Q: My husband works for a much larger company than I do. I have always been covered under his plan because it is more affordable than the one offered by my smaller company. We just received a letter from his company stating that beginning next year, if I had access to my own health insurance I can no longer be covered under his insurance. Is this legal?
A: Yes, it is legal. The ACA requires employers with 50 or more workers to offer coverage to employees and their children (until age 26), but not spouses. But most employers do still offer coverage to spouses.
According to National Business Group on Health data, four percent of their members wouldn’t offer coverage to spouses who had access to their own employer plan in 2016, while one percent wouldn’t offer coverage to spouses at all.
But a much higher percentage — more than a third of employers — are tacking on a surcharge for spouses who continue to receive spousal insurance coverage despite having the option to obtain coverage through their own employers. And this approach is gaining popularity among employers.
Since you’ll no longer have access to coverage through your husband’s job, the affordability test for your coverage will depend on what it costs to obtain coverage through your own job. Assuming the portion of the premium that you’re required to pay (for yourself only) doesn’t exceed 9.86 percent of your income in 2019, and assuming the coverage your employer offers pays for at least 60 percent of the average enrollee’s medical costs and provides “substantial coverage” for inpatient and physician care (ie, meets minimum value requirements), you wouldn’t be eligible for a subsidy to purchase individual health insurance in the exchange.
But if the coverage your employer offers doesn’t meet the tests for affordability and minimum value, you’d be eligible to receive a subsidy to offset the cost of health insurance purchased through the exchange, as long as you’re a legal US resident and you qualify for a subsidy based on household income.