Affordable Care Act: Subsidy to pay for employer’s plan?

“How will the subsidy work – can I keep my current health insurance and the government reimburses me?  I have a plan from work, but I wouldn’t be opposed to having the government pay for part of it.  It costs a lot to have my family covered! “

Looking for Help

Dear Looking for Help,

By now, President Obama’s statement that you can keep your healthcare plan has been skewered thousands of times over.  For thousands (perhaps millions) of people, their health plan is discontinued because it doesn’t meet health reform standards.  Health reform standards touch a lot of different facets of a plan – from annual benefit limits to covering all licensed medical caregivers.

Your employer’s plan will, if it hasn’t already, give you a letter stating whether the plan meets health reform standards.  There are two important standards.  One is that it cost you less than 9.5% of your income (assuming your income is less than 400% of Federal Poverty) to cover yourself; there are no rules about how much covering your family can cost.  The second is that the plan cover 60 percent of average health expenses, also referred to as actuarial value.

If your employer’s plan meets these two standards, then you are not invited to the health insurance marketplace.  The marketplace is the only place that offers people subsidies to buy their health insurance.  People who get their coverage at the marketplace are not reimbursed by the government.  Rather, the government pays their health plan the difference between the plan’s cost and the person’s share of the cost.

So, you can’t get help to pay for your employer’s plan.  But count your blessings – you have an employer plan offered to you!

Recommend this article
Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.