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Have you or your family been offered health insurance at work? In the past, if the insurance was “affordable” for the employee, the whole family was blocked from getting any kind of subsidy. With new rules as of 2023, that family MAY now qualify for a subsidy.
Affordability is not based on the cost to cover just the employee but family members too. If the family has to pay more than 9.12% of their household income, they will qualify for a subsidy (for 2023).
If you have been offered Health Insurance coverage at work…what do you do? Take it, in most cases. Prior to accepting your group coverage at work, call our office for information to see if you qualify for a subsidy, or call your HR department at you or your spouse’s work.
If it’s NOT “affordable”, you can continue to enroll and apply for a subsidy. Call us for assistance.
If it IS affordable, you can look at plans “Off Exchange” (without a Government subsidy). Again, in most cases, it’s best to enroll with your employer.
You can’t have an employer offering health insurance to you AND receive a subsidy if it’s considered “affordable”. If you ignore this rule, you will find yourself paying back the IRS for the entire subsidy. If you receive a subsidy you were not supposed to have, you’ll have to pay it back on next year’s tax return. It is VERY important you are honest and accurate when stating your income as well as health insurance options offered at yours or your spouse’s work.
About half of the U.S. population gets their health insurance through their employer. This provides a wonderful benefit to the employee, because a minimum of 1/2 (50%) of the total cost of that health plan for the employee must be covered by the employer (if the employer offers group health insurance to their employees). In many cases, employers pay more than 50% of their employees’ premium, and the rest is paid by the employee.
When you combine what the employer pays, and what the employee contributes out of their paychecks, this makes the overall dollars spent on a health plan higher. This generally will give the employee a much better health insurance policy than they normally would if the employee had purchased it on their own.
Across the country, employers cover an average of 83% of the employees’ health insurance costs. Many employers, however, do NOT contribute anything towards the spouse and kids’ portion of the health insurance premium (Employers are not required to help pay for the spouse and children). But because of certain rules and regulations, employers are required to OFFER this insurance to the spouse and kids, but they are NOT required to PAY for the spouse and kids. They must offer it, but they don’t have to pay for it.
This makes the amount of premium an employee would need to pay to cover their spouse and kids extremely expensive. This is because the spouse and kids are full price (the employer is NOT contributing to their insurance). Some employers will contribute to spouse and dependents, it’s all up to the employer.
There are distinct differences between hospital emergency rooms and traditional urgent care centers, including the level of care that can be provided at each location.
When you claim you make a certain amount of money in a year (and receive a subsidy), you must try to be as accurate as possible and notify them of any changes that may occur throughout the year. Be honest in stating your income. There are very serious consequences to playing games with your income.
The short answer is yes; medical debt is considered non-priority unsecured debt and can be discharged in bankruptcy. While you cannot target medical debt in bankruptcy, this process can help lower payments or eliminate the debt altogether.
4260 W. Craig Road #150-A
N. Las Vegas, NV 89032
So, here’s the rub. Up until 2023, for the past few years since the Affordable Care Act was passed in 2010, if an employee was “offered” health insurance through their employer-based plan, in almost all cases, the spouse and children would be BLOCKED from qualifying for a government “subsidy” (government helps pay). It didn’t matter if the employee enrolled into the employer’s health insurance or not, they would still be blocked from a subsidy. The options for this family were: they could pay full price for their employer group plan for the spouse and kids, enroll in a private plan for spouse and kids, or enroll into a Marketplace plan for the spouse and kids (but they would be paying full price). Only a very small percentage of these Nevadan’s spouses and kids’ could qualify for a subsidy, because the employee’s plan was considered “unaffordable”.
The reason they could not get a subsidy is because the employer’s health plan was considered “affordable” to the employee, and the employers affordable health plan to that employee would BLOCK their spouse and kids from qualifying for a government “subsidy”. This was the “Family Glitch”.
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In October of 2022 the Treasury Department announced new rules to the American Rescue Plan Act, stating that starting on 1/1/2023 employees that are offered “affordable” health insurance by their employer (and decide not to take it), their family members may now qualify for a subsidy.
“Affordability” is calculated in a way that the health insurance plan costs the family less than 9.12% of their household income. This household income will determine what amount of subsidy the family would qualify for, then the family can decide what health plan they’d like to enroll into. This is such a huge deal! We’ve seen so many families that desperately needed the tax subsidies, but because of this family glitch, the family members of the employee were not eligible. Many of these Nevadan’s had pre-existing conditions that really needed coverage, and this put the employee in a situation that made them think twice about their employment.
In the past few years, if employed Nevadans that had group health insurance were super lucky, (probably less than 5% of the population) where the employee’s portion of the health insurance was considered “unaffordable”, (this means that the employee’s portion of their health insurance premium must be considered unaffordable), then the spouse and kids could get a subsidy to help pay for their health insurance, but this occurrence was very rare. Under the new rules, the affordability of employer-subsidized health insurance is based on the cost of insuring the entire family, not just the employee. There are estimates that the new rules will put affordable health insurance within reach of about a million people nationwide.
Finding health insurance coverage that fits your needs and budget can be challenging, and ever-changing rules can make it confusing to determine what you qualify for. Our agents study the different insurance companies’ health insurance plans and options each year. They know what HMO, EPO, and PPO options are available from each insurance company. They know how the plans work, how the coverage works, what coverage you’ll have outside of Nevada, can answer difficult questions, and help with situations that may need additional research.
At Nevada Insurance Enrollment, our health insurance agents are knowledgeable, patient, caring, and can help you determine whether you may benefit from the new rules regarding the family glitch, and if you can save money by purchasing health insurance through Nevada Health Link. Our services are free to our clients. We are paid by the insurance companies to assist Nevadans into health plans that work best for them, and your insurance premiums will not go up in price one cent for using our assistance. Your plan will cost you the same with or without assistance. It only makes sense to get the help you deserve from a licensed agent. Call us today at (702) 898-0554 for an appointment in person or over the phone.
By page visits (this month)
There are distinct differences between hospital emergency rooms and traditional urgent care centers, including the level of care that can be provided at each location.
When you claim you make a certain amount of money in a year (and receive a subsidy), you must try to be as accurate as possible and notify them of any changes that may occur throughout the year. Be honest in stating your income. There are very serious consequences to playing games with your income.
The short answer is yes; medical debt is considered non-priority unsecured debt and can be discharged in bankruptcy. While you cannot target medical debt in bankruptcy, this process can help lower payments or eliminate the debt altogether.
Today’s Health Insurance plans may offer benefits above and beyond just doctors and hospitals, such as free preventive services, fitness programs, teledoc/telehealth, and so much more!