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Q. Our family of four gets coverage through my wife's job. This plan costs nothing for my wife alone but family coverage eats up 22 percent of our annual income. Can we get a subsidy to buy a cheaper plan on our state's exchange?
A. Regrettably, the answer is that you cannot. Your family will fall smack-dab into a major loophole in the Affordable Care Act that's likely going to strand a lot of middle-income working families without affordable coverage.
Here's the problem. According to the law, if a large business (defined as an employer with 50 or more workers) offers an "affordable" health plan to its employees, they aren't allowed to get subsidies to purchase coverage on their state's exchange.
Plainly, the critical question is: what's "affordable"? Well, according to federal regulations issued just the other day, if your wife's contribution towards coverage for herself alone costs no more than 9.5 percent of your household income, your entire family's coverage is considered affordable. Since hers is free, it obviously meets that standard and then some, never mind that the cost to your entire family is a lot more than 9.5 percent.
Sounds unfair, and it is, but it's also how the law is going to work unless Congress passes legislation to fix it. And it means that you and your children are not eligible for subsidized coverage on your state's exchange.
What to do? Well, you could always divorce your wife (kidding). You'll want to check the price of coverage for yourself and your kids on the exchange anyway, on the chance that even without subsidies it might be cheaper than your wife's employer plan.
If your kids are under the age of 19, they may be eligible for CHIP, but if they're older, that's not an option.
I wish I had better news for you. Sorry.
For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
Got a question for me? Ask it here. Please include the state you live in.
