ACA Health Insurance: Losing Coverage Due to Employer Offer

Understanding the Employer Mandate

In the United States, employers with 50 or more full-time employees must offer health insurance to their employees. If an employer offers health insurance, employees are generally ineligible for premium tax credits or subsidies through the health insurance marketplace.

Case Study: Working Hours and Health Insurance Eligibility

Consider the case of an individual working “part-time” at 30 hours per week. This individual is currently enrolled in a health insurance plan through the health care exchange. However, their employer has offered them an employer-sponsored plan.

Due to the employer mandate, the individual is no longer eligible for the premium tax credits they were receiving through the health care exchange. As a result, their monthly premium would increase from $23.98 to almost $400 for a comparable plan.

Options to Keep Current Coverage

Unfortunately, it is not possible for this individual to keep their current plan through the exchange while also working for their employer. However, there may be other options available:

Consider the employer-sponsored plan: While it may be more expensive, the employer-sponsored plan could offer a wider range of benefits or a lower deductible. It’s important to compare the plans carefully and consider the long-term financial implications.
Negotiate with the employer: Some employers are willing to negotiate with employees who have concerns about the cost or coverage of their employer-sponsored plan. It’s worth discussing your situation with your employer and exploring if they can accommodate any changes.
Seek external assistance: A licensed agent or broker can help you explore your health insurance options and provide personalized guidance. They can assist you in understanding the different plans and benefits available and help you make an informed decision.

Avoiding Penalties

It’s important to note that individuals who do not maintain health insurance coverage may be subject to penalties under the Affordable Care Act (ACA). These penalties are designed to encourage individuals to obtain health insurance and reduce the number of uninsured Americans.

Conclusion

The Affordable Care Act and the employer mandate are designed to ensure that all Americans have access to affordable health insurance. While it can be frustrating to lose eligibility for premium tax credits, it’s important to understand the reasons behind this and explore all available options to maintain adequate health insurance coverage.