ACA Subsidy question

[SamIam]

This lady has what looks like to me an indemnity plan that has the mandated ACA preventative care visits through her job. Since the plan has limits on surgical and everything else I believe I'm able to get her a subsidy through the marketplace for a Blue Cross plan. Her HR department doesn't believe they are allowed to get a subsidy because the plan has the mandated preventive care benefits.

Is she able to get a subsidy? I attached the PDF

 

[bluediamond]

Can't open the attachment but yes it sounds like she may be able to receive a subsidy.

 

[Ann H]

This lady has what looks like to me an indemnity plan that has the mandated ACA preventative care visits through her job. Since the plan has limits on surgical and everything else I believe I'm able to get her a subsidy through the marketplace for a Blue Cross plan. Her HR department doesn't believe they are allowed to get a subsidy because the plan has the mandated preventive care benefits.

Is she able to get a subsidy? I attached the PDF

Couldn't open the pdf file. Preventive care isn't the issue. The issue is whether it's MEC, MV and Affordable. (The employer and individual penalties look at MEC, and that's what the HR dept is probably thinking about. A "preventive care only" is a pretty skinny plan and might not even be MEC!) But anyway, for the person who wants a subsidy, they can be blocked from the subsidy due to employer sponsored insurance, if the insurance is MEC, MV, affordable for the employee, and the employee is not enrolled in it. At least that's the way that I remember it. I'm doing group and not ACA IFP anymore, so my memory is purposefully waning on the subject of subsidy eligibility.

 

[SamIam]

Here is the link to the plan PanaBridge Advantage Day 1 Insurance Plan | Supplemental Health Care

On the PDF I found it says : The Limited benefit Indemnity plan alone does not constitute comprehensive health insurance coverage (major medical coverage) and does not satisfy the requirement of minimal essential coverage under the affordable care act, however the preventive care plan offered as a part of Panabridge does meet the individual; responsibility requirement under the affordable care act as it provides minimum essential coverage.

So that being said I still can't determine if they can still get a subsidy.

 

[Ann H]

Thanks, SamIam. That is not a plan that I want, and I feel for people who are in a position like that.

Either way, Preventive Care is not the issue for the subsidy. If the client has employer sponsored insurance, here are the issues for subsidy qualification.
1 - Is it MEC (minimum essential coverage)?
2 - Is it MV (minimum value)?
3 - Is it affordable for the employee at the 9.56% of MAGI rule? (Affordability for dependents is not relevant, by the way).
4 - Even if the plan fails any of the tests above, but the employee ENROLLED IN IT, then the employee would need to unenroll during OEP to get a subsidy.

My understanding is that if the employer sponsored insurance fails to meet any of those tests, the client can get a subsidy.

The link you provided says it is 100% employer paid for the employee. Well that blows out the "affordable" test. My general assumption is that the employer covered the MEC and affordable issues, because that is what is important to them to avoid the penalty. But it likely may fail the minimum value test. I can't tell from the short summary on the link you provided. The employer should know if it is MV, or else the insurer should know.

Do some research on my understanding, because I stopped doing subsidized IFP at the end of OEP 2015, and I do mostly group now. Fuzzy memory about subsidies!

 

[TN_agent]

Ann H, that is my understanding as well.

What I am not clear on is how that pertains to the administration of the subsidy and the 1095 A/B/C (whichever) that people get from their employers and health insurance companies for doing their taxes. If the IRS says "we got a 1095 from your employer saying that you were offered MEC coverage, yet you enrolled in marketplace coverage and got a subsidy, pay us back" when these were MEC plans that were not MV. How does the employee respond to the IRS?

There are TONS of people in TN who are offered these MEC plans, a lot of manufacturing in TN makes people work 9-12 months as temps before hiring them on full-time and all the temp agencies offer the MEC plans after 1-3 months of full-time.

 

[Ann H]

The Employer reporting is specific. It shows if the plan is MEC, MV, and affordable, and if it was offered to employees. If the employer did the reporting correctly, then a plan that is MEC, but not MV, would clearly show that. However, the reporting is incredibly complicated. It requires codes for various situations, and that system is terribly confusing. Many employers do not know how to properly fill out the IRS forms for employer reporting. So, if a person receives a letter from the IRS saying they owe the subsidy back, that person should consider appealing the decision, and giving facts to support the appeal.