Can I opt for self-paid insurance if employer offered plan too costly?

Reply Mon 20 May, 2013 09:08 am
I am currently employed as a part-time employee and am not offered health benefits. I've been offered the option to become full-time as of Jan. 1, 2014. Under the current plan that my employer participates, I would not be able to affordably cover my cost portion and add coverage for my dependents. Right now I self-pay (myself and 3 dependents) for the same high deductible plan under the same insurance provider as my employer participates; my total cost for this same plan is less than the cost it would be to add my dependents if I was a participant in the employer plan. My spouse is self-employed and is covered under a separate policy.

Under Obamacare, could I decline the employer offered plan if it is too costly and choose to self-pay without incurring the penalty?

Reply Mon 20 May, 2013 09:24 am
I don't know the answer but I assume you should be able to opt for the self-paid insurance. Not sure what kind of sacrifices you'll have to make when opting for a cheaper health insurance (in terms of lesser amounts of coverage and higher deductibles, etc...).

I'm interested in how others see how this might be the case for this type of situation. I have a feeling a lot of people will still not be able to afford the health insurance plans that their respective companies/employers will offer and thusly will have to go with a cheaper/lesser grade health insurance and thusly make far too many compromises in their health coverage.
0 Replies
Peter Frouman
Reply Mon 20 May, 2013 12:24 pm
There are a couple factors to consider:

You won't have to pay the penalty for not having coverage if your share of the premium (after any employer contributions and subsidies) would exceed 8 percent of your income. This is one of several exemptions to the penalty. Unlike the income test for premium subsidies, the premium amount used as the basis for this calculation can include premiums for dependents.

To qualify under the Affordable Care Act, policies have to provide minimum essential coverage and minimum actuarial value [in most cases the minimum actuarial value is 60% (also called Bronze level)]. A high deductible plan you purchase on your own may not meet these requirements.
0 Replies

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