9.56% Rule Violation due to lower plan not available for out of state worker and if dropping unaffordable healthcare(9.56% rule) is special event.

My company is based in GA but I live and work at a facility in NJ. They offer two types of insurance, Blue Essential, which is exactly 9.56% of my income, and a PPO which is 11%. Blue Essential of BCBSGA appears to only be available for GA residents so obviously had to join the PPO. After looking up quotes, I would save over $110 a month with a silver plan and have better benefits or get a gold plan with the subsidy based on my income. Question is two fold, while the lowest plan available to be is lower than 9.56%, I would not benefit from it since I am in another state, and might outright be ineligible for it, can I then drop my work insurance and get a subsidy based on my income? If then my PPO does violate the 9.56% rule, and I have no cheaper option, does dropping my employer sponsored health insurance trigger a special life changing event allowing me to enroll immediately, or must I wait for open enrollment?


If the cheapest employer plan available to you is 9.56% of MAGI for self only coverage you can get ObamaCare's cost assistance. This is true even if the employer offers other cheaper plans that aren't available to you (for instance a plan is not offered for the state you reside by your company). To be eligible for cost assistance your employer will need to fill out an employer coverage tool on your behalf confirming coverage isn't affordable.

Dropping insurance or getting kicked off to non-payment are two of the only ways to not trigger a special enrollment period. I don't know if they would make an exception in your case where you are realizing that insurance through the employer is too expensive. If that doesn't count then you should be able to do this process starting at the start of open enrollment in anticipation for January 1st.

Learn more about open enrollment here.

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