Small Group Waivers and Subsidy in Marketplace

[JosephDeacon]

I have a small group (10-12 lives) who is moving to a new ACA group plan, as it will save them some $.

3 of the lower paid EE's wish to waive and see if they can qualify for subsidies in the marketplace. The carrier states that if group is offered at all, they cannot receive any subsidies.

I was under the impression that they would be able to receive subsidies as long as the plan is unaffordable, i.e. greater than 9.5% of the EE's single income.

Can anyone clarify this? I believe the carrier is incorrect.

 

[leevena]

Is the carrier saying they will not offer becasue someone received a subsidy or are they saying that if someone receives a subsidy the group will fail the participation test?

 

[JosephDeacon]

The group will not fail participation because of this person.

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Also this is a small group so the penalties will not apply in this case.

 

[RayNY]

Carrier is wrong
-EE's are eligible for a subsidy if their employer does not offer:
1)a plan that has Minimum Essential Coverage
2)to eligible employees
3)at an affordable (<9.5% household income) cost for an individual.

To quote Healthcare.gov: "Your employees won't be able to save money on monthly premiums in the Marketplace if the coverage you offer your full-time employees in 2015 is affordable and meets minimum value."

https://www.healthcare.gov/what-is-the-employer-shared-responsibility-payment/

 

[JosephDeacon]

That's what I thought.

Carriers not knowing the full story is very damaging/potential to create problems.

Ugh.

Thank you for confirming my belief.

 

[Ann H]

Be careful... the affordability test is not based on the EE's single income. It's based on the EE's single premium (self-only premium without regard to the cost to add dependents). And it's based on 9.5% of the entire household Modified Adjusted Gross Income.

As Ray said, though, the carrier is wrong.