I am full-time employee with an annual salary of about $37,000 year. The Health Insurance my work offered me this year has an indivual deductible of $6,500.  I feel like that’s way too high. Can I qualify for ObamaCare or not? Some times I have to pay $200.00 for a doctor visit out of pocket. I’ll never reach that deductible, so I’ll always have to pay. Can I qualify for other affordable obamacare plans?


Answer

You can always decline your employer's offer and opt for a MarketPlace Health Insurance Plan.  However, this probably won't be more affordable for you unless you qualify for Health Care Subsidies.

Since you're offered an employer-sponsored plan, you will not be eligible for ObamaCare Cost Assistance subsidies unless

  1. Your plan is unaffordable: the coverage offered would end up costing more that 9.5% of your household income, or
  2. Your plan is inadequate: the coverage offered by your employer doesn't have an actuarial value of at least 60%.

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Isaac Comer on


Answer Rating:

My employer health insurance plan has a $4000 yearly deductible. I.e. the first $4000 of medical bills in a plan year go straight to me.

I am being sued for the second time to pay some highly past due medical bills.

I wince every time I have to ask my wife to not go see the doctor about her chronic back pain because we can’t afford to get sued anymore.

How do I calculate whether a plan is “unaffordable”? I suspect you expect me to see how much of my paycheck goes to cover the premiums and go with that number.

But if there’s a $4000 deductible, then that monthly premium amount doesn’t really tell the whole story. It’s just a way for my insurance plan to lie and pretend that it’s affordable when, in practice, it is not.

Furry cows moo and decompress.

ObamaCareFacts.com on


Answer Rating:

You have a really good point. The law includes cost sharing limits, but aside from that “affordable” is based on premium cost. If the premium is more than 9.56% of your household income (per-person) then you can use the Marketplace. A medical savings account can help with taxes and medical costs, and you can also take medical deductions over 10% of household income.

This is the sort of case where you really have to look at your household income and deductions you can take to figure out what your options are. You can talk to your employer too, they may have suggestions.

You should review this linked page to learn more about your options. https://obamacarefacts.com/affordable-employer-sponsored-coverage/

bob on

the plans are not affordable when considering the deductibles, sure there is a base rate but in reality nothing is paid for until the deductibles are met, adding much more to the true cost of the plan. and another thing, why is total household income included to cover only on the employee? does the government think the spouse and children are free? the whole thing really screws a working class family.

ObamaCareFacts.com on

We can understand the high deductibles, but the rules for family coverage for employers are one of the things we have failed to comprehend over the years. It just seems flat out unfair to the families, especially with the rule barring them from cost assistance. We assumed the GOP would have been all over this day 1. Not sure i’ve ever heard it brought up by politicians?

Emily on

I am in the exact same boat as the person who posted this question, and the answer given is pathetic! My employer only offers a high deductible health plan. I am in my early 40’s and only see my PCP twice a year for blood work and prescription renewals. With such a high annual deductible, I will be paying for ALL my health care out of pocket, and so will my husband, and yet I am forced to pay high monthly premiums that do us no good. I’m essentially throwing all that premium money into the trash every month because we’re healthy and won’t ever meet the high deductible in a year’s time. So the employer plans are unaffordable, Obamacare is unaffordable, and we don’t qualify for any tax credits because our household income is around $50,000. Before Obamacare, at least I could opt out of this outrageous, absurd plan and choose to go without health insurance if I wanted to. But now I can’t even do that. I am giving my hard-earned money away to greedy health insurance companies and my government basically took away all my rights. This is an outrage with no fair outcome. I have done the ‘right thing’ all my life; worked, bought a home, paid my taxes, and contributed to this economy, and I am being penalized for it, while welfare recipients get to sit home and collect checks and other government money for free. This system is so broken when it rewards laziness and opportunists by punishing hard-working Americans.

Lory on

Im in the same boat right now and your comment hits home. Its unfair.