Obamacare: I’m covered at work, husband and kids are not

I have insurance through my employer, but my husband and 2 children, ages 12 and 20, do not. How do I determine what we qualify for?

Gave at the Office

Dear Gave at the Office,

If your employer plan costs you less than 9.5% of your income to cover yourself, then you will not qualify for any subsidies to buy a plan on the exchange. There are no rules, however, for how much it costs you to cover your family in an employer’s plan.

Even with an employer plan, your family may qualify for other help based upon your income. If you live in a state that is expanding Medicaid and your income is 138% of federal poverty or less (about $27,000 for a family of two adults and one minor child), then you would enroll in Medicaid.   See List of States Medicaid Expansion Decisions as of September 16, 2013.

Assuming your income is higher than that or you live in a state that is not offering the “Medicaid expansion”, then you have at least two options. One is to cover your husband and children on your employer’s plan. This may be cheaper than buying a separate plan for them.

Another option is to go to the insurance exchange for their coverage. The 20-year-old child would be able to apply separately and qualify for subsidies based upon his/her income. It’s not clear whether your husband and two-year-old child will be considered to be offered an employer plan, and therefore also not eligible for subsidies. They should apply and find out what they would be offered. Note: Your income will count on their application.

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.