Ron Bliss of the Affordable Healthcare Pros in Carson City, is doing a blog helping explain provisions of the Affordable Care Act, also known as ObamaCare. Nevadans have until Feb. 15, 2015 to enroll for 2015 without penalty on their taxes. You must be enrolled for at least nine months of the year to avoid a penalty which this year is a minimum of $325 for an individual or 2 percent of your gross income, whichever is more. Today’s subject: The 9.5 percent rule.
The 9.5 percent rule is a misunderstood part of the ACA that explains when you can and can’t qualify for a government subsidy.
The rule states: An “affordable” offer of insurance (from an employer) can only be as much as 9.5 percent of household income. This becomes important because anyone who has an “affordable” offer of employer insurance, has to take it (or, alternatively, pay a fine for not carrying coverage). But anyone with “unaffordable” insurance, coverage that costs more than 9.5 percent of household income for premiums alone, gets a little more choice. They can take the unaffordable option, or they can head to the exchange for something cheaper, likely with a federal premium subsidy.
That is easy enough for someone who is not married. For instance, if a worker makes just $17,000 a year but the employer’s insurance costs $250 per month, that worker can opt out of the employer insurance. He makes just over $1400 a month and to be affordable, the insurance would need to cost no more than $133 a month to fit within the 9.5 percent allowance.
It gets more complicated when families are involved. One recent example was a woman who came to us because her husband’s employer was asking $845 per month for herself and her son, even though he was the sole breadwinner in the family. His insurance premium was well within the 9.5 percent rule and if his insurance was considered affordable, theirs was too, even though it clearly was not.
That means that she would not qualify for a subsidy from the government and would either have to pay the outrageous amount or go without insurance and get fined. But there is another solution.
We can got onto the open market and find a plan for much less even without a government subsidy. We found a plan for her and her son for around $500 per month that provided as much coverage as her husband’s plan and saved the family over $300 per month.
If this is your situation, contact us at 775-883-3414, call me personally at 775-450-6769 or come by our office at 2307 N. Carson St., in Carson City for a quote.
Ron Bliss is a former long-time sports writer in Tennessee who has been in the healthcare field the last five years. Affordable Healthcare Pros offers major medical insurance through a number of companies, on and off the Federal Exchange as well as Medicare supplements, supplemental health plans like accident insurance, cancer, heart attack stroke, and disability insurance and life insurance.