When is non affordable employer coverage an sep

kstein

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Client makes 40k and employer coverage is 800/mo .

Could this client get subsidy and SEP mid year or are they forced to stay put. I get conflicting from documents and HC.gov calls .
 
Is the employer plan year ending or are they just wanting to leave it because of the cost?
 
employer coverage is 800/mo

Does that include dependent premium or just for the employee?



Affordable coverage

A job-based health plan covering only the employee that costs 9.56% or less of the employee’s household income. If a job-based plan is “affordable,” and meets the “minimum value” standard, you're not eligible for a premium tax credit if you buy a Marketplace insurance plan instead.

  • The plan used to define affordability is the lowest priced “self-only” plan the employer offers — meaning a plan covering only the employee, not dependents. This is true even if you’re enrolled in a plan that costs more or covers dependents.
  • The cost is the amount the employee would pay for the insurance, not the plan’s total premium.
  • The employee’s total household income is used. Total household income includes income from everybody in the household who’s required to file a tax return.
Affordable coverage - HealthCare.gov Glossary
 
Are they sure the employer will let them off the plan? Most cafeteria plan's won't do that mid-year unless there is a special reason.
 
Yes it is $800 for employee only and yes they would let him leave. Looks like hc.gov won't allow an sep so I'm not gonna push it .seems a little weak since plan is renewing 5-1 at higher rates but whatever .
 
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