First let me say that I am a supporter of the ACA. At the very least its something. But I am facing a problem with regards to my employer’s coverage being too expensive for me to afford. I make less than 30000 per year and work full time. I would like to obtain Group Health coverage as offered by my employer, however, the premiums are around 400 per month. Obviously I can’t afford it. Group Health has told my employer that our rates are sky high because we are as a pool of subscribers a “high risk” group. I gather we have historically had more employees that are sick/debilitated for whatever reason.

My question is this: Since the ACA mandates coverage for everyone why are insurance companies still able to gouge with high premiums certain groups of people? They have just been given a multitude of young, healthy individuals to offset these costs by way of the mandate. We are all now no matter where you work required by law to obtain insurance.

For now, my employer (without so much as an inservice) gave us all a form from Group Health waiving our interest in employer provided insurance. They stamped a date on the form that was wrong so I refused to fill it out. I wrote on the form that I would not decline the insurance were the premiums affordable. I have obtained basic insurance of very low quality by comparison through the exchange.

I feel something isn’t right.


Insurers can charge a group health plan as a whole more based on health status, but not individuals or families. The law doesn't actually protect groups of people for being charged more, just from being denied. As for accepting or declining coverage, that is your call. It's not up to your employer to tell you what to do there. $400 is most likely not more than 9.5% of your MAGI, so you don't qualify for an exemption that would let you obtain health insurance through the Marketplace... but it if it is more than 8% you can deny coverage in general and be exempt from the mandate.

This is actually just an unfortunate situation. We have seen some group health plans and health plans in some regions that were just flat out overpriced... 9.5% of one's income or more for a single person's coverage, when that coverage has a high deductible isn't ideal no matter how you slice it. The ACA does a lot of good, but some groups and regions get the short end of the stick.

Read more about HIPPA rules for group plans from the Department of Labor.

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