You’ve Got Questions, We Have The Answers

The Michigan Business and Professional Association (MBPA) through its health care reform website, Health Care Reform Connect, have been fielding thousands of Affordable Care Act/Marketplace questions.  We have learned that some of these questions are frequent and have been posting them on our health care reform website, which is solely dedicated to getting you the answers you need as you navigate the new health care law.

We wanted to share some newer frequently asked questions, in hopes of possibly answering some questions that you may have, or may come across in the future.  As always, our government relations team is ready to assist with any questions or concerns relating to the Affordable Care Act/Marketplace.

Frequently Asked Questions:

Q: My employer offers health benefits but doesn’t contribute much toward the premium. I can’t manage to pay for my share. Can I submit an application for coverage and subsidies in the Marketplace instead?
A: You can always shop for health coverage in the Marketplace. However, if you’re offered employer health benefits, you can’t be eligible 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 9.5% or more of your household income, it is considered unaffordable, and you can apply for premium tax credits in the Marketplace.

Q: When can my eligible employees enroll in Medicaid through the Marketplace?
A: They can enroll in Medicaid or CHIP at any time during the year, not just during Open Enrollment.

Q: I work for a large employer, and they offer health benefits to me. My husband works and has coverage through his job as well. To figure out whether my coverage is affordable, do I just count my income or do I count my husband’s salary, as well?
A: If you are considering applying for premium tax credits for coverage in the Marketplace, the test for whether your employer coverage is affordable is based on the cost of self-only coverage in the lowest cost plan your employer offers, compared to your household income (and not just your salary).

Q: I work part-time for a large employer. Is my employer required to offer me health benefits? What about benefits for my spouse and kids?
A: No, large employers are not required to offer health benefits to part time employees and there is no penalty for large employers that don’t offer health benefits to part-time employees or their dependents. If you work part-time and you are not offered health benefits, you (and your family) can apply for coverage in the Marketplace; and, if your income is between 100% and 400% of the federal poverty level, you can apply for a premium tax credit that may reduce the cost of coverage in the Marketplace.
Note that a part-time employee is one that works, on average, fewer than 30 hours per week. If your hours vary during the year, your employer may have some options in determining your status as a full-time or part-time worker. Your employer can tell you whether you are a full or part-time worker.

Q: My family isn’t eligible for subsidies in the Marketplace because I am eligible for self-only coverage at work that is considered affordable. We do not have the funds to buy Marketplace coverage on our own. Will I have to pay a penalty because my family members are uninsured?
A: No you will not. Since the amount you would have had to pay to actually cover your spouse and kids was more than 8% of your family income, they won’t be penalized for not having health coverage.

MBPA continues to strive to keep you up to date as you navigate through health care reform.  If you have any questions you need answered, please contact our team.