Health insurance subsidies: how to count people for income, benefit plan

I am currently working and my family health insurance is covered through my employer (large over 5000 workers).  I am considering retiring this next year.  I am eligible for Medicare but my wife is not, nor is our 13 year old adopted daughter.  My question is this:  When using the cost estimators they want to know who is being covered (adult and child) and want to know the total in the household.  The projected cost are different if I just indicate two (my wife and child) than three (the total number in the house).  The second question, is since I would be on Medicare, what would count for income for my wife and daughter regarding subsidized premiums?


Kentucky Dad

Dear Kentucky Dad,

All excellent questions!  It is a bit confusing because there can be different “counts” of people for the household and for the health plan.

Whether your household income qualifies your wife and daughter for subsidies is based upon how many people live together.  You have a three-person household.  If your income is less than $78,120, your wife and daughter will be able to get some help in purchasing their health insurance.  You would get more help at lower income, less help at higher income.  The income definition does not change just because you will have Medicare; it is the same regardless of how or where people get their coverage.

The number of people who need health insurance is a different question.  In your case, only your wife and daughter need insurance.  You will have Medicare.

I’m not sure which cost estimator you are using, but perhaps it is not sophisticated enough to allow you to choose three for the household number but only two for the plan enrollment number.  Try the Kaiser Family Foundation’s Health Exchange Subsidy Calculator.  It allows you to put in each number separately.

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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.