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My employer offers a health plan that covers preventive services and some other benefits, but it doesn’t cover inpatient hospital care (or only pays $100 per day for hospitalization). Because I’m offered this policy, does that mean I can’t qualify for subsidized coverage through the Marketplace?

The standard for “minimum value” has been clarified to also require plans to provide substantial coverage for hospitalization and for physician care.  The plan your employer offers would not meet this standard.  If that is the only plan your employer offers to you, then you would be eligible to apply for Marketplace coverage with premium tax credits.  However, if this so-called skinny plan is only one option offered to you, and if other plan choices offered to you by your employer do meet the “minimum value” standard and the affordability standard, then you would not be eligible for premium tax credits through the Marketplace.

Apparently my family isn’t eligible for subsidies in the Marketplace because I am eligible for self-only coverage at work that is considered affordable and my family is also offered coverage but the cost of family coverage is not affordable. But we can’t afford to buy Marketplace coverage on our own. Will I have to pay a penalty because my family members are uninsured?

No. Starting in 2019, there is no tax penalty for not having health insurance.

How do I project my household size/income for next year if I’m pregnant now? I’m married and this pregnancy will be our first child. We want to find subsidized coverage in the Marketplace.

During Open Enrollment, you and your spouse will apply as a household of two. When the baby is born, you can update your family information with the Marketplace to reflect that you have become a household of three. At that point, you may qualify for a larger premium tax credit. (For example, if you and your spouse together expect to earn a 2019 income that is twice the federal poverty level for a household of two ($32,920), you would be required to contribute about 6.54% of your household income toward the premium for the benchmark plan in the Marketplace. Once the baby is born and you are a household of three, that income would constitute just 158% of the federal poverty level for a family of three and you would only be required to contribute about 4.15% of your income. When you report your new family status to the Marketplace you will also have a 60-day special enrollment opportunity to add the baby to your plan and increase your advanced premium tax credit amount.  You will also have the option of enrolling your baby in a different plan.  However, you and your spouse generally will not be able to change health plans as a result of the “newborn” special enrollment period.

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