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I have COBRA and it’s too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

During Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA.  You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins.  After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period.  Only exhaustion of your COBRA coverage triggers a special enrollment opportunity.

My employer’s plan is grandfathered so it doesn’t cover preventive services. Can I shop for better coverage in the Marketplace if my job-based plan is grandfathered?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

You can always shop for coverage in the Marketplace. However, you can only apply for premium tax credits if your job-based plan – whether it is a grandfathered plan or not – is unaffordable or if it doesn’t meet minimum value. Whether your employer’s health plan meets minimum value will depend on a number of factors. The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer and has them to fill it out. With that information the Marketplace will determine whether the plan meets minimum value. If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.

The prescription drug benefit under my employer’s health plan only covers generic drugs. Does that mean it doesn’t have minimum value? Can I shop for better coverage and subsidies on the Marketplace?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

Whether your employer’s health plan meets minimum value will depend on a number of factors. Some employer plans might be able to meet the minimum value standard even if they don’t provide coverage for brand name prescription drugs.  The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer and ask them to fill it out. With that information the Marketplace will determine whether the plan meets minimum value. If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.

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?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

I’m offered health benefits at work, but they’re not very good. I’m applying for better coverage and subsidies in the Marketplace. The application asks whether I’m offered job-based health coverage that meets minimum value. What does that mean?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

The term “minimum value” means that your job-based plan would cover at least 60% of an average group of people’s covered health costs.   In addition, employer plans must provide substantial coverage for hospitalization and for physician care to meet the “minimum value” test.  Most employer plans will meet this test, but some may not.  The Marketplace application includes a form with questions about job-based coverage.  You should take this form to your employer and ask them to fill it out.  With that information the Marketplace will determine whether the plan meets minimum value.  If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.

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?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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

My employer offers health benefits to me and my family. The company pays the entire cost of my coverage but contributes nothing toward the cost of covering my family. We can’t afford to enroll my spouse and kids. Can they get coverage and subsidies in the Marketplace instead?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

My employer offers health benefits but doesn’t contribute much toward the premium. I can’t afford my share. Can I apply for coverage and subsidies in the Marketplace instead?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

You can always shop for health coverage in the Marketplace. However, if you’re offered employer health benefits, you can’t qualify for premium tax credits in the Marketplace unless your employer coverage is considered unaffordable. If your share of the premium for self-only coverage in your employer plan is 9.86% or more of your 2019 household income, it is considered unaffordable, and you can apply for premium tax credits in the Marketplace.

I work and am eligible for health benefits. Do I have to sign up for my job-based plan or will my employer do that for me?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.

I was just hired and told I’m not eligible for health benefits right away. New employees have to satisfy a waiting period. Is that allowed?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

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.