9.5% is Figured On?

[SouthernComfort]

the wife and son do not work, I apologize I should have been more clear.

With the employer mandate being delayed, how in the world is employer coverage going to be tracked? I have had only 1 application where income information was pulled from the employer but have had zero show current employer coverage.

 

[Ann H]

the wife and son do not work, I apologize I should have been more clear.

With the employer mandate being delayed, how in the world is employer coverage going to be tracked? I have had only 1 application where income information was pulled from the employer but have had zero show current employer coverage.

One of the reasons stated for the delay was the fact that Employer reporting is so onerous. Now that it has been delayed, only large employers with an HR department or employers with a good agent will know if their plans are at last 60% actuarial value.

If you want, you can use the actuarial value calculator offered by CCIIO, a division of CMS. Just google 2014 actuarial value calculator, and it will give you a link to an Excel file where you enter the plan benefits, and it tells you the actuarial value.

However, be aware that some employers (especially large employers) may have an HRA or another benefit plan that is a companion to their medical plan, and the combination of both plans will result in a higher actuarial value.

 

[RayNY]

Quotebroker, you're right (slipped my mind as NY has no age banding/true community rating).

So yes, you'd be using the employee with the lowest pay/premium ratio for this calculation. Fun times.

 

[cadylou]

What about other family members who have access to the employer based coverage, but it's too expensive. I have a situation where husband takes the employer based insurance, but the wife & 2 kids currently have their own policy. They would qualify for a subsidy based on full household income. The price that they would have to pay to be included on the husband's group policy, far exceeds 9.5% of their household income - just for the 3 of them. Can we put them in to receive a subsidy?

 

[Yagents]

No. Search "family glitch" if u want to know why.

 

[russelltw]

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/


"Affordable" plans and the 9.5% standard
A job-based health plan is considered "affordable" if the employee's share of premiums for the lowest cost self-only coverage that meets the minimum value standard is less than 9.5% of their family's income.


In other words, if your share of your premiums for a plan that covers only you (the employee)--not your family--is less than 9.5% of your family's income, the plan is considered affordable.


You may pay more than 9.5% of your income on premiums for spouse or family coverage from your employer. But affordability is determined only by the amount you'd pay for self-only coverage from your employer.

 

[cadylou]

So, the answer is NO? am I getting this right? Even though what it would cost them is about 16% just for the spouse & kids? and it's optional - not required? Am I right? They don't get a subsidy then? (not trying to be dense, but this doesn't seem to make sense . . . .)


He- the employee is covered - he has to pay for the wife & kids if he wants to add them to the group -- it's available, but they have to pay out of pocket.

 

[Ann H]

So, the answer is NO? am I getting this right? Even though what it would cost them is about 16% just for the spouse & kids? and it's optional - not required? Am I right? They don't get a subsidy then? (not trying to be dense, but this doesn't seem to make sense . . . .)


He- the employee is covered - he has to pay for the wife & kids if he wants to add them to the group -- it's available, but they have to pay out of pocket.

The answer is "no". The "family glitch" is a glitch in the law where the "affordability" test is based on the employee's self-only premium. It doesn't matter what the premium costs to add a spouse and kids. If it's affordable for the employee, then no member of the family can get a subsidy.

 

[cadylou]

Wow - that blows. Can't wait to be the bearer of bad news . . . .just keeps getting better & better! . . . . .ugh!