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?
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.