Question on Exiting Employer Plan...

[G.Gordon]

She makes just enough to have a $0 ACA plan, her work insurance is IMO, at the unaffordable limit, since they don't pay for 100% of her insurance, and she is gaining coverage from another source, doesn't that give her the right to exit their plan? They are telling her she is locked in.

 

[LGilmore]

Is her portion that she pays GREATER than 9.5% of household income? If no, then they're correct. She can still waive coverage if she wants, but will receive no subsidy in doing so. If her employer is picking up some of the cost and offering pre-tax deduction for her portion of the premium. She's going to need to stay there as it probably pencils out as the best place to be.

 

[G.Gordon]

Yes, her portion is >9.5%.

 

[taterpeeler]

Gordon, I think you should read the law and you will find your answer..... is that not what you tell a less experienced medicare agent after you completely rip his head off... you tell us go read the book before we ask these questions.... so back at you pall, go learn the rules

 

[LGilmore]

"Yes, her portion is >9.5%. "

Her portion of coverage costs for her are greater than 9.5% of her family income?

Gotta ask, are you certain of this? We are just talking about her premium, not dependents. What portion of her premium does her employer pick up?

If her costs are greater than 9.5% she can waive employer coverage and go through exchange for subsidy. I would make sure first. I have a feeling something is lost in translation here.....

 

[G.Gordon]

F you tater. A. This is not my client, but a fellow agent. B. We're all dealing with a new world here, unlike the Medicare world where everything is pretty much common from year to year. C. We've read the law and can't find supporting documentation for this situation even though I'm 99% sure she has the right to exit her employer's plan. D. Unlike Medicare, there aren't handy publications that cover every possible detail of the ACA.


LG, she is single and lives alone. She contacted our office because she has to pay $XXX.XX per month, when you do the math, that premium is more than 9.65% of her cross hourly wage for a typical week.

 

[cadylou]

The way it reads in the glossary on the healthcare.gov site is "employer coverage is considered affordable - as it relates to the advanced premium tax credit - if the employee's share of the annual premium for self-only coverage is no greater than 9.5% of annual household income."


So, reading this -- if it's greater, it's not affordable, and they should qualify for a subsidy.

 

[G.Gordon]

We understand that, it is a question of can the employer require her to stay in the plan. She is eligible, the agent has done the application, acquired the subsidy, and helped her enroll under the assumption that exiting the employer plan was possible. When the employer told them she needed off, they told her she was locked in.

 

[ameneses54]

We understand that, it is a question of can the employer require her to stay in the plan. She is eligible, the agent has done the application, acquired the subsidy, and helped her enroll under the assumption that exiting the employer plan was possible. When the employer told them she needed off, they told her she was locked in.

Hi,
It can't be done under an assumption, you have to download the employer coverage tool have it filled out by HR and if the employer says it's unaffordable you have a case.
Don't forget that you have to consider the MAGI not just the employees income to really calculate if the above is true.
In the real world, it's almost "always " affordable and not worth the time to find out if it's not.

 

[Yagents]

If premium is 9.65%, I am sure it's really 9.5%. Why would employer be so close and subject themselves to employer penties. The calculation must b off.

Plus, why would an agent or client take the risk of taking subsidies when it could be clawed back. Not worth the biz and/or exposure.