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

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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
1 year ago

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

Vanessa
Vanessa
1 year ago

How would the spouses employer or insurance company know?

Louise Norris
Louise Norris
1 year 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/

Lynda
Lynda
11 months 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
8 months 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
8 months ago

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

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