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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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

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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.

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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.

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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

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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?

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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?

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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?

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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?

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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.

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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?

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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.

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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?

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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.

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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

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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!!

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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.

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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.

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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.

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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?

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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.

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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?

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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.

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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.

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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?

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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….

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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?

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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.

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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.

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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.

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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?

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So am I allowed to get insurance for me and my spouse through my work and kids get it through Medicaid since they qualify?

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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.

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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.

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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.

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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?

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does it typically cost more for health insurance for multiple health insurance versus one child

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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.

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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?

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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.

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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.

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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

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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?

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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?

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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

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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?

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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?

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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?

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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.

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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???

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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!!

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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???

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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?

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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)

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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.

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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?

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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

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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 .

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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?

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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.

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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???

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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

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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?

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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!

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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 ….

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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!!!!

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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.

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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.

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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!!

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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!

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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

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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?

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Can my employer pay my health subsidy and deduct from my payroll after tax? I can’t pay the full amount at one time.

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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.

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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!

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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.

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Can my fiancé add me to is plan?

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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.

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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.

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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

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Thank you for this real good information.

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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?

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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.

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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.

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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?

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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!

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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.

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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.

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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

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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

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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

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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%

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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.

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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?

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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

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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.

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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.

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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!

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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?

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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?

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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.

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Very similar situation in our home!! Maddening! I’m so mad at politicians (on both sides) I could spit!

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Does my employer have the legal right to make me prove to them I have coverage from somewhere else and not through them

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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?

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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.

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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?

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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.

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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?

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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.

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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

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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?

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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.

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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.

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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…

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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.

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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.

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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

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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!

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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?

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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.

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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.

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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?

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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?

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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?

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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?

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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?

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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.

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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….

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