President Obama’s much-maligned statement that if you like your current health insurance, you can keep your insurance, proved true for most of us. The large majority of people still carry health insurance through an employer – either their own or a family member’s. For some, though, this may seem like more of a burden than a blessing.
What if you don’t like your current health insurance situation? Some employers offer group health insurance coverage but don’t pay much – or any – of the cost, particularly for your spouse and children. If this sounds like you, you may ask yourself the question, “Can I buy ‘Obamacare’ – health insurance through Healthcare.gov?”
If you cover the entire cost of health insurance for a two-parent family with children and your company doesn’t subsidize any part of the monthly nut, you could easily pay north of $1000 or $1100 per month.
The good news is that when your company’s next yearly open benefits enrollment comes along, you can look into enrolling your spouse and children in health insurance through Healthcare.gov. Although the government’s health care exchange marketplace’s plan year runs January 1 through December 31, you can get on board during the year if your company’s open enrollment falls at a different time, for example, if it runs November 1 through October 31.
I found out about this from a person who is highly knowledgeable about health insurance matters and verified it by calling the support line for Healthcare.gov.
The bad news? If you decline coverage available through an employer, you probably won’t qualify for a tax subsidy to help cover the cost of the monthly premium. If you have employer group coverage available, you can only qualify for the subsidy if the employer insurance is not considered affordable.
Whether a plan is “affordable” depends on how much it costs for the employee’s coverage, not how much you have to fork over in monthly premiums for your family. That means if you pay $30 a month for your coverage and $1000 a month for your family’s, it’s still affordable – an illogical but likely unintended quirk in the law.
However, the lack of help with monthly premiums may not matter much if you discover you can find better coverage at a lower price – even without a subsidy – by using Healthcare.gov. In my area, the most expensive “Platinum” health insurance plans available through Healthcare.gov cost a little more than $900 monthly for an adult with children.
When deciding whether to waive family coverage with your employer, make sure that you consider all parts of your current insurance situation. For example, if you pay $1000 for family coverage each month, but the premium comes out of your paycheck using pretax dollars, your actual cash outlay may be $800 or $900, depending on your tax situation. If your employer has a “cafeteria plan,” you might still be eligible to receive that tax benefit, even if you buy health insurance outside of what the company offers to employees.
Also, your employer’s plan may be significantly worse or better than what you could find for the same or less amount of premium at Healthcare.gov. Fortunately, Healthcare.gov provides you with detailed information on each available health plan. You should receive similar information from your company benefits administrator or through the mail during your open enrollment period at work. You can use this to compare items such as yearly deductible and out of pocket limits, copayments for primary care and specialist visits, copayments for prescription drugs and exclusions for certain types of treatments and procedures.
If you have certain ongoing medical needs or you believe you’ll soon require a specific medical service, you’ll want to verify that whatever insurance you choose will cover these procedures, services and products. You’ll also want to check to make sure that your family’s doctors, including primary care doctors like internists and pediatricians as well as specialty physicians such as cardiologists and dermatologists, are “in network” with any new health plan that you consider.
All health plans sold through the “Obamacare” Marketplace at Healthcare.gov must cover pre-existing conditions and preventive care along with a variety of other items such as prescription drugs, mental health care, substance abuse services, hospitalization, rehabilitation care, maternity and newborn care, laboratory services and chronic disease management.
This article is not meant to provide insurance advice or advocate for purchasing any particular type of insurance. It is meant to help point you toward the correct information when you are researching health care choices for yourself and your family.