Q: I have lousy health insurance at work. The deductible is $4,000, and I pay 20 percent of my medical bills. Right now, I’m scheduled for a knee replacement. I make $27,000. Can I get better insurance and help with my bills through Obamacare?
A: Obamacare could be a great help to you, but you won’t know unless you hang in there and apply for health insurance on your state’s public exchange. If you’re having trouble connecting to your state exchange because of computer glitches through HealthCare.gov, simply call 800-318-2596 for help anytime day or night.
Any worker, no matter what company insurance they currently have, can enroll in Obamacare health insurance for 2014. Since you’re offered a policy at work, though, under the Affordable Care Act, you may not qualify for the federal subsidies to help you afford these new plans, and you would forfeit any employer subsidies.
But that’s not the whole story.
The law says you can drop your employer coverage and still qualify for subsidies if your boss’s insurance fails to meet minimum federal standards. President Obama waived the employer mandate—the financial penalties for employers who fail to provide coverage next year.
But the law still requires employers with 50 or more workers to offer their workers “credible” health plans. They just won’t be penalized thousands of dollars if they don’t.
So, even though there is a health plan at work, you may be able to opt out and still qualify for federal subsidies on the public exchange, under the following circumstances.
Your employer’s health insurance must be affordable: That means your monthly premiums cannot exceed 9.5 percent of your income. In your case, if you are paying a penny more than $2,565 in annual premiums, you can apply for subsidized coverage.
Your employer’s insurance cannot stick you with too many medical bills: As long as you stay within your plan’s network, your boss’s plan must pay at least 60 percent of your total drug and medical bills. Again, if it does not, you can go to the exchange seeking subsidies.
Your boss’s plan must provide decent health care: Here, the law gets fuzzy. The line between decent and indecent coverage is like the government’s old standard for pornography: The exchanges will know it when they see it. Or, at least that’s the hope.
“Don’t wait. Find out if you qualify for financial assistance to help you afford quality health care, maybe for the first time,” says Ron Pollack, executive director of Families USA, a leading consumer advocacy organization.
In addition to getting comprehensive coverage with Obamacare, you cannot be rejected, penalized with higher premiums, or terminated because of your medical condition—including no longer shutting out, slamming or shucking women of childbearing age or people facing an operation.
The exchange’s counselors, called Navigators, will tell you if you qualify for Obamacare coverage and federal subsidies. And depending on your income and dependents, they can tell you if you are eligible for Medicaid or the Children Health Insurance Program for children under 19.
The bottom line: Generally, dropping “credible” employer coverage will not be wise. But if you have a truly lousy policy, it has no credibility.
If you’re wondering whether you qualify for subsidized Obamacare coverage, make the effort to contact your state exchange. What do you have to lose except some of your patience as federal workers struggle to work out the exchange computer glitches?