ObamaCare: Your Spouse Isn’t Covered By Your Employer
The employer mandate is not set to go into effect until 2015. Under the law employers with 50 or more full-time equivalent employees must provide health insurance to both the employee and their dependents. But the IRS only deems children under 26 as dependents not spouses.
Employers’ Health Coverage Responsibility
Employers must cover all full-time employees (work 30 hours or more per week) and their children. However if an employer has 20 part-time and 40 full-time employees they are still responsible to offer insurance to the 40 full-time employees with the following provisions:
- Employee’s premium cannot exceed 9.5% of income
- If employer does not offer insurance or offers insurance that is not affordable the employer pays a penalty
- Insurance minimally must cover 60%
What if Insurance Premiums Are Too Much for My Family
Your employer is not responsible to make sure that your premium is affordable for your family, your employer is only responsible to make sure that your insurance is affordable for you.
What if My Spouse Doesn’t Work Can He Get Insurance Through My Employer?
It is not mandated for your employer to offer insurance to your spouse, even if they are unemployed. Your employer may choose to offer insurance, as that is their prerogative. This may mean that the insurance your company offers now to your spouse may be dropped in 2015. For instance, UPS sent a memo to all employees stating that all employees’ spouses who are offered insurance through work will no longer be eligible. “We believe your spouse should be covered by their own employer—just as UPS has a responsibility to offer coverage to you, our employee,” the UPS in-house memo states according to CNNMoney.
How Does My Spouse Get Affordable Insurance?
Your spouse is eligible to purchase one of the new Affordable Care Act metal plans: Bronze, Silver, Gold, or Platinum. These plans however will more than likely have a higher monthly premium than an individual plan purchased through the Health Insurance Marketplace or an off-Exchange plan. There are also plans available now to purchase for your spouse to purchase. As well as your spouse may need separate dental coverage, which are offered with low-premiums.
To learn about individual plans for your spouse or about SHOP the new marketplace for small businesses with less than 50 employees call 800-930-7956 or contact Medicoverage for assistance.
Comments and Questions
Click to leave a CommentComment from Jmanuel on December 11, 2015
If my employer offers group coverage but it is not affordable for my spouse can he get Obamacare which is a cheaper premium?
MEDICOVERAGE AGENT RESPONSE
Jmanuel,
Your spouse may be able to get a plan on the exchange, but if your employer’s insurance is considered affordable (by the Exchange), he may not qualify for subsidies. Please call a licensed insurance agent at 800-930-7956 to help you.
-Amy from http://www.medicoverage.com/
Comment from Leslie Horton on August 09, 2015
Questions:
1. Am I correct that am employer is not required to provide insurance coverage to the spouse of a covered employee? Where is this provision located in the ACA?
2. May an employer charge a fee/premium to add the spouse of a covered employee to the employee’s plan irrespective of whether or not the spouse has insurance through his/her employer? Where is this provision located in the ACA?
3. May an employer design its insurance plans to provide for an employee and dependent(s) plan but not a “family” plan that includes spouses? Where is this provision in the ACA?
MEDICOVERAGE AGENT RESPONSE
Leslie,
Thank you for your questions. We will attempt to give you the best information we have. The information can be a little tricky because the Affordable Care Act law uses “dependents”, not spouses, when discussing employer based insurance. Therefore the language, as far as we know, does not directly say if your spouse is employed, but rather it is implied by the language of dependent, that if your spouse is employed with job-based insurance they are not your dependent.
1) You are correct. Sec. 1514.
2) We do not believe so. This would be dealt through the employer, not the ACA.
3) No, we do not believe so. Sec 1514.
We will update this comment if we receive more detailed information.
-Amy from http://www.medicoverage.com
Comment from Mark on May 26, 2015
I have family health insurance coverage through my employer. It includes my spouse and children. My wife is also covered through her employer as her primary. My employer offers employee only or family coverage, not employee and children, only. How will we be affected under the new health care rules? Does my spouse have to stay under her employer plan?
MEDICOVERAGE AGENT RESPONSE
Mark,
That is a great question. However, each company sets up their own rules for how they cover dependents and spouses. You will want to speak to both your wife’s and your HR person to learn how your companies handle your situation, and what is the best option for you as a family. I do wish I had a more concrete answer for you. Please do write us back when you learn more.
-Amy from www.medicoverage.com
Comment from Teri Taylor on April 30, 2015
We have a new ins plan through my husbands work. They pay for him, but 600. A mo. Is deducted from his payroll for me as his spouse. I have not worked since a major surg. For 19 mos. and receive no Disab. Payments, so our income is 20,000. Less then last year. We cannot afford the ins. Deductions for myself, 600. Per mo., not to mention I have such a high deductible it’s useless. Can I drop out of this plan now, and find an individual plan for myself being unemployed. I do need a second surg. ASAP, but have an 11,000. Copayment-out of pocket on current is. Plan that we cannot be responsible for. Would a lapse in coverage for a month or so cause a penalty to us, or my preexisting condition make it difficult to get an individual new plan for myself?
MEDICOVERAGE AGENT RESPONSE
Teri,
Thank you for your questions. You might qualify for a Special Enrollment Period, because of the specifics of your case we suggest that you call us at 800-930-7956.
-Amy from www.medicoverage.com