Reader: Can I swap workplace coverage for Obamacare?

Reader D.C. Tomlin has a timely question:  "Even if your workplace offers health care insurance can you still price the costs of the Affordable Care Act and perhaps qualify if it is cheaper?"

It's timely because many of us are getting 2015 health insurance packets from our employers and learning that premiums will rise.  But while it can't hurt to check out HealthCare.gov  (the site says  "window shopping"  info on 2015 rates is coming in early November),  it's unlikely you'll find a better deal.

If your employer's insurance meets the federal government's standards for affordability and value  (read details here),  you aren't eligible for a subsidy,  which is what keeps ACA premiums low for many low-  and moderate-income people.  You can still opt out of your employer's plan and pay full price on the exchange,  but if your employer is covering part of the premium you're likely to end up paying more.  And if you're going that route,  you'd do better to look at a wider menu of private-pay offerings  (only three companies will offer ACA policies in North Carolina in 2015,  and some counties have fewer options).

Families like mine face another twist.

As the only full-time employee,  I've got my husband and 25-year-old son on my Observer policy (the ACA requires employers to offer coverage until children turn 26). 

Our son works two part-time jobs,  neither of which offers health insurance.  His income would likely qualify him for a hefty tax credit.  But I was initially told that because the ACA makes him eligible for my plan he can't claim that aid.

"Having an offer of adequate, affordable employer coverage prevents those family members from accessing financial assistance in the marketplace.  This is known as the 'family glitch,'  "  said Madison Hardee,  a Legal Services of Southern Piedmont lawyer and health insurance navigator.

However, Donna Elliott Grissom,  executive director of HealthNet Gaston,  found a link indicating he does have that option.  Because he pays his own taxes,  rather than being listed as our dependent,  HealthCare.gov says he is eligible for subsidies  (Hardee agrees that's a crucial distinction).  But that's true only if I don't sign him up  --  and the Observer's enrollment ends before the ACA exchange opens for 2015 enrollment on Nov. 15.

I'm glad we have options,  but it does make for complex choices.  And in North Carolina,  the calculation has to include whether his 2015 income might dip below $11,670,  plunging him into the coverage gap in which he would no longer be eligible for aid.  That's an issue in states that have declined to expand Medicaid,  which was supposed to fill that gap for low-income adults.

Grissom,  who has young adult children of her own,  says she was also unclear on how this works until she started digging.  "We both learned something new today,"  she said.  "And like everything else ACA-related – it’s complicated!"
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