I am a recently retired teacher. I have been told by my district that I must have a 26 week break in service before I can substitute teach. Even though I have insurance their understanding is they have to offer me health insurance, and I can’t decline it because I was employed full time from Oct. 1, 2014- July 1, 2015. Is it true that under the affordable care act, even though I would be working a few hours as a substitute, they still would have to offer me insurance? This is hurting the small income I would like to receive from substitute teaching.


This needs a two party answer, firstly:

Once you are offered coverage (due to qualifying under the employer's measurement period for full-time) then they must continue to offer it for a set time (again dictated by measuring periods). Thus, if you stay employed it makes sense that they would continue to offer coverage despite the break in being full-time (until you officially became part-time under the measurement period rules; which are complex).

Secondly, all that aside, if you want:

You can decline employer health insurance (it's called a waiver of coverage), but you won't be able to get cost assistance through ObamaCare or dependent coverage through the employer plan if coverage was offered.

Essentially everyone has the right to decline or accept any private major medical plan under the Affordable Care Act if they can afford it, but having access to affordable employer coverage bars you from getting cost assistance on the health insurance marketplace. Also if you decline employer coverage your tax dependents can't get coverage through the employer or cost assistance either. Employer coverage does not affect Medicaid eligibility.

However, if you can't afford coverage, or if two people in your family cannot afford coverage on arrogate (per guidelines, see link below) then you can get an exemption and use the marketplace.

For more information on determining affordable coverage see "What is Affordable Employer Coverage Under ObamaCare?"

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Carol peterson on

Answer Rating:

“If they can afford it”? My employer, less than 50 people pays half of my premium and none of my husband’s. Both our full premiums come to 1300. Employer pays about 300 of my coverage so would cost me 1000 a month. I only take home after paycheck taxes around 2000. My house payment is 850 a month. Only leaves me enough to put gas in my car to get there. Will I be homeless but have coverage? So I signed up through marketplace and receive assistance through Obama Care. I pay 240 each month as even this was hard to adjust my budget. I have been told that I will have to pay back all of my assistance. I have also been told to quit my job.

Linda Pera on

Answer Rating:

I have been told same thing. Quit my job . is it better for everyone to go on public assistance
I cannot afford 700.00 monthly insurance through
My employer but I can squeeze by on the obamacare 240.00 a month. Why can’t I still get the entitled discounts

ObamaCareFacts.com on

Don’t quit your job. That is not a good solution. What you can do is looking into affordability exemptions from employer coverage. You can also straight up ask your employer like “seriously guys, why are you offering a $700 a month plan after employer contributions?!?!”

THIS is why the cadillac tax is coming in 2018. Either the employer is getting the run around or you are. No one has any business offering an individual a $1,400 premium. That is INSANE! To think they are getting tax breaks on that. Mixed up world.

Lori Marceaux on

I manage a company that is less than 50 employees and I went to market to bid for insurance for my staff for 2017 because Premera came through with a 32% increase for us!! Affordable? Doesn’t exist!!! The cheapest plan I could find was $396.89 Per adult and $113.64 for each child. This plan has a deductible of $4750 per person and $9500 per family. It only covers 60% of all services and only 50% of medications after you’ve met this high deductible. This is affordable? For who? The coverage is garbage and can’t be sustained by the average employee. We ended up selecting a plan that costs $603.14 for each adult and $172.69 per child. This plan has a $3000 deductible and $6000 per family. We are paying the premiums in full for our employees but nothing for dependents and we have set aside an HRA account to cover $2000 of their individual deductible. This is painful for our company and I’m truly disgusted with this so-called “affordable care” because there is NO SUCH THING!

lerbel on

I agree you are pretty much working just to pay health insurance cant afford food or utility bills, Better off getting a free ride like a lot of the free loaders we are paying for. Hurry up Trump get in office. Government has no business being involved in our health care I will cancel our plan, the fine at end of year is cheaper and at least we will be able to put food on the table

Erin on

If the insurance you and your family are eligible for is more than 8.13% of your families income than you can apply for an exemption from the requirement to have insurance and the fee. That doesn’t help everyone in every situation, but for those considering “just paying the fee” its worth trying.

Nun ya on

My company offers part timers who work full time hours health insurance. But it’s expensive. It’s 16% of my pay. And because of this I get exempt each year. Even the first time I applied for Obama care it was the same price. I can barely afford food to eat. Why should I be penalized each year cuz I’m trying to make a living but I’m still broke.

Lo on

I’m a full time employee whos work doesn’t offer health insurance; im not a free loader, and I love Obamacare; Obamacare literally saved my life. F Trump.

Amanda on

The employer I work for does not offer health insurance. I recently applied for a job and was told that they pay half of the employee’s health care but nothing on family members. Now I have to take into consideration as well as salary, environment, etc. how much being offered that health care help will actually hurt me……our family plan went up almost $200 a month this past year but it will only go up more if I can’t be on the marketplace policy due to employer coverage! With the cost of insurance and daycare, I am thinking about quitting my job too!

Tracy on

From what I understand of Covered CA and the rules, the employer can’t offer you an insurance and make you pay the premium if it is more than 9% of your income. Looks like in your case it is. Talk with HR about it and fight it!

Bob on

Correct, but that is only for the employee. In my case, it’s only $25/week for my coverage (doesn’t cover much), but to cover my family (me, wife, daughter) it’s over $24000/year. So even though I can’t take the family plan into consideration for the 9%, they still count the whole household’s income to calculate for my individual policy. This is creating a huge mess. People ARE quitting their jobs because they can’t afford to make a go of it while working.

tom lash on

If you have coverage at work then you have to take it. If you tell the marketplace a lie like 40% of the people that used these subsidies you will get caught and you will owe the 6000-10000 back on your next tax return. I would take the coverage for myself and get a short term or Faith-based plan for your husband. He could also find a job with benefits or go uninsured or file for Medicare or Medicaid depending on the state and his health. Not planning for old age is a real problem in this country. There are also plans called MEC that are cost effective and there is Life Insurance with Living Benefits. Find a good agent and use the lowest cost approach for your health history. This is a puzzle not a one size fits all.

Shane on

Im kinda in the same boat I have the VA means tested I meet the ACA requirements and the Hero act tells my employer to exlude me in calculations. I tried to waive coverage but they denied VA waiver they only allow people with other group coverage to opt out. They even wont let people keep State or individual plans.

Company is using Ohara Service contract act bonafide fringe benefits to pay 100% of the premium. However its not required to offer health it could have offered 401 instead. Just because they pay 100% doesnt mean its affordable.

Id like to see where its written that someone who already coverage that meets the ACA has the right to decline an employer.

Also seems to be no protection for the poor. You could work full time mininum wage have the right to mediciad but be forced into employer group as a condition of employment. Meaning a company would fire you trying to use open enrollment cause they be hit with the shared responsibility. Or am I wrong please provide proof I can opt out.

ObamaCareFacts.com on

That is crazy. Can an employer even do this? I’ll look into it. I didn’t think an employer could force you to make a healthcare choice.

Vicki Robertson on

My 19 yr old son is covered under my plan and his employer is stating he MUST take their insurance and lose his H&W fringe benefit under the Service Contract Act to pay for it. Where does it say he has to be dually covered? They stated they would fill out the papers and enroll him if he didn’t do it. ISN”T THAT ILLEGAL? He has FULL coverage and a much better plan under mine. HOW does he OPT OUT???

Laurie on

My 19 year old is in the same boat. The employer actually crossed off the “Waiver of Coverage” he is covered under both my plan and his fathers plan and they are trying to force him into a $2500 deductible HSA account without telling him how much is coming out of his paycheck. Oh, I don’t think so! I called the Dept of Insurance and have a call into the Dept of Labor. My kids have a great work ethic and are not going to be jerked around like this by an employer.

Asha on

What if we declined my husbands insurance because we were going to put him on my work insurance but then I lost my job. They say he is past the enrollment period and can’t sign back up.

ObamaCareFacts.com on

If he had coverage and then lost it they have to offer a 30 day special enrollment period. If he never got the coverage they are right, unfortunately they don’t have to offer special enrollment.

Chrisssss on

This is the biggest load of C&*^#…thanks Obama…

Michelle Anderson on

To the person stating, “Thanks Obama”:

Family coverage insurance has not been affordable for decades. This is nothing new. Our family coverage has been between $550 and $900 for 20 years! Therefore, the only thing President Obama has done is to make it where ‘some people’ are finally catching a break. This issue cannot be blamed on Pres Obama. Family coverage insurance was unaffordable before anyone had ever even heard of Obama! Nothing has changed in my world. I still do not have affordable family coverage. NOW, if the politicians would fix the Family Glitch (which is what is preventing low-income and lower middle-income families from being able to access affordable health insurance), a whole new world would open up for families! Err… then you would sincerely be saying, “Thanks Obama”, as would I!

Jon on

I have been an insurance agent for 15 years and the cost of health care WAS ABSOLUTELY AFFORDABLE BEFORE Obamacare. I have families that are STILL ON THE SAME PLAN from 2008 a grandfathered UHC plan. Their prices are STILL WAY LOWER than Obamacare. They still pay under $600 a family! Health Insurance WAS AFFORDABLE before Obama………..HEALTHCARE COSTS have not been AFFORDABLE in DECADES……..THAT HAS TO BE FIXED FIRST!

ObamaCareFacts.com on

Think that is well said and fair. Healthcare costs have been unaffordable for decades, but having to cover more people has been a factor in insurers raising premiums and out-of-pocket cost sharing. If only we could have come up with a solution that didn’t spike premiums but also didn’t leave tens of millions without coverage.

Sarah U. on

Does this particular situation apply to California? Our employee only pays 1/3 of the medical/dental plan at $150 per month and we pay the rest. She’s hoping if she cancels the plan to go without coverage at all. What penalty is charged on Federal Income Tax for no insurance? Is she going to be saving money?

kylah on


My husband gets 1,800 a month working, and we have to pay 500 a month for ins. thru his work. that leaves 1,300 for rent, grocery, and gas. If we opted out of his company’s ins. can we get a cheaper ins plan elsewhere?

ObamaCareFacts.com on

Costs and coverage options largely depend on region. I always suggest healthcare.gov first, but a local insurance broker can also help. It gets a little more complicated when you have employer coverage, so make sure to let any assister know your exact situation, family size, and household income.

Patricia on

I would check into what another comment in this thread referred- the employer affordability waiver. After that, generally, if your income is between 100%-400% of the federal poverty level you should be entitled to a tax credit. In 2016 the Federal poverty level, for an individual, was around $11,600. I know someone who is getting Silver Plan coverage, with a full premium of $500+ a month, for just over $1- yes, One Dollar!

Frederick Allen on

If I decline my employer health care insurance, but they still take the deduct the money out of my paycheck, what can I do? Can get my money back?”

ObamaCareFacts.com on

You would need to coordinate that with the employer. That doesn’t really make sense on paper, but there could be details we don’t know.

Becky C on

My son declined employer insurance. He was without insurance for the 7 months he worked there. Then, he was unemployed for the last 5 months of the year.(2015) His total income for the year was 13,807. We live in TN which has not expanded medicaid, but he didn’t apply to get a decline letter. Also, he was technically homeless those 5 months. Does he owe the penalty and for all the year?

ObamaCareFacts.com on

If he applied for Medicaid he can likely take the rejected from Medicaid exemption on 8965, but it isn’t simple. Technically he made enough to owe the fee if he is self filing. Another solution is to take deductions to get under the tax filing limit where the fee isn’t owed. That might be rough logistically though.

Mary on

My husband’s company offered health insurance that we do not need having been covered with my group plan. The health insurance company we are declining is requesting information regarding our current health insurance Medicare and social security numbers. Why would they request this information? Can we decline their insurance without revealing our personal information?

wendy on

All I want to know is will I be penalized if I decline my employers insurance?

Kevin on

Why am I being fined $1200 because I made a financial decision to decline health care coverage? I wanted to save for 2016, but when I did my taxes in 2015 I was shocked when I was informed I was being fined. So, now I don’t have the right to decide for myself whether or not I can afford health insurance? The money I was saving is now gone, and so I still cannot afford it for 2016. This law needs to be revoked. It does nothing but place honest, middle-class people in debt.

ObamaCareFacts.com on

Well it does a lot aside from that, but it is frustrating. There is a fee for not getting coverage and lots of options for cost assistance. You should be looking into what your options are and then make a decision based on that. Its easy to see being frustrated in this position, but the story hints that you could have gotten low premium insurance after cost assistance on the marketplace had you shopped during open enrollment.

Bob on

Not necessarily…It only takes into account your income, but not your expenses. How do you know what people already have on their budget. Before Onummacare, my insurance was 5200 per week for a family plan. Now a few years later, it’s over 24000 per year for the same plan. I can’t absorb that kind of increase. I was barely making it as it was. Now if I don’t live off credit & get a second mortgage on my house to pay for it, I’ll be fined. THIS IS JUST PLAIN WRONG & UNCONSTITUTIONAL. WE’VE BEEN RAILROADED!!!!!

Donna Keplinger on

I make $50k a year and have all 4 kids covered. It’s a hardship to pay ~$900 a month for health coverage. Does that make any difference in getting assistance w Obama care?

ObamaCareFacts.com on

You have them covered through work? You could potentially exempt some if not all of them based on cost, and you can look into CHIP. $900 to cover a family of 6 (2 adults and 4 kids i’m guessing) is not a “bad deal”, but at $50,000 it is like 20% of income which should give you some leeway. I would try to coordinate with the health insurance marketplace as you’ll need a few details to about exact income and costs to know for sure, and then you’ll have to coordinate moving from employer to marketplace coverage if you qualify.

rich on

family of 3. I earn about 68k but is the only wage earner. employer only assist with $200 of the $1600 premium for a family plan. I declined and was able to get a plan with a high deductible for 980 but was just notified that they submitted a 29% rate increase for 2017. I don’t qualify for CHIP in CT, which for a family of 3 is under 66k. with income tax, rent, health ins, and monthly public transport to work, I’m down to 700 a month before paying for food, utilities, student loans, etc. what is the point of even having a full time job? if I worked part time, I might get deductions on Healthcare and maybe get welfare… Healthcare is very broken for families.

Mio on

I work with a Federal Contract security Company. And they deduct money for health insurance but no one singed up for this health insurance. They haven’t sent health coverage info to anyone. Is this legal.

ObamaCareFacts.com on

That certainly doesn’t sound right. A company can have a opt-out policy where coverage is automatic, but that should of course result in employees having the coverage they are paying for.

Obviously deducting money for health insurance and then not furnishing a health plan is outside any set of reasonable rules. As for specific provisions disallowing this, I’d have to dig through federal registers and other such documents (which I haven’t recently).

Tony Paul on

Is an employer required to verify an employees alternative coverage if they waive coverage?

ObamaCareFacts.com on

I don’t think so. If an employee waives coverage they shouldn’t have access to the marketplace tax credits and thus the employer shouldn’t incur a fee. This is why there are employer coverage tools to fill out if an employee wants to get marketplace tax credits and has an expensive employer plan. You may want to get a more official answer on this, but this is the way I’ve understood the process.

Heather on

I live in Albany, NY and I started a job on 1st April and I was eligible for Health and welfare benefits on June 1st. I asked to have the health insurance through my employer for July 1st. I didn’t sign any paper before and I have never sign any paper to sign up for health insurance. My employer took money from my paycheck for health insurance for the month of June. I asked to the HR why is that? they told me that I was eligible on June 1st and they are required by law to provide me health insurance (and make me pay for it) even if they didn’t notify me that I was insured since June 1st. By the way, I received all my insurance cards on July and I have received insurance letters welcoming me on July 1st.

So my question is : If I am eligible for health insurance through my employer beginning June 1st, can he force me to pay his health insurance with arrears?
Thank you,

Connie Bryant on

I have Medicare and Supplemental Medical Insurance. Am I required to sign a waiver saying that I have declined employer heath insurance?

Sofia on

My employer has under 50 employees and is therefore NOT mandated to provide health insurance. They actually DO offer insurance, however my coworkers have told me that the out of pocket biweekly fees and deductibles are much higher than I currently pay under my ObamaCare due to the cost assistance. I am currently only at 23 hours per week, but my employer is considering the possibility of bumping me to 30 hours. I am assuming that even though my employer is not mandated to provide insurance, since they do if I decline their more expensive insurance (as with the question above) I would no longer be eligible for cost assistance through ObamaCare unless it exceeds 9.5% of my income? If this is the case we may decide to cap me at 29 hours, which seems silly but would actually make better financial sense. (the extra hours likely won’t change my overall income as determined during open enrollment, as I used to work multiple part time jobs which were included with my gross income)

lee on

I worked for lexington market and they took out my check for insurance and had me file a tax paper saying they paid it that year.the thing is I never filled any papers or received a insurance card.they took my yearly raise and I worked 12 hrs and she would give me 8.saying that’s all on schedule not knowing what my supervised said.what to do

Andrew on

Heath care told Me (on the phone) that I could keep my insurance if I could not afford my companies. I told them I can’t. They said ok no problem. Months later my company got a notice about being fined so I then told the marketplace I would just cover my family under my job which I still can’t afford. They said they are going to charge me for all the credits I was given… Can I fight this or am I screwed?

Teresa Lanham on

How can a full time employee earning $17.00 an hour with no dependents and the employer offers health insurance be eligible for Medicaid?

ObamaCareFacts.com on

Yes, if you qualify for Medicaid based on income in your state then you can get Medicaid, there are no other considerations (that is if you live in a state that expanded Medicaid or if this is otherwise the case based on circumstances in a non-expansion state). In short employer coverage blocks you from cost assistance on the marketplace, not Medicaid.

That said, full-time at $17 should put you over the 138% poverty level, and thus you shouldn’t qualify for Medicaid, and thus may be barred from cost assistance due to being offered employer coverage.

It really depends on what full-time means in hours and what the total MAGI dollar amount will be for annual income.

Dan Gibson on

This is an incomplete answer. No mention of the .0966 (9.66%) of income test. I expect this person cannot afford the group plan and would be eligible for tax-payer subsidies.

ObamaCareFacts.com on

Thank you for pointing that out. Not sure how that slipped through, we actually have a whole page on the matter that people use often: https://obamacarefacts.com/affordable-employer-sponsored-coverage/

More information can be found here: http://www.flexiblebenefit.com/blog/calculating-affordability-under-employer-mandate

Stacey Kim on

I currently have the medicaid expansion in Michigan, and I’ve reached my 90 days with my employer which means I qualify for their insurance. It is expensive. $200 a month for just myself, and I am paying for my daughters separate since she is at school in a different state. That cost me $150 a month. Can I decline my employers insurance and just stay on the medicaid?

paul sonico on

My employer is forcing me to take aca when i already have insurance from my previous employer’s retirement program and ia better than the one the company is forcing on me. What options do I have to make my retirement insurance be my primary insurance?

ObamaCareFacts.com on

You can’t be forced to take coverage actually, they just have to offer it, you don’t have to take it… So not 100% sure how to answer this.

Brianna on

I have insurance.But now my employer(Dunkin Donuts) offered insurance.But said if i dont take it they will cut my hours down to part-time!Is that legal?I can not afford their plan and need to keep mine.Isnt their a waiver i can sign and keep my plan.

ObamaCareFacts.com on

Yes, essentially, but there are a few rules: https://obamacarefacts.com/affordable-employer-sponsored-coverage/

Landi on

If my company offers me insurance and it is “affordable” in the eyes of the government, but then to add my dependent it goes from $300 to $1000 almost is this still considered affordable?

[email protected] Erin on

It depends on your families income whether it is considered “affordable” for you and/or your dependents. Your employers is required to offer you insurance that is considered “affordable” for them (9.66% of your families income for employee-only coverage), but it is a different guide than what is “affordable” for you. Equally important note: you and your dependents are not required to accept the insurance offered, even if it is considered affordable. All you are required to do under the law is provide minimal essential coverage for your household or pay the fee (which is intended to cover unpaid hospital bills aka charity care). Unfortunately, you are unable to use the marketplace and get cost assistance for yourself or your dependents if the employers insurance is considered “affordable” for them (costs more than 9.66% of families income for employee-only coverage). This is known as the Family Affordability Glitch. Some have reported finding more affordable coverage options than their employer offers even outside the marketplaces and without cost assistance.

If the least expensive employer plan to cover just you is more than 8.13% of your families income, than you and your family can apply for an exemption from the requirement to have minimal essential coverage (go to healthcare.gov).

If the least expensive employer option to cover you and your dependents is more than 8.13% of families income, than your dependents are exempt.

Being exempt doesn’t mean you don’t have coverage options. If you are exempt you will be able to choose from a larger variety of insurance policies including catastrophic coverage. Despite high deductibles, catastrophic plans low premiums usually add up to more savings and flexibility. You also get the low prices negotiated by the insurer even though you are responsible for early out-of-pocket costs.

Patty on

If my job offers heath insuranse.. Do i have to drop my obama care ..or can i still keep it and decline my jobs insurance

[email protected] Erin on

You are never required to take an employers insurance, but you won’t be eligible for cost assistance through the marketplace if your employer’s plan is considered affordable. Read more here.

nick on

I have my own health insurance plan not payed for by my employer. They recently got a new insurance carrier and want to photocopy my medical insurance card. Do they have a right to do this if they are not paying for it?

ObamaCareFacts.com on

I don’t know the answer, but perhaps another reader might.

Maria S. Lopez on

I receive H & W through employment. I do not have a choice on the health insurance I have to accept what the company I work for provides, it says is mandatory. I feel the current fee I am paying for insurance to United Health is too high $513.00 a month, if I want to add my spouse and daughter I would have to pay $1644.00 a month is for the family. I think I can purchase health insurance for less if I receive the allowance.

Erin on

You employer is giving you the wrong information. Your employer is required to offer you coverage, you and your family are not required to take it. You are only required to have minimal essential coverage for your household or pay the fee for not having it. People with employer coverage options though are limited in that they can’t qualify for cost assistance thought the marketplaces.

Depending on your income and which state you live in, your children may qualify for low cost or free health insurance under CHIP (Medicaid for Kids). This coverage is offered to lower income families with incomes up to 300% of the Federal Poverty Level in some states. If your employers coverage is more than 8.13% of income for your coverage only, than you and your family qualify for an Affordability Exemption from owing the fee for not having insurance. If it is more than 8.13% of your families income for the family plan through your employer, than just your family members can apply for the Affordability Exemption. Your employer must do his part to comply with the ACA, but that law applies to him: The Employer Mandate. The part of the law that applies to you is the Individual Mandate and it doesn’t require you to take any specific insurance plan, it just has to qualify as minimal essential coverage or pay the fee or get an exemption.

This type of comment comes up a lot and I don’t think most employers are tying to take advantage, I simply think they are confused about how the law applies to employees vs how the law applies to employers. That being said, if you continue to have issues with your employer trying to force you or your family to take their coverage, call your state’s Insurance Commissioner and/or Attorney General’s office to file a complaint or to get additional assistance.

Anna Konwinski on

Hello, I work out of state, and the coverage my employer offered me is within a network that isn’t normally accepted by doctors in the state I live in. The Healthcare Marketplace filed a claim a month ago stating that my employer offers affordable coverage, but I declined it because I live out of the state it’s being offered in. I gathered all the paperwork they told me to, and explained my reasoning in a letter as to why I denied it, but they still insisted I take it. So, now that my tax credit has been revoked, I’ve had to take insurance under a different network that’s almost $100 more. Also, my boyfriend, who’s employer doesn’t offer him health insurance and who still qualifies for the tax credit through the marketplace, has been talking to me about getting married since we’ve been together so long. I’ve been wondering, though, if we get married, can ObamaCare try to force him to take the insurance that my employer offers as well if it’s “affordable” in spite of both of us being out of the state it’s from? That’s something we’ve been wondering, and I can’t seem to find anything regarding this particular situation.

Ritz on

I will try to explain this clearly. I am full time but get paid by production (medical transcription). I have health coverage through my husband’s job. My job is telling me that because I haven’t not produced enough in the year to earn X amount of dollars that they (my job) are going to be penalized by the government because I have fallen short of the required amount (supposedly) for full time employees under Obama care – this is EVEN THOUGH I HAVE PROOF AT TAX TIME THAT I AM COVERED ELSEHWERE. Is there a dollar amount for full time employees to make even if they are covered under a spouse’s job AND HAVE PROOF at tax time? Is my job just trying to buffalo me into thinking I have to produce X amount? They are telling me that I have to work extra from now (10/19/2016) through 12/31/2016 to make up over $3000. I’m so confused AND ANGRY. How can Obamacare dictate how much I work or earn if I am legally covered under a policy??

Jose Rodriguez on

when a job health insurance is consider no affordable? How can i get the exemption?

Mike on

Can I get ACA with subsidies if I am offered “very high cost” retiree health coverage at $1,200 a month with very high deductible and annual out of pocket max of $10,000. Can I decline the company retiree plan and get an ACA policy with the subsidies?… (my low MAGI income qualifies for subsidy)

S. Vincent on

My insurance through my employer is going up to $214.00 a week. I only make $400.00 a week before taxes and insurance. I can not afford to even drive to work on this. My husband is self employed and work is slow. My daughter is in college. Is there a way for me to get my husband and daughter on a cheaper insurance plan or do I have to keep them on mine.

teresa martinez on

if i want to keep mu ohp and not go with the company insurance can i do so i also got a raise of 12 dollars an hour and will i still be able to keep ohp working 40 hours a week

Jonah Stan on

I have been penalized for the last two tax years for not having Obamacare or health care insurance. Now that Trump is President am I required to purchase Obamacare or can I decline Obamacare and not be penalized by the IRS?

gerette on

married with 2 children (18 and 15) yearly income $40,000.00.we now have family health coverage thru my employer. I pay 630.00 a month. I think is extremely high. (this is half my paycheck) would it be worth keeping myself on plan thru work and getting coverage for spouse and 2 children thru marketplace? or maybe just my spouse getting coverage thru marketplace?

Matteo S. on

hi i have a question please to ask, through my job i had the possibility to get health insurance coverage, but the premium was too high to afford, so i got insurance through ObamaCare and is little less expensive than with my job.
I tried to apply again for 2017 through ObamaCare and at the begging i need to select if”Eligible for health coverage through a job”.
What am i supposed to answer ,yes or no?
If i do as last year not selecting this the premium for a base insurance is around 400$/month, if i select that i am Eligible for health coverage through a job the premium is like 150$/minth.
So if i refused to get insurance with my job because was too pricey can i still select the option “Eligible for health coverage through a job”?
i am a little confused.

Dave on

The ACA is a disaster period, it’s very expensive, so far it hasn’t helped me.

Susan Wilson on

I had medicaid, when first offered my company’s insurance. Due to this, I was offered a waiver, worth 200 per month, for already having health insurance. I lost my insurance in Feb (2016) of the following year – had waiver since July of 2015. I was unaware of losing the insurance but told my company as soon as I found out, which was a month later. Once I told them, via email, they told me that I wouldn’t be able to get their insurance until I provide proof of the lose of my insurance but the lostime had to have taken place within 30 days of that. Since it was slightly over 30 days I waited to open enrollment (August). They were still sending me the waiver so I was under the impression that they had to give it to me, or it was protocal. Now they’re making me pay 1200 dollars for not suspending the waiver when I asked them to in February of this year. Is this legal?

Dave on

My question is how many people complaining about insurance voted for someone other than Bernie Sanders? My advise is keep your mouths shut and stop complaining if you didn’t vote for Bernie.

Erin on

I’m pretty sure Bernie Sanders would be suggesting that, “We need to start educating ourselves about the issues and stand up for working people.” He says that even when people complain to him. If we are going to figure out how to move forward with healthcare reform that, “works for all of us and not just the very wealthy people at the top” then we will have to start listening to each other and acknowledging each others’ experiences. We can boast the areas the ACA was really successful without dismissing the challenges the ACA created for millions of working families of all income levels.

Travis on

Glad Obama was thinking about all the bums who don’t work in this country and put the screws to the ones that do. WORST PRESIDENT IN HISTORY!!!

Discusted American on

My health ins just doubled under our Blue Cross plan. He will be working really only for 1 week pay rest goes towards insurance can’t live off that;. This is so disgusting and the welfare people get a free ride at the expense of people like us. I am declining this plan and will pay fine at end of year will still save a hell of a lot of money. were people stoned when they came up with these premiums? How are the hard working people suppose to pay bills and eat. The Government has no business being involved in our health care. Can’t wait until Trump gets into office . Better to quite job and get free food and medical or cheaper to just die.

Erin on

You’ll have to ask the private insurer’s about whether they were stoned when they set the prices for the health insurance they sell. The government didn’t set the premium prices, the private insurers do, though because of the Affordable Care Act, those insurers are required to publicly disclose and justify raising premiums.

If the only coverage you are offered is more than 8.13% of your families income than you are eligible for an exemption from owing the fee, but you have to apply for it. Here is more information about how to apply for affordability exemptions.

ANMoore on

Erin knows very well that, although Obama and ACA doesn’t set the premium costs for private insurance, the exhorbitant and un-affordable premiums are directly linked to the costs of providing top-quality care for people who don’t work, live strictly on government welfare, and in the worst scenario, have shaky immigration status. This is abominable.

Chris R. on

My work doesn’t offer health insurance, but my husband’s does. This past year we were covered and paying $825/month for myself and my son. Am I right that I can decline coverage through my husband’s work and sign up through Healthcare.gov? I understand I wouldn’t receive assistance, but the coverage would be significantly less per month for myself and my son. My husband’s employer is trying to tell us that we don’t have the option to enroll through Healthcare.gov.

Erin on

If the employer sponsored coverage being offered costs less than 9.66% of the household income just to cover your husband then you will not be eligible for cost assistance through the marketplace (healthcare.gov). However, if the lowest cost plan to cover the family is more than 8.13% of the household income then the family is eligible for an affordability exemption from the requirement to have minimal essential coverage and you will not owe the fee on your year end taxes. Depending on your household income, however, your son may qualify for CHIP (Medicaid for kids) despite having employer sponsored options available. Eligibility thresholds for CHIP vary slightly state to state, but they tend to be higher income levels than thresholds for adult Medicaid.

Shirley McGraw on

What if an employee enrolls then later wants to cancel. Can the employer let them without penalty from the IRS? Even thought the minimum requirements from the carrier impact everyone else trying to get affordable insurance.

Erin on

Employees are in no way required to accept and employers insurance and employers are not penalized if their employees reject the coverage offered. As long as the employer offers coverage that meets the guidelines of the Employer Mandate, they have done their part with regards to being taxed. The employee wont be eligible for tax credits for marketplace insurance, but as long as they and their tax family are covered by minimal essential coverage they have met their obligations under the Affordable Care Act.

AS long as the employer offers the coverage to essentially all employees and their families then they are in no way penalized by the IRS if this coverage is declined by employees of their families. However, employers are not restricted from requiring employees to accept employer coverage as a term of employment and they are not restricted from deduction “alternative coverage fees” for employees or their spouses who decline coverage.

Thomas on

This most definitely answers part of my question. However, do you lose money from filing your taxes by declining the insurance because you have obama Care.

ObamaCareFacts.com on

If you are offered employer coverage and go with ObamaCare’s exchange insurance without an exemption, then you can’t get cost assistance and may miss out on some employer-based incentives related to health benefits. Typically it is best to use employer coverage if you have access to it, but every situation is different.

Kimberly Robinson on

I work for the school board. they have insurance but i cant afford it medicaid says with my income all of us me and my two over 18 children are eligible through aetna better health of Louisiana. I dropped my insurance during open enrollment will i be penalized for my taxes. I make 19,000 yealy.

Erin on

For 2016 taxes: You can simply claim exemption code ‘G’ on tax form 8965. There is an exemption for simply living in a state that had not expanded Medicaid for some part of the year and having an income below 138% (which yours is for a family of three). Louisiana fits the bill.
For 2017:
If your children that are over 18 are your tax dependents, then you are limited by a couple of factors. Louisiana is in the process of expanding Medicaid to non-disabled adults and typically employer-sponsored coverage is not limit Medicaid eligibility. However, Louisiana has used waivers to expand Medicaid in a custom way in June 2016, so perhaps that is one of the areas they customized. I wasn’t able to actually find anything on the Louisiana website or the HHS website that would make you in-eligible based on that, though. You may want to contact the Louisianans Health Insurance Commissioner and/or appeal the Medicaid denial decision. Also, please let us know if you find out more specific information about this, so we can tell others.

If your children are over 18 and not your dependents, you are not required to cover them on your employer-sponsored plan. The insurer is required to allow you to enroll non-dependent adult children under 26 on your plan, but it is in no way a requirement for you to keep them on your plan once they are adults. If, this is the case your adults kids may be able to apply for Medicaid using their own incomes and eligibility.

If those things fail you will likely still be able to qualify for an affordability exemption or a hardship exemption to avoid the fee.

Lo on

Is it possible there is a tax racket going on with some employers? Mine has sent me eligibility notices every year, so I have signed up through them because apparently my eligibility through them makes me ineligible for the tax credit through the Marketplace. And every year they promptly cancel me after the enrollment period through the Marketplace has ended. Are they cheating their taxes at my expense?

Erin on

There’s no way for us to know that, but you may want to report it to the Insurance Commissioner’s Office in your state or the IRS. They will be able to better answer that question and it’s why they exist.

Jennifer Marino on

I started a new job and initially declined the health coverage bc I thought we would be eligible for Mainecare. We are not and now I need coverage for my family. My boss said I have to wait for the next open enrollment. Is that true or as a new employee (less than a month) can he still add me on?

Thank you very much for your assistance!

Erin on

Under HIPPA laws (around long before the ACA) employers must offer employees special enrollment if they of their family members lose their Medicaid coverage. However, it doesn’t specify that you must have a special enrollment period if you were simply denied Medicaid and never enrolled. It’s a loophole in the language of the law, but you may try bringing the HIPPA law to your employer’s attention with your Medicaid denial letter and see what they say. You can also contact your state’s Insurance Commissioner’s office for additional advice.

Patsy on

Affordable care? I am a widow in my 40’s and have 2 children. One is a freshman in college and the other is in elementary school. I make $50K a year and I can take $11,800 off the top of that salary for a 70/30 medical plan with a high deductible + dental. I essentially make around $38K before taxes after you take medical out. I can not afford to live on this!!!!! I work 45-48 hours a week as a nurse but if I deny my employers insurance and shop the market place, I read I no longer qualify for assistance there. What to do?!!! My children are at the doctor’s a lot and with this high deductible and then paying 30%, it’s breaking us!!

Erin on

First, double check that you are calculating your MAGI correctly. This is the income that is used for ACA eligibility and exemption thresholds. If you haven’t already try to apply for Medicaid for your children. You can also apply for yourself, but your income level will likely exclude you. However, CHIP (Medicaid for children) has a higher eligibility limit in most states and sometimes offers low cost children’s insurance for families earning over 300% FPL. Being offered employer sponsored coverage doesn’t make you or your children ineligible for Medicaid if they are otherwise eligible, but many people aren’t aware that their children may be eligible. Next, depending on what you qualify for, if you are still unable to financially afford the coverage options available to you, then you should apply for a hardship or affordability exemption. This won’t get you coverage, but it will help you avoid the fee for not having coverage and will give you and your family access to catastrophic coverage. Catastrophic coverage will still cover the required preventative care at no cost before deductible and will ensure your family is covered in the worst-case-scenario. I hope that you are able to find a good solution and good coverage for your family.

Maria Stolfi on

If I am covered by my parents health insurance because I am under 26 do I have to enroll in my employers insurance instead?

ObamaCareFacts.com on

No, if you have coverage, you can keep it… however, if your parents get cost assistance this is another matter. In this case you may need to take the employer coverage, I would call healthcare.gov directly.

Deven Kaing on

I work in the HR department. For our health insurance plans, we offer coverage for your spouse and dependents, but we do not pay for it. If an employee were to decline coverage for their spouse and dependents, would they still be able to apply for Obamacare?

Mar on

Question: I’ve just accepted a job from a California school district as a full time employee. I’m told I can not opt out of their health care, but I am covered by my husband’s private health insurance. Can I get a waiver?

Ann on

Hi I just found out that I am pregnant, I have insurance because of my husband but it doesn’t cover much and it very expensive. Can I get Obama care?

ObamaCareFacts.com on

For like the next 12 hours. This is the last day of open enrollment and the Republicans are about to repeal the law. That said, because you have access to coverage via your spouse, you may not be able to claim cost assistance if you file taxes together. So yes, you can get coverage, but no, you might not have access to cost assistance, and then everything changes in a few hours because of Republicans controlling the government majority as of the election.

Kera on

What if I signed up for my employers insurance policy and after a month I separated from my husband and had to move again with my son only to realize that $140 for insurance I pay every 2 weeks is the difference of me getting an apartment or living in my car with my son bit yet they won’t let me cancel my insurance ? I only make $9.25 an hour and work 25 to 35 hours a week. Can they force me to keep paying ?

Carmen on

My spouse is retiring from work and the employer offers health coverage with the retirement package, is it beneficial and cheaper that going on the marketplace

Nannie on

If my employer offers health insurance to parttime employees, do I have to take it instead of staying on husband’s health plan??

Joel on

I just received a 1095-C from my employee. It shows that I’m being charged 123.50/mth for Obamacare. I already have Molina Health Care, and never signed up for Obamacare. Can I tell them to un-enroll me from this program?

Julie on

I had insurance through July 2016, I became unemployed and lost my job based insurance. My spouses insurance for family was unaffordable to us as far as we were concerned. My question is when I calculate the penalty it says use the Adjusted Gross income (which is when both of us were working) but once I became unemployed it was just my husbands income for August 2016 through Dec 2016, so why isn’t it that I can just use his income to figure the penalty for those months since that was our only income during the penalty period?

Rachael on

I feel like this answer only touches on half of her problem. The answer also needs to include information on how ObamaCare has set these rules, such as the 26 week break, and not just about insurance coverages.

This is her question and this is what needs to be answered: Is it true that under the affordable care act, even though I would be working a few hours as a substitute, they still would have to offer me insurance?

ObamaCareFacts.com on

Good catch, I don’t know why this one got half-answered? Ah, well. It has been updated. The answer is:

For the purposes of the ACA, once a person has to be offered coverage there are rules for them having to be continually offered coverage until they can be measured as part-time under the next measuring period. https://obamacarefacts.com/questions/initial-measurement-period-start-date/

So it would make sense that she would be able to move to part-time or take a break without losing access to health insurance.

The rules are in a Federal Register (which exact one I can’t remember off hand; think it is this one: https://www.federalregister.gov/documents/2014/02/12/2014-03082/shared-responsibility-for-employers-regarding-health-coverage).

NOTE: It isn’t directly related, but one might also note that the rules for full-time differ by job type. Adjunct teachers have special rules for instance.

Pamela Christenson on

I have a question……. My daughter has health insurance which was ORIGINALLY purchased threw the marketplace. We have now stopped the marketplace and are now paying independently. Her employer is now saying she MUST take his company insurance plan or they will notify the state and her insurance premiums will increase dramatically…. Mind you, this company only employs MAYBE 20 people TOTAL. She is paying a very low premium at this moment. If she has to take the company insurance, her premium will quadruple. What can she do?

Roberto Martínez on

I have insurance through my job, I pay almost $400.00 premium per month but I have a $5000.00 deductible, so every time that I visit doctors I have to pay almost the full amount of visits, for my wife and me. I can’t afford this high costs of insurance. I was told that I don’t qualify for Obamacare because my employer offers me insurance.
How can I get an exemption and get a quote through Obamacare?

ObamaCareFacts.com on

You can apply for one via the health insurance marketplace by filling out a form that shows you can’t afford the plan (based on a set figure which I think is 9.65% of household income currently (it changes each year).

In other words, I would call the marketplace and let them guide you in the right direction. The term that describes being stuck in that position is generally “the family glitch” (although that applies more to family members stuck with unaffordable employer coverage the solution is similar).

Berry on

I don’t know if this is really related, but I was employed with a company from 2014-2016 and now am trying to fill out my taxes. What I thought was my W-2 turned out to be a 1095-C, for employer-offered health insurance. I declined this insurance as I was covered through my mom’s still, but this form shows that $49.84 was taken from me each month January 2016-May 2016(my last month at this employer)

Wouldn’t this be illegal?
What can I do?

Quan Nguyen on

I’m part of a union. I just started at a new job/company and I just found out I have to pay 250 every two weeks for insurance and they told me I can’t opt out of it. How do I go about getting a waiver. They keep telling me it’s part of the contract. But they only have one option for insurance and I HAVE to get the plan. And it’s +20% of my monthly income.

ObamaCareFacts.com on

So there is a very real problem in here that should be addressed. I’m fairly sure that you can opt out (and pay a fee), but I don’t want to misspeak because Unions can have special rules. Seems unjust, I’ll research it more.

Michele on

I Have Medicaid right now me & my son Ifor I get offered insurance from my employer do I have too take it ? If not will they still take money out my check?

ObamaCareFacts.com on

It can be a little complicated, generally you don’t have to accept coverage, but there are actually instances where you essentially be penalized for not taking it. I wish I had a clear set of rules to point you to, but it actually took me a while to even dig up that general answer (I had initially assumed that you couldn’t be penalized).

Since it is complicated, you should talk to your employer or the appropriate person at your place of employment and ask them.

Taryn Masters on

If I already have Medicaid and get promoted to full time, can I decline the offered insurance from my employer and still keep my Medicaid?

ObamaCareFacts.com on




ObamaCareFacts.com on

For whatever complex reason declining employer health benefits is actually very complex. There is no one answer to give here.



ObamaCareFacts.com on

You can report them to the Department of Labor: https://www.dol.gov/whd/howtofilecomplaint.htm

Kelly on

Just got a new job and coverage is $150 a month for just me not including my son and it doesn’t include dental. I currently get a tax credit and only pay $48 for medical a month and $22 for dental. How can I afford this I also only work ten months out of the year. Please help me.

LINDA Cook on

What if I declined my new employer’s affordable Group coverage during my 60 day SE and continued to have the APTC applied to my Individual plan?

ObamaCareFacts.com on

If you had access to “affordable” employer coverage, but declined, then you aren’t supposed to be getting the Tax Credit. So in this case you could end up being in a sticky situation. You would probably want to get assistance from an accountant to help you sort that one out.

Cheryl Yost on

I was already covered by federal health insurance through my husband’s job. I was forced to take my company’s insurance as my primary when the employer mandate was rolled out. I lost $3.84 extra an hour from my pay that I was given to me because I didn’t need my company’s insurance before the employer mandate. That’s over $8,000 of lost income each year plus I have a $1,500 deductible each year with my company’s insurance. Then add up the coordination of benefits issues. I’ve lost over $60, 000 in income. There are also delays in coverage with prior authorization and the funny thing is that my federal insurance and my companies insurance use the same exact authorization for procedures. When I call to verify anything with my company’s insurance, I get the federal blue cross answering the questions. I’ve had a delay of over 3 weeks to get an authorization for a procedure using my company’s insurance and I wouldn’t have any delay if I just had my federal insurance. My company is very large. I don’t want nor need my company’s insurance.

Rose Cumpton on

my employer offer insurance at 120 bi weekly 3 dollars less than the mandate, and its horrible coverage. Very high deductible its like they wanted to meet the bare requirement to keep from getting fined. I cant afford 580 a month for malonia but if they had charged me 3 more dollars I could get it at 97 dollars at my pay. HOW is this right . I would have to pay 240 MONTH for insurance that I cant use, And after that I still cant afford to go to the doctor. There is absolutely no one that can help me I live pay check to pay check and 240 out of my check is an 8 th of my check. I meet poverty guidelines I work full time. Why is there no one to double check these companies that they can get away with this .. Am I less of a person cause I work? Or is it although I love my job this company is slowly killing me. Other than going to the er I havent been to the doctor in two years cant afford it. I still have to pay rent and still have to eat. Is there no accountabily for these companies?.