Obamacare: Canadian plan “counts” but not for long

We got married in 2012. My wife still has legal resident status in Canada which entitles her to free medical care. She just started a part time job where she does not earn a lot of money. I am making about $60,000 a year. We have many expenses and financial obligations. I cannot afford another monthly payment. What are our choices? I do have coverage through my employer but to add coverage for my wife it is extremely high where I cannot afford it either

Newlywed in Florida

Dear Newlywed in Florida,

I’m afraid that I have bad news for you.
First, your wife does not have full health coverage while she is in Florida regardless of her legal residency status in Canada. There are complex rules about how long a Canadian can be outside of the country and still keep the health coverage. Ontario’s rules state, “You may be temporarily outside of Canada for a total of 212 days in any 12 month period and still maintain your coverage as long as your primary place of residence is still in Ontario.”
If she were outside of Canada to study, work, or do charitable work, then she could keep her coverage if she had been physically present in Ontario for at least 153 days in each of the 12-month periods for 2 consecutive years immediately before the absence.

Second, even if she kept her Canadian coverage, it won’t help you much with regular medical costs. The Canadian plan gives her free care in Canada, not the United States. While she is here in the U.S., her Canadian plan covers emergency care only. She effectively is uninsured for regular, routine medical care that she might need while in Florida.

Third, if your employer’s plan offers coverage to spouses, then you cannot go to the Florida health exchange to buy your wife a plan. This means that you cannot get a subsidy to help pay for her coverage. I am assuming that your employer’s plan meets health reform standards, and costs you less than 9.5% of your income to cover yourself (single coverage). If so, then no subsidies for your wife.
The bottom line is that your options are to cover her at your employer’s plan, or pay the tax penalty. I suppose there is another entirely impractical option too: she could return to Canada for at least 153 days a year and get all of her regular medical care there. You would still face the penalty here, if she remains a legal U.S. resident. This would simply give you a way to keep her Canadian coverage, and use it for her regular, routine care.

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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.