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If I have access to health insurance, can my husband’s company deny me coverage?

Image: Antonioguillem / stock.adobe.com

Image: Antonioguillem / stock.adobe.com

If I have access to health insurance, can my husband’s company deny me coverage?

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 according to the Kaiser Family Foundation’s annual survey of employer-sponsored coverage, 95 percent of employers that offer health benefits extend that offer to employees’ spouses.

However, only 86 percent of those employers allow spouses to enroll if they have access to coverage from their own employer. And of those employers, 13 percent charge a higher premium for spouses who have access to their own employer’s coverage. And this approach has been gaining popularity among employers.

Do I have any other alternatives?

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 9.83 percent of your household income in 2021, 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 U.S. resident and you qualify for a subsidy based on household income (note that you might still end up being ineligible for a subsidy, since the calculation will be based on whether or not the cost of the benchmark plan for just your coverage exceeds a specified percentage of your entire household’s income, including the income your husband earns).

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Nellie Hornbeck
Nellie Hornbeck
2 years ago

This is a form of disparate impact because women will be affected by it more than men.

Vanessa
Vanessa
2 years ago

How would the spouses employer or insurance company know?

Louise Norris
Louise Norris
2 years ago

Employers can have employees fill out a form that has to be signed by the spouse’s employer, verifying whether or not the spouse is eligible for their own coverage. Some employers use a third-party verification service, such as this one: https://www.hms.com/working-spouse-provision-verification/

Kimberly Chandler
Kimberly Chandler
1 year ago
Reply to  Louise Norris

Yes, this is correct. We just received our letter from a third-party verification service, So disheartening to know that employers/unions are paying for this service and not strengthening their family health plans. 🙁

Jess
Jess
1 year ago
Reply to  Louise Norris

They only know if you tell them you are working. Do not tell them. Say unemployed.

Louise Norris
Editor
1 year ago
Reply to  Jess

I would strongly advise against that. Some employers use third-party verification services, as mentioned above. And even if they don’t, they may choose to audit employees’ attestations of spousal coverage at any time (particularly if a spouse were to have a large claim). Lying about a spouse’s access to coverage could technically be considered insurance fraud, and the employer could take whatever disciplinary action they deem necessary. It’s just not worth it.

Lynda
Lynda
2 years ago

So my share of my healthcare premium is almost 25% of my salary. Would I be eligible for the subsidiary? My husbands company is not covering spouses who work and who have access to company health insurance plan.

Louise Norris
Louise Norris
2 years ago
Reply to  Lynda

If you’re in a state that uses HealthCare.gov, this is the employer coverage tool that’s used to determine eligibility for a subsidy: https://www.healthcare.gov/downloads/employer-coverage-tool.pdf
This gets a bit circular, but my interpretation would be that you’re not eligible for the coverage offered by your spouse’s employer, since you do have access to your own plan (so the family glitch does not apply in your case: https://www.healthinsurance.org/obamacare/no-family-left-behind-by-obamacare/ )
So then it’s a matter of seeing whether the plan your own employer offers is considered affordable and provides minimum value. Keep in mind that it’s not just your income that’s considered; the affordability determination is based on household income. But if the amount you’d have to pay to cover just yourself through your employer’s plan is more than 9.78% of your household income in 2020, you’d be able to apply for a subsidy in the marketplace (this threshold is increasing to 9.83% in 2021).
But it’s also important to note that your subsidy eligibility in the marketplace would also be based on household income and keeping the cost of just your coverage at a level that’s considered affordable for your household. Assuming your total household income isn’t more than 400% of the poverty level, if the cost of the benchmark plan for just yourself in the marketplace would be more than the percentage of total household income that’s considered affordable, you’d qualify for a subsidy. Here’s where you can see the percentages of income that are considered affordable at various income levels: https://www.healthinsurance.org/faqs/is-the-irs-saying-ill-have-to-pay-more-for-my-health-insurance-next-year/

Mark Vacca
Mark Vacca
2 years ago

Going to get a divorce to get health care for my wife

Rebecca Fields
Rebecca Fields
1 year ago

If my husband and I work at the same place. Can they deny me to carry it

Louise Norris
Editor
1 year ago
Reply to  Rebecca Fields

If you’re each eligible for coverage due to your own employment, you can each have your own plan. Assuming they offer spousal coverage, they may allow you to be on one plan together, but the specifics would be up to the employer in terms of the coverage they offer to spouses. So for example, if your husband works full-time and you work part-time, you might not be eligible for your own coverage. If that’s the case, your eligibility to be covered would depend on whether they offer spousal coverage.

Dae
Dae
1 year ago

What if my spouse’s employer provides benefits that mine does not? We have been going through fertility treatment and spent thousands upon thousands out of pocket. We currently have health insurance through my employer but it’s time for his open enrollment with his employer and they now offer fertility benefits. Spouses are only approved for coverage if they do not have coverage through their own employer. I do have coverage through my employer but not for fertility. Having fertility benefits would be huge for us.

Louise Norris
Editor
1 year ago
Reply to  Dae

I’m sorry you’re having to go through this — both the infertility struggle and the financial ramifications. Is it possible that his employer has a spousal surcharge if the spouse has access to their own coverage, as opposed to not offering it at all? There are no federal requirements that fertility treatment be covered by health insurance (some states do require it on state-regulated health plans), and it’s not one of the essential health benefits that have to be covered on individual and small group health plans. So this is very much an area where rules and benefits will vary from one employer to another. We wish you all the best in your journey to conceive.

Dolores Tackman
Dolores Tackman
9 months ago

Hi! So my husband’s employer is requiring this same situation. My employer offers health insurance, but I don’t qualify since I work part time. Can I still get on his insurance since technically I could have access to health insurance if I worked full time. I work part-time by choice.

Louise Norris
Editor
9 months ago

Yes, you should be able to enroll in your husband’s employer’s health plan (during their annual open enrollment period). Your employer doesn’t offer you health insurance. The reason (because you work part-time) doesn’t matter. The only factor is whether or not coverage is offered to you, and in your case, it’s not.

Lisa Campbell
Lisa Campbell
9 months ago

My husband has always carried health insurance for me through his employer. I am now employed and am forced to take my employers insurance which is not accepted in many facilities. I would like to cancel my employers insurance and keep my husbands insurance as my primary for this very reason. His insurance is accepted anywhere. My employer is telling me that I can not cancel the insurance that they offer me. Is this legal? or maybe its their policy…

Louise Norris
Editor
9 months ago
Reply to  Lisa Campbell

For employer-sponsored health insurance, you can only drop your coverage during open enrollment, unless you experience a qualifying life event (such as getting married or having a baby). This is different from individual (self-purchased) health insurance, which you can drop at any time.

So if you are already enrolled in your employer’s plan, you will likely need to wait until their next open enrollment period to drop the coverage. Open enrollment for employer-sponsored plans tends to occur in the fall, but it can be at another time of the year if the employer’s plan year doesn’t follow the calendar year.

Olga Santana Coqueran
Olga Santana Coqueran
9 months ago

I’m covered under my husbands health insurance, can I also acquire health insurance through my job?

Louise Norris
Editor
9 months ago

Yes, as long as your employer offers you coverage. Some employers will not allow you to enroll as a spouse if you also have access to your own health plan, so you’ll need to check with your husband’s employer to see what their rules are. You’ll also want to check with both plans to see what you need to know about how their coordination of benefits works.

If you do enroll in both plans, your own plan will provide your primary coverage and your husband’s will be secondary. Make sure you understand each plan’s provider network (if they don’t overlap, you may have trouble with coordination of benefits). Depending on the services you need, the secondary plan may or may not cover some or all of the out-of-pocket costs you’ll have under your primary plan.

Chad
Chad
8 months ago

Can my employer charge me the taxes for my spouse she is on my insurance? I already am paying a extra fifty per request to keep her on since she can be offered insurance through her work but I don’t understand why the taxes.

Last edited 8 months ago by Chad
Louise Norris
Editor
8 months ago
Reply to  Chad

Chad, do you mean that your employer is payroll deducting your premiums on a pre-tax basis, but deducting your wife’s premiums on a post-tax basis? That would be unusual, for sure. In order to deduct premiums on a pre-tax basis, the employer must have a Section 125 plan (cafeteria plan) in place. But that allows premiums to be paid pre-tax for the employee and any tax dependents they have on their policy. There are times when a domestic partner’s premiums wouldn’t be paid on a pre-tax basis, as described here: https://tax.thomsonreuters.com/blog/can-employees-pay-for-domestic-partner-health-coverage-on-a-pre-tax-basis-through-our-cafeteria-plan/ But I can’t think of a reason that would be the case for a spouse. Has your employer fully explained this to you?

Heather Nichole Miller-Newman
Heather Nichole Miller-Newman
8 months ago

I have insurance through my company. After getting it for me a my 2 biological children, I realized it is going to be extreamly costly!! My husband is offered a much better insurence for our needs. We enrolled and they included everyone but me the spouse. When checking into it, they are saying they do not offer insuance for the spouse if they are working with a company that offers it!! Is this even LEGAL?

Louise Norris
Editor
8 months ago

Yes, as described in the article above, this is legal. Employers are not required to offer spousal coverage at all (large employers are required to offer coverage to employees and their children, but not spouses). Most choose to do so, but it’s always optional. Employers that choose to offer spousal coverage can opt to only offer it to spouses who don’t have their own employer-sponsored coverage offer, or to impose a surcharge if a spouse chooses to forego their own insurance and enroll as a spouse.

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