Do I Lose Cost Sharing Amounts I Paid if I Switch Plans?
My husband’s employer has to offer Health ins. To their full time drivers this year. They were unaware of this until the middle of Jan. 2015, and they’re still looking and deciding.
We signed up with ACA again for this year…I’m assuming they will meet the guid lines for it being affordable so we will have to switch to their plan..
Our question is, my husband has had numerous test, scans and was diagnosed with mild COPD, and a small lesion in lung that will need CT SCANS every 3 month for the next 2-3 years to monitor it…we met our out-of-pocket co-pay already, but if we have to switch, would we have to meet that insurance out of pocket co pay?
We’re looking at an incredible cost and would truly be a hardship for us..it’s where we are considering for him to go on early retirement (he’s 62.5) and quit or even go part time to afford not going on another insurance, his health is okay considering the above, so what’s the scoop on our dilemma?
Answer
Out-of-pocket cost sharing amounts are based on policy periods and holding a specific policy. So don't switch health plans mid-year if you have already paid a considerable amount in. In situations where one needs to switch plans mid-year, there is no easy answer.
Luckily, your employer should start offering coverage on the 1st of the year. Starting in 2014 most policy periods are the calendar year Jan 1 to Dec 31. So if the employer offers the plan on time then he should simply switch to the new policy on the 1st.
If your employer starts offering coverage mid-year, and you've paid a considerable amount to covered benefits, then you'll have to be careful. If they offer your husband affordable coverage it will make him in eligible for subsidies. He won't necessarily have to leave the plan he is on, but will owe back tax credits. Also if he is getting cost sharing reduction subsidies he will lose those. That could be an issue. You won't have to repay them, but they are part of what make out-of-pocket costs more affordable.
Hope this helps you to make some decisions. Please feel free to ask more questions.