How Would Subsidy Work in this Situation?

[benwrigh]

Situation:

Two young adults, married.

Husband, has full time job, insurance is not offered, covered on parent's plan.

Wife, homemaker, needs her own plan as parent's are not stable.

Any one have an idea if she will qualify for the subsidy since the husband would not be on the plan? Or, is this a wait and see situation?

 

[houcoogster]

Situation:

Two young adults, married.

Husband, has full time job, insurance is not offered, covered on parent's plan.

Wife, homemaker, needs her own plan as parent's are not stable.

Any one have an idea if she will qualify for the subsidy since the husband would not be on the plan? Or, is this a wait and see situation?

She can go to the exchange and apply for subsidy...household income needed.

 

[Zane Benefits]

Her eligibility for a premium subsidy will depend on the household income - so both hers and her husband's income - even if she is only looking for insurance for herself. Using this income she can calculate where her household falls in comparison to the Federal Poverty Level (FPL).

If her household income is up to 400% of the FPL, then she will be eligible for a subsidy. Depending on what percentage of the FPL she falls into, and taking into account that her household holds two people, she can figure out exactly the amount of that subsidy will be.

There are online subsidy calculators (kff.org has a good one) that help with this information.

 

[benwrigh]

Her eligibility for a premium subsidy will depend on the household income - so both hers and her husband's income - even if she is only looking for insurance for herself. Using this income she can calculate where her household falls in comparison to the Federal Poverty Level (FPL).

If her household income is up to 400% of the FPL, then she will be eligible for a subsidy. Depending on what percentage of the FPL she falls into, and taking into account that her household holds two people, she can figure out exactly the amount of that subsidy will be.

There are online subsidy calculators (kff.org has a good one) that help with this information.

This is what I thought. However, I used one of the calculators and it showed 0% subsidy for her. If both were covered under exchange, subsidy was about 50%.

 

[Yagents]

So, I run calc at kaiser

Two 50 year old parents, two teenagers, making 60k a year or 250k FPL. Price for whole family = $400/mo (with huge subsidy). Price for just the wife = $400/mo (same price with very small subsidy).

What am I missing? I get it's on % of income. But if this is accurate, those spouses buying private insurance may not get the full impact of the subsidy.

 

[djs]

It will be the same price since they hit subsidy. 9.5% of the household income is 9.5% of the household income, regardless of how many people are covered.

Now, the expense of the plan may change, so covering 1 person may mean you don't get any subsidy, where as it covers more, it may kick in.

In your case, you are just burning through the range of subsidy.

Dan

 

[NWBenefitProvider]

So, I run calc at kaiser

Two 50 year old parents, two teenagers, making 60k a year or 250k FPL. Price for whole family = $400/mo (with huge subsidy). Price for just the wife = $400/mo (same price with very small subsidy).

What am I missing? I get it's on % of income. But if this is accurate, those spouses buying private insurance may not get the full impact of the subsidy.

I like much of what Kaiser has put out, with exception to their subsidy calculator. I find this one on our WA exchange to be far more user friendly. At a training today, the guy from the Wa health exchange also agreed that this calculator, created by UC Berkley or something like that was the most accurate they have seen so far. Try it:

National Health Care Calculator

 

[Zane Benefits]

This is what I thought. However, I used one of the calculators and it showed 0% subsidy for her. If both were covered under exchange, subsidy was about 50%.

That's a great point.

The subsidies will begin to kick in once the sum of the premiums of the household, reach a certain percentage of the household income.

So, for example. let's say the household income for these two individuals is $40,000, putting the household at 258% of the FPL. Under the ACA, they should not have to pay more than 8.3% of their income in premiums annually.

Furthermore, let's say both individuals are 24 years old. If just the spouse gets health insurance through the exchange, the premium cost will be about $231 a month, amounting to 6.9% of their income annually, therefore not qualifying for the subsidy.

However, if both were to get health insurance, the premium cost is now double, amounting to $462 a month, and is now 13.9% of their annual income. Now they will qualify for a subsidy of $186 in order to cap their premium cost to 8.3% of their annual income.

Hope this makes sense!

 

[HealthGuy]

Incentive not to get married isnt it !!!

 

[benwrigh]

That's a great point.

The subsidies will begin to kick in once the sum of the premiums of the household, reach a certain percentage of the household income.

So, for example. let's say the household income for these two individuals is $40,000, putting the household at 258% of the FPL. Under the ACA, they should not have to pay more than 8.3% of their income in premiums annually.

Furthermore, let's say both individuals are 24 years old. If just the spouse gets health insurance through the exchange, the premium cost will be about $231 a month, amounting to 6.9% of their income annually, therefore not qualifying for the subsidy.

However, if both were to get health insurance, the premium cost is now double, amounting to $462 a month, and is now 13.9% of their annual income. Now they will qualify for a subsidy of $186 in order to cap their premium cost to 8.3% of their annual income.

Hope this makes sense!

The numbers at least make sense to me now

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Incentive not to get married isnt it !!!

Perhaps I should recommend this to them?