I just signed up for covered Ca. bronze plan, effective 3-1-15. My monthly amount to pay is $67.00 with a subsidy amount of $162.00. I was offered insurance at my job but the premiums were $70.00 – $90.00 every pay period (twice a month) I couldn’t afford that. I am hearing a lot of rumors about this insurance and it got me thinking maybe I am not supposed to have this insurance because I was offered it at work. My question to you today is: am I going to have to pay the subsidy amount back at some time, or is my work insurance unaffordable by your standards?


Answer

If you have access to affordable employer coverage then you can't get Marketplace cost assistance. You can't claim a tax credit on premium tax credit form 8962 if you have employer coverage or access to another type of minimum essential coverage offered by a public healthcare program. This is to say you have access to another coverage for the full month. Usually when you fill out the application you'll be denied upfront, in a case where you end up with cost assistance (but shouldn't have) you should let the Marketplace know.

The only way out of this is to show that employer coverage would cost more than 9.56% of household income.

The above being said, there are a few things to be aware of

1. There are
repayment limits. Those are based on income.

2. The IRS is going to have your W2 on file, so they will have a pretty simple window into looking at your employment.

Probably the best idea here is to just get yourself correct, so first step is to look into affordable employer coverage rules. Then if you should have employer coverage, get that then switch off the Marketplace plan. If you can't get employer coverage, just consider paying full-price for your Marketplace plan... Or simply repay the full amount using 8962 next year. But be prepared to repay the full advanced tax credit (you can't be charged more than that or punished in any other way).

Here is this information from the 8962 instructions:

Minimum essential coverage. Under the health care law, certain health coverage is called minimum essential coverage. Even if you have coverage purchased through a Marketplace, you cannot take the PTC for any individual in your tax family for any month when that individual is eligible for minimum essential coverage, other than coverage in the individual market. Types of minimum essential coverage include:

Government-sponsored programs (including most Medicaid coverage, Medicare parts A or C, the Children’s Health Insurance Program (CHIP), and Tricare).

Employer-sponsored coverage, if the premiums are affordable and the deductibles and co-pays are no more than a certain amount, or if you enroll. Other health coverage the Department of Health and Human Services designates as minimum essential coverage. Coverage purchased in the individual market outside the Marketplace is minimum essential coverage.

Eligibility for this type of coverage does not prevent you from being eligible for the PTC for Marketplace coverage, but it does not qualify for the PTC. For more details on eligibility for minimum essential coverage, including special eligibility rules, see Minimum Essential Coverage in Pub. 974.

You can also check www.irs.gov/uac/ Individual-Shared-Responsibility-Provision for future updates about types of coverage that are recognized as minimum essential coverage. Example. You, your spouse, and your two children whom you claim as dependents were enrolled in a qualified health plan in 2014. Your children were eligible for coverage under CHIP. Your tax family size is four, consisting of you, your spouse, and your children. Your coverage family has only two members, you and your spouse. Your children are not part of the coverage family because they were eligible for CHIP, which is minimum essential coverage. As a result, although your children were enrolled in a qualified health plan, the PTC provides financial assistance only for the coverage of you and your spouse.

Rate and Comment on the Answer

Your email address will not be published. Required fields are marked *

1 2 3 4 5

This site uses Akismet to reduce spam. Learn how your comment data is processed.

James on

Hello I am employed at the rate of 20.75/ hr. I have a family of six. Me and my wife and four children. My employer offers the crap ACA, which I didn’t realize because I’m too busy making enough money for my family. But anywho the bronze ranges from 216-381. Nronze plus from 417-681. Silver from 583-1586. Gold from 755.41 – $2,383.67. And platinum from $1,041.63 – $3,129.60. This is after employee contributions of 458.00 based on me and spouse being non-smokers. My question is that from bronze to platinum the plan cost annually ranges from 6k-76k. WTF!!! Now I understand my family had no need for gold or platinum. But the in-network deductible for the lowest is 9000 for the family and 4500 individual. SERIOUSLY!!! I’m a nurse so I know bullshit when I smell it. Please explain how one goes about affording such health care. Every job I worked prior to 2003 the premium never went up past 100 a pay cycle. So now I either. Health coverage for everyone doesn’t help anyone if they can’t AFFORD it. fyi I’m in illinois. And can you please explain the 9.5% of employee gross income is the max a premium should be?

SEF on

My following question does not appear to be explicitly addressed here or elsewhere on this site.

My step-daughter has some health needs, but unfortunately her employer, a baptist church, only offers a “health care sharing ministry,” not actual insurance. I understand that the ministry makes her exempt from the tax fine for not having insurance (moot anyway with recent legal changes), but it does not meet the “minimum value standard” for employer insurance. My question then is, can she sign up for all the standard benefits of ACA insurance for her state and her income level without leaving the sharing ministry? Her employer is currently paying the small monthly fee for the ministry, and probably wouldn’t give her that benefit in any other form if she left it; it might also raise questions in their mind about whether she has sufficient faith or was trying to get health treatment forbidden by the religion. Neither is the case; the problem is simply that the ministry’s benefits are paltry, and she needs better coverage. But if she had to quit the sharing ministry to get ACA benefits, she might risk her job, so we need explicit guidance on whether that is the case.

ObamaCareFacts.com on

I think, but would have to double check, that since she has access to coverage through work that she wouldn’t qualify for the ACA. I’m assuming this applies to the health sharing ministry.

Since I don’t know the exact answer, I would strongly suggest contacting healthcare.gov and asking them directly!