Category: What To Know

You can always shop for health coverage in the Marketplace. However, your employer-provided coverage is considered “affordable.” That’s because the affordability of employer sponsored coverage is only measured with respect to self-only coverage. Because your employer pays the entire cost of the employee-only coverage, you are technically considered to have affordable coverage (even though practically speaking, it was unaffordable to you.) As a result, neither you nor your spouse and children are eligible to apply for premium tax credits in the Marketplace. Sometimes this rule is referred to as “the family glitch.”

There are some other things you should know. First, depending on your family income, your children might qualify for the Children’s Health Insurance Program in your state. Check with your state Marketplace to find out if your children may be eligible for CHIP.

Second, if you find you cannot afford to get coverage for your spouse and/or children, you should know that starting in 2019, there is no tax penalty for not having health insurance.

You generally are responsible for enrolling in a health plan offered by an employer, so it’s up to you to sign up for coverage under the rules and procedures established by your employer health plan.

Some employers may use auto-enrollment, which means that your employer will enroll you in a plan and you must opt-out of the plan if you do not want to be covered. If your employer auto-enrolls you in the group health plan, you must be given the opportunity to disenroll if you want or to change plans if your employer offers more than one option. If you have concerns with the way auto-enrollment in health coverage is handled at your job, you can contact the US Department of Labor at 1-866-444-3272.

Yes, employers can require a waiting period before new employees are eligible to enroll in a group health plan. These waiting periods are not allowed to be longer than 90 days. If you are concerned that your employer requires a waiting period longer than 90 days, you can contact the US Department of Labor at 1-866-444-3272.

Usually, you can sign up for health benefits when you are first hired. Most employers also have an annual open enrollment period, or open season, when you can sign up for coverage or (if your employer offers a choice of plans) change your enrollment to a different health plan. In addition, there are special circumstances, called “qualifying events” that trigger a “special enrollment opportunity” outside of the normally scheduled annual open season. These qualifying events include loss of eligibility for other coverage (for example, because of job loss or reduction in hours worked, death, divorce or legal separation, or loss of dependent status) and certain life events such as marriage, or the birth or adoption of a child. In general, you must be offered a special enrollment opportunity of at least 30 days following these qualifying events to enroll in your job-based health plan.

No, small businesses are not required to offer health benefits to either full-time or part-time employees, or to their dependents. Small businesses are not subject to tax penalties when they don’t offer health benefits. If your small employer doesn’t offer health benefits, you (and your family) can apply for coverage in the Marketplace; and, if your income is between 100% and 400% of the federal poverty level, you can apply for a premium tax credit that may reduce the cost of coverage in the Marketplace.