Subsidy

[steveadlman]

I do not sell individual health but I have a Medicare client that I referred to Healthcare.gov to see if his wife could get a subsidy to help pay for her an individual health plan. She is getting coverage through his former employer at $460 per month. It is not Cobra. She is age 64 and their total income is $1,339 per month or $16,068 annually. When they called Healthcare.gov they were told they could not qualify for a subsidy. How can that be correct with such a modest income?

 

[ctg]

A couple thing could be happening.

From HC.gov:

If you have coverage from a job (or a family member's job), you're considered covered and won't have to pay the fee that uninsured people must pay.

You may be able to change to Marketplace coverage, but you might not qualify for lower costs on your premiums based on your income. This will depend on the type and cost of insurance the employer provides.

Basically, if she is offered coverage through an employer, she won't qualify for subsidies.

Also, if she qualifies for Medicaid due to low income, she won't qualify for subsidies.

 

[Yagents]

Because.................the gov't rep said so................silly boy.

She can get a subsidy at OEP starting Jan 1st, if above medicaid levels, and since the plan is NOT through her own employer.

 

[indiana260]

Even if an employer offers coverage you can get a subsidy of the cost of the rollers coverage is to high. I think it's like 10% of your base pay. In this case I am not 100% positive but I think she would be able to get a subsidy because her insurance is costing 25% of their income.

 

[somarco]

her insurance is costing 25% of their income.

Total family premium or just the ee cost alone?

 

[rugerred]

Because.................the gov't rep said so................silly boy.

She can get a subsidy at OEP starting Jan 1st, if above medicaid levels, and since the plan is NOT through her own employer.

I don't think she can if it is offered from the husband's employer.

If you have coverage from a job (or a family member's job), you're considered covered and won't have to pay the fee that uninsured people must pay.

You may be able to change to Marketplace coverage, but you might not qualify for lower costs on your premiums based on your income. This will depend on the type and cost of insurance the employer provides.

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

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[Yagents]

OP states the group plan is from husbands FORMER employer (he is on medicare), and must be some type of retiree health plan.

 

[rugerred]

OP states the group plan is from husbands FORMER employer (he is on medicare), and must be some type of retiree health plan.

That is still an employer offerd plan though. I could be wrong but I think that falls in the same category unless she is getting dropped.

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Even if an employer offers coverage you can get a subsidy of the cost of the rollers coverage is to high. I think it's like 10% of your base pay. In this case I am not 100% positive but I think she would be able to get a subsidy because her insurance is costing 25% of their income.

It has to be calculated at the lowest single plan. I haven't had anyone hit that.

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[Happy Texan]

Because we are discussing the spouse and not the employee, I do not think the ability for a subsidy applies.
My thinking is that if the employee has affordable coverage and it meets minimum value, the spouse is not eligible for a subsidy, regardless of the cost.
I am thinking the same rule would apply for a spouse of a former employee, I assume.
Don Levit

 

[rugerred]

Because we are discussing the spouse and not the employee, I do not think the ability for a subsidy applies.
My thinking is that if the employee has affordable coverage and it meets minimum value, the spouse is not eligible for a subsidy, regardless of the cost.
I am thinking the same rule would apply for a spouse of a former employee, I assume.
Don Levit

I agree, the employer offered plan whether it is active or retiree is the road block for a subsidy.

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