ACA/When someone has employer cov available?

[vic120]

" In 2024, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 8.39% of your household income. "

See Your Options If You Have Job-Based Health Insurance

If you have a Marketplace plan and then get an offer of health insurance through a job, you may no longer qualify for savings on your Marketplace plan. Learn what you can do if you have job-based health insurance. Visit Healthcare.gov to see the health care options at the Health Insurance...

www.healthcare.gov

" Financial assistance to buy health insurance on the Affordable Care Act (ACA) Marketplaces is primarily available for people who cannot get coverage through a public program or their employer. Some exceptions are made, however, including for people whose employer coverage offer is deemed unaffordable or of insufficient value. For example, people can qualify for ACA Marketplace subsidies if their employer requires them to spend more than 9.83% of his household income on the company's health plan premium. "

The ACA Family Glitch and Affordability of Employer Coverage | KFF

This analysis estimates that 5.1 million people fall into the Affordable Care Act's "family glitch," which occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage...

www.kff.org

So if someone made 50K and there employer cov was $500 a month they could get ACA because it is above that 8.39%?

Is there dif % for more in household

 

[LostDollar]

What’s included as income

Find out if you qualify for lower costs on Marketplace health insurance coverage at HealthCare.gov.

www.healthcare.gov

Note, the income limit is based on "household" income, not "Wage" income.

 

[Yagents]

So if someone made 50K and there employer cov was $500 a month they could get ACA because it is above that 8.39%?

Is there dif % for more in household

Use this

Family Glitch Calculator | Health Agents for America - HAFA

www.hafamerica.org

 

[vic120]

Use this

Family Glitch Calculator | Health Agents for America - HAFA

www.hafamerica.org

Thank is Awesome thank you

 

[bill3173]

There is a section in the application where the calculation is done for the employee, and the family, based on family size, and household income.

I had a case last year where, although the wife and child were entitled to the spouse's employer coverage, they were able to get aptc.. The employed spouse didn't apply for himself, only his family.

 

[Jim Wright]

So if someone made 50K and there employer cov was $500 a month they could get ACA because it is above that 8.39%?

Is there dif % for more in household

Group Health Affordability is based on employee only income, not household. It's one of the 3 safe harbors for determining affordability. If that contribution is not affordable to the employee only, the employee can go to the marketplace and get a subsidy. If the family is not offered any contribution or an unaffordable contribution, they can go to the marketplace and get a subsidy. Where it gets tricky, is if the employer offers a contribution towards spouse/dependents.

There are a few things to keep in mind for employee and employer. If the employee is offered affordable coverage, they decline and go to the marketplace and get their subsidy, they will have to pay it back when they file their taxes.

If the employer is considered a large employer (over 50 EE's) they may have to pay 2 penalties for each employee that gets a subsidy from the marketplace if the contribution they offer is unaffordable.

 

[Jim Wright]

What’s included as income

Find out if you qualify for lower costs on Marketplace health insurance coverage at HealthCare.gov.

www.healthcare.gov

Note, the income limit is based on "household" income, not "Wage" income.

Be careful with this because the affordability markers for the marketplace are different than the affordability markers of a group plan

 

[vic120]

Group Health Affordability is based on employee only income, not household. It's one of the 3 safe harbors for determining affordability. If that contribution is not affordable to the employee only, the employee can go to the marketplace and get a subsidy. If the family is not offered any contribution or an unaffordable contribution, they can go to the marketplace and get a subsidy. Where it gets tricky, is if the employer offers a contribution towards spouse/dependents.

There are a few things to keep in mind for employee and employer. If the employee is offered affordable coverage, they decline and go to the marketplace and get their subsidy, they will have to pay it back when they file their taxes.

If the employer is considered a large employer (over 50 EE's) they may have to pay 2 penalties for each employee that gets a subsidy from the marketplace if the contribution they offer is unaffordable.

Ok so what is this family glitch calculator about if not this?

 

[Jim Wright]

Ok so what is this family glitch calculator about if not this?

Maybe I read it incorrectly but it seemed like your original question was more about employee coverage, not family coverage. It's much easier to put a family on the marketplace than an employee who is offered coverage.

It didn't seem like anyone had addressed the employee specific part when it relates to affordability

 

[The Benefit Coach]

Ok so what is this family glitch calculator about if not this?

If a person is offered qualified health coverage through their employer, and it is deemed "affordable", they can still go on the exchange and get a policy, but they will pay the full price. They are not eligible for a subsidy. If they are being truthful when asked about it on the exchange, the marketplace coverage will never be less expensive.

Yes, I've had a couple of employees do that and get caught. I'll get a call from their manager saying that the employee lost their coverage because the insurance company "raised their rate" and needs to enroll in the group plan. Unfortunately, losing coverage due to none payment is not a qualifying event and they're stuck until the employers next open enrollment. On the other hand, I know a lot of employees still do it but haven't been caught yet. It takes the IRS a good year or 2 to match up their subsidy rolls with the employers 1095s.