Employee Within 9.5% of Income

[Ann H]

To make sure I read this right. If the family opkt is greater than 15k under group plan they can get subsidy?

Not necessarily. To be "adequate", the employer-sponsored plan must be 60% actuarial value (AV) and above, and it is POSSIBLE (but not likely) that a plan has an out-of-pocket maximum greater than $12,700 and still is within 60% AV. You might find some of these pre-ACA plans with high out-of-pocket, but with other benefits that are rich, and it still meets 60% AV.

Even post-ACA, large group plans are not limited to platinum, gold, silver, bronze. They can design their own plan. So, you might find $15K OOP here too, but still at least 60% AV. Once again, possible but not the majority.

Post-ACA plans in the small group market must be at least Bronze, so they are 60% AV or above.

 

[SouthernComfort]

What about when the premium exceeds 9.5% of income for the individual?

 

[Ann H]

What about when the premium exceeds 9.5% of income for the individual?

Yes, that is the "unaffordable" issue. As TaterPeeler pointed out, if the employer sponsored plan is EITHER unaffordable or inadequate, the client may qualify for a subsidy.

 

[Agent045]

Not necessarily. To be "adequate", the employer-sponsored plan must be 60% actuarial value (AV) and above, and it is POSSIBLE (but not likely) that a plan has an out-of-pocket maximum greater than $12,700 and still is within 60% AV. You might find some of these pre-ACA plans with high out-of-pocket, but with other benefits that are rich, and it still meets 60% AV.

Even post-ACA, large group plans are not limited to platinum, gold, silver, bronze. They can design their own plan. So, you might find $15K OOP here too, but still at least 60% AV. Once again, possible but not the majority.

Post-ACA plans in the small group market must be at least Bronze, so they are 60% AV or above.

Thanks Ann..you ROCK!!