Ron Bliss: Some families caught in middle by Affordable Care Act

As we enter open enrollment for major medical plans (Nov. 1, 2015-Jan. 31, 2016), some families find themselves caught in the middle by an Affordable Care Act rule.

The way the Affordable Care Act reads: If the employee is offered “affordable” health insurance by his or her employer, they must either accept that insurance, buy private insurance elsewhere or pay the penalty for not having creditable coverage ($695 per adult for 2016, $347.50 per child or 2.5 percent of gross income, whichever is greater). They CANNOT go onto the Federal Facilitated Marketplace (FFM) and get a subsidy.

“Affordable,” for the employee, is defined as 9.5 percent of their monthly salary or less. In other words, if the employee makes $2000 per month before taxes, an “affordable” premium would need to be $190 per month or less.

If the premium is more, the employee has the right to apply to the FFM for a plan with a subsidy.

Employers tend to get around this by making sure the cost for the employee is “affordable” by paying part of the premium. The hang-up is that coverage offered to the spouse and family is usually without assistance and NOT affordable.

In one case we had, the husband — who made $40,000 a year or $3,333 per month — was given his insurance for very little ($100 a month), but his wife and child were offered insurance on his plan for $800 per month. The wife did not work, so the amount was clearly not affordable.

One possible solution, however, is for the spouse and children to look off the marketplace to get a plan from a broker, usually for a lot less. In this case, we were able to find a plan for the wife and child for between $400 and $500 a month. That would still not be considered affordable, but it is much better than the $800 a month the employer was asking.

The only stipulation is that you cannot get a subsidy from the FFM, if the employee is offered affordable insurance. There is no requirement to buy from the insurance company offering the other spouse’s plan.

If that is your situation, let us help. We can search all the plans and come up with the most-affordable situation for you and your family.

You can also call us if the premium for the employee is NOT affordable. Then, we would be able to put the entire family on a FFM plan.

An employee who has a three-month waiting period before the insurance kicks in can also get short-term insurance through Affordable Healthcare Pros to fill the gap between the start of employment and the end of the probation period. We can also help with Medicare supplements and Part D drug plans for those individuals 65 and over.

Our help is free of charge. If we can help, call us at 775-450-6769, 775-224-7169, 775-450-7754, 775-450-6867, or call our office at 775-883-3414.

You can also call one of our two Southern Nevada lines — 702- 721-3657 or 702-721-3810. Our office is located at 2307 N. Carson St. in Carson City, but we help clients throughout Nevada and California.

Ron Bliss is a former long-time sports writer who has been doing health insurance since 2009. He is certified on both Covered California and the Nevada Health Link and can sell products on and off both exchanges. Affordable Healthcare Pros also offers a variety of dental plans to include dental-vision-hearing plans in both states, as well as a wide variety of Medicare supplements and other health supplemental products to include critical illness, short-term care, disability, plans to cover in-home or nursing home costs, accidents and hospital indemnity policies.


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