health care plans that are not very good, because its all I can afford since we receive no help; or pay 12% of my monthly income in order to provide her with the same plan I have. And we are expected to make those payments with only one member of the family working (as a teacher!). Absolutely ridiculous that we qualify as just “rich” enough and healthcare technically “affordable” enough to not get a dime of help, but still struggle to make payments to make sure she is able to see someone when she does get sick or have an emergency. It just makes me sick.
ObamaCareFacts.comThe Author
It is called the family glitch for a reason… it is glitchy. It is a safe-bet that either candidate will fix this. Either by addressing the glitch or taking a sledge hammer to the whole thing.
As for your situation, the exemption starts at 8% of self-income only and then she can use the marketplace at 9.65% (or whatever the current limit is for the year). So at 12% she just needs to coordinate with the marketplace and she can get an individual plan through there.
Very Frustrated
I believe I understand this correctly, but I want to confirm, because I have been told this by calling the healthcare.gov line as well as researching it myself online.
I am provided with health insurance through my job; it’s a good plan and provides good coverage. My wife is eligible to receive benefits under my plan, but at a very high cost, about $600 a month. She does not work, and we file taxes jointly, so to cover her would cost about 12% of our household income. My wife SHOULD be eligible for subsidized care and a lower monthly premium, but she is not. She doesn’t get any type of hell through the Marketplace.
If I am to understand correctly from what I have researched, the reason she does not qualify is because the affordability of the coverage is not based off of the percentage of our income that HER health care coverage cost would be (which would be 12% through my employer), but off the percentage of my income that MY health care coverage costs are; which is basically nothing. So even though is would cost me more than is considered “affordable” to cover her under my plan at work, she doesn’t get to receive any help through the marketplace, because MY coverage costs are “affordable”. For this reason, I am expected to pay full prices, through the marketplace, for health care plans that are not very good, because its all I can afford since we receive no help; or pay 12% of my monthly income in order to provide her with the same plan I have. And we are expected to make those payments with only one member of the family working (as a teacher!). Absolutely ridiculous that we qualify as just “rich” enough and healthcare technically “affordable” enough to not get a dime of help, but still struggle to make payments to make sure she is able to see someone when she does get sick or have an emergency. It just makes me sick.
Kayla
This new plan is ridiculous, simply put. If you cannot afford health insurance and thus don’t pay for it, you’re fined at the end of the year. Most people can’t pay the fine.
The good thing about the fine is that they cannot sue you or garnish your paycheck or do anything other than tell you to pay or take your tax refund at the end of the year. So if you cannot afford health insurance but don’t qualify for an exemption, then just don’t pay the tax. There’s nothing they can do about it other than take it out of your tax refund.
Onto the health insurance. Bronze plans cover exactly NOTHING!!!! They’re worthless!!! Less than worthless, same thing with Silver plans, because you have to pay a huge deductible before they’ll even start paying anything. AND the deductible resets every year!!
My husband has already paid $3100 of his $3200 deductible THIS YEAR!!! We’re drowning in medical debt but they still expect and require us to maintain coverage that doesn’t cover anything!!
So we sent in copies for the $3100 in medical bills and qualified for an exemption, actually for the entire year of 2016. So we wasted our money for 7 months paying $300 a month to have the 2 of us covered, plus another $53 to have our daughter covered when neither myself not my daughter went to the doctors a single time this entire year. Only my husband went to multiple doctors and the hospital. But that’s normal for him because he has Diabetes. Next year I’m getting him a Platinum plan with little to no deductible (if we can afford it, which I doubt) and then I’m sending in for an exemption for myself and our daughter.
This whole Obamacare thing didn’t really help anyone. It caused my employer to cut my hours 3 years ago which made me have to find a different job. None of the jobs after that worked out so I don’t work anymore.
We’re living on 1 income minus child support for his other daughter.
Going into THAT story: he was court ordered (or so he says but has none of the court documents for his divorce or child support orders) to pay for her health insurance. Which is stupid in the first place because his ex lives off the government and gets Medicaid for herself and free Chip her 2 sons (different dads for all 3 kids). She also has had his daughter on Chip for years without telling him. A girl tripped her in 2014 which caused her to break her wrist. The medical bills were sent to our insurance and his ex told us we had to pay the bills. Why the f didn’t that b!tch ever tell us she had his daughter covered???? He’s wasted thousands of dollars on having her covered when she never needed it and the entire time the ex KNEW because he gave her the medical card EVERY SINGLE YEAR!!!!! I despise her. (The ex not his daughter, his daughter is awesome.)
Anyways, obamacare is just another way to rip us off from our money.
Jen
I’m just trying to figure out if I am eligible for a subsidy. I am self employed. My wife’s employer offers her very good coverage for herself, but their coverage for the spouse is very expensive, but available. So, just picking a number, but if we make a combined 50,000 per year, what is the most her workplace can charge for my insurance before we would be eligible for a subsidy? Her coverage is clearly affordable, as defined, but I’m not so sure mine would be if I were to get it from her employer. If they charged $500 per month for me, would it be considered affordable, even though that exceeds 9.5% of our combined income?
ObamaCareFacts.comThe Author
You have the right idea, if the coverage for an family member exceeds 9.65% (they updated the figure slight for 2016) then you are exempt and can use the marketplace (at 8% you are just exempt).
So lets say it was $600 and you claim $50,000 as a family in MAGI, then you would be exempt according to the rule. To verify your exemption you would contact the marketplace and likely get an employer coverage tool that the employer fills out to verify this. That is the gist. In other-words, if you think you are exempt, the next step is healthcare.gov (that should be coordinated before coordinating with the employer). This avoids a misunderstanding where you cancel employer coverage but somehow aren’t eligible.
AB
So am I allowed to get insurance for me and my spouse through my work and kids get it through Medicaid since they qualify?
ObamaCareFacts.comThe Author
Yes. If you are in the right income bracket the kids can use CHIP (Medicaid for kids) and you can use the employer coverage.
Mary Preston
I had a work injury in April of 2015 as a result I was not able to average 30 hours a week and my employer cancelled my insurance at the end of the year and was not offered cobra. My husband has dependent coverage available to me for over $300.00 a week premium and because of this I can not get it through Obama care does this qualify for a hardship.
[email protected] Erin
It depends. Your husbands employer is likely doing his part to meet the employer mandate, but you are not required to take it. You are required, however, to have minimal essential coverage for everyone in your family IF it is considered affordable. While “affordable” is obviously a relative statement, but with regards to the ACA:
Your husbands employer is required to offer coverage to a certain number of his full time employees and their families. That insurance must also be considered “affordable” for his business. If not he has to pay a fine. This is the gist of the Employer Mandate. “Affordable” for the employer means that the plan covering just your husband must be less than 9.66% of your family’s income. He must offer family coverage though and that isn’t always “affordable” for the family.
Your family is required to have minimal essential coverage or pay a tax (or qualify for one of the many exemptions). If an employer offers it, you can’t get cost assistance on the marketplace . You are exempt from this rule if that coverage is not “affordable” for you and your family. This is the Individual Mandate. For this the ACA provides two definitions for whether employer coverage is “affordable” for you and your family. First, if the employee only coverage is more than 8.13% of the family’s income, then he is exempt from the fee for not having minimal essential coverage. Second, if the cheapest employer coverage for the family is greater than 8.13% of family’s income, then the family members are exempt from the fee for not having minimal essential coverage.
This is the Family Affordability Glitch and its a very confusing element of the law. If your husband and the family members are exempt, I would still recommend trying to find some for of private insurance coverage. You won’t be able to get marketplace insurance, but you also don’t have to get coverage that meets the guidelines of minimal essential coverage. You will need to be more vigilant when comparing plans, but you will have a greater variety of coverage options to choose from.
CS
So much on here is just incredibly frustrating to read. I accepted a job offer with a new company that would allow me to be closer to home and earn more base pay. Unfortunately my mistake was not finding out the insurance premiums before accepting and tendering my resignation with my current employer. Now I find myself out of my current job in two days and being denied subsidies or exemptions because of this “glitch” where as long as the employer sponsored plan is ‘affordable’ for the employee-only plan, then nothing else matters. My husbands employer is a small business not required to offer insurance. We collectively earn too much for our child to qualify for Medicaid/Medicare. I’ve shopped the local private plans and the marketplace and nothing is reasonably cheaper than the $450/month for our family of three that my new employer offers. So I’m going from paying $25/month for family medical insurance to $450 which eats up way more than the pay increase and gas savings that I’d have seen.
I have tried every imaginable option to find out if we would qualify for an exemption or subsidy. Every answer is no. For a working family who’s 2015 AGI was under $35,000 this is absolutely absurd. Insurance is highway robbery, but with a young child we can’t NOT have insurance coverage in the even they fall ill or need treatment.
Unless you have some magic secret that I haven’t found that ensures an exemption or subsidy that would bring our insurance costs below $200/month, I’ve gone from being a proponent of the ACA to being incredibly disgusted with the state of this countries health care system.
Angry
My employer pays the full cost of a family health insurance plan which they purchase through my union, my union dropped spousal coverage due to the affordable care act I have a contract that says I get a family health insurance plan how is my spouse not part of my family? Is this legal?
Carlos Rivas
does it typically cost more for health insurance for multiple health insurance versus one child
mary
So if i am offered insurance thru an employeer can my spouse still remain with the obama care insurance even thou they have no income only ssi diablity. we first qualified for it with my income, but since i will no longer be in the policy will he remain with the insurance or will the insurance deny him.
Stacie
Is there any plan to alter this glitch? My family is in the “perfect storm” of this situation. My husband makes a decent salary. We have a family of 5. We to not qualify for any subsidies. My husband’s employer based insurance for medical and dental for the entire family is $1,100 a month! That is 26% of his salary! We turned to Healthcare.gov to try and find an alternative. But, on healthcare.gov the offered plans cost almost as much as his employee offered plan. The reason we do not qualify for any subsidies is that his “employee only” insurance is free. This is a horrible loophole. What would happen if everyone had to pay 26% of their salary just to cover health insurance for their family? I feel trapped. I don’t know what to do. We struggle every month to pay medical bills and our premium. Please tell me that the small percent of people like me will have some sort of alternative someday?
ObamaCareFacts.comThe Author
That is a great question for the politicians in Washington. A really great question.
Anna
Family of 5 (husband, wife, three kids). Husband’s job does not offer insurance. The insurance available through my employer is “affordable” ($48/week for employee). Family coverage is $258/week (over $13,000/year). This is only medical-no dental, vision, etc. High estimate of gross household income for this year is around $70-75k, before any deductions. Are my husband and kids eligible for subsidies through the markeplace? $258-$48=$210/week-$10,920/per year for husband and three kids with my employer offered plan. I am so frustrated and confused.
Kristina
This “glitch” is financially killing our family of 5. My husband’s employer offers insurance. We picked the cheapest of the plans which only covers 60% and has outrageous copays and deductibles. All for the low low price of $1200 per month. Yes $1200 per month. Which we have to pay b/c our children have asthma. We cannot afford to not pay it. Yet because his company offers insurance, we do not qualify for assistance. This is just asinine to me. How can this make sense to anyone? How can $1200 / month be considered “affordable” yet my husbands portion is.
Susan
My situation is my husband takes 2 very exspence medication for Hph the one had a really expensive co-pay he gets help frim caring colition they pay his 250 co we just made it in 2014 by 3000 for them to help . now 2015 next round we will be probly make 3000 to much because of my back pay from SSID i dont know what to do it will be very hard to pay 250 co pay we are haveing a hard enough time haveing money for medication….. Im beside myself
Michelle Yarwood
We have a family of 4, only one person working. AGI is approx $40,000. Through the exchange we qualify for the kids to be on Medi-Cal and tax credit for two adults making it $135 a month… however, employer states that they provide “affordable” insurance. So, $213 for employee and $298 for spouse total of $511 for cheapest plan. How is this affordable? We live pay check from paycheck and don’t have debt or car payments. How can we afford this? Why are we punished because the employer provides coverage? We would have to pay less if we could get on the exchange with the tax assistance. Why do they get the credit and we don’t?
Christie Stewart
Most of our staff are under 26 years of age. We offer health benefits but most decline because they are still under their parents policy. I do not see a payroll code for this situation in order to file our 1094 and 1095’s. Can you help me with that?
ObamaCareFacts.comThe Author
It’s explained in the instructions of 1095-C for line 14 https://www.irs.gov/pub/irs-pdf/f1095c.pdf
You would use the code that you offered coverage (1B) I believe. Think this is true whether or not they opt-out of coverage.
Mai
I have a question. I might be pregnant. My employer offers affordable HSA insurance. However, it technically becomes unaffordable for me as soon as I start going for my prenatal check ups, labor etc. My out of pocket/coinsurance/deductible total will be about 6000. I definitely can not afford that. Ami able to get medicaid for pregnant women?
If someone has an answer to this, please please respond to this. I’m desperate for an answer..
Thank you
ryan
i may be moving positions to a new company that offers insurance through group plan. However, the out of pocket costs for that group plan is roughly 12k more per year than an similar plan i’m paying for now through the marketplace.
i just learned about this idea that if the group insurance provided by an employer is more than 9.5% of your household income, then you could apply for the tax breaks which would make a family marketplace plan more affordable. If i understand all of that correctly, this could work for us, especially considering the housing allowance that would come off of my gross income. After a housing allowance, our insurance costs would be aboutl 44% of our household income, putting us way over the 9.5% threshold…assuming i’m doing this right.
Does this create any opportunities for us to get some better/cheaper insurance through the marketplace?
ObamaCareFacts.comThe Author
So it is 9.5% per person, or arrogate cost of two or more. So the exact answer to this depends on family size, but yes generally you have this right. Sometimes the employee-only coverage is affordable but the family coverage isn’t. Whoever is exempt due to being over the threshold can move to a marketplace plan with cost assistance.
This all requires coordinated with healthcare.gov, so calling them is a good next step.
ryan
So, i am married and have 3 kids. after calling in…it sounds like my only option would be accepting the group coverage for myself (which would only be $11 per month) from the employer group plan instead of the family plan (which would be $1500 a month). Then, apply for insurance on the marketplace for my wife & kids and hope they are accepted and given tax benefits because of the affordability of the family plan offered. It all still sounds way more complicated than it seems like it should and i’m not sure if i’m doing this right.
i’m not trying to do anything wrong or sneaky…just trying to figure out what is the most affordable way for me to get good healthcare for my family.
what i hate is that there’s no way to really check on these things without just applying. but i won’t be moving until mid june. i’m just looking to see what we need to plan for, but it seems like we won’t know until we get there and just apply. just seems backwards.
Roger
I had a job from Jan thru March, during that period I had health Ins through the company I worked for. I started a new job in April making about half of what I was paid in my last job. The new company did not offer any insurance. When I signed up for Obama Care I gave them my new income level. I had a monthly payment of about 38.00 . I also pay a monthly alimony. When I did my taxes they said I have to pay back all of the subsidy totaling 3864.00. So totaling my alimony that I paid and the subsidy I have to pay back. That equals 35% of my gross income from April to December. Why isn’t the income for the insurance calculated for the time I had the insurance? Why is it penalizing me for having a different job and insurance for the first three months?
ObamaCareFacts.comThe Author
The 8962 instructions should walk you through the process. Three are number of things that could have happened, generally though, your tax credits are based on household income compared to the poverty level (with respect to what plan you chose). So those should be the deciding factors (unless you claimed credits for a month you had employer coverage).
Connie W.
I noticed whoever is answering some but not all of these questions /problems chooses to address and answer only the ones that arent totally screwed by Obama Care. The true stories and majority of Americans have been frustrated, hurt and totally exhausted from working and trying to provide for their own families and now are even more penalized by these glitches and mountains of garbled insurance talk that even professionals cant understand. Add to that the hours of waiting to speak to a Marketplace Rep to only be more confused or even hung up on! Why cant someone just admit its a big failure and please the need to fix is NOW not after it has devastated millions of Americans! It has been a disaster for my daughter and her family. She is on Medicare disability (profound deaf plus other disabilities) and after hours of non compliant ADA marketplace means of communication with the hearing impaired, she had to pick a plan for her working spouse (also deaf but not on SSD) and 2 children. The plan is a very high deductable and low paying (seems insurance companies cleverly wrote policies that exclude even more coverage than they did before) and premiums that are more than triple what they were paying before ObamaCare.! Now they have stacked medical bills they cant pay because their premiums and living expenses take it all. Top it all off with I spent 3 hours on the phone with a Supervisor Rep in the Market Place to just set it up so I could represent my deaf daughter and son in law (just for this one 3 hour call!) because when my daughter repeatedly tried to call with her VP, EVERY time the agent would hang up on her because they didnt want to mess with her or else they had not a clue for what deaf means, interpreter through Video Service means. . Top that with when they filed their taxes, all of their refund was taken by the IRS (oh great the IRS has even more power over us all now) because her husband (who refuses SSD and wants to work to support his family!) got a raise during the year and because my daughters SSD benefits has to be included in their yearly income EVEN though she has Medicare and pays premiums for that! (which is not taken into account in the exclusion of her income. Double penalized. Triple considering he could take SSD but is no honerable he chooses to work hard instead. It is very hard for me to watch this scenario as I am 65 (just on Medicare myself) and with a entirely different hair raising story about ObamaCare pertaining to my husband and I. I dont know how to help my daughter as she is so ill, just out of the hospital and if anyone needs the help and assistance it is them. Yet, because of his 82,000 K income and her SSD they do not qualify for any assistance. and yet are having to pay an insane premium on a policy that NEVER pays a dime because of exclusions and high deductables and double deductables ( deductable plus ER deductable stacked on top etc!)
It would help I suppose, if this person on this website that is answering these comments would at least say I am so sorry , seems this is a great failure and is hurting more people than it is helping and needs to be fixed . Instead , pride in the name of “Obama” seems to take first place. I am sick to death of all the politics and outright lies and stealing from hard working Americans , punishes them more and takes more from them to give to those who want it all free and act as if they deserve it because ., well its always been given to them . Nice to find a place to vent, but this is as disaster!
ObamaCareFacts.comThe Author
100% glad to help provide a place to vent. We put a lot of work into this site. We get hundreds of comments every week, often they are long like the above comment, and we have to go through each by hand. So we do our best to address everything, but there can’t be an expectation that we can do it all as a private website unaffiliated with the government or insurers.
With that said, we 100% represent and respond to all comments that aren’t total hate speech. Sometimes I ignore really negative comments because, either I’ve addressed it many times, or “what can I really say to someone who is upset”. If someone feels like a point is missed specifically, just say it clearly and i’ll respond.
Remember 10’s of millions with coverage for the first time, lots the ACA gets right, a few big sticking points related to costs that we are very vocal about (as our audience is as well). So, to your point, it isn’t “a disaster” aspects of it are, but we are so divided as a country we can’t come together to demand change. Change needs to happen. Check out this recent article we wrote for instance: https://obamacarefacts.com/2016/04/07/drug-prices-and-the-cost-of-healthcare/ … or this one: https://obamacarefacts.com/2015/12/29/obamacares-sticking-points/
Jenny
My husband was laid off twice in the past two years. The family was covered by Medicaid. Ours needs to be renewed soon but kids are covered until December. He has found steady work now but insurance will not be available to us until January 2017. Do I have to call my health.gov to let them know? Or do I just let ours expire and then wait for the kids to expire? How does that work?
Kassie Patton
My family is directly affected by this “glitch.” We live in OK, my husbands company offers affordable health insurance for him. However, the family plan they offer would cost our family over 20% of our total income, just for the premium, and that does not include dental. We qualify for the exemption, but my son and I are left uncovered. We tried to afford the catastrophic plan on the exchange last year, but it offers very little coverage and we are unable to afford to continue paying for it this year. This “glitch” is extremely frustrating. We are a working family, trying to get by. Why does the system always seem rigged against families like us??? If you know the glitch exists, why not do something to fix it. In the meantime, we will try to stay healthy.
Donna Speranza
My Employer is offering me health insurance at a cost of $75 per week. My Gross income is $800 per week, so technically it meets the affordability formula. HOWEVER (a big however) is that the insurance covers nothing until you meet a $6,350 deductible. Is that also factored in? I could accept higher premiums and lower deductibles but it would than cost almost 15% of my pay. This is only for me . . If I included my husband earning about $25k and daughter, the lowest weekly coverage (again, covering nothing until you meet the deductible of $6,350) is $225 per week . . .and 26% of our GROSS income . . over $18,000 . . .How is that affordable for the already squeezed nearly poor middle class???
ObamaCareFacts.comThe Author
I couldn’t agree more. We have often stated a sticking point of the ACA is deductibles and all the Democrats have this as a priority on their healthcare platform. Not sure what it will take, but deductibles sure need a second look as a nation.
Jade Salazar
I have insurance through my work that has a $4,000 deductible and 20% owed after that deductible is met (until a total of $6,000). I make $44,000 a year. Is there any way to get out of that insurance and sign up for Obamacare before my open enrollment?
I just went to the emergency room and will now be basically paying a car payment for next year or two and cannot afford this current insurance. Please help!!
ObamaCareFacts.comThe Author
Yeah, I don’t even know how to react to this sort of thing. It is nothing short of a shame that congress has been so slow to act in the interest of the people to improve healthcare, what Obama did was monumental, but more needs to be done.
For you, you can write off the medical debt on your taxes and likely save some money. You can also consider bankruptcy, but that is a last resort. https://obamacarefacts.com/tax-deductions-for-medical-expenses/
Rebecca Walton
My husband and I are retired. He is 65 and on Medicare. I am 60, and have private insurance. For 2016, I have a silver plan that costs 1000 per month with a 6000 dollar deductible . He is also paying for a Medicare supplement, as well as his Medicare. If I did not have to combine our incomes, I would be able to obtain a lower premium. Is there anything that can be done about this???
David D
My wife’s employer has coverage that falls in the affordable category so I know we will have to use that for ourselves. My question is can our child qualify for CHIP in Ny? Our income is about $60000?
ObamaCareFacts.comThe Author
Well you can appeal any insurer decision. So, not sure the exact mechanics, but an employer has to offer coverage and the employee must decline. My guess is that the employee is in the right here. If this happened to a large chunk of families at the business then something needs a closer look. I wish I had more exact advice, but 30 families filing appeals to the insurer isn’t going to hurt as a starting point.
Diane Alderson
Healthcare.gov says, “Include anyone other than yourself and your spouse who you’ll claim as a tax dependent in 2016 and who’s required to file a tax return.”
My fiance claimed me (stay-at-home mom) and our son as dependents on his tax return, but me and our son are not required to file a tax return. Does he still need to count both of us and him, our son and him, or just himself? (I am on Healthy Indiana Plan and our son is on Medicaid)
David D
My wife’s employer offers coverage that falls into the affordable category so we will have to use that for ourselves. My question is can our child qualify for CHIP in Ny? Our income is about $60000.
ObamaCareFacts.comThe Author
It depends on family size, but generally that income is likely too high to qualify. That said, states tend to have loose rules for children, so it is always worth confirming with your state. General rule of thumb, that income is way too high though.
Diane Alderson
Healthcare.gov says, “Include anyone other than yourself and your spouse who you’ll claim as a tax dependent in 2016 and who’s required to file a tax return.”
My fiance claimed me (stay-at-home mom) and our son as dependents on his tax return, but me and our son are not required to file a tax return. Does he still need to count both of us and him, our son and him, or just himself?
Philip George
Dear sir:
In one family everyone had 1095C through employer except a parent who was new in 2015 to the country and did not have health insurance in 2015 but have in 2016. So will the parent as a dependent need to pay penatly and at the same time check the box 61 because rest of the people had insurance through job. Please advice.
Thanks
Philip
ObamaCareFacts.comThe Author
The proper thing to do, I believe, is to file the 8965 exemptions form and take the foreign presence exemption for the person outside the states and the exemption for having coverage for the rest of the family.
https://obamacarefacts.com/form-8965-health-coverage-exemptions/
Ivan Blanco
I think its horrible. I was unemployed and my wife had Medicaid but then I got a job and I make $2400 a month so now my wife can’t get Medicaid anymore , she’s 5 months pregnant! My new employer offers health insurance but it will cost me $385 a month to add my wife! I still got to pay rent, a car payment, auto insurance, plus food, and also all the copayments for the doctor visits. I thought health insurance would he affordable with the new law but its more expensive now .
Jenewel
I am a single adult and I work two part time jobs at gas stations that are private owned and do not offer insurance to their employees. I work from 8am-12am every day and I made 18k from one job and 20k from the other last year. My father passed away a couple of years ago and my mom has a bad back and does not work. I am her sole provider. How do I go about getting insurance or are we exempt? We came here from Pakistan 5 years ago, will that affect our options? Last year I did not know about the fine for not having insurance and so I didn’t have any. Is there anything to help me when I file this year to help with the fine?
ObamaCareFacts.comThe Author
Anyone legally in the US paying taxes can use the Marketplace and claim tax credits. Your income qualifies you, and this is the best bet. That said, we are now outside of open enrollment. You would want to look at the exemptions information to your other questions: https://obamacarefacts.com/obamacare-exemptions-list/
Dan S.
I was hoping to clarify something:
My work covers me with health insurance and pays the cost of insurance for me. I was also offered coverage for my spouse but would have had to pay the full amount. This coverage would have been 33% on my salary. My spouse went on the marketplace and got covered that way until she got a new job that covered her health insurance starting in October.
I had believed that since my spouse was offered coverage through my employer, regardless of affordability, my spouse would not be eligible for the advanced premium credit assistance those months.
We paid the full premium without assistance, throughout the year. Now as we are filing taxes with our different 1095’s, I wanted to be sure that when answering the question on the software my spouse covered by an employer-plan for the January-September months and we are not able to get some of the credit back now at the end of the year.
ObamaCareFacts.comThe Author
You are right, in any month where a family member has access to affordable employer coverage they can’t claim tax credits. It works the same in retrospect on 8962 as it does in real-time with advanced marketplace tax credits. If someone didn’t have access to affordable employer coverage for even one month then they can get tax credits for that month (1/12th of the total amount, based on income and family size, per month).
Terri A. Shipley
I have just retired from the U.S.P.S. I have BCBS federal benefits. I also have 3 children 22,23, and 25. All are offered full benefits through their employers so I had planned to switch to self only upon retiring. Now I am told that there is absolutely no way I can get the kids off my policy until they turn 26! I will get $1497.00 per month pension and $377 per month will go for basic insurance, self and family! 2 of my kids employers are deducting for health care from their paychecks as well ! How can we get any answers???
Ann Clarkson
I think this set up is just ridiculous. Having my husband on my employer-sponsored health insurance, combined with mine costs nearly 20% of my salary, nearly $7,500 per year. (I pay 20% of my premium-employer pays 80% of mine, but NOTHING toward family/spouse so I pay 100% for husband)…It’s UNAFFORDABLE but we have NO CHOICE…husband is self-employed
Derek Brown
My employer gave me the wrong health plan and it been a little over two month with no success in correcting it. HR is stating that it is the insurance provider fault and they at this time not correcting the problem. I also ask my HR to change back to my old insurance plan but HR said it can’t be done. Who can I contact to fixed this issue, both private and public?
ObamaCareFacts.comThe Author
Hmmm. Not sure, but that is one heck of an issue. You may try to appeal: https://obamacarefacts.com/appeal-health-insurance-denial/
Totally Confused
This is way over my head and the reps explaining coverage are no better! Add to the fact that I’ve had to wait over one-hour or better on the Health Insurance Marketplace for a rep; ask detailed questions and all of a sudden the calls drop!! I’m astounded at this level of complexity for health insurance – you can or cannot have this or that? At this rate, I’d like to just go to urgent care, let them bill me over and above and pay it monthly. It’s too much of a mess – even with Obamacare I didn’t go to the doctor that much and when I did the out-of-pocket, before services were rendered, after-copay, for less services was ridiculous!
Renda
The Big Speeches with the President and Congress Dems and Senate Dems telling everyone who makes less than 150,000.00 annually how THEY would not be affected by the rising cost of covering everyone in the USA; was of course NOT TRUE! We have coverage through Spouse’s workplace, and this year 2016 we can’t afford the deductibles and the Co-Pay hicks factor in the drug cost some of them “Specialty Drugs” and you have a family that has to make tough decisions, looks like I will get off my Infusions and sit at home waiting for the end. NONE of the Co-pay relief will help me, since I have Medicare A! I do not have Medicare Drug coverage but in 2016 the Commercial Insurance Company’s Representatives are so confused they told me that my Co-pay would be from 50 to 75 a infusion, well; the truth is it is $88.88 a infusion.
My Spouse has to have Insulin pump, so what are we to do? As I said, it looks like I am going to have get off my life saving infusions since none of the Drug companies will help me by assisting me with the High Co pay, and wait for the symptoms to overwhelm my system. The Federal Government should be ASHAMED of itself for it’s promises and clever speeches that have turned into one LIE after another. Yeah, the saddest thing of all, the Government is still trying to convince itself that it’s Cellphone and Pen really did the right thing???????? Yeah, All the Mr and Mrs, MS in the Federal Government who approved and voted in the Un-affordable Healthcare Act, you should all be ashamed and next time you pull out your cellphone and pen to VETO what the minority Voters voted DOWN. Check you pen in you jacket and turn off your cellphone.
The American people should be wary of a PARTY that continues to try and SELL this Lie as a good thing for all ….
Nicholas Glover
This sucks. I have to quit my job early in the year to protect my Affordable Care Act plan and subsidies????? The employer plan has a 2k deductible and NO RX coverage. It would cost 15 to 20k more!!!!!!! This is insane. My third year in Obamacare and every year gets worse!!!!
ObamaCareFacts.comThe Author
That is literally insane. Make sure to take advantage of the tips and tricks on this page.
Brian Jones
My question is what is deemed affordable? And I don’t mean the generic 8.5% crap. How can these criminals force citizens to have health insurance or fine people? I work in the service industry and the only plan my work offers is 170 a month and since they offer that I don’t qualify for other discounts on plans from the Marketplace. What is that? Why would I wont to pay 170 bucks a month when I MAY go to the doctor once a year for a cold when the insurance they offer only covers 70 percent of anything including basic doctor or urgent care visits AFTER i pay 6000 bucks upfront lol. If that isn’t straight STEALING i dont know what is. Does anyone have any ideas as to what I could do to waive the fee for not having insurance? It’s not that I don’t wanna have insurance but making 30k a year and being told to basically throw 170 away on a c*&#*&$ plan is just insane to me. Most of the policies that actually make sense cost way too much money.
ObamaCareFacts.comThe Author
Simple answer is healthcare inflation is rising faster than wages. It’s like “affordable student loans” or “affordable housing” or “affordable childcare”. Only in that these are the biggest expensive we face, and they are super expensive, and all need to be continually addressed as we move forward as a country.
Think about it if your wages don’t go up, but your costs do, and then you throw health insurance into the mix your net income is going to start hurting. We all need to support cost curbing measures and regulation, or alternative solutions to “curb” the problem before the problems curb us. Luckily, despite the infighting, I see lots of evidence of this being the case… But I’m admittedly an optimist.
$170 / $6,000 seems to be a magic number. Wonder why this seems common? Thinking out loud.
Kaetlin
My employer is offering insurance and I already have Medicaid the employer told me I have to take the insurance through my employer unless my insurance is through my parents employer or through my spouse. My insurance is through my parents but it is the ACA. Is there anyway to avoid taking the employers insurance? It’s completely awful.
YpsiBob
None of this addresses the employees rising co-pays and increased deductibles in addition to my portion of my helathcare that has also increased to $204/month. My co-pay for the DR is $50 and for a specialist is $100. Perscriptions are now $25 for generic meds and deductible of $5000/person! This is our third increase since the Affordable Care Act came into being. So just looking at the Insurance payments I make is one thing but there are other expenses that should be considered.
Mike Clowery
I sign up for the Horizon Silver Plan at $149.00 per month premium. What if I accept a job in February, 2016 that pays $40,000 annually, what will be the payback to the IRS next year for tax year 2016??? I cannot find that simple calculation ANYWHERE!!
ObamaCareFacts.comThe Author
https://obamacarefacts.com/advanced-tax-credit-repayment-limits/
Nicholas Glover
It doesn’t exist and no one seems to know – the whole situation is horrible. I am going to have to quit my job 15 weeks before the end of the year to protect my subsidies. The employer plan is just to avoid a penalty! 2k deductible for everything and no RX coverage. I have 8 RXs!!!! I am so sick and tired of this mess – every damn year there is a major problem all damn year! Basically, yeah, your screwed. You lose any subsidy unless plan is considered non-affordable which means either more than 9.5% or more than 9.66% of your income (not sure which). Cost of epmoyer insurance only covers your share of premium – does not account for deductibles (2k vs. 0) or lack of all RX coverage. INSANE!
Denise Carter
I’m married and my spouse insurance only pays 80% if I need certain tests required from my doctor can I get Medicaid to pay 20% of the balance
Barb
I am currently getting financial assistance but will turn 65 this year and from what I can tell, the financial criteria is very different for assistance with Medicare. I don’t have enough credits for Part A, so my monthly expenses will increase roughly $600 (Parts A & B), something I can’t afford. Can I continue as I am now, i.e. getting financial assistance with private insurance once I turn 65, and skip Medicare?
Alana Carlock
Can my employer pay my health subsidy and deduct from my payroll after tax? I can’t pay the full amount at one time.
ObamaCareFacts.comThe Author
The rules for how employers can take deductions for reimbursing individual coverage are nuanced. Take a look here to better understand. https://obamacarefacts.com/hras-fsas-and-employer-healthcare-arrangements/
Ultimately it’s the employers choice of how they structure and plan and comply with the mandate. If they don’t know the rules then the safest bet is using ObamaCare’s SHOP. Firm size changes options dramatically.
Liza
This program is one of the worst thing that has ever happened to myself and other hardworking individuals like me. I could not afford health insurance before Obamacare and I still cannot afford it, but now I’m being penalized monetarily for every year I am unable to afford Health insurance. Obamacare wants me to pay more then my car payment to have medi-cal, which is given away free to anyone who isn’t working. Perhaps those who are not working should not be getting money out of my paycheck to cover their health care expenses. If my pay wasn’t being deducted to pay for those aren’t working, then maybe I would be able to afford health insurance, or at least afford the penalties for not having insurance.
Maria
I really appreciate this post it is very helpful. I have a question about insurance for my husband.
First of all our combined income is:
wife: $34000
husband: $21000
Total: $55,000
I, The wife has an employer based insurance costing $140.00 a month ($1680 yr). if I put my husband in my insurance it will jump to $850 per month ($10,200 yr) which is absolute unaffordable.
My husband doesn’t qualify for insurance through his work (he has to wait 1 year) and the cheapest he can find through marketplace is for $325 per month. We can’t afford that amount so my question is based from these numbers does he have to pay the fee if we decide to not get insurance for him since we can’t afford it?
I will be very grateful for your help.Thank you!
ObamaCareFacts.comThe Author
Thank you for the kind words, they are appreciated.
So $850 – $140 = His coverage costs $710.
$710 x 12 = 8,520. That is more than 9.56% of $55,000.
So he can use the Marketplace and get tax credits based off your MAGI and household size. (Although double check with the Marketplace about what forms are needed).
The marketplace plan is less than 8% of household income, so he isn’t exempt from that. The fee is big enough to where he should probably look into the cheapest marketplace plan with cost assistance. He can look into HSAs as well to drop ALL costs.
You can see the fee here: https://obamacarefacts.com/obamacare-mandate-exemption-penalty/
The flat fee isn’t too bad, but that is assuming he doesn’t get sick. The fee as a percentage of income can be a little heavier, but it’s your call.
Sylvia H
Weare in the same boat as a huge amount of families. Those families may “choose” to by Insurance and pay more than their house payment a month (and in some cases a LOT more, or go without. I am choosing to go without. We fall in the just above help place. Husband on medicare,still working at 81 to help pay for all the mandated insurances etc an his job along with the SSI income and my income makes us ineligible. My insurance went from $215 a month to $595 a month and the deductible is nearly $6800 before you get any help. My old catastropic plan covered more in an emergency with less out of pocket before the government started meddling. This needs to be fixed. My daughter an d son are also going without insurance.
Saelle paul
Can my fiancé add me to is plan?
ObamaCareFacts.comThe Author
If you are in the same tax family (will file taxes together) then you can get a family plan together.
Ethel Moser
I would like to know if I can be covered under my husband’s insurance do we have to do this? They only offer a high deductible plan – $4000 a year, with many items not covered at all or covered with huge co-insurances after the $4000 is paid.
Struggling Middle Class
No matter how you cut it, you can’t get descent medical insurance for an affordable price through obamacare. For a household of $35k, to have a plan through obamacare without HUGE out of pocket expense, your plan will run (for 2 people) between $600 and $900/month. Not many of us can afford a second mortgage. So, your options… get a plan (like low-end silver or bronze) and have major co-pay and never ending limits… or go higher and pay through the nose. For two years we tried to maintain (being self-employed) obamacare payments without success. It just wasn’t affordable. Another Federal government scam on the American people. And now, thanks to obamacare… insurance prices separate from obamacare have gone through the roof. Thank you for nothing.
Elizabeth lambert
I work 2 jobs 1 40 hrs the other it depends on how many pts I have right now I’m working 16 hr. And I claim my disabled son his income is separate and I’m able to claim him. Why don’t I qualify for help? I dropped my Healthcare last year cause I can’t take care of us both on my income. Yea he draws disability but I still help him
ObamaCareFacts.comThe Author
His Social Security is likely factored into your total household income, tax credits are based on family size and income. You should check out the information on these pages:
https://obamacarefacts.com/obamacare-subsidies/
https://obamacarefacts.com/modified-adjusted-gross-income-magi/
Vollie d pearson
Thank you for this real good information.
Derrick
Here’s our situation. My husband lived in Texas with discounted insurance through the exchange. He was in school and not working. He moved to Florida when we got married in June. He started working in September but ineligible for his work health insurance until January. Because of being married, we’re told the household income is now too high and we owe over $1,200 for the insurance or we can cancel and pay the fine of 2% of income which is about the same. Is this correct that because we got married we now owe for the subsidized insurance from Jan.-June?
ObamaCareFacts.comThe Author
This could be right, but it would all be based on the Federal poverty level and your joint income.
https://obamacarefacts.com/federal-poverty-level/
Kati
I am without health insurance for the first time in 15 years and I’m not happy about it. I have a history of diabetes, cancer and heart disease in my family, I am pre-diabetic, have PCOS, anxiety and depression. I am faced with the option of feeding my family or having health insurance. Paying 8% of our adjusted gross income PLUS 9.5% =17% of income which is not affordable. We’re not 138% of federal poverty level, we’re about 175%. We have a family of four using WIC and food shelf services to help feed ourselves. My older daughter gets free school lunch. We get assistance to pay part of our utility bill. Both our children are thankfully covered by our state insurance plan due to income guidelines for children…Even if I could find the $ (which I can’t without losing our home, I have crunched the numbers many many times) to get health insurance, I wouldn’t be able to afford to go to the doctor or pay for my medication with the additional co-pays. It’s very upsetting and has caused me and my family a lot of stress which pairs really well with my anxiety, depression and family history or heart attacks (note sarcasm). I understand the intention of this program, it has helped my step-father go from paying over $1000/month to less than $100 so I’m thankful people are being helped, but this glitch thing has got to be worked out. I reached out to my governor and my senator last year to try to get help so I could get insured through our state program (that I am inelligible for due to this “glitch”), but there was nothing they could do. If it weren’t for the way the law is written (or if it was never enacted) my husband and I would be eligible for our state program and for the two of us we’d pay less than half what it currently costs just to insure just him and the co-pays would be something we could actually afford if we needed to go to a dr…Going on year 2 of not being uninsured and it’s a terrible burden. I am not uninsured by choice, I have been forced out of health insurance and I am very concerned for my health and angered by the situation.
Gene Blackman
Spouse dropped health care with Company 2016
must pay portion on health plan 2016 so it was dropped
Spouse is 66
has Medicare,
BC/BS federal plan covered by spouse.
has Tricare covered by spouse Military Serve
OK for exemption on not using employer health plan.
ObamaCareFacts.comThe Author
The only thing you can’t get if you have an employer plan is tax credits. The rest like Medicare, TRICARE, VA, Medicaid is all individual choice. No exemption needed.
Gene Blackman
My fault asked a question that was not clear on my part previously.
What I need help on is this question.
Wife works for a firm that starting 2016 they will require employees to pay a portion of their health care.
I informed her to drop the plan as she is fully covered by
1 Medicare in effect over 2 years her Medicare
2 My BC/BC Federal Plan
3 Tricare Navy Retired
She has used and fully registered with both plans before Obama care. Was I wrong to tell her to drop Employees health plan.
A local Doctor’s biller informed me she may not be allowed to drop her employees health plan due to Obamacare. Employees plan already dropped by her.
Is my wife forced to continue employers plan even if she is completely covered by my health plans.
My coverage should be enough and not require her employees health care to be involved since she must pay a portion to the employee plan 2016.
Rodney Ficklin
My daughter just married, her husband is 23 and is still on his parents policy, our daughter was on our market place policy and is 25.
His work does offer a policy.
Can he stay on his parents policy until 26?
My daughters work place does not offer insurance, so can she go to the market place even though his work place offers insurance?
If she can go to the market place, and he can stay on his parents policy, are both of their incomes used to calculate the household income to see if she qualifies for assistance or can she use just her income?
ObamaCareFacts.comThe Author
“Whoever files taxes together can get plans together”.
“Cost assistance is based on total household income of those filing together”
“If you have access to employer based coverage you can’t get cost assistance”.
“Anyone who’s employer coverage costs more than 9.56% of household income can qualify to get cost assistance”
So he likely has to go with the employer policy and she can get cost assistance based off her total household income in regards to tax filing (assuming she isn’t offered employer coverage).
Cole
My jib started to offer insurance to me and my spouse. It is free for me but cost like 245 every check for my wife. That is far from affordable in my opinion. Gross month check is about 3800. If I how 500 a month would fall anywhere in the affordable area. We where getting insurance through the market place for like 245 for both of us and now that my employer offers insurance the rep said we will not be eligible for any assistance through the ACA anymore? The insurance is about by the same carrier and is 2x more expensive so frustrated with this cr@p. Seems like the middle class is just getting the shaft again. By the way why does the ACA call the assistance a credit when really it comes from you tax return they should call it an advance. Insurance corporations getting rich by our gov mandating unconstitutional rules so upset. In the scope of this helping America it don’t just confirmed me to a republican!! Thus will hurt the people and it is not affordAble for anyone but singles and people in poverty it screws the rest of us thanks Obama!
James
Currently, my spouse and I live on my income of $36,400 a year. My spouse is unemployed. My employer is offering health coverage that is $193.78 for just myself and $537.55 for both myself and my spouse. It is my understanding that we would not be eligible for premium tax credits through the Marketplace since $193.78 is less than 9.56% of my average monthly income of $3033.33. Is this correct?
We both want health coverage for next year. What are our options? Can my spouse apply for Medicaid or anything like that because she is not employed?
Thanks for the guidance.
ObamaCareFacts.comThe Author
You are right. The $193.78 doesn’t qualify, but your spouse who (you implied) is offered coverage for $343.77 would because that is more than 9.56%. So your cheapest options would likely be you keeping that plan and your spouse getting an individual plan with marketplace cost assistance.
James
Thanks for the quick comment and awesome advice. Let me clarify. My employment offers self-only coverage to me for $193.78 and an employee + spouse plan for $537.55. Wouldn’t both myself and my spouse be ineligible for tax credits through the Marketplace, since the lowest cost self-only coverage is $193.78, and I believe that is the only number the Marketplace asks for? Or am I mistaken?
Stefanie
Question: I was just told that the only way you have to pay the fee for not having insurance is if your employer does not offer health insurance. Is this true?
ObamaCareFacts.comThe Author
No that is not even remotely true. The fee is a line on your taxes. You need coverage or an exemption or to pay the fee every month.
JoAnna
Just came across this site as I’m searching for a solution to my family’s pending insurance problem… My husband has carried the insurance for our family for years because his employer’s plan was really really good. Until now that is, his company was bought out a few months ago and on top of the new company eliminating monthly bonuses they sent out a memo this last week outlining the increases to the employee premiums… The “affordable” family plan premium will have a 230% increase, that’s right, 230%! It equals out to a $750 increase each month. On top of that the HRA and FSA benefits will be eliminated all together, and the dental plan is 100% employee responsibility. The monthly premium will go from $68 to $144. The company covered their butts by keeping the employee-only affordable plan premium low, that premium will see a 75% increase. My employer offers insurance, BUT the enrollment period isn’t until June.
The health plans on the marketplace have premiums totaling more then a $1000/month. Because the employee-only premium through my husband’s work is far below the 9.56% of our combined income we don’t qualify for any subsidies. The lowest family premium is more then 20% of our income, but that doesn’t matter. The employee only plan is affordable, but what good is that for myself and our kids? We can’t use that plan. And we cannot afford the family plan through his company or the marketplace. As it stands the kids and I will be uninsured come Jan. 1st, unless my employer approves a special enrollment period for us.
And just to add, I don’t blame Obamacare, I blame the greedy companies like my husband’s and the lawmakers who didn’t take families into consideration when writing the “affordability” clause into law.
ObamaCareFacts.comThe Author
Just so we are clear, each member of the family can qualify for an exemption or to shop on the Marketplace in their own right or if the arrogate of two or more (non-employee) coverages are more than 9.56%. So if that threshold is crossed the family members can move to a marketplace plan while the employee stays on employee coverage.
roxanne
This entire system is bullshit and only helps a small portion of the public, typically those already receiving assistance while f***ing everyone who has always worked hard for coverage for themselves and families. This system takes a family income into account to determine eligibilty but not the cost already being paid for insurance by a spouse to determine it above the 9.5% threshold. We just got quoted for my husband, and if we include what i pay to my employer the total premiums equal 25% of our wages. Way to go you flippin morons, quit your jobs people you will live better
ObamaCareFacts.comThe Author
Right so then you know you qualify for an exemption and cost assistance based on the information on this page.
Marina
My husband is the only one working right now. We had our second child in july this year. He is making $51000 a year and the insurance he is offered through work is $100 just for him or $1200 for all of us. I don’t think i need to say we cant afford 1200 a month just for health insurance. Last year, with also 2 dependents (his daughter was with us last year) we bought solid health insurance though market place for $500 a month (with subsidy of course). What do we do? if we turn it down we don’t qualify for subsidy am i correct? we live in FL
ObamaCareFacts.comThe Author
In this situation it’s likely that everyone but your husband would be able to get exempted from the employer plan and use the Marketplace. It’s best to have HealthCare.Gov walk you through the process as getting it right requires specific calculations based on household income and family size.
Lillie Bauer
My husband is offered health insurance at work. his cost for his coverage is 260 per month and for him to add me is like 700. This is a nightmare i can’t afford that, what would you recommend
ObamaCareFacts.comThe Author
Depending on your income you may qualify for an exemption or an opportunity to shop on the Marketplace (read the page to understand the process or call HealthCare.Gov). If you are high income just get private non-employer coverage to avoid the fee.
John Frasier
So, currently i have a traditional ppo plan through my employer that covers my wife and 2 children. The premium is about 1000 per month including dental, vision, etc. The duductable is 2500 per person. Currently making around 60k but paying out nearly 12 grand a year with fed and state taxes, i see only half my check. Are there any options? The individual plan would be under the 9.5 percent, but the family coverage is over 15%
ObamaCareFacts.comThe Author
That is pretty much “the family glitch” right there. You can look at an arrogate of two people’s coverage for exemptions (this may work). You can also decline employer coverage and look at the private Market. The good thing about going non-employer is that you can use an HSA and bring down taxable income. You can’t get subsidies, but you can pay less in taxes. That being said, typically even expensive employer plans are actually providing decent coverage. $250 a family member implies that your employer is matching it with $250. Why would an employer choose to offer such an expensive plan? That isn’t rhetorical, I really have never been able to wrap my head around it honestly. If someone tried to sell me $500 a person plans i’d laugh in their face and be like “are you nuts, why would I do that to my employees, that is evil.” But perhaps the employer coverage market is worse than one would imagine.
Melissa
Question:
Husband has ability to get policy from work. Employee portion for the whole family is $1500 (the employer allegedly contributes $400 per employee to the cost of their insurance plan). I do not know what the employee only portion is. I am not eligible for insurance through work, because I work PT, less than 30 hours a week.
I anticipate we will be between $65k-$75k in income next year based upon our respective salaries.
If I am reading and understanding your article. We would be exempt from the tax penalty because the insurance costs more than 8% of our income, even though it maybe considered afford depending upon what the employee only portion is.
Based upon our income, it is most likely that even the kids would not qualify for the low income insurance.
janet
I enrolled in Marketplace in Feb 2014 for family coverage which started March 2014. At the time I was not employed and my husband’s employer didn’t offer health insurance. I had padded my husband’s income to $70,000. Also at the time I applied my two teenagers were also not working. I got a job in April and since my new employer’s health insurance would have been more expensive and coverage would have been less even with them paying half the family plan I opted to stay on the Marketplace. I wasn’t aware that this would have caused any problems or violated any subsidy standards. Long story short, my kids got part time jobs in May for average 15-20 hrs a week at minimum wage. When I saw that our combined incomes were going to be over the amount I originally estimated I called Marketplace and had the subsidy adjusted to the new projected income thus making a higher premium portion to pay for the purpose of not having any penalties. I got a notice from Marketplace stating that based on projected income my premium cost would now be around $1400-1500 for the same plan I am on. I checked with my employer to see if I could opt for their coverage since the situation now is that their plan would now cost less but I have to wait until July 2016 to enroll in their open enrollment. So my question is will I have a tax penalty when I change plans in July for subsidies that I received up to July?
ObamaCareFacts.comThe Author
Your subsidy is taken on form 8962 and is based on family size and household income. As long as you don’t have access to employer coverage, and your income allows it, you qualify for a subsidy (in advance and/or adjusted on the 8962 form). When you get employer coverage you must stop taking the subsidy for the following months, but it doesn’t affect the rest of the months you took subsidies for during the year. You should be OK. Good call updating the Marketplace. You can always double check everything with them.
Steve naegele
In 2016 my wife will be on Covered CA ACA. She will qualify for medicare starting October, thus leaving ACA the end of September. The people at Covered CA told me only our income during the Jan-Sept will be considered.
I turned 70 in August 2015 and will be taking my first RMD in December, 2016. The people at Covered CA told me the income from the IRA if taken after September 30, 2016 will not be considered by the IRS regarding the repayment of subsidies when I send in my taxes for 2016.
I cannot get the IRS on the phone to confirm this as the operator sends me to the ACA specialist s and the phone line is so long they just hang up.
Will the RMD be considered in income regarding the subsidies?
Thank you
Steve
ObamaCareFacts.comThe Author
So income that hasn’t been taxed yet will could as income when you take it out. That will affect MAGI. Income that has already been taxed can be taken out without being added to MAGI. That is the rule of thumb.
So given this you can take IRA deductions (from traditional IRAs). I don’t see why the timing on taking the deduction would matter since IRA deductions are deducted from MAGI? Although, we are a general advice place and not a professional advice place. So you should still double check with the IRS or a tax professional.
Our page on MAGI explains things a little more: https://obamacarefacts.com/modified-adjusted-gross-income-magi/
You can also check out a 1040, 8962, 8965, and other tax forms and look at how things are added in to AGI / MAGI (although this is a bit of a feat).
Katherine Osuna
The Family Glitch should be challenged in Federal Court because I am permanently Disabled and cannot AFFORD any HealthCare! My spouse makes $1.00 above minimum wage and was offered healthcare for himself @ approximately 9% of his income. However, the cost for me was $500 per month – total costs for both 700 per month. So the affordable healthcare ACT is a lie with 40 percent of our income going to insurance premiums!!! Because I am sick, I need health insurance. I won’t receive Medi-care for another year.
Jeremy mann
I do not qualify for obamacare because I am disabled. I receive $1,280 per month in social security.
I am allowed to work up to $1,800 per month without being docked social security which I do. My wife works part time making minimum wage,and we have a 15 year old daughter. If I am not eligible for obamacare because I already have medicare, then why is it that for the past 3 years my income has to be included with my wifes income to determine what her price will be for her and my daughter. This year they are telling us it’s gonna be $350. I just might stop working alltogether since I receive social security anyway. This way my wife and daughter can get a lower price on their obamacare.
ObamaCareFacts.comThe Author
Household income counts regardless of what health insurance type a family member holds. This can be good or bad depending upon the family. If the only income is from a Medicare recipient, this is good because it could mean the difference between no coverage and cost assistance in a state that didn’t expand Medicaid. On the other hand there are many scenario where the Medicare recipient’s income will result in less cost assistance. Every family has to create a situation that is smart for them, hopefully that doesn’t result in you having to stop working to lower healthcare costs. Keep in mind SSD and SSDI both count toward household income as well (but SSI doesn’t).
Jeremy mann
Thanks for the response. The info you gave was very useful to our family.
Barry
I am losing coverage through the marketplace for 2016 because my spouse’s employer offers insurance for spouses. I would be eligible for a subsidy through the marketplace, but no longer am due to this. The cost of the lowest plan for my wife is very reasonable around $90 a month. However, for me to be added it would be almost $200 a month extra. The $90 is below the 9.5%. But $200 just for me is easily over 9.5%. Should I appeal the marketplace? Or is there nothing I can do to receive the subsidy I received before? Thank you in advance!
ObamaCareFacts.comThe Author
Yes you can call HealthCare.gov and they will direct you. Likely you’ll need to have the employer fill out a form stating this is the fact and then you’ll be able to get a Marketplace plan with cost assistance. Good advice would be to have it in place ASAP to have your plan for the whole of next year.
Barry
Thank you for your quick response and the website, found it very helpful! Just wanted to let you know though that I called and was told that the 9.5% is based on what my spouse would pay for her policy, and that is what they use to see eligibility. Although I will have to pay $200 a month myself, they only go off my spouse’s premium alone. Really strange and annoying, will cost me a lot of money in 2016. Thanks for the help!
K
Isn’t this insane? could cost employee $1 and cost spouse $100,000 and would still be considered affordable because $1/month is. I don’t understand why more people don’t know about this and why there’s not more information out there in the mainstream media. With no attention nothing will change. *sigh* Good luck.
ObamaCareFacts.comThe Author
Amen. The spouse can opt out depending on income or opt to buy full priced insurance elsewhere, but that doesn’t exactly fix the glitch or make it fair.
Jeff
I have myself my wife and 3 children I have to cover my plan is around $550 a month about 1/6 of my income. My problem is the coverage is horrible. It does not cover anything until I hit 3500 and even after that it it is picky on what it does cover. I found a plan for about the same on the market place. Can I not go with my employer plan and get the market place coverage that is better?
ObamaCareFacts.comThe Author
You’ll have to crunch the numbers based on MAGI for each person. Unfortunately and we think unfairly it’s based on individual coverage (even on a family plan) and not the affordability for the group.
Shelly
My husband started a new job and is offered affordable insurance through work at less than 9.5% of his income but to add me and our three kids it will be 20% of our income. If we could just buy insurance through the marketplace with a subsidy it would be great but we are all denied because coverage is affordable for my husband through his workplace. We are currently enrolled in a marketplace plan which will end in December. My children are being denied CHIP because they are currently enrolled in a plan. I’m being told that my two children over the age 6 will probably not meet the income requirements but my baby may or may not qualify for CHIP. I have to wait until they are not covered to apply for CHIP and even then my baby might not qualify because coverage is offered through my husbands employer. We have never gone without health insurance coverage, we have had insurance through jobs, private plans and cobra options but now because of Obamacare I can’t find an affordable option for our family. Our family lives on a strict budget, we have no debt, our cars are paid for and when I say we can’t afford to pay 20% of our income for health insurance we can’t afford that. Do you know what the fines will be for a family of five to go uninsured for the year 2016? If my husband pays for the affordable coverage through work will that exempt the rest of the family from the uninsured fines? I just want to cry I’m so frustrated, is there anything I’m missing?
ObamaCareFacts.comThe Author
You can file for an exemption based on affordability for you and the children. You also do qualify for CHIP based on your situation, assuming the income qualifies you. You may even be able to opt out of employer coverage for all but your husband due to affordability. You should call the Marketplace. You are in one of those rough spots where the employer mandate is backfiring, but Medicaid, CHIP, and, if the coverage is deemed unaffordable for you and your kids, Marketplace subsidies, and exemptions should all be options on the table for you.
Don’t go without coverage (at least for the kids). It seems the person you are getting advice from or the way you are filling out the application is missing something.
Shelly
Thank you for your response.
I have had multiple conversations on different occasions with people from the marketplace and have found them extremely unhelpful. They know less than I do and try to figure out my questions with me instead of having answers to my questions. They have given me incorrect information on most occasions, including a two hour phone call the other night.
As for the exemption, the form I found to fill out only asks for information regarding my husbands coverage and not the whole family. https://www.healthcare.gov/downloads/employer-coverage-tool.pdf
This form will be useless in our situation, is there another form I am unaware of for an exemption?
I would love to opt out of employee coverage, all of my questions just keep leading me to “family affordability glitch”
Ginny
Shelly,
My family is in the exact same predicament so I feel your frustration. I don’t know what to do either. No one seems to be able to help. To make matters even more confusing, my husband’s hourly wage makes his employer coverage unaffordable but over half of his income is overtime which then makes the coverage for him affordable but so very not affordable for the rest of his family!
Sean Hockabout
I am in the same boat. Insurance through my work for my family of 5 costs 22% of my gross income. We had already declared bankruptcy a couple of years ago, and insurance continues to go up 7-10% every year. And through my work, there are only 3 plans available, and the lower cost plan uses pharmacies that won’t fill my wife’s prescriptions. If our insurance costs continue to rise at this rate, we will loose our house in 5 years.
Kati
Very similar situation in our home!! Maddening! I’m so mad at politicians (on both sides) I could spit!
Kevi
Does my employer have the legal right to make me prove to them I have coverage from somewhere else and not through them
ObamaCareFacts.comThe Author
Your employer’s responsibilities in regard to the mandate have nothing to do with your health insurance or health care decisions outside of the workplace. Don’t know if it’s illegal to ask, but you shouldn’t need to tell them anything. What is the scenario? Perhaps we are missing something.
Tricia
I’m very confused. I work my spouse is self employed. We make 60kish. My employer pays for a portion of my insurance I pay 300ish. My spouse doesn’t have health insurance because it costs us $1,100 a month to add him to my plan with my employer. 1 are we exempt? 2 if my spouse wanted to get insurance what’s the best way to get affordable insurance?
ObamaCareFacts.comThe Author
Your spouse is exempt $1,100 is more than 9.5% of $60,000. He can get a Marketplace plan with cost assistance, but you can’t ($300 < 9.5% of $60k). You may have to have your employer fill out an employee coverage tool (i'd call HealthCare.Gov first and confirm). If you are applying for an affordability exemption for coverage that costs more than 8% of MAGI for self-only coverage you’ll need to fill out this form: https://marketplace.cms.gov/applications-and-forms/affordability-ffm-exemption.pdf
If you are applying for the marketplace because coverage costs more than 9.5% MAGI for employee only coverage you’ll need to fill out this form: https://www.healthcare.gov/downloads/employer-coverage-tool.pdf
Rebecca
I hope this glitch changes. Because of our income when my husband wasn’t offered insurance at work we qualified for $20.00 insurance per month with subsidy. New job and he isn’t making any more money than before…and his boss pays for his insurance which is great BUT because his boss offers a very expensive insurance for spouses…I no longer qualify for a subsidy an need to either sign up for $500.00/month insurance (25% of his income) from his work or 200.00 insurance from marketplace with 6,000 deductible. Our income hasn’t changed we can’t afford insurance every month but are forced to because of this plan. It doesn’t matter how crazy a percentage of income the spouse is offered insurance it just disqualifies us from insurance that we can afford at our income but we are still forced to purchase.
Mrs C
I have not found anyone at Access Health CT to give me the same answer regarding my application for coverage. Trying to figure out the MAGI, and I have 3 different answers. Situation: New job. No employer insurance.
Family of 2 (adults). One full time worker. One p/t worker with SSDI. Spouse was on medicare but dis-enrolled when my previous job offered very good insurance.
We have told representatives about spouse receiving SSDI.
We have gotten 3 answers on how to calculate MAGI.
Is it true that we do not qualify for any subsidies because spouse qualifies for medicare? (WE found that info online – not ONE representative has said anything about not qualifying – and we told them he could go back on medicare.)
If spouse goes on medicare, does his income count towards household income as I apply for insurance? Will I be eligible for subsides if my income alone is below threshold?
ObamaCareFacts.comThe Author
SSD and SSDI count toward income. This can help to ensure that those on SSD and SSDI can qualify for cost assistance (as you must make over 100% FPL).
Everyone’s income counts who files together. No-one’s income counts if they don’t file taxes with you.
If you have access to Medicare can’t get on the family plan or get cost assistance, but your income counts.
If you have access to employer coverage you can get on the family plan, but you can’t get cost assistance.
tracy nielsen
my employer only offers employee and family health care insurance coverage. not employee/spouse coverage. the family deductible and out of pocket is 3 times than for employee only. not fair. gotta fix it.
Mary
My husband is unemployed, so I am the only one working now. We file tax return married jointly without any dependents. My job offers insurance, but costs over 9.5% of household income for employee-only insurance coverage, so is considered unaffordable. The lowest bronze price employee-only coverage in the Maryland health exchange also costs more than 8% of household income (before any premium tax credit is considered). Does that mean I have two options, either 1) simply claim an exemption of code A on Form 8965 for fee exemption for both of us without buying insurance, or 2) go to Maryland health exchange to qualify for premium tax credits to buy insurance for both of us at a discount?
ObamaCareFacts.comThe Author
Yes, essentially. In a case like this calling healthcare.gov is smart. To get cost assistance you’ll need to file an application with healthcare.gov showing that employer coverage is projected to be too expensive. For the exemption you just have to prove it on your taxes, but healthcare.gov can help you go over the situation and double check you aren’t miscalculating.
Jada Stripling
How much is too much for healthcare? My husband has 250 a week taken out of his check for our family of 3 and we still have roughly 4700 in medical bills and 600 a month in prescriptions. Our AGI for 2014 was 69,500 and will be less this year. Would we benefit by getting our own plan for better coverage and tax purposes? Keep in mind that his employers plan was grandfathered in under ACA laws.
ObamaCareFacts.comThe Author
In this instance you need to calculate if the cost of coverage for each family member to understand your alternatives. The process is a little detailed so we have included a link below that explains it. You are at an income level where you may be eligible for cost assistance on ObamaCare’s Marketplace (HealthCare.Gov), but only if the employer coverage is deemed unaffordable. $1,000 a month for a family of 4 isn’t unheard of, but it’s a safe bet to say it’s more than the cheapest Marketplace plan would be with cost assistance.
https://obamacarefacts.com/affordable-employer-sponsored-coverage/
Jada Stripling
Thank you. Got our new plan information from husbands employer and the new premium is 266 a week. That’s over 13,000 a year when my husband is the only one working and he is not guaranteed 40 hours a week because he works in construction. I think we are going with an exchange plan.
Jada Stripling
My husbands cost of insurance for him only is $246 a month. The cost for spouse and child coverage is 910.00 a month. His income is roughly 48,000 a year and I’m not working. Can he take employer coverage and me and child get an exchange plan?
jamie rainey
i’m at a loss my wife can get family coverage from her job at more than she makes for the month while at the same time can not get help for anyone else on the plan dont know what to say
ObamaCareFacts.comThe Author
If coverage costs more than she makes in a month then she can have her employer fill out an “employer coverage tool” (found on HealthCare.Gov) and this will grant a exemption allowing her to use the Marketplace for cost assistance. Although, this is only helpful if she is eligible for cost assistance based on income.
In short, get out a pay stub and get out last years tax returns. If her coverage is going to cost more than 9.5% of annual household income she will get the exemption. If it’s more than 8% she will be exempt from the fee.
The same is true for other family members. Double check the above page for additional details.
joan smith
Does this make any sense to anyone else? A family of 8 (2 adults, 6 children) who have an income of 30,000/year applied for insurance. The kids were eligible for Medicaid, but the parents are not. The parents then applied for the marketplace insurance. Based on the income, the husband was eligible to get insurance on the marketplace but his wife (stay at home mom, no income), was not. Do they not base eligibility as a family?
ObamaCareFacts.comThe Author
Unless the husband had access to employer coverage and the wife didn’t then this seems like it was a problem with the application process. Cost assistance and Medicaid / CHIP are based on household income. The total household income governs the eligibility of each household member. All of this being said $30,000 is actually not enough for a family of 8 to qualify for cost assistance. Everyone in the family would qualify for Medicaid in a state that expanded Medicaid under the ACA. In a family that didn’t expand anyone who didn’t qualify for CHIP should technically not have any cost assistance options (in an non-expansion state) would not qualify for any assistance as they would be too low income due to decisions made by their state in regards to ObamaCare and Medicaid.
Guess My Name
I just went through this, and what I think is the biggest glitch is calculating when there are dependents involved. Here’s the scenario. We are a house of 6. My husband and I just lost our Medicaid, but the kids are still covered. Hence, him and I need to purchase health insurance.
Using the Employer Tool to determine whether or not we qualify for a subsidy, the Marketplace uses my employee cost of insurance multiplied by 2 (because there are 2 of us). Because I am the employee, my coverage is $110/month. That’s reasonable. To see if we meet the 9.5%, they factor the 2 of us at $220/mon. HOWEVER, to insure both of us, my employer actually charges $464/mon because my spouse is not an employee.
The Marketplace does not consider ACTUAL costs. They consider self costs multiplied by the number of people. By actual costs, we qualify for the subsidy. By the way they calculate it, we don’t. Our insurance would be $104/mon with the subsidy we should be getting. Instead, we have to pay out 5x as much in insurance costs. That is hard on a teacher’s salary and a husband that can not find a job.
Maria
Would you review and correct me if I’m wrong:
Family of 4 (married couple, 2 minor children), only SpouseA works. Employer coverage offer (meets all minimums and is less than 9% of household income) and is offered to SpouseA and family. Income is 90k.
So because SpouseA has employer coverage offer, it includes family coverage and the employee-only cost is less than 9% of household income – then this family is not eligible to go out on the marketplace or covered ca to obtain health insurance.
But because the family rate of that coverage would be more than 9% of household income then the SpouseB and 2 kids qualify for the penalty exemption, Code A, for unaffordability.
So if this family chooses to cover the family or or not, they would not receive a penalty. So it’s basically up to them if they want to have insurance for the SpouseB and 2 kids?
The family would probably need to obtain insurance outside of the marketplace/covered ca if they want to shop around for something cheaper for the SpouseB and 2 kids at normal prices I guess.
ObamaCareFacts.comThe Author
That is essentially correct. 9.56% is the limit for what employer coverage must be for self-only coverage for any family member. 8% is the amount that qualifies for an exemption. It must be 8% per member or an arrogate of 8% for two or more family members. So if spouseB and 2 kids have an arrogate cost of 8% or more (in your case 9%) they can shop on the Marketplace (but because it’s less than 9.56% not get cost assistance).
KAti
We’re in a similar situation Maria. I’ll be paying the fine this year because I haven’t had insurance for all of 2015, simply could not afford it and still feed my family and pay the mortgage. Was hoping something would change before 2016. I guess they’ll have to keep fining me. I am extraordinarily unhappy about not having health insurance, I actually need it, but…what’s that saying? you can’t get blood from a turnip. 🙁 Good luck to you and your family…
Carrie Stewart
My family is currently in this situation. My husband’s company is on a group plan, they pay his premium 100%, but nothing for the family. We would have to pay $726 dollars for myself and our children a month. To put that in perspective for our family, that is almost double we pay a month for our mortgage, and would take almost half of our monthly net income of $1,900.
ObamaCareFacts.comThe Author
Sometimes kids can end up qualifying for CHIP despite access to coverage through an employer based on income. Depending upon your state and their age $1,900 might qualify you.
Anastasia
9%, lol, I WISH! All estimates for my family put the lowest quotes at 1/3 of MY TOTAL INCOME! (To be fair our state decided NOT to expand Medicaid/Medicare)
And as mentioned by SEVERAL others, very few people know there is an exemption for insurance costing too much.
ObamaCareFacts.comThe Author
And of course being exempt from the requirement to obtain and maintain coverage certainly doesn’t relive a family of the need of health insurance and healthcare in the first place. This is one of the reasons Medicaid expansion was so important it covered the gap that many fall in to under the current system. https://obamacarefacts.com/medicaid-gap/
beverlee nichols
Can a husband who works full time and has himself and 2 children covered with health insurance exclude his wife- they are happy and living together- he makes around $35,000 a year- company says wife not covered
ObamaCareFacts.comThe Author
An employer must offer coverage to an employee and the employee’s dependents up to age 26. The spouse does not have to be offered coverage under the law. However, if a spouse is offered coverage and for that matter if anyone in the family is offered coverage, then this will make them ineligible for cost assistance on the health insurance marketplace. A person can deny employer coverage and elect to get other coverage (including Medicaid, CHIP, or private insurance) but cannot get cost assistance on the marketplace. The one exception is if coverage is considered “unaffordable” as explained in this article.
amy
Hello! I would like to tell you my family’s situation. I am just growing tired of speculating and would like some insight. I am voluntarily going to leave my full time job to take care of my daughter and my household which means my husband would have to cover all 3 of us. At the time I leave, he would be making 30,000 a year plus an additional monthly incentive anywhere between 300.00-500.00. His insurance is extremely high ( family plans for med, dental and vision all together would cost over 1000.00 a month! I cannot find the form that he had that tells how much is individual coverage is. I guess I need to know that if he can cover himself under his employer based coverage, where does that leave me and my daughter? I can’t make any solid decisions without insight. Thank you!
ObamaCareFacts.comThe Author
For everyone that has access to the employer plan, they can’t get cost assistance unless that coverage is considered unaffordable. If employer coverage for a single person or an arrogate of 2 or family members is more than 9.56% of household income then the employer insurance is unaffordable. If it is less, it’s considered for these purposes “affordable”.
If the plan cost more than 8% for self-only coverage per person, that person is exempt from the requirement to get coverage, but can’t get cost assistance on the Marketplace.
If your household makes $30,000 a year plus lets say on the high end $500 a month ($500 x 12 = $6,000) then we have $6,000 in household income before tax deductions. So 9.56% of $36,000 is $3,441.6. $3,441.6 / 12 = $286.80. If anyone’s coverage is $286.80 or more that coverage is unaffordable. The problem is $286.80 x 4 = $1,147.2 which means that everyone’s coverage is probably just under 9.56% per person. If we use the 8% rule though we get $2,880 / 12 = $240 x 4 = $960. That could mean that the whole family is just barely exempt from the requirement to get coverage.
What you can potentially do here is get the kids free or low cost coverage from CHIP and then use the employer coverage and/or exemptions and/or other coverage without cost assistance.
The whole thing has been a little odd for us to help people with as employer plans can sometimes be wickedly expensive, especially compared to what people of a certain income would get on the health insurance marketplace after cost assistance. If you ask us the 9.56% limit for self only coverage is far too high and the law should include more nuances to make sure the law’s definition of affordable makes a little more sense.
Hope this information helps.
Frances
My husband and I both work full time and have five kids. The family plan offered at both of our places of employment is too high for us to afford. If we both use the individual coverage offered, can three of our kids under eighteen have the Children’s Health Plus and the two oldest who are still dependents in college use a different low cost insurance?
ObamaCareFacts.comThe Author
So the rule of thumb for employer coverage is that you can’t get cost assistance (and therefore should typically go with employer coverage) unless a single person’s premium cost or the arrogate of two or more people’s premium cost exceeds 9.56% MAGI. Each person whose costs exceed that mark can be exempt from the rule and qualifies for cost assistance on a Marketplace plan. That being said, depending upon income, children may qualify for CHIP despite you having employer coverage (probably best to call the state Medicaid department on that one).
For getting them individual coverage, you can, but be aware cost assistance is still based on household income, family size, and access to affordable employer coverage. If the two oldest file taxes on their own and the state they go to school in expanded Medicaid they may be able to get free or low cost Medicaid coverage. If they make enough on their own they may also qualify for Marketplace coverage. This would have tax implications, but it is an option.
Typically, unless Medicaid/CHIP or cost assistance is involved, it makes the most sense to have everyone on one plan due to limits on maximum out-of-pocket costs and deductibles.
Eric Thomas
I feel like I’m being robbed, Obamacare is not affordable, just to insure my wife and two kids will cost more than my mortgage and about the same or more if I put them on my policy at work, apparently I make too much money and I was born here so, I get screwed because I have a job that doesn’t include flipping burgers or a leaf blower. Even with a subsidy , my wife and kids insurance will cost more than a ultra luxury car that I will never get to drive.
ObamaCareFacts.comThe Author
Deep breaths. Health insurance isn’t even close to the cost of a luxury car for most people, at least not annual health insurance costs after subsidies. Health insurance is capped at 9.5% of MAGI for the second lowest cost silver plan for those making less than 400% of the Federal Poverty Level on HealthCare.gov. So let’s say you make $90,000 in household income (for a family of 4 two adults, two children). 9.5% is about $8,500 a year. This IS expensive, but the difference between that maximum and what you would have paid before the ACA is likely not equivalent to what it would take to own a luxury car (although now we get into semantics about what qualifies as luxury and are taken away from the actual point). There is often cheaper plans sold on the Marketplace such as the “lowest cost bronze plan”, so on premiums alone one should never actually have no choice cheaper than 9.5% of income.
The above being said, you can’t get cost assistance on the Marketplace for you and family members with access to employer based coverage. So probably employer coverage is the only real option for you.
Non-residents don’t get cost assistance and people who truly make low-wages (under 100% of the poverty level) don’t have access to tax credits and cost sharing reduction subsidies on the Marketplace due to their income being too low. If a state expanded Medicaid low-income get that, but 20 states have opt-ed out of expanding Medicaid and thus there are literally millions who simply have no access to health insurance.
The truth is health insurance is VERY expensive. Not just for you, but for most Americans and America. Healthcare costs are a big problem, but this is a big part of why the ACA was created. We all need to do a better job of addressing healthcare costs in America, but confusing the need for reform with ObamaCare not being affordable is not helpful.
Eric Thomas
I don’t know what you drive but I can get a REALLY nice loaded special edition car for $600 to $850 a month and that’s where my insurance just for my wife and kids has risen to because of the “ACA” , it was a third of that before the wonderful Obamacare came into play, now if you work a regular mid range job and make enough money to survive pay check to paycheck, you are now transformed into poverty level because of this non-sense. If I put my family on my insurance plan at work, it would be $830 a month…simply NOT doable! Something has to give.
J
I drive a very cheap economy car you are insulting AND the plans deductibles will drain any savings for working but modest wage earners. Many local providers Will Not acceptCaresource Bronze or Silver in Lorain County!
Eric Thomas
I wasn’t referring to paying for a luxury car in full with in a year, I don’t know anyone that can do that, I was talking about a monthly payment, most families are on a budget and the ACA doesn’t account for that unless you work at McDonalds and have six kids on wic .
Ann Hearn
Ok, hold on a minute here! I don’t know who is answering everyone’s questions on here, telling you that you can just get cheaper plans and still afford a monthly luxury car payment! What he/she is leaving out is with the less expensive plans your maximum out of pocket expenses will be so high that you will NEVER reach the limit and if you or a family member has a hospitalization you will be in big time debt! Could be as high as 12,000 not including your deductibles and co pays! People please get advice from an insurance expert that you TRUST to explain this to you!
ObamaCareFacts.comThe Author
Of course no one from ObamaCareFacts.com actually said this. What we said is that we couldn’t see the difference in what someone pays for a premium now (especially considering cost assistance), versus what they would pay before the law, being the equivalent of a luxury car payment. It was the reader who asserted that they could have bought a luxury car with the money they spent on ObamaCare. In retrospect we regret entertaining the idea because it moves us away from the issue of healthcare and gets into semantics. To your point however cost sharing amounts like copays, coinsurance, out-of-pocket maximums, and deductibles should all be taken into account. So should actual medical needs, networks, and more. Talking to an insurance agent is a great idea. HealthCare.Gov offers 24/7 assistance and as long as you know your Marketplace options getting in person help from an official navigator or even talking to a local insurance agent is a good move. The new limits on out-of-pocket maximums help to eliminate the amount of families who will face medical debt, but high deductible plans without cost assistance applied could still leave some families in a bad place.
Katherine
Eric…You are sane. You are correct in your observations. We are being pushed into a health care system that is definitely price gouging. The man that keeps challenging you is probably an insurance agent or politician.
Eric Thomas
“but confusing the need for reform with ObamaCare not being affordable is not helpful.” ?? It’s obvious I’m not the only one not happy with “Obamacare” , millions of people that once could afford insurance , now can’t because of Obamacare. He said that this would drive down the cost of insurance, it did just the opposite, it tripled the cost. I’m so stressed out over this and it should be like shopping for car insurance, but it’s a nightmare, I’m worried something will happen to my kids and they’ll be denied medical care because I can’t afford ample coverage and I’m disgusted that I work all day to provide for them and now I have no choices.
ObamaCareFacts.comThe Author
There is nothing wrong with venting frustration, we do understand that for a portion of Americans the cost of coverage did go up (even after cost assistance). We actually sympathize with those people and really want to see everyone band together to push for more impactful and meaningful healthcare reform. In order to get meaningful reform we know the conversation has to go beyond “ObamaCare is bad” and move toward what changes do we have to make in healthcare. When costs of one thing, like health insurance go up, but wages don’t that means cutting back. It’s not really fair or cool for that to happen to a family, but probably the fairest statement here is that for tens of millions costs didn’t go up.. they became affordable for the first time.
On a more practical level, have you looked into health savings accounts? Those can help you to bring down your taxable income and to for out-of-pocket healthcare costs with tax free dollars.
Barbara
Deep breaths? Health insurance CAN cost as much as a luxury car payment — I’m paying over $370 every 2 weeks to cover my husband on my employer’s plan. It is more than 20% of my income and doesn’t cover my son, who is now having to go on full-premium CHIP plan at $300 per month. All told — I make less than $50k per year and I’m paying over $13k for insurance. That’s over $1100 per month — I can get a 2016 Jaguar for less than $985 per month. And because I have employer coverage and I, as an employee, don’t have to pay for coverage, I am screwed and can get no assistance whatsoever.
ObamaCareFacts.comThe Author
I am always slightly irked when people compare their families healthcare to luxury items, but here you make a good case.
Your coverage is way overpriced and that is unacceptable, how could one be anything less than upset?
I would say this, since it is more than 20% you qualify for the the exemption noted on this page, that means you can forego the employer coverage and get marketplace coverage. At that income for a family of 3 you would qualify for a sliver plan on the marketplace at less than roughly 9.5% of your income.
So this is 100% what you should be looking into.
This page details how to claim the exemption and use the employer / employee coverage tool: https://obamacarefacts.com/affordable-employer-sponsored-coverage/
Heather Adams
Can we drop our health insurance yet? Didn’t an executive order say they will not enforce these stupid tax penalties?
ObamaCareFacts.comThe Author
I haven’t been advising on this because the executive order only tells the agencies to not enforce taxes to the best of their ability within the bounds of the law… but people still need to follow the law and thus file taxes honestly (paraphrasing)….
So this means you have to obtain and maintain coverage and file the paperwork, but Trump’s order nudges the IRS not to punish people.
Couldn’t be more ethereal, meanwhile I can’t in good conscious suggest not following the law.
https://www.forbes.com/sites/kellyphillipserb/2017/02/16/irs-softens-on-obamacare-reporting-requirements-after-trump-executive-order/#1b6f8514a3cb
Devastated
My wife and I earn just above the level for assistance. My employer and my wife’s do not offer insurance plans. we get absolutely no assistance at all and my wife’s health insurance is 340$ per month mine is 310$ this takes massive chunk of our take home. After Obamacare kicked in we are now only taking home 3/4 of what we were making previous monetary responsibilitys very difficult to keep up with. Taking away 1/4 of our income is devastating.
ObamaCareFacts.comThe Author
So if you are just over the 400% mark after losing 3/4 of your income, we would suggest getting a Silver family plan that is HSA eligible. This could lower your taxable income up to $6,600. So that could help. If $650 a month times 12 = $7,800. The 400% poverty level is $62,920 for 2015 subsidies (will raise a little each year). If this is all in vain and your income is to high for this to effect things then the amount you guys are paying is a lot… but it’s not technically unaffordable. It’s also not much higher then premiums ever where for a decent plan. Still, all things considered, with all the other expenses of life, $650 a month (not counting out-of-pocket costs) is just plain old steep.
K
Yeah…We make about $40K/year in a metropolitan area where we barely pay our bills and the HSA (cheaper option) option for family is about $550/ month. There’s no spouse-only option. ugh
Kwame
Well I make a little over 50,000 a year after taxes 42,000. I have a family of 4. My wife does not work. My jobs insurance covers me. I add my 2 kids and wife . 908$ dollars a month! Thats 10,896 a year. Which means I make about 32,000 a year? The whole medical system is killing me right
Ana Moreno
I file my taxes with only one dependent, my son. My employer didn´t provide any insurance and I didn’t get insurance in 2014. The marketplace plan for both (my son and I) is $680dlls, which is more than 8% of my montly income. Do I have to pay the penalty?
ObamaCareFacts.comThe Author
It has to be an arrogate of 8%, so it would have to be 8% per-person. You can find out if you qualify by filling out the worksheet on page 10 of the 8965 – Exemptions worksheet. http://www.irs.gov/pub/irs-pdf/i8965.pdf
Angela
I am currently divorced and I have full physical custody of my two kids. My divorce decree does not state that I legally have to carry medical insurance for my two children. My X-husband is not offered health insurance through his employer and carries health coverage through the marketplace. My employer currently offers insurance that is considered affordable and I am currently carrying our two children on my plan as well. Is it possible that if coverage was cheaper through the marketplace that my x-husband could carry our children on his plan versus mine at a higher rate? Or if it is considered being affordable through my employer, am I required to carry my two children on my health insurance plan?
ObamaCareFacts.comThe Author
Whoever is claiming the children on their tax return is also responsible for paying for coverage, is eligible for tax credits, and is held to the affordable employer coverage rule.
Patricia
My husband works full-time. His employer offers affordable health care for him, as an employee. They also offer coverage for myself and our 3 children, one which is a full-time college student. Our two, younger boys are currently covered under MediCal where we pay $13 for each to have coverage.
Unfortunately, the cost of coverage for his family is not affordable. We’d have to pay $224 a week to be covered. In some weeks that’s almost 50% of his gross paycheck.
Through the ACA I am able to get insurance for my daughter and I for $243/month, still not really afforadable in my opinion considering that it doesn’t include the cost of the boys and my husband.
My question is: Should my husband drop his insurance at work and join the plan with found through the marketplace? And what about the boys, should we leave them on the state plan they’ve been on or transfer them? If he drops his insurance, will that later create problems for us with the IRS in regards to penalties?
ObamaCareFacts.comThe Author
The only way to get cost assistance on the Marketplace is to show that employee-only coverage costs more than 9.5% of household income. That being said the family can still get covered on the Marketplace (they just won’t have access to cost assistance).
The other choices like you say are CHIP or catastrophic coverage via the exemption for coverage costing more than 8% of household income (all details explained in the article).
The fee is ONLY for not having coverage, it doesn’t matter if you take employer coverage or utilize other coverage options or exemptions.
Eric Thomas
The statement that the fee is ONLY for not having coverage is not accurate, even if I get my family short term coverage, it is now considered , not “minimum essential coverage” , so I still pay a ridiculous amount for sub par coverage and still out in the open for a penalty from the government .
ObamaCareFacts.comThe Author
The fee, as you say, is only for not having “minimum essential coverage” which is includes almost all coverage except limited benefit coverage like short term.
Eric Thomas
That’s my point , but there aren’t multiple options for coverage, it’s either pay three times what you were paying or get short term and pay a penalty in the end. So where’s the “affordable part in all of that?
ObamaCareFacts.comThe Author
If your employer offers you any plan that meets minimum cost sharing requirements ($2,000 deductible does) and costs less than 9.5% employee-only then it is considered affordable. So yes you would take the cheaper plan offered.
Dena
Hello I am totally confused by this obamacare!! My husband just changed jobs this last week our old medical was very very affordable high deductible but still cheap. Anyway the new company has a medical plan BUT does not pay towards the premium the family premium is $1050.00 a month divided into weekly payouts my question is how is this affordable?? Believe me the plan is much better then what I’ve seen on obamacare marketplace but it’s going to cost us $250 a week!! Plus my husband is fully covered at the VA so he is paying for me and our 2 kids to have coverage (only offers single or full family so he’s included even though he doesn’t need it and my jobs do not offer medical at all I work for 2 small medical offices)when I went on to apply at the end my results were I could not get covered but my son could go on child health plus and my daughter could get a plan in the marketplace!! Why??? I wanted a plan for one adult and 2kids (technically my daughter is an adult but I will pay for medical till she’s 26) did it give me that scenario?? I’m confused and very pist with this whole obamacare!!!! The deductible is only $1500 a family but the premium is so high!! HELP ME UNDERSTAND THIS CR@P PLEASE!!!!
ObamaCareFacts.comThe Author
If the employer plan costs more than 9.5% of modified adjusted income (MAGI) per person then you can have the employer fill out an employer coverage tool and submit that to the Marketplace (this lets you have access to subsidies, if you don’t qualify for subsidies you don’t need to do this). If your income is above 400% of the federal poverty level you may want to compare other non-marketplace options to see what is going to give you the best value as you won’t have access to cost assistance. Typically employers pay at least 50% of the costs of employee health premiums, this helps high priced group plans appear affordable for the average family. The truth is though, you are paying full price for a family plan with a low deductible… $1,000 + a month sounds pretty on par with what one would expect. Does the employer offer any higher deductible lower premium plans? You could always get a cheaper premium, higher deductible and use an HSA. The tax advantages can be pretty significant. Come next open enrollment you have lots of options, for now you’ll need to make sure you are covered when you have the opportunity. One last piece of advice, if coverage per person or arrogate coverage of two or more costs more than 8% of MAGI you qualify for an exemption from the fee for not having coverage.
Debi
I lose my current health insurance at the end of 2016. Due to the unfortuante ‘ACA Family Glitch’,I am in process of completing application for a Hardship Exemption due to the aggregate of two being over 8% with my spouses employer plan, but won’t have the ECN until after I’ve filed 2016 taxes next year. I want to purchase a Catastrophic Health Plan and really don’t want to go uncovered until I receive the ECN which is needed on application for plan. Any suggestions? Thank you. Have talked with folks at Heatlhcare.gov and they are of little help with this matter.
[email protected] Erin
This is a good question and I am not completely sure of the answer. If you are really confident that your exemption will be approved you can look up what catastrophic plans are available in your state on healthcare.gov and then simply contact those insurers directly to purchase catastrophic coverage. You may not be able to use the healthcare.gov site to purchase catastrophic coverage until you have an ECN, but those insurers are all private insurers and you can always purchase insurance directly without it. It will add a whole other challenge for filing taxes, but here is more information about that.
aj
my company started the surcharge because my husband can get ins through his work. his plan is in another out of state and out of network(his is cheaper)mine is better, my family plan is better. but now I have to pay $25 a paycheck or $650 total for 2016 because we are not taking his ins.. From what i read eventually he will have his own policy which will cost us an additional $86 a week $4472 a year. because companies are dropping spousal coverage alltogether when working spouses company offers ins. so if my cmpy ofers a rate for family plan but i am not allowed to cover said spouse now I have to pay for family at my work and his has to pay for his own how is that affordable? Obamas affordablity just took $4472 out of my childrens mouths that could cover camp, food, tutituion, electric bill, home repair, copay, deductible, to rising medical. AGAIN HOW is taking and ADDITIONAL $4472 to pay for a separate MEDICAL insurance policy when I pay for family coverage all ready, AFFORDABLE. YOU are now taking money out of my pocket. We just got to the point where we are able to put $200 a week into a savings because of the $25 surcharge that now drops to $100 a week. there goes kids future
ObamaCareFacts.comThe Author
There is nothing affordable about this loophole in our opinions. One of the worst positions (premium-wise) to be in is to have two working spouses with plans that don’t cover the other spouse. Deductible-wise it is sometimes actually a fair deal (high family plan deductibles for a two person family are also lackluster as they are the same for 2 as they are for 3 or more).
This isn’t saying it’s fair for employers to be forced to offer coverage to spouses, it’s saying that it’s unfair to bar families without spousal coverage from opting to use the Marketplace instead.
Make sure to double check this link to ensure that your employer coverage offers are “affordable” https://obamacarefacts.com/affordable-employer-sponsored-coverage/
Kathy
This is what my husband and myself are experiencing on he has a $2500.00 deductible. Why have health insurance if you have to pay for everything anyway? The insurance is considered affordable, but it makes no sense because I don’t think we will even meet that deductible. So we will be paying $2500.00 a year for him and I have to pay for an Obama plan…. Half of our money is going to health insurance! Does anyone remember that people have rent, electric, heat, food & other insurance to pay here? This is so wrong!!!!!!
Don Pickford
I have a question; If my employer is offering me health insurance with the option of no deductible, and that premium is over 9.5 percent of my salary, and also offering me coverage with $2,000 deductible that brings the premium to below 9.5 percent, would what I am being offered be technically affordable?
ObamaCareFacts.comThe Author
Eimaan that is close. It is 9.5% of employee only income that is considered unaffordable. It doesn’t grant you an exemption on it’s own, rather it qualifies you for subsidies on the Health Insurance Marketplace (you’ll need to submit proof by having your employer fill out an employer coverage tool form first, specifically question 15 on the form addresses affordability).
If the cheapest plan on the marketplace is more than 8% of your income after subsidies, or your employer based plan costs more than 8% of income, you are exempt from the fee.
The actual wording on HealthCare.Gov, IRS.Gov, and all says, “The lowest-priced coverage available to you would cost more than 8% of your household income”. Everything we can find, including the affordably exemption form (link provided below) seems to back up the idea that you aren’t required to shop for affordable marketplace coverage if your employer based coverage is offered, but unaffordable. Also, if your coverage for self-only will cost between 8%-9.5% you should be able to simply decline coverage or shop else-where and not be granted an exemption from the fee after submitting the affordability exemption form.
With all of this stuff, especially considering this is the first year people will be using exemptions and paying the fee, it’s always wise to double check with healthcare.gov. You’ll need to use them to submit forms for all of this anyway, and will also use them or your state’s marketplace if you decide to shop there.
No one should simply assume coverage is unaffordable and assume they have an exemption.
Here are some resources for those dealing with employer coverage and affordability.
https://www.healthcare.gov/downloads/employer-coverage-tool.pdf
https://marketplace.cms.gov/applications-and-forms/affordability-ffm-exemption.pdf
https://www.healthcare.gov/have-job-based-coverage/change-to-marketplace-plan/
https://obamacarefacts.com/obamacare-mandate-exemption-penalty/
kevin garza
I’m not benefiting from this at all. Instead my employer dropped the group policy that we had now forcing us employees. To get insurance on our own. Now I have to pay 324 out of my pocket for just me and my daughter. A month. That half my paycheck. My wife has to do her own. We don’t make much money and from where I sit the onlyy ones who truly benefit are the people who work part time and get assistance. So I’m better off not trying to better myself working full time? Or working partime and getting on assistance. If your not at poverty level where are you?
Eimaan B Khan
If I understood what I read correctly, IF the monthly cost amount of the insurance is greater than 9.25 % of your wages, you are exempt and do not have to carry or pay a fine. Which does make better sense to me, as even my employer based health coverage is take 1/3 of almost half of my monthly wages. They need to better explain this to people, who are single, low income or low income families. You can use the 9.25 percent to calculate how much you would pay for insurance a month to meet that 9.25 % (1200.00 income month would mean insurance that cost OVER 111.00 or more makes you exempt.) This is how I understand it, keeping that 9.25 as a tool.
Diego A
Working full-time I made 35k but my plan is $400 through my employer. I did not get help by obamacare or coveredCA (Tax Credits) but I did use the marketplace but now my employer wont let me opt out of it….