I'm having a hard time understanding options if i decline employer coverage

[aaron5]

I am having a hard time understanding if there are penalties for declining employer-based health insurance and deciding to purchase insurance through the marketplace. Based on my salary and the premium I pay for our family on the high-deductible plan, the premium ($$ per paycheck x 26 pay periods) ends up being 9.37% of my annual salary.

This is outside of the 8.39% range that the website says is "affordable". Does that mean if I choose to buy health insurance through the marketplace I would get the full subsidy it estimates or are there factors I'm not aware of?

Ultimately, I'd like to not pay so much for our insurance which we hardly need to use, yet pay almost 10% of our salary toward. What are my options? (I'm only calculating the health insurance premiums in my numbers here, not dental or vision care). I pay ~250 per paycheck for our families health insurance premium.

 

[foreverthankful]

@aaron5 Good Evening,

Unfortunately, "affordability" is calculated by the least expensive plan available to you by your employer and the "employee only" rate. If the Employee only rate of the least expensive plan (even if that's not the plan you're choosing) is 8.39% or less, then you did have "affordable coverage" offered to you, you just decided to add dependents and/or choose a more expensive plan.

You can still opt for a plan on the Marketplace, but you would not be eligible for a subsidy.

To be eligible for the subsidy, you have to meet income requirements AND not have a qualified offer of coverage from your employer.

An offer from your employer is qualified if it meets minimum essential value (that is based on the what the plan covers- and 99% of employers meet this) and meets affordability standards based on the lowest price plan available to you- at the Employee only level.

 

[aaron5]

@foreverthankful Thank you, that makes a lot of sense!

 

[erin30ga]

@aaron5 I am estimating your premiums for coverage of your family at about $6500 per year which is not that high for a family of four - even with a high deductible.

You actually wouldn't pay significantly less through the Market Place.

You could possibly see if you can enroll your kids in the CHIP plan in your state. The income levels are higher than Medicaid and the coverage is much better than your current plan.